Depression can often be caused by the unrelenting pain of severe headaches. Just knowing that a chronic disorder is disrupting your life, and that the painful headaches can return at any time, can result in depression. But even if the migraines haven’t upset you in this way, headache experts say that depression can be brought on as a physical byproduct of the same chemical imbalances in the brain that cause the headaches. Regardless of the root cause, if you are suffering from depression, see your doctor because this condition can be successfully treated.
“The average patient with migraines will not be depressed and should not be tagged this way,” says Seymour Diamond, MD, executive chairman of the National Headache Foundation and director of the Inpatient Headache Unit at Saint Joseph Hospital in Chicago. But those with chronic migraines easily become depressed.”
Headache and Depression: Research Finds the Combination
A study at Madigan Army Medical Center near Tacoma, Wash., showed that soldiers returning from combat service in Iraq who suffer from migraines are twice as likely to have symptoms of depression, anxiety, or post-traumatic stress disorder, compared with soldiers who do not have migraines.
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That study looked at 3,621 soldiers within three months after their return from combat duty and found that 19 percent suffered migraine headaches. Half of those soldiers with migraines also had symptoms of depression. Those soldiers with the migraine-depression combination also had more frequent headaches, compared with those who had migraines alone.
Another new study, done in Germany, adds further evidence for the migraine-depression connection. Researchers from the University of Manitoba evaluated data from more than 4,000 adults. Of those, 11.7 percent reported migraines. This group also suffered from a variety of mood disorders, including depression. Although the researchers did not uncover a reason for the connection, it may be the first large study of its kind to verify the link.
Headache and Depression: Five Ways to Identify a Problem
The National Headache Foundation reports that people with headaches can develop psychological symptoms and that people with depression can also develop physical symptoms. But there are ways to identify headaches that are caused, at least in part, by underlying depression:
• A depressive-type headache tends to be worse in the morning and evening.
• Depressed people will sometimes say their headaches last for years or for their entire lives.
• Headaches occur at regular intervals of daily life, such as the weekends, holidays, or the first day of vacation.
• Headaches with depression usually have a steady, non-pulsing ache that feels like a band around the head or a vise-like grip.
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Until recently, physicians had not always realized or treated this connection.
“It might be a good idea for the physician to work in conjunction with a psychotherapist,” Diamond says. “In these cases, I would prescribe a tricyclic antidepressant such as amitriptyline (Elavil). I would make the distinction that we’re not talking about the new antidepressants, known as selective serotonin reuptake inhibitors, such as escitalopram (Lexapro) or sertraline (Zoloft); they don’t work [for this type of headache]. I also use much smaller doses of the tricyclics than a psychiatrist would.”
Diamond said he can prescribe different tricyclics for people who have migraine, depression, and insomnia, versus those who do not, because about 70 percent of people who suffer from these combinations typically also have sleep disturbances.
It’s important to visit your doctor to have the headache-depression combination identified because therapies are available to help to break this cycle. If your primary care doctor cannot help treat both problems, contact a headache specialist or neurologist, because they may have the more experience in successfully treating the headache-depression connection.
