Migraines and Depression

Is there a link between migraines and depression? Imagine having a headache so painful that the only recourse is to hide in a dark, quiet room until it is over. Imagine this happening several times each year, or even each month, and having these episodes last for up to several days. This is clearly enough to put anyone in a depressed mood. However, migraine sufferers (migraineurs), are five times more likely to develop clinical depression than people who do not have these debilitating headaches. Conversely, people who are depressed are three times likelier than happy people to become develop migraines.

The question is, what is the causality between the two conditions, if there is any at all? Researchers view the intertwining of migraine and depression as a chicken and egg situation. They are patently comorbid, but does one cause the other? If so, which one starts the process, the migraine or the depression? The answer is not that simple. Migraines, depression, and, unsurprisingly, insomnia, a state associated with both conditions have something in common. All three are associated with neurotransmitter deficiencies in the brain.

One study involving over 3,000 soldiers returning from combat service in Iraq suggests a clear link between migraines and depression. The study found that 19% of the soldiers suffered from migraines, and about half of those soldiers also had symptoms of depression. These soldiers also suffered more frequent headaches.

Is there a genetic link between Migraines and Depression?

A recent study published in the medical journal Neurology suggests a more basic connection: genes. The study found that there is a genetic predisposition by people with migraines to be depressed. Another study published in the journal Headache in 2009, supports the idea of a common genetic link. This study found that among sets of twins, migraine was inherited 44% of the time and depression 58%. When one sibling had both diseases, 30% of the time her twin did too.

Doctors believe that while they are related, depression and migraine headaches have distinct causes with a similar neurobiology. For years, doctors blamed depression in migraineurs on their resultant loss of quality of life due to headaches. Now it looks as though the link is a biologic shared mechanism rather than psychology.

One danger for clinically depressed migraineurs is possible drug interaction between their depression medication and their migraine drugs. In July 2006 the FDA recognized one such danger, that of mixing triptans for migraines with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin and norepinephrine reuptake inhibitors), used to treat depression and mood disorders. Combining the drugs can lead to a condition called serotonin syndrome.

Serotonin syndrome occurs when there is too much serotonin in the body. Symptoms include hallucinations, increased heart rate and body temperature, fast changes in blood pressure, and gastrointestinal upset. Sometimes a patient has no choice but to take these medications together, but they need to weigh their options with their doctor and be monitored closely for serotonin syndrome.

Nevertheless, the recent research is shedding new light on the link between migraines and depression, and this should allow for improved treatment regimens going forward.