The link between chronic migraine and mood disorders is well established. People with chronic migraine often also suffer from depression and/or anxiety disorders. Not surprisingly, it is not uncommon for people with chronic migraine to struggle with lost productivity. They may also experience poor quality of life. Some of this is due to mood disorders like depression, which may accompany migraine. In some instances, people with this illness may also struggle with substance abuse.
The Link Between Pain and Depression
Chronic migraine was once called transformative migraine. It is defined as a headache that lasts 15 days or more a month, for more than three months. You might expect that someone living with chronic pain would also become depressed. Research shows that people with other chronic pain conditions, such as lower back pain, do not get depressed as often as migraine sufferers, though. So there’s thought to be a link between migraine and mood disorders that is not necessarily due to the constant pain itself.
It’s unclear what the exact nature of this relationship might be. There are several possible explanations. Migraine may play a role in the development of mood disorders such as depression, or it could be the other way around. Alternatively, the two conditions might share an environmental risk factor. It is also possible—though unlikely—that the apparent link could be due to mere chance.
People who suffer from more frequent migraine headaches report having lower quality of life than people with occasional headaches. Disability and lower quality of life are also worse when people with chronic migraine simultaneously suffer from depression or an anxiety disorder. Moreover, some people report worsening headache symptoms after an episode of depression. Some researchers have reported that people who suffer from migraine with aura are more likely to have depression than people who have migraine without aura. Due to the chance that chronic migraine sufferers may also have major depression, doctors are urged to screen chronic migraine patients for depression.
When depression accompanies chronic migraine, it may be possible to treat both conditions with an antidepressant medication. It’s important not to mix modern selective serotonin reuptake inhibitor (SSRI) drugs with triptan drugs, though. These two classes of drugs can interact to cause a rare and possibly dangerous side effect called serotonin syndrome. This potentially fatal interaction results when the brain has too much of a chemical called serotonin. SSRIs and a similar class of drugs called selective serotonin/norepinephrine reuptake inhibitors (SSNRIs) are antidepressants that work by boosting the serotonin that’s available within the brain.
Triptans are a class of modern drugs used to treat migraine. They work by binding to receptors for serotonin in the brain. This reduces blood vessel swelling, which relieves migraine headache. There are presently seven different triptan medications available by prescription. There is also a drug that combines prescription triptan with over-the-counter pain reliever naproxen. Brand names include Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Treximet, Zecuity, and Zomig. Some are taken by mouth, while others come in the form of a nasal spray. Still others are available as injectable medicines or are delivered through a patch applied to the skin. At least four of these medications are now available as generic drugs.
The nonprofit consumer advocacy organization Consumer Reports compared the price and effectiveness of various triptans in a report published in 2013. They concluded that for most patients, generic sumatriptan is the best buy.
Treatment Through Prevention
Triptans are only useful for the treatment of migraine attacks as they occur. They do not prevent the onset of headache episodes. Some other drugs may be prescribed to help prevent the onset of attack. These include drugs called beta blockers and certain antidepressant medications. It may also be helpful to identify and avoid triggers that can provoke an attack. Triggers may include certain foods, alcohol, caffeine, or caffeine-containing foods. Other common triggers include skipping meals, jet lag, dehydration, and stress.