There appears to be a bidirectional relationship between migraine and depression, in which one disorder increases the risk for the other and vice versa.
If you treat patients for migraines, you know that these headaches frequently occur in the absence of triggers, such as lack of sleep, skipping meals, noxious odors, and anxiety.
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.
Migraine and depression comorbidity
Many individuals with depression do not experience migraines, and many individuals who experience migraines do not have depression. However, migraineurs have a reported 2- to 4-fold increase in lifetime risk of developing major depressive disorder.1
Distress caused by migraines and depression
Migraine headaches and depression each cause a patient significant distress. Time lost to each of these disorders can interfere with work, productivity at home, and social and family relationships. Patients who live with both illnesses experience external and internal criticism of exaggerating symptoms. Friends and family may encourage them to “think positive.” And patients themselves attempt to control their own symptoms through positive attitudes and attempts at self-control.
And while depression typically lasts longer than migraine headaches, there is an episodic nature to both disorders. Thus, most people experience intermittent relief and, often, they experience an urgency to make up for lost time once symptoms begin to resolve.
Overlap in prophylactic treatment
SSRIs and tricyclics are among the most commonly used prophylactic treatments for migraines. That these agents are used for both disorders does not necessarily point to a common etiology, but it does raise the possibility that there could be a similar basis shared between the two conditions.
That SSRIs and tricyclics treat both depression and migraine raises the possibility of a shared basis between the two disorders.
Thus far, genetic studies have shown a correlation between migraines and depression. A study in Cephalgia found a bidirectional relationship between migraine and depression, in which one disorder increased the risk for the other and vice versa.2 The study also showed that genes from serotonergic, dopaminergic, and GABAergic systems and variants in the MTHFR and BDNF genes are strong candidates in the etiology of both disorders.
Depression and migraine are separate disorders, yet both cause bouts of suffering for patients, and some patients have both conditions. As research on migraines and depression begins to unravel the genetic causes and the affected regions of the brain, more effective treatment approaches are likely to follow.
1. Amoozegar F. Depression comorbidity in migraine. Int Rev Psychiatry. 2017;6:1-12.
2. Yang Y, Ligthart L, Terwindt GM, et al. Genetic epidemiology of migraine and depression. Cephalalgia. 2016;36:679-691.