People with chronic migraine often experience depression or anxiety disorders. It’s 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 migraines. In some instances, people with this condition also abuse substances.
Chronic migraine was once called transformative migraine. It’s 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 people who have migraines. Because of this, 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 is due to chance.
People who experience 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 have depression or an anxiety disorder. Some even report worsening headache symptoms after an episode of depression.
Researchers have suggested that those who get migraines with aura are more likely to have depression than people who have migraine without aura. Due to the possible connection between chronic migraines and major depression, doctors are urged to screen those with migraines for depression.
When depression accompanies chronic migraine, it may be possible to treat both conditions with an antidepressant medication. However, it’s important not to mix selective serotonin reuptake inhibitor (SSRI) drugs with triptan drugs. These two classes of medication 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 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:
This type of medication comes in:
- oral pill
- nasal spray
- skin patch
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 people, generic sumatriptan is the best buy.
Triptans are only useful for the treatment of migraine attacks as they occur. They do not prevent headaches. Some other drugs may be prescribed to help prevent the onset of migraine. These include beta blockers, certain antidepressants, antiepileptic medications, and CGRP antagonists. It may also be helpful to identify and avoid triggers that can provoke an attack. Triggers may include:
- certain foods
- caffeine or caffeine-containing foods
- skipping meals
- jet lag