Migraine is very disabling, which takes a toll on mood which can lead to depression and anxiety.
As if living with the debilitating pain and other disturbing symptoms of chronic migraine wasn’t enough, combine it with a psychiatric disorder and quality of life drastically declines for many migraineurs. Comorbidity means two chronic diseases or conditions existing simultaneously in a patient. Chronic migraine is often comorbid with psychiatric conditions such as depression, anxiety, post-traumatic stress disorder, personality disorders and bipolar disorder. However, migraineurs have a reported 2- to 4-fold increase in lifetime risk of developing major depressive disorder. (1)
People who experience migraine earlier in life are more likely to develop depression, and vice versa, over the course of their lifetime. Migraine sufferers who also experience depression should know the signs of both ailments since each might be at a higher risk for the other condition.
WHAT IS DEPRESSION?
According to the DSM-IV, a manual used to diagnose mental disorders, depression occurs when you have at least five of the following nine symptoms at the same time:
- a depressed mood during most of the day, particularly in the morning
- fatigue or loss of energy almost every day
- feelings of worthlessness or guilt almost every day
- impaired concentration, indecisiveness
- insomnia or hypersomnia (excessive sleeping) almost every day
- markedly diminished interest or pleasure in almost all activities nearly every day
- recurring thoughts of death or suicide (not just fearing death)
- a sense of restlessness — known as psychomotor agitation — or being slowed down – retardation
- significant weight-loss or gain (a change of more than 5% of body weight in a month)
WHAT IS A MIGRAINE?
Migraine is a common, multifactorial, disabling, recurrent, hereditary neurovascular headache disorder. (2)
The frequency and intensity of migraines can vary among sufferers but commonly is characterized by
- a throbbing headache often localized to one side of the head
- intense head pain usually gradual in onset, then progressively more painful.
- sometimes accompanied by a pronounced sensitivity to light and sound or nausea and vomiting.
- a dull, deep and steady pain or throbbing and pulsating if severe
- can occur any time of the day, through it often starts in the morning.
- pain in the temples or behind one eye or ear, although any part of the head can be involved.
- may be accompanied by a variety of sensory warning signs or symptoms, such as flashes of light, blind spots, temporary loss of vision or tingling in your hand or face (MIGRAINE WITH AURA)
- pain lasting a few hours or up to one or two days,
- occurrence varies – once or twice a week, or only once or twice a year
Because of the migraine-depression connection, I wanted to bring up a topic I covered in an earlier MigreLief Blog Post – the danger migraineurs face when attempting to treat both depression and migraine headaches at the same time with prescription drugs.
WARNING: ANTI-DEPRESSANTS AND MIGRAINE DRUGS –
POSSIBLY A LETHAL COMBINATION!
Migraine sufferers should be aware of the dangers of combining some anti-depressants with prescription migraine medications. Unfortunately, the mechanism of action of many antidepressants is to increase serotonin (a feel good neurotransmitter) levels in the brain. Triptan drugs like Imitrex, which are used to reduce or end the pain of a migraine attack also work by stimulating serotonin receptors.
This combination of antidepressants and triptan migraine drugs, can lead to too much serotonin in the brain. This is not a good thing and can result in a potentially life-threatening condition known as “serotonin syndrome.”
In some people, just the use of triptans drugs such as Imitrex or Zomig alone can result in unhealthy levels of serotonin, leading to serotonin syndrome. This risk increases substantially if these people are also taking an antidepressant like Pristiq or any other of several antidepressants known either as SSRI (selective serotonin reuptake inhibitors) or SNRI (serotonin-noradrenaline reuptake inhibitors).
The symptoms of “Serotonin Syndrome” are:
Rapid heart rate and high blood pressure
Agitation or restlessness
Loss of muscle control or twitching muscles
In severe cases of serotonin syndrome life-threatening symptoms can occur:
Irregular heart beat
Sad moods are not among the typical migraine triggers, but some migraineurs notice that they experience sad moods before migraines occur—especially premenstrual migraines. There appears to be increasing evidence that there are a number of links between migraine and depression. As researchers explore these links, findings may eventually lead to insights about the etiology—and potentially even treatment, of the two conditions. People with migraines and comorbid psychiatric or mood disorders often need treatments that address both conditions, as well as management of sleep, stress, and lifestyle issues.
If you and your physician decide to use this combination of drugs, you must be monitored very closely for any of these signs and symptoms of serotonin syndrome.
To the Best of Health
Curt Hendrix, M.S., C.C.N., C.N.S.
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