Migraine and depression #MHAM

I was diagnosed with depression associated with chronic pain, but the fact is migraines play a significant role in this. Migraines can dramatically affect my mood. Significantly when the migraine is a status migraine and lasts for three days to, well, way too long. I have had suicidal ideation. Suicidal attempts. The depression itself can rise and fall like a storm, much like the migraines itself. And powerful. However, due to the chronic nature of my migraines it also became a force in-in-itself. More powerful in times of high pain, but there regardless.

It was ignored for years and I wrote a post about why here. Point is after a second suicide attempt the pain clinic rather thought the depression itself needed to be paid some attention to. When I first when to them they thought it could be managed with just some support from the psychologist who specialized in chronic pain, because the depression was a beast of the chronic pain. In a way, that was true but the intensity of the depression when I was in high amounts of pain and sleep deprived was extremely difficult to get around the excessively dark thoughts. Since I already in the past had a suicide attempt my second one was very spontaneous. I had already crossed that mental barrier and knew how easy it was to cross… so just leap right on by it the second time with little thought or consideration. Pain has a way of influencing thoughts to be deeper and darker. Not, unfortunately, unrealistic… just sharper and more exemplified of reality. Nothing gentle can sneak in there. Therefore they decided I needed to temper the storm with medication. Here is the irony; antidepressants make me suicidal. In fact that was the contributing factor to my suicide attempts, the medications, that made suicidal thoughts aggressive and persistent. Therefore when they looked at my medication choices the pain clinic psychiatrist said I can never be put on that class for pain management again, let alone depression. There were two alternatives and I am on Abilify. It actually works well. I have depression still, especially with a wicked migraine hitting hard. I just don’t really have the extreme lows that I was used to. The freaky scary lows.

Depression is an insidious beast that affects my chronic migraine treatment in so many ways. I was not as involved in my general self-care. I lacked the motivation to do anything let alone the exercise I was supposed to do. I didn’t care about my hobbies and the things I used to enjoy anymore. I just wanted to sleep. I’d miss work from the migraines but also because I didn’t want to move, exist, be in pain that day. I am still in what I call a ‘funk’ still trying to encourage my motivation, force myself to engage in self-care. Trying to work on my hobbies hoping to spur my creativity again.

Another thing about depression is the lack of hope. When I feel a bit better I try. I try all the things on my pain management list and I do them every day. Set a routine. But when the depression sinks into me lower. I don’t try. Because why does it even matter? Nothing is going to work. And my routine falls apart. I have yet to find a way to keep my routine through the dips of the depression.

Here is some research to look at for migraines and depression.

Psychiatric Comorbidity in Chronic Daily Headache research states people who have chronic pain do not get as depressed as often as people with chronic migraines. So there must be a link or correlation to explain why this is so.

Migraine and psychiatric comorbidity: a review of clinical findings research points to the fact migraine with aura migraineurs are more likely to have depression than those without aura.

Migraine and depression The association with depression is high with migraine with aura and in chronic migraines. They suggest migraine patients are carefully screened for depression.

For more than a century, clinicians and researchers alike

have noted the possible relationship between migraine and

different psychological characteristics, including tenden-

cies toward depression, perfectionism and repressed

aggression. With few exceptions, the previous investiga-

tions have been highly consistent in reporting an increased

prevalence of major depressive disorder (MDD) in patients

with migraine. The discrepant studies were characterised

by several methodological differences or limitations that

may explain the lack of association with MDD. These

include the fact that the sample was not representative of

the general population or of clinic settings and the cohort

studied was notably younger and had a different sex com-

position than the other published investigations

In a population of subjects aged over 65 years, Wang et

al. found that the risk of current depression was much

greater in migraine sufferers than in non-migraine patients

[12]. Merikangas et al. investigated 457 younger subjects

and found an increased risk of developing major depres-

sion and anxiety disorders in migraine patients compared

with controls [13]. Lipton, in a population-based case-con-

trol study conducted in a community setting, confirmed a

higher risk of current depression among patients suffering

from migraine [3].

In another paper, Breslau reported that a history of

migraine is associated with increased frequencies of suici-

dal ideation and suicide attempts in patients with major

depression [28]. In the study of Fasmer and Oedegaard, the

frequency of suicide attempts was higher among the

patients having MWA than in patients affected by migraine

aura without headache (MAWH). This was despite the fact

that the frequency of suicidal thoughts was approximately

equal in the two groups [29]. In a recent study of 201

patients with MDD, the authors compared MWA and

MAWH. They observed that the MAWH group had a sig-

nificantly lower prevalence of affective temperaments and

suicide attempts [30]. Zwart et al., in a large cross-sec-

tional population-based study, observed that the OR for

depression was significantly higher in subjects with

migraine and non-migraine headache compared to the

headache-free group. Moreover, there was a strong linear

trend of higher prevalence of depression with increasing

headache frequency [31]

They found that migraineurs had a more than

three-fold relative risk of developing depression compared

with non-migraine patients; in turn, depression patients

that had not previously suffered from migraine had a more

than three-fold relative risk of developing migraine com-

pared with non-depressed patients. The association seems

to arise from the two conditions reciprocally affecting each

other in a “bidirectional” relationship rather than resulting

from a one-way action, thus ruling out the possibility that

mood disturbances may be secondary to repeated migraine

attacks [34]. 

There is evidence for involvement of both monoamine

(serotonin and dopamine) and peptide (endorphin and

encephalin) neurotransmitters in depression. Endorphins

and encephalins are involved in both mood and pain con-

trol. Serotonin (5HT) in particular has been implicated in

mood disorders, anxiety disorders, sleep disorders, eating

disorders, obsessive–compulsive disorder, migraine and

TTH. There is good evidence for the involvement of 5 HT1

receptor [36, 37]. Evidence is accumulating that dopamine

is also intimately involved in migraine. Migraine prodrome

is often characterised by dopaminergic symptoms and anti-

dopaminergic compounds can often be helpful in treatment

[38]. According to these data, it can be hypothesised that

severe headache, severe somatic symptoms and major

depression may be linked through dysfunction of the sero-

toninergic and dopaminergic systems