Knowledge Learned From Imaging Studies: How Functional Imaging Studies Might Lend Insights Into Shared Pathophysiology Between Migraine And Psychiatric Comorbidities
Research neuroimaging studies provide insights into the emotional component of migraine symptoms and might provide insights into the comorbidity between migraine and psychiatric disorders. Migraine studies demonstrate abnormal function, structure and connectivity of brain regions that play important roles in determining emotional responses to pain and to other sensory stimuli, and in determining general affect and mood. Greater pain-induced functional activation, and stronger functional connectivity of these regions, likely contribute to determining the emotional aspect of migraine symptoms, and could partially account for the coexistence of psychiatric disorders with migraine.
Affective-motivational brain regions that have been commonly identified as having abnormal function or structure in migraine studies include: anterior cingulate cortex, anterior insula, prefrontal cortex, hippocampus and amygdala. illustrates these brain regions.
Affective-motivational brain regions commonly identified as having abnormal function or structure in migraine studies.
What Is Secondary Service Connection
Secondary service connection is a method of service connection for a disability that has been caused by a condition that is already service-connected. The most crucial part of establishing secondary service connection is providing a nexus.
A nexus is a medical opinion that links a veterans secondary disability to the disability that is already service-connected. In order to be granted secondary service connection, there must be a medical nexus that clearly establishes the connection between the primary condition or disability and the secondary condition or disability.
To file a claim for secondary service connection, veterans may file VA Form 21-526, the same as if the veteran were filing for service connection. Veterans will want to be sure they indicate on the form that they are filing for secondary service connection and include all the necessary evidence, such as the diagnosis, medical nexus, and any lay statements to establish the in-service occurrence or explain how the secondary condition was caused by the original service-connected condition.
Are Migraines Linked To Depression
These days, it seems like everything can be directly linked to depression. However, it turns out that if youre a female who suffers from migraine headaches, you may be 40 percent more likely to develop the signs of depression.
While this information is only in its preliminary stages, studies are being conducted to see if migraines and depression are truly linked. Researchers also want to know if there are biological links between the two conditions. For now, a group of researchers at CCNYs Grove School of Engineering has developed tDCS , a device that they claim can undo the brain changes that are caused by patients having chronic migraines. The researchers believe that using tDCS repeatedly can reduce the intensity of a persons migraines by 37 percent. They think the device can be used every day as a means of preventing migraines, as well.
This device may be safer than taking migraine medications as well as antidepressants for depression such as Paxil or Effexor. The side effects linked to tDCS include a mild tingling sensation. Other treatments used for depression have been known to cause serious side effects, which can include violent and suicidal thoughts and behavior and birth defects in babies whose mothers take the drugs while pregnant. Other than antidepressants, researchers are also looking into using deep brain stimulation as a relief for depression.
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What Type Of Doctor Should I See For Migraine And Depression
A neurologist with a headache specialty is the preferred doctor to treat migraine and other headache disorders. For depression, a psychiatrist and psychologist are most useful for diagnosing and treating this condition. A primary care provider may also be involved to help manage these conditions as well. The health care providers should utilize an interdisciplinary approach to treating migraine and depression.
Studies On Depression And Migraine
A 2010 Dutch study of 2,652 distant relatives found that 360 participants suffered from migraines, while 977 had depression. In the study, a quarter of the people with migraines also suffered from depression, which is twice the rate of depression seen in the family members who didnt suffer from migraine. Researchers believe the data points to a possible genetic link between depression and migraine. The researchers said it is more likely that they are caused by related genes rather than one disorder causing the other. This is called a bidirectional association and that link to depression isnt seen with other types of headaches.
Other research has found that people with migraines are more likely to suffer from other mental or mood disorders, which include anxiety and panic attacks, bipolar disorder, as well as depression.
Migraine sufferers develop depression five times more often than people without migraines.
A 2008 survey by the National Headache Foundation found that of those polled:
- 92% said their lives would be happier if they didnt suffer from headaches
- 80% had symptoms of depression, but only 52% have been diagnosed with depression
- 79% had energy loss
- Feelings of guilt or worthlessness
- Lack of energy, fatigue, tiredness
- Difficulty concentrating, thinking, decision making or remembering
- Changes in sleep, such as insomnia or increased sleep
- Unexplained physical problems such as headaches, pains, cramps, back ache, digestive problems
- Crying for no apparent reason
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Overview Of Treatment Considerations And Options
Migraine attacks are commonly managed by abortive medications such as triptans and non-steroidal anti-inflammatory drugs. When necessary, preventive medications, such as antidepressants, antihypertensives and antiepileptic drugs, are added to the treatment., Beyond medications, behavioural treatments are often used to treat migraine, and have been found to be effective in reducing headache frequency. Biofeedback, deep breathing, progressive muscle relaxation and guided imagery-coping skills are often used to help patients successfully manage headaches. Additional cognitive strategies often used include cognitive modification, problem-solving techniques, and cognitive-behavioural stress-management therapy. The combination of medication and behavioural therapy has been found to be more effective than either medication or behavioural therapy alone in treating migraine.,,
First, the choice of the migraine-preventive medication in patients with psychiatric comorbidities should be based on psychiatric comorbidity severity, patients preference, patients risks for adverse events and prior treatment history.
Pharmacological treatments used for migraine prevention and psychiatric comorbidities
Other Medical Conditions Must Be Considered When Treating Migraine
Treating migraine and headache can be less straightforward than treating other types of conditions, says Mueller. With headache you have to look at the whole picture and any comorbidities, or other health conditions, that the person might have, she says.
In addition to depression and anxiety, other comorbidities that may accompany migraine include post-traumatic stress disorder , asthma, allergies, IBS, hypertension, Crohns disease, COPD, chronic fatigue, sleep disorders, fibromyalgia, epilepsy, multiple sclerosis , and stroke, according to American Migraine Foundation.
We often try to choose a medication that will address both conditions when possible, and we want to avoid prescribing anything for migraine that might aggravate another condition, she says.
For example, tricyclic antidepressants are often avoided in managing migraine in people with bipolar disorder, because they may cause a shift into mania, says Mueller.
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Understanding The Relationship Between Migraine Depression And Anxiety With Dawn Buse Phd
AHS: What do we know about the relationship between depression and migraine?
DB: Depression and migraine share a common relationship, and one may actually come before the other. That may not mean that one causes the other, but it could be a predisposer. We know that people with migraine are about five times more likely to develop depression than someone without migraine. We also know that someone who has depression is about three times more likely to have migraine later in life than someone without depression.
AHS: What about anxiety and migraine? Whats the relationship there?
AHS: What are some of the misconceptions people have about migraine, depression and anxiety and how they interrelate?
DB: When we talk about migraine, depression and anxiety occurring together, we have to be very careful not to make patients feel like how theyre feeling is their fault. These things co-occur because they share underlying biologic and neurochemical mechanisms. Theres a reason why the nervous system and the brain have these conditions together, and its very logical that youre going to feel sad, down and frustrated when youre living with a chronic disease like migraine. Youre also going to worry about when the next attack will come, what your future may hold, and how migraine will continue to affect your life. It makes sense that these conditions might travel together, but we cant blame this persons illnessand subsequently their depression or anxietyon weakness.
Can Depression Cause Headaches
Up to 80 percent of adults experience tension headaches throughout their lives sharp throbbing pains that can occur throughout multiple regions in the head. Occasionally, people with depression experience headaches caused by their condition.
Research shows that there is a link between tension headaches and mental health illnesses like depression and anxiety. One study indicated that up to 11 percent of people with mental health disorders also suffered from migraine attacks, and other research reports that 40 percent of people with migraines also suffer from depression.
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Serotonin A Likely Link
Serotonin is a neurotransmitter that is active in the brain. It is known to affect your mood, and it also plays a role in the constriction and dilation of blood vessels.
Although low serotonin levels may not directly cause migraines, many patients who suffer from migraines do have low serotonin. A deficiency of serotonin can also lead to anxiety, depression, and other mental health ailments that often coincide with chronic migraine. Elevated levels of serotonin can also lead to migraine and serotonin syndrome a collection of symptoms including anxiety, flushing, confusion, and changes in heart rate.
Serotonin may not be the link between migraine and mental health disorders, but it is almost certainly a link for many of my patients.
A Note To Patients And Providers
Although migraine and depression are more likely to occur in females, it is important to note that anyone can develop both of these conditions regardless of age or gender. The gold standard for diagnosing depression is through individual clinical interviews with a health care provider. Those living with migraine should be screened for comorbid depression and vice versa. The patient should inform the provider if they are showing signs and symptoms of depression. This will allow the physician to create an individualized treatment plan and decrease the risk of transitioning from episodic to chronic migraine.
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Migraines And Their Effect On Mental Health
When describing migraines, patients often focus on the physical symptoms the pounding headache, the debilitating nausea, and the searing sensitivity to light. However, migraine is not merely a physical ailment. Chronic migraine sufferers often suffer mentally, as well as physically. The condition can affect your lifestyle, your goals, and your relationships, and it can have a profound impact on your mental health. Your mental health can also impact the frequency and severity of your migraines.
Depression And Anxiety More Common In Migraine With Aura
The strongest association between the two mood disorders and migraine is in people with migraine with aura, she adds.
About a third of people with migraine get aura during their attacks. This can be a visual aura, or more rarely a sensory aura or an aura that causes weakness, she says. People with this type of migraine seem to be even more vulnerable to the anxiety-depression link, she says.
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The Relationship Between Migraine And Mental Health
Chronic migraines and depression often go hand-in-hand. In fact, migraine sufferers are, over their lifetime, between two and four times more likely than people without migraines to develop major depressive disorder. Migraine patients are also at an increased risk of anxiety. About 50% of migraine sufferers have anxiety. For some patients, the anxiety comes first, followed by the onset of migraines, and for other patients, anxiety develops after a period of chronic migraines.
Researchers are not certain exactly how chronic migraines, depression, and anxiety are related. Does depression cause or increase the risk of chronic migraine? Do migraines lead to depression? Most feel that the relationship works both ways. Migraines contribute to depression or anxiety, and these mental health disorders make migraines worse.
Migraines Impact On Mental Health
Those affected by migraines are more likely to have mental health issues like depression and anxiety. In fact, people dealing with migraines are three times more likely to experience depression, especially if said migraines are frequent. About 30 to 50 percent of people suffering from chronic migraines also have anxiety, and 20 percent of those dealing with episodic migraines less than 15 occurrences per month have anxiety, too. Theres also some evidence that migraines frequently co-occur with bipolar disorder.
In fact, studies show that migraines dramatically impact quality of life, so it makes sense that migraines manifest in your mental health. Even occasionally handling these painful incidents can cause you to drag for days waking each morning wondering if today will be the day you experience your next migraine takes a serious toll. Spending so much time either focusing on your migraines or dealing with your migraines can spark anxiety or depression.
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Migraines Linked To Depression
Women who suffer from migraine headaches may be more likely to develop depression.
A new study shows that women who have migraines are about 40% more likely to develop depression than women who have never had migraines.
“This is one of the first large studies to examine the association between migraine and the development of depression over time,” researcher Tobias Kurth, MD, ScD, of Brigham and Women’s Hospital in Boston, says in a news release. “We hope our findings will encourage doctors to speak to their migraine patients about the risk of depression and potential ways to prevent depression.”
The results will be presented in April at the annual meeting of the American Academy of Neurology.
Migraine-Depression Link
In the study, researchers looked at the risk of depression among 36,154 women who took part in the Women’s Health Study. None of the women had depression at the start of the study.
The women were divided into four groups: those with active migraine with aura, active migraine without aura, past history of migraine , and those with no history of migraine. Aura are visual disturbances like flashing lights sometimes associated with migraine headaches.
During about 14 years of follow-up, 3,971 women were diagnosed with depression.
The results showed that women with any history of migraine were 36% more likely to develop depression compared to women with no history of migraine. Women with a past history of migraine were 41% more likely to experience depression.
Pharmacologic Treatments For Migraine And Depression
Ideally, migraines and depression should be treated simultaneously. It is a mistake to think that migraine should not be addressed until the depressive symptoms have resolved, or vice versa. The 2 conditions can be treated at the same time, Dr Seng emphasized. Patients with these conditions should be receiving aggressive treatments on all fronts to help reduce both migraine and depressive symptomatology.
Choosing migraine-preventive medication in patients with psychiatric comorbidities should be based on a number of factors, including the severity of the psychiatric comorbidity, patients preferences, patients risk for adverse events, and prior treatment history.9
If the psychiatric comorbidity is mild, it may be possible to use monotherapy for migraine prevention as well as the psychiatric condition. However, with severe conditions, or the absence of overlap, separate treatments are needed.9 In addition, using separate treatments for migraine and psychiatric comorbidity rather than monotherapy appears to improve outcomes and minimize side effects.9
Treatment should proceed in a sequential stepwise manner with close monitoring of potential side effects and treatment interactions.9 Some migraine preventives like topiramate can affect mood, while it is possible that -blockers may be associated with depression.9Table 1 lists pharmacotherapies for migraine prevention and psychiatric comorbidities.
Table 1: Pharmacotherapies For Migraine and Psychiatric Comorbidities
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How To Take Care Of Your Mental Health
Certain healthy habits help protect your emotional well-being. As a bonus, many of them also may help you have fewer or less intense headaches.
Stay connected to friends and family. Migraine gets in the way of being social. But the support of others is a key part of good mental health. Research has shown that strong connections with family and friends lower your chance of both depression and anxiety. One study found that out of 100 things that can affect your mental health, social connection offered the best protection against depression.
Make sleep a priority. Not only does getting enough sleep help you avoid migraine, but it’s also critical to your emotional health. Your best bet is to stick to a consistent sleep routine. Go to bed and wake up at the same time each day. Give yourself time to wind down before you go to bed. And avoid caffeine or alcohol for at least 4 hours before bedtime.
Move your body every day. Exercise helps stave off headaches while it improves your mental outlook. And it doesnât have to be intense. A 30-minute walk can boost your mood in a big way. If that feels like too much, start with shorter sessions of movement throughout your day.
Practice relaxation techniques to reduce stress. This is another tactic that can help control migraine while benefitting your mental health. Try mindfulness exercises, meditation, or mind-body practices like yoga or tai chi.