Connection Between Chronic Migraine and Depression

People who have migraines are well aware of how debilitating and painful this condition can be. Doctors diagnose you with chronic migraine when you have at least 15 migraine headaches a month, out of which you experience eight days of having a migraine attack with all the associated symptoms for longer than three months. Chronic migraine tends to begin as less frequent headache episodes that slowly change into a more frequent headache pattern and increase other migraine symptoms. It has been found that people with chronic migraines tend to experience depression or other anxiety disorders. It is also common for people with chronic migraines to struggle with productivity. They experience a poor quality of life. Some of this could also be because of mood disorders like depression, which is sometimes observed alongside migraines.

Read on to find out more about the connection between chronic migraine and depression.

Connection Between Chronic Migraine and Depression

Chronic migraine can be defined as a migraine headache you experience for at least 15 days or more during a month, for more than three months.(1,2,3) In the past, chronic migraine was also known as transformative migraine. It is common for people to expect that a person living with some kind of chronic pain is more likely to become depressed. In fact, research shows that people with other types of chronic pain conditions like lower back pain are not as likely to get depressed as frequently as people who experience chronic migraines.(4,5,6) Due to this, there is believed to be a connection between chronic migraine and mood disorders. However, this does not necessarily have to be due to the constant pain itself.(7,8)

While it is not completely clear as to what is the exact nature of the connection that exists, but there are a number of possible explanations. It is believed that migraine plays a role in the development of mood disorders like depression, or it could also be that mood disorders like depression lead to migraine. Alternatively, it might be that both depression and migraine share an environmental risk fact. On the other hand, it is also very much possible that there is no apparent link between the two conditions, though researchers think this to be highly unlikely.(9)

People who experience more severe and more frequent migraine headaches have reported having a lower quality of life as compared to those who experience an occasional headache. Some people have even reported experiencing worsening headache symptoms after going through an episode of depression.(10,11)

Some researchers have found that people who experience migraines with aura are at a greater risk of having depression than those who experience migraines without aura. Because of the potential link between chronic migraines and major depression, it is recommended that doctors screen people with migraines for depression.(12)

What Is The Treatment For Chronic Migraines and Depression?

When a person has depression as well as chronic migraine, it is possible to treat both these conditions with an antidepressant medication. However, while treating both these conditions, it is important to know that you cannot mix the selective serotonin reuptake inhibitor (SSRI) medications with triptan drugs. These are two different classes of drugs that can cause dangerous interactions. If taken together, these drugs can cause a rare and potentially dangerous condition known as serotonin syndrome.(13,14) This type of possible fatal interaction between the two classes of drugs happens when the brain gets too much serotonin. SSRIs and other similar classes of drugs known as selective serotonin/norepinephrine reuptake inhibitors (SSNRIs) are types of antidepressants that work by increasing the serotonin levels in the brain.(15)

Triptans, on the other hand, are a class of new-age drugs that are used in the treatment of migraine.(16) These medications work by binding to the serotonin receptors in the brain. This decreases the swelling of the blood vessels, thus relieving the migraine headache. Currently, there are seven different types of triptan medicines that are only available with a prescription. There is another drug that combines triptan with naproxen, which is an over-the-counter pain reliever.(17) Some of the brand names this drug is sold under include:

  • Amerge
  • Relpax
  • Imitrex
  • Frova
  • Axert
  • Treximet
  • Zomig
  • Security
  • Maxalt

These medications are available as a skin patch, as oral pills, nasal sprays, and injectables.

Conclusion

The thing to know about triptans is that they are only useful for treating migraine attacks as they happen. They cannot prevent these headaches. Your doctor may prescribe some other medications to help prevent the onset of migraine attacks. These can include certain antidepressants, beta-blockers, antiepileptic drugs, and the newer CGRP antagonists.

If you want to prevent a migraine attack, it is also helpful to learn your migraine triggers and avoid them. Some common migraine triggers include:

By being vigilant about your triggers and taking any preventive medications prescribed by your doctor can help you prevent a migraine attack and also reduce the likelihood of developing depression.

References:

  1. Schwedt, T.J., 2014. Chronic migraine. Bmj, 348.
  2. May, A. and Schulte, L.H., 2016. Chronic migraine: risk factors, mechanisms and treatment. Nature Reviews Neurology, 12(8), p.455.
  3. Manack, A.N., Buse, D.C. and Lipton, R.B., 2011. Chronic migraine: epidemiology and disease burden. Current pain and headache reports, 15(1), pp.70-78.
  4. Ashina, S., Serrano, D., Lipton, R.B., Maizels, M., Manack, A.N., Turkel, C.C., Reed, M.L. and Buse, D.C., 2012. Depression and risk of transformation of episodic to chronic migraine. The journal of headache and pain, 13(8), pp.615-624.
  5. Mercante, J.P.P., Peres, M.F.P., Guendler, V., Zukerman, E. and Bernik, M.A., 2005. Depression in chronic migraine: severity and clinical features. Arquivos de neuro-psiquiatria, 63(2A), pp.217-220.
  6. Buse, D.C., Silberstein, S.D., Manack, A.N., Papapetropoulos, S. and Lipton, R.B., 2013. Psychiatric comorbidities of episodic and chronic migraine. Journal of neurology, 260(8), pp.1960-1969.
  7. Zhang, M., Liu, Y., Zhao, M., Tang, W., Wang, X., Dong, Z. and Yu, S., 2017. Depression and anxiety behaviour in a rat model of chronic migraine. The Journal of Headache and Pain, 18(1), p.27.
  8. Gesztelyi, G. and Bereczki, D., 2005. Disability is the major determinant of the severity of depressive symptoms in primary headaches but not in low back pain. Cephalalgia, 25(8), pp.598-604.
  9. Antonaci, F., Nappi, G., Galli, F., Manzoni, G.C., Calabresi, P. and Costa, A., 2011. Migraine and psychiatric comorbidity: a review of clinical findings. The journal of headache and pain, 12(2), pp.115-125.
  10. Frediani, F. and Villani, V., 2007. Migraine and depression. Neurological Sciences, 28(2), pp.S161-S165.
  11. Lipton, R.B., Hamelsky, S.W., Kolodner, K.B., Steiner, T.J. and Stewart, W.F., 2000. Migraine, quality of life, and depression: a population-based case–control study. Neurology, 55(5), pp.629-635.
  12. Antonaci, F., Nappi, G., Galli, F., Manzoni, G.C., Calabresi, P. and Costa, A., 2011. Migraine and psychiatric comorbidity: a review of clinical findings. The journal of headache and pain, 12(2), pp.115-125.
  13. Sternbach, H., 1991. The serotonin syndrome. Am J Psychiatry, 148(6), pp.705-713.
  14. Boyer, E.W. and Shannon, M., 2005. The serotonin syndrome. New England Journal of Medicine, 352(11), pp.1112-1120.
  15. Dale, E., Bang-Andersen, B. and Sánchez, C., 2015. Emerging mechanisms and treatments for depression beyond SSRIs and SNRIs. Biochemical pharmacology, 95(2), pp.81-97.
  16. Tfelt-Hansen, P., De Vries, P. and Saxena, P.R., 2000. Triptans in migraine. Drugs, 60(6), pp.1259-1287.
  17. Lipton, R.B., Serrano, D., Nicholson, R.A., Buse, D.C., Runken, M.C. and Reed, M.L., 2013. Impact of NSAID and Triptan Use on Developing Chronic Migraine: Results From the A merican Migraine Prevalence and Prevention (AMPP) Study. Headache: The Journal of Head and Face Pain, 53(10), pp.1548-1563.

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