(LifeWire) - Relationship Between Headaches and Depression
Though there seems to be a connection between headaches, especially migraine headaches, and depression, researchers are still unsure as to what accounts for this linkage. However, the connection may involve chemicals, known as neurotransmitters, which help transfer nerve impulses in the brain. The neurotransmitters serotonin, dopamine and norepinephrine, in particular, are thought to play important roles in both headaches and depression.
The links appear to go both directions: Individuals with chronic headache pain are more likely to develop major depression, and individuals who experience major depression find that it can trigger headaches.
Studies Confirm Connection
According to a 2003 telephone interview based study in the journal Archives of General Psychiatry, 40% of individuals who reported experiencing an episode of major depression also had a chronic painful condition, such as headache or backache. Moreover, participants who reported both depression and a chronic painful condition had, on average, depressive episodes that lasted six months longer than individuals who did not report any chronic pain. "Therefore," the authors of the study noted, "pain could also contribute to the prolongation of a depressive episode."
Additional Research
A 2007 questionnaire based study in the journal Neurology found that women who reported experiencing chronic headaches also reported symptoms of major depression four times as often as individuals reported experiencing only episodic headaches. The study also found that women who experienced severe migraines in conjunction with severe nausea, insomnia, low energy or joint pain, were significantly more likely to experience symptoms of major depression.
Gretchen Tietjen, MD, one of the authors of the Neurology study and director of the Headache Treatment and Research Program at the University of Toledo, Ohio, as quoted in the ScienceDaily.com website, explained that "[p]ainful physical symptoms may provoke or be a manifestation of major depression in women with chronic headache, and depression may heighten pain perception." Further, she noted, "[t]his relation between migraine and major depression suggests a common neurobiology."
Yet the specific physiological links between these two conditions are not fully understood. "Regardless of what's causing the link between migraine and depression, psychiatric disease, such as depression, complicates headache management and can lead to poorer outcomes ... ," Tietjen said.
Headaches May Conceal Depression
According to Seymour Diamond, MD, executive chairman of the National Headache Foundation and director of the Diamond Headache Clinic in Chicago, physicians need to take steps to address and treat the depressive components of chronic pain. In addition, Diamond notes that chronic tension-type headaches can obscure the symptoms of depression. Physicians need to question patients about their headaches; doing so could reveal hidden depression.
A depressive headache is often dull and generalized, and is usually worse in the morning and evening. A depressed individual will sometimes describe such headaches as lasting for years or for his or her entire life. Such people may feel that physical symptoms are more socially acceptable than depression.
Potential Treatments
While not approved by the FDA for treatment of headaches, several antidepressants have shown some effectiveness in treating headaches, particularly tension headaches. These medications include Elavil (amitriptyline), Cymbalta (duloxetine), Aventyl, Pamelor (nortriptyline), Sinequan (doxepin), Norpramin (desiprimine), Effexor (venlafaxine HCI), Prozac (fluoxetine), Zoloft (sertraline HCI), Paxil (paroxetine), and Celexa (citalopram hydrobromide).
In many instances, a combination of psychological treatment and antidepressants is most beneficial in treating the combination of chronic headache and depression. In addition to medication, some people may find that massage, yoga, meditation and emotional support can help alleviate both headaches and depression.
FDA Warning
In 2006, a FDA public health advisory warned consumers against combining two classes of antidepressants -- selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) -- with the migraine medications known as triptans (or 5-hydroxytryptamine receptor antagonists). The warning followed reports of serotonin syndrome, a potentially fatal condition, in some patients who took such drugs together.
Sources:
Kunkel, Robert. "Headaches." The Cleveland Clinic. 25 Jan. 2005. The Cleveland Clinic Foundation. 27 Mar. 2008. <http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/neurology/headache/headache.htm>.
"FDA Public Health Advisory: Combined Use of 5-Hydroxytryptamine Receptor Agonists (Triptans), Selective Serotonin Reuptake Inhibitors (SSRIs) or Selective Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) May Result in Life-Threatening Serotonin Syndrome." 24 Nov. 2006. FDA.gov. 24 Mar. 2008.
<http://www.fda.gov/Cder/Drug/advisory/SSRI_SS200607.htm>
Ohayon, Maurice, and Alan Schatzberg. "Using Chronic Pain to Predict Depressive Morbidity in the General Population." Archives of General Psychiatry 60.1. Jan 2003. 39-47. 2 Apr. 2008
<http://archpsyc.ama-assn.org/cgi/content/full/60/1/39>. .
"An Open Trial of Duloxetine on Comorbid Major Depression and Chronic Headache." 18 Sept. 2007. DrugLib.com. 19 Mar. 2008. <http://www.druglib.com/trial/95/NCT00531895.html>
Diamond, Seymour. "Depression and Headaches." Headaches.org. 2005. National Headache Foundation. 19 Mar. 2008. <http://www.headaches.org/education/Headache_Topic_Sheets/Depression_and_Headache>
Tietjen, G.E., J.L. Brandes, K.G. Digre, et al. "High Prevalence of Somatic Symptoms and Depression in Women with Disabling Chronic Headache." Neurology. 68. 28 Sept. 2006. 134-140. 19 Mar. 2008
<http://www.neurology.org/cgi/content/abstract/68/2/134?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&fulltext=headache+depression&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&fdate=1/1/2006&resourcetype=HWCIT> (subscription)
Breslau, N., R.B. Lipton, W.F. Stewart, et al. "Comorbidity of Migraines and Depression." Neurology. 60. (2003) 1308-1312. 19 Mar. 2008
<http:www.neurology.org/cgi/content/abstract/60/8/1308> (subscription)
"Women with Migraines More Likely to Have Depression." 9 Jan. 2007. ScienceDaily.com. 19 Mar. 2008. <http://www.sciencedaily.com/releases/2007/01/070108191705.htm>
"Amitriptyline" MindDisorders.com. 2007. Encyclopedia of Mental Disorders. 20 Mar .2008.
<http://www.minddisorders.com/A-Br/Amitriptyline.html>.
