When the people we care about are depressed - we'll try everything in our power to support them. And when they're also dealing with the debilitating symptoms of migraine, they may need more than just a shoulder to cry on. For years we believed that the only reason migraine sufferers were depressed was because they had bad headaches. Today we know much more about the brain chemistry and genetic differences that make migraine sufferers more susceptible to depression. And though the biological relationship between migraines and depression is a complicated one, dealing with the symptoms doesn't have to be. The good news is that if you or someone you know has migraine related depression, there are several things you can do to fight this disease and help maintain some control over your life.
Understanding the link between migraine and depression.
Findings from recent studies of twins (who share identical genes )suggest that the relationship between migraines and depression could be genetic in nature. Scientists found that twins, as well people who share a similar genetic background tended to have similar health outcomes. They showed that the presence of certain genes in an individual, could often predict whether they would experience migraine with depression. In addition, subjects with similar genes had similar migraine and depressive symptoms.
These studies support the idea that the relationship between migraines and depression is a two-way street. The same genes that can cause some migraines sufferers to be at greater risk for developing clinical depression may also put depressed patients at greater risk for developing migraines.
The research also suggests that migraines and depression don't always have to occur as a consequence of the other. The genetic pathways associated with either condition can allow a person to develop both migraine headaches and depression independently.
Identify your depressive symptoms.
Though doctors frequently see migraine sufferers who are depressed, addressing the combination of depressive symptoms and pain management issues can be challenging. In any case, depression is a serious condition that requires medical attention. Migraine sufferers with the following symptoms may be clinically depressed and should seek help immediately:
• Feelings of sadness, worthlessness or pessimism
• Heightened agitation and restlessness
• Constant movement, pacing or hand-wringing
• Loss of interest in activities that were once enjoyed
• Reduced sex drive
• Extreme fatigue and loss of energy
• Poorer concentration and decision making ability
• Memory loss
• Changes in sleep pattern - either too much or too little sleep
• Unexplained crying
• Physical aches and pains throughout the body for no apparent reason
Recognize the presence of other mental health conditions.
To further complicate matters, several studies have shown that migraines can induce more than just depression. Because a variety of mental conditions are controlled by the same brain mechanisms, the same systems that might put a person with migraines at risk for depression can also put them at greater risk for anxiety, phobias and substance abuse. And, because your depression treatment can affect any other mental health conditions that you are suffering from, it's important to try to identify any mental health issues with your physician early on.
Establish a health care team.
Because the mechanisms of migraine and depression go hand in hand, it's very important that you choose both a neurologist and psychiatrist that will work together to fully evaluate your symptoms and treatment options.
It is also important that your health care practicioners recognize that migraines should not be treated as just a symptom of depression, but they should be treated as an important condition that occurs with depression. For example, several patients have been known to report that their headache worsens after a depressive episode.
Your physician will want to do a thorough physical exam on you to evaluate whether you're experiencing true migraines (as opposed to another form of headache). She may also order some lab work and tests to rule out the possibility of some other physiological explanation for your headache and depression, such as musculoskeletal abnormalities or brain lesions.
Evaluate your treatment options.
When it was discovered that the biological factors that make some of us more vulnerable to depression can also make us more vulnerable to migraines, it was also uncovered that antidepressants can reduce the severity and frequency of migraines. However finding the right treatment regimen can prove challenging, and studies have shown mixed results regarding the ability of any one drug to eliminate all symptoms in patients.
While it's possible to treat some patients' depression and migraine with a single pill, some clinicians will choose to focus more on the physical pain associated with the migraine symptoms. Because being in pain can have such a negative impact on a person's overall quality of life, it can also exacerbate your already depressed mood and make it hard to isolate your depressive symptoms.
To treat migraine and depression, many physicians choose to prescribe tricyclic antidepressants like Elavil (amitriptyline), which modify the levels of serotonin and other chemicals in your brain, or Effexor (venlafaine), a drug that modifies the levels of noreprenephine in your brain. However because higher doses of antidepressants are often required for treating depression than would be safe for treating migraines, this treatment is not always effective at treating depression.
To get around this, some clinicians may prescribe selective serotonin re-uptake inhibitors (SSRIs)or monamine oxidase inhibitors, which are drugs that can be used in combination with certain migraine pain medicines. In some cases they can be combined with tricyclic antidepressants. However, your clinician may be hesitant to prescribe this combination regimen because of the potential risk for potentially lethal serotonin toxicty; the combined effects of these drugs may be dangerous if too much serotonin is allowed to circulate in your system.
In addition to working with your physicians, you might also enlist the services of a psychotherapist and social worker to help manage your health and lifestyle. Cognitive-behavioral therapy combined with meditation and breathing techniques have shown to be beneficial for reducing migraine and depressive symptoms in some patients. These providers may be able to facilitate group or individual counseling sessions, provide you with other useful resources, or refer you to a support group where you might benefit from sharing your feelings about how migraines and depression have affected your life.
National Headache Foundation. Depression and Headache. Accessed: January 2012.
Finocchi C, Villani V, Casucci G.Therapeutic strategies in migraine patients with mood and anxiety disorders: clinical evidence.Neurol Sci. 2010 Jun;31 Suppl 1:S95-8.
Casucci G, Villani V, Finocchi C.Therapeutic strategies in migraine patients with mood and anxiety disorders: physiopathological basis.Neurol Sci. 2010 Jun;31 Suppl 1:S99-101.