Wednesday, January 29, 2014

Does Depression Cause a Migraine Or Does a Migraine Cause Depression?

Migraine triggers and other causes of headaches can come from many sources. So often we are looking for just one thing that causes migraines and headaches when in reality it is a combination of many factors. The most frequent cause of headaches in general is stress, but all too often mood plays a large role.

Quite frankly, until you are able to recognize and accept this, you might not have much success in getting these headaches under control. The effects of lifestyle on headaches cannot be underestimated.

Depression and anxiety can greatly affect your headache profile and are recognized by headache experts as a migraine trigger. Now wait!! Before you dismiss the idea, up to 85% of all chronic pain sufferers have depression and/or anxiety to SOME degree. It's almost like the chicken and the egg, which came first?

Pain and depression impact each other; the more pain, the more depressed you feel and then that makes the pain worse. If you have a headache, doesn't crying or being upset make it worse? This is the anxiety fueling the headache. Along the same vein, if you have headaches or migraines on a regular basis, are missing school, work and family outings, you are bound to feel a bit depressed.

Too many times this is one of the most difficult concepts for people to get their minds to accept; that they may have some degree of depression which makes the pain more chronic and more severe. Don't be too hard on yourself! The receptors and pathways for headache are similar and sometime the same as anxiety receptors in the brain. Without getting in to a medical lecture when they are all firing off you have a headache and are anxious. One basically fuels the other.

Treatment of Anxiety and Depression in Headaches

Just like treating the headache itself, it is important to realize that treating mood is multi-factorial. Counseling with a good psychologist is invaluable. The rule of thumb when getting counseling is to give it at least three visits to see if you and the counselor "mesh" so to speak. Not all patient/provider relationships are perfect.

Counseling will allow you to dump some of the stress, in addition to learning how to develop good coping skills for future life stressors. Try too, to develop a good social structure. Even if you can't participate in activities that your friends may do (sports), you can still invite people to your place for a get together once a month or so. Regular human social contact is a form of support and can help stave off depression. In fact, more than 6 million women experience depression each year in the USA.

Many people disregard the recommendation to take medication for mood in the presence of headaches. So many times people make this mistake and think there is something wrong with them if they accept the fact that they are anxious or depressed. Even MILD depression can make headaches worse. Many of today's medications can treat BOTH mood and headaches.

SSRI's: This group of drugs are seratonin re-uptake inhibitors (what??). Seratonin is one of the natural "happy drugs" in the brain, but is taken up by nerve endings and recycled, so to speak. By slowing this process, you have more of it in the way you need it and feel happier. Side effects include weight gain, odd dreaming, mild episodic vertigo and rarely some of them can cause headaches to be worse. Zoloft, Lexapro, Celexa, Prozac and Paxil are all in this class. Paxil and Lexapro are excellent if you have more anxiety. If you are over the age of 60, you may need to start at a lower dose than normal.

TCA'S: Tricyclic antidepressants (TCA) are an older class of drugs that are NOT first line for depression. I mention them here because they are used in the treatment of headaches and can reduce headache pain.

CYMBALTA: Cymbalta is a drug that functions with two effects. Part of the drug is an SSRI but most of the drug functions on another pathway called norepinephrine. The end result is another brain chemical is boosted and you feel happier. It also has and effect of calming back pain in some patients.

Treatment of depression that is fueled by migraine involves treating not only the migraine but the also the mood. Until both sides of the problem are addressed, progress may be slow.

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