Michael Craig Miller, M.D., is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.

Question:

Is there a link between depression and migraines?

Answer:

Yes, there is a link between depression and migraine headaches.

Let's first consider headaches in general. Depression is the most common psychiatric disorder studied in connection with headaches. Headache in some cases is considered a symptom of depression.

There is a connection between the frequency of headaches and the severity of depression. As headaches become more intense and frequent, it is more likely that a person will become depressed. Getting bad headaches every day, whether they are migraine or not, can lead to depression or can aggravate it.

But not all severe headaches are migraines.

Of all headaches, migraine headaches have been most frequently studied and many researchers have observed a close relationship between migraines and depression. For example, in people who have a clear diagnosis of migraine, when compared to a control group, their frequency of major depression is almost triple. The reverse is also true, that people with depression are more likely than non-depressed people to develop migraines.

It might help to review the classic description of a migraine headache, because people sometimes use the word migraine to describe any very bad headache.

The classic migraine headache is severe. It may be preceded by symptoms that warn the person that the migraine is on its way. Classically, there is throbbing pain on one side of the head. The headache may last from a few hours up to as much as three days. Physical activity makes the pain worse. People often feel sick to their stomachs. Light or sounds can be intolerable. This is why many people lie down in a dark, silent room when they get a migraine.

In one-third of people with migraines, the warning symptoms can include an aura. This may be a visual or auditory experience, such as flashing lights or musical tones. Some people will have difficulty with speech or movement.

Many experts now believe that there may be common biological or genetic roots for depression and migraine. That is, the same biological factors that make some people vulnerable to depression can also make them vulnerable to migraine headaches.

This association has led to the discovery that antidepressant medication is useful for treating migraine headaches. (Antidepressants, in fact, are used to successfully treat many pain syndromes.)

Migraine headaches are tricky to diagnose, because they take a many forms, not just the classic one described above. If you have bad headaches that come back repeatedly, make sure your doctor reviews the symptoms and evaluates the problem fully. Headaches occur in many medical illnesses, so you will want your doctor to consider all the possibilities that might be relevant to you.

If you do have both depression and migraine headaches, that can be very difficult to bear. Fortunately, good treatments are available for both.