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The association between chronic migraine and depression

Overview

People with chronic migraine often suffer from depression or anxiety disorders. It is not uncommon for people with chronic migraines to struggle with the loss of productivity. They may also experience poor quality of life. Some of these are caused by mood disorders, such as depression, which can accompany migraines. In some cases, people with this condition also abuse substances.

Pain and depression

Chronic migraine used to be called transformative migraine. It is defined as a headache that lasts 15 days or more per month for more than three months. You might expect someone living with chronic pain to also become depressed. Research shows that people with other chronic pain conditions, such as low back pain, do not become depressed as often as people who have migraines. Because of this, it is thought that there is a link between migraine and mood disorders that are not necessarily caused by the constant pain itself.

It is not clear what the exact nature of this relationship might be. There are several possible explanations. Migraine can play a role in the development of mood disorders such as depression, or it can be the other way around. Alternatively, the two conditions may share an environmental risk factor. It is also possible, although unlikely, that the apparent association is due to chance.

People who experience migraine headaches more often report having a lower quality of life than people with occasional headaches. Disability and lower quality of life are also worse when people with chronic migraine have depression or an anxiety disorder. Some even report worsening headache symptoms after an episode of depression.

Researchers have suggested that those who suffer from migraines with aura are more likely to be depressed than people who have migraines without aura. Because of the possible link between chronic migraines and major depression, doctors are encouraged to screen migraine sufferers for depression.

Medication options

When depression accompanies chronic migraine, it may be possible to treat both conditions with antidepressants. However, it is important not to mix selective serotonin reuptake inhibitors (SSRIs) with triptan medications. These two classes of drugs can interact to cause a rare and possibly dangerous side effect called serotonin syndrome. This potentially fatal interaction occurs when the brain has too much serotonin. SSRIs and a similar class of drugs called selective serotonin/norepinephrine reuptake inhibitors (SSNRIs) are antidepressants that work by increasing serotonin that is available in the brain.

Triptans are a class of modern medications used to treat migraines. They work by binding to serotonin receptors in the brain. This reduces the swelling of the blood vessels, which relieves the migraine. There are currently seven different triptan medications available by prescription. There is also a drug that combines a prescription triptan with the over-the-counter pain reliever naproxen. Brand names include:

• Merge
• Axert
• Fr
• Imitrex
• Maxalt
• Relpax
• Treximet
• Zecuity
• Zomig

This type of medication comes in:

• oral pill
• nasal spray
• injectable
• skin patch

The nonprofit Consumer Reports compared the price and effectiveness of different triptans in a report published in 2013. It concluded that for most people, generic sumatriptan is the best buy.

Treatment through prevention

Triptans are only useful for treating migraine attacks once they occur. It won’t prevent headaches. Some other medications may be prescribed to help prevent the onset of migraines. These include beta-blockers, some antidepressants, antiepileptic drugs, and CGRP antagonists. It can also be helpful to identify and avoid triggers that may trigger an attack. Triggers can include:

• certain foods
• caffeine or foods containing caffeine
• alcohol
• skipping meals
• jet lag
• dehydration
• stress

Treating depression and migraines together

If you suffer from depression and migraines, you’ll want to explore treatment options for both with your doctor. It is important to treat both conditions at the same time, as treating one is unlikely to work as well if the other is not treated.

Here are some common approaches used to treat both conditions.

Therapy

Depression and other mental health disorders can be treated with talk therapy, medication, or a combination of both. Many people find that a combination of therapy and medication is the most effective.

Talk therapy involves talking to a therapist or counselor about your symptoms and how to manage them, either individually or in a group setting. Some therapies can help you correct negative thought patterns and adopt healthier behaviors in your life.

Therapy can also help you manage migraines better. You can learn to identify which aspects of your headaches you can control. Therapy can also help migraine sufferers manage their emotions and improve their overall functioning and quality of life.