Women who suffer from migraines or who have had them in the past are at an increased risk for developing depression, according to new research.
The study, conducted by Brigham and Women’s Hospital in Boston, found that women with any history of migraine were about 40 percent more likely to develop depression than women without a history of migraine. The results were the same regardless of whether the women had a migraine with aura.
The study, supported by the National Heart, Lung and Blood Institute and the National Cancer Institute, will be presented at the American Academy of Neurology’s 64th annual meeting in April in New Orleans.
For the study, 36,154 women were asked about migraine history. Out of those women, 6,456 had a current or past migraine. During an average of 14 years of follow-up, 3,971 of the women developed depression.
Although the study may be new, Dr. Dustin Harker, a neurologist at Davis Hospital and Medical Center, said that health-care professionals have long linked migraine and depression.
“In general, any chronic pain complaint is likely to be associated with depression, and this includes migraine,” Harker said. “It is also true that depression makes headache more likely.”
Harker said screening for depression in a migraine patient is a routine part of his practice, and he will often choose to prescribe an antidepressant for the migraine.
“Many antidepressants affect serotonin and norepinephrine, neurotransmitters which are implicated in depression but also implicated in the pain pathways of the nervous system,” he said. “In other words, an antidepressant may directly affect the brain to make it less irritable or headache-y and may indirectly improve migraine by treating any comorbid or underlying depression.”
Dr. Melissa Bentley, an internal medicine physician on the staff of Ogden Regional Medical Center, said that disabling headaches might affect one’s mood, and one of the most commonly identified triggers for a migraine attack is emotional stress.
“Some studies have shown individuals who suffer from migraines have lower levels of serotonin than the general population, and low serotonin levels have also been described in depression,” she said.
A migraine is a chronic condition of recurrent attacks of headache lasting four to 72 hours, Bentley said. The migraine can occur with or without an aura, which includes visual disturbances such as flickering lights or spots, and a loss of vision. The aura can also include feelings of pins and needles or numbness and tingling and abnormal speech and dizziness.
Once the aura is gone, the headache sets in, sometimes accompanied by nausea, vomiting, pain on one side of the head, and sensitivity to light and sound.
Although the cause of migraines isn’t entirely clear, it is thought that a collection of nerves called the trigeminal ganglion, with some contribution from nerves in the upper neck, become activated, Bentley said. They then release various chemicals, neurotransmitters which cause “neurogenic inflammation” and, through a series of signals, pain.
“Some evidence for this theory includes the finding of elevated levels of chemicals known to be involved in pain signals in the cerebrospinal fluid of patients with chronic migraine,” Bentley said.
Genetics and environment can also predispose a person to migraines.
According to the Mayo Clinic, some triggers of a migraine include hormonal changes in women, food containing monosodium glutamate, aspartame, processed foods and meats, red wine, beer, chocolate and aged cheeses.
Skipping meals and fasting can also trigger a migraine attack, as well as overuse of caffeine.
Smells such as perfumes, paint thinner and secondhand smoke are other triggers, as well as stress, bright lights, sun glare, loud sounds, changes in sleep patterns, changes in weather, certain medications and physical exertion.
Bentley and Harker said a variety of medications are used to treat migraines, while others are used to help prevent attacks. Sometimes a single medication can be used to treat both the migraine and depression.
“A successful treatment plan may restore a patient’s ability to function normally, engage in enjoyable activities and have a hopeful, optimistic outlook for the future,” Bentley said. “If depression is already present, treating it is also both possible and essential and may improve or resolve the headache disorder as well.”