Several patients I'm treating for depression also suffer from migraine headaches. One of them asked me recent if there is any connection between the two. Definitely—but it's a bit complicated.
First consider headaches in general. Depression is the most common psychiatric disorder studied in connection with headaches. In some cases, headache is considered a symptom of depression.
There is also a connection between the frequency of headaches and the severity of depression. As headaches become more intense and frequent, it is more likely that a person will become depressed. Getting bad headaches every day, whether they are migraine or not, can lead to depression or can aggravate it.
But not all severe headaches are migraines.
Of all headaches, migraine headaches have been most frequently studied. Many researchers have observed a close relationship between migraines and depression. For example, people who have a clear diagnosis of migraine are almost three times as likely to develop major depression, when compared to a control group. The reverse is also true, that people with depression are more likely than non-depressed people to develop migraines.
It might help to review the classic description of a migraine headache, because people sometimes use the word migraine to describe any very bad headache.
The classic migraine headache is severe. It may be preceded by symptoms that warn the person that the migraine is on its way. Classically, there is throbbing pain on one side of the head. The headache may last from a few hours up to as much as three days. Physical activity makes the pain worse. People often feel sick to their stomachs. Light or sounds can be intolerable. This is why many people lie down in a dark, silent room when they get a migraine.
In one-third of people with migraines, the warning symptoms can include an aura. This may be a visual or auditory experience, such as flashing lights or musical tones. Some people will have difficulty with speech or movement.
Many experts now believe that there may be common biological or genetic roots for depression and migraine. That is, the same biological factors that make some people vulnerable to depression can also make them vulnerable to migraine headaches.
This association has led to the discovery that antidepressant medication is useful for treating migraine headaches. (Antidepressants, in fact, are used to successfully treat many pain syndromes.)
Migraine headaches are tricky to diagnose, because they take a many forms, not just the classic one described above. If you have bad headaches that come back repeatedly, make sure your doctor reviews the symptoms and evaluates the problem fully. Headaches occur in many medical illnesses, so you will want your doctor to consider all the possibilities that might be relevant to you.
If you do have both depression and migraine headaches, that can be very difficult to bear. Fortunately, good treatments are available for both.
Do you or does someone you know suffer from depression and migraine headaches? What medications or lifestyle changes have helped?
Dr. Michael Miller has been on staff of the Beth Israel Deaconess Medical Center, a large teaching hospital in Boston, for more than 25 years. He is also an Assistant Professor of Psychiatry at Harvard Medical School.
Depression
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Comments: 25
Thanks for posting this
When I was started on a particular medication for the depression it suppressed the migraines.
I still get the headaches, but it stops at the warning symptoms. Pressure at one side of my face and numb nose. This is easily ignored or treated with an over the counter medicine and I can get on with my life. Where as before I could be bed-ridden for up to three days. I think that would depress anyone.
Thanks for posting a great article.
A friend of mine is into Reiki, which is a Japanese technique for stress reduction and relaxation that also promotes healing. She performed Reiki on me a few times and said that she felt so much stress when she touched me that it made her want to cry. She kept cautioning me to do something about it soon, and it kind of scared me. But it did nothing to alleviate my headaches.
The doctor I last saw for acute migraine treatment prescribed Vicodin, Phenergan and a new medication called Maxalt and told me to see a neurologist. The Vicodin actually makes the headaches worse, and the Maxalt works great if taken at the onset of the headache, but it makes me so tired. So I can't take it unless I'm at home. I'm not inclined to see a neurologist, as I don't think I have a brain tumor or anything.
So I guess I'm wondering ... when you have patients with depression and migraines, and you successfully treat the depression, does that alleviate their migraines?
The description of your headaches sounds pretty classic. And your response to medication is a good example of how sometimes one treatment can help two related problems -- in this case, you took a medicine that helped your depression and your migraines.
Helen:
Your story comes from the opposite angle and demonstrates a very important point. Although headaches and depression may be related, there are many instances where they are two DIFFERENT problems. In that case, it is crucial for your doctor to evaluate all the possible causes for the headaches. He or she should not assume it's all related to depression before doing an evaluation.
Your comments trigger a thought. You point out that depression and other (non-headache) pain can be linked. This connection has gotten a fair amount of press in the last year or two, in part because of the marketing campaign of one of the newer antidepressants (duloxetine, which carries the brand name Cymbalta).
This new antidepressant is advertised as being particularly good for treating the pain that goes along with depression. There is evidence that it is helpful for some people who have the combination of problems.
But I am skeptical that the new medication is unique. In other words, it has long been known that antidepressants of all classes can help improve pain. So it is not necessary to focus on the new drug to get relief. If your doctor suggests an antidepressant to treat a pain syndrome, be aware that there are many good options.
Thanks for telling us about your problems. I have a couple of reactions.
First, I like that term "walking depression." It describes many people — those who feel down and stressed, but still function. Sometimes it is more difficult for people with such a depression to visit a psychiatrist, perhaps because they're embarrassed. I would encourage them to try to get the help anyway, because there is a lot of potential benefit.
On the comment that you're in total avoidance mode — I would put it another way. You're doing the best you can to deal with the pain. I actually think most people are better off if they can continue to function. It is hard to do, but you can feel proud of it — it's an accomplishment.
There are a great many techniques that aid stress reduction. I think of these approaches as "mindfulness techniques." That's borrowed from mindful meditation, which is known to be helpful. But things like Yoga, Reiki, massage, and the like are all good for reducing stress.
But sometimes that kind of technique is hard to sustain without support from other people. That can come from family members or friends, but a well-trained therapist may offer you ways of thinking about your problems that go beyond what friends can offer.
Now to the question of treatment for depression. Seeing a therapist, which I've already mentioned, is a good way to treat depression. In addition, the problems you describe can also be treated successfully with antidepressants. In many instances, they reduce the frequency or intensity of the headaches. (See Wendy C's comment above for an example of this.)
Note that Vicodin and Phenergan are not antidepressants. Maxalt also is not an antidepressant, but it works on serotonin receptors — so you have to be careful about combining it with some antidepressants, especially those that also work through the serotonin system.
A psychiatrist or neurologist should be able to help you review your options and choose a plan that makes sense.
But I should point out that while I AM aware those medications are not antidepressants, I am really not concerned with treating the depression. I do think I need to work on reducing the stress in my life, and that in of itself should cure any lingering depression.
While I am aware that some people do suffer from a clinical type of depression, I don't believe mine is of that variety. Personally, I think many people reach for medications too quickly, which can in some cases serve to further avoid the problems that cause the depression in the first place. I have never had much luck with antidepressants, and I've tried several over the years. They either tend to make me too dizzy and nauseous to wait the 2 weeks or so to get used to them. Or, they totally take away my ability to "feel" anything emotional.
I hate that I can't control my tears sometimes, but for the most part I like my emotions the way they are -- I just need to fix my problems! I mean, how could anyone be happy being broke, or not having love in their life? Or worse, not living to their potential.
When I say "walking depression", I mean I still sleep, work, exercise and even laugh and smile. I try to find joy in life, and often do ... but deep down, I am totally and completely miserable. And I know I find ways to subconsciously punish myself for not being able to do something about it. I think headaches may be my body's way of doing that, or a chemical reaction to the toxins produced by all the excess stress.
So at this point, I only take the medications I mentioned to alleviate excruciating pain and prevent the subsequent loss of work associated with my migraines.
It wasn't until my face swelled on one side that the problem became obvious. As soon as my wisdom teeth were removed my migraines stopped and it has been almost forty years without another one. The depression link is fascinating, however, and certainly makes sense as chronic pain is enough to push some of us over the edge.
My husband is 29 years old and he has had migraines since he was about 19. In the last year and a half they have gotten worse. He has had a CT scan, MRI, bloodwork, etc. to find out if there is anything physically that they can pinpoint as to the cause. There is nothing at this point He has a definite diagnosis of migraines though. The pain is on one side of the head and he is sensitive to light and sound. He becomes nauseated and usually vomits multiple times. He has no warning though. He just wakes up with one. After the migraine is gone (usually about 24 hours) he still has this "soreness" in his head. He is on Topamax 150mg Q AM and 100mg Q HS. He is also on Ultram 50mg QID prn. He was also given Phenergan for the nausea. The last time he went they gave him Relpax I believe. He is not getting relief from this stuff. He misses work about twice a month. We have 3 children and I am an RN and work part time. When he has a migraine he cannot take care of the kids when I am at work causing me to miss some work as well. We just don't know what to do. It seems like (to me anyway) his frequency of migraines increases according to how stressed he is. I don't necessarily believe that it is diet related however it could be. Last year before his mom moved out of state he had them approx once every one to two weeks. It was extremely bad for a while. It got a little better for a few months. The last two months have been bad again even though more meds have been added and others have been increased. He is on a high stress job at work right now and just had a really bad migraine the night before last. I don't know what to do.