Department: Ask the Experts
Answers to your questions about migraines and depression, MS progression, methadone for neuropathic pain, and exercises for carpal tunnel.
Fred D. Sheftell, M.D., is director and founder of the New England Center for Headache in Stamford, Conn.
Q I've read that migraine and depression are sometimes linked. What's the best therapy for dealing with both conditions?
A Migraine is linked to both depression and anxiety disorders. In some studies, depressive disorders were four times as common in people with migraine compared to those without migraine. People with chronic daily headache are more than 50 percent likely to have diagnosable depression or an anxiety disorder.
First, it's important for a doctor to diagnose both your migraine and depression. Some drugs target both conditions, but you have to take high doses for an antidepressant effect. For example, you need at least 100 mg for the drug amitriptyline to work as an effective antidepressant, and some people have difficulty with the side effects at this dose. Other medications with fewer side effects may be effective for depression but less so for headache.
A better option might be treating the conditions separately. Either way, you can and have to treat both. In fact, the outcomes for headache are going to be much more robust if you identify and treat the accompanying depression.
Also, I think it's important to not rely only on drugs. Cognitive behavioral therapy, for example, can also target both depression and migraine. This form of therapy is based on the premise that one's thoughts and behaviors have a major influence on one's feelings. So saying “I'm never going to get better” or “I'm always going to be like this” will negatively impact your health, while positive thoughts will contribute to your improvement. Exercise is also a very good nonpharmacological therapy for both headache and chronic depression. It's important for you to play an active role in your illness; if you leave it up to your doctor to do something to make you feel better, the outcome won't be as good.