Headaches as a Symptom of Depression

You are not alone if you suffer from both depression and a headache disorder. One could be triggering the other, or you could just happen to be enduring two complex and painful medical conditions at the same time. It's often tricky to tease apart—even scientists are scratching their heads over the precise link.

No, not always. Sometimes, individuals do not complain to their doctor or loved ones about "feeling sad or down." They may, instead, complain about physical ailments. These ailments, of course, warrant investigation, but if normal, may be indicative of a mood alteration. Just as a headache disorder, especially a chronic one, can trigger depression or another mood disorder—depression can trigger headaches. It's like the chicken and egg theory and can be puzzling for doctors to tease out. Remember, even if the depression is the root cause for a person's headache, their head pain is still very real.

Often times, too, the connection between depression and headaches is not causal—instead, depression contributes to the headache disorder or vice versa. So a person may notice that depression makes their headaches more severe or occur more frequently.

Keep in mind, besides a headache, there are other somatic (bodily) complaints you can experience with depression:

• Pain (neck, back, abdominal)
• Joint aches and pains
• Constipation
• Weakness

According to the Diagnostic and Statistical Manual of Mental Disorders, the criteria for Major Depressive Disorder (MDD) are the following:

Depressed mood or loss of pleasure/interest in daily activities for more than two weeks plus at least five out of nine symptoms below, present nearly every day.

• Depressed or irritable mood most of the day, nearly every day, as indicated by either subjective report (e.g. feels sad or empty) or observation made by others (e.g. appearing tearful).
• Decreased interest or pleasure in activities once enjoyed
• Eating too little or too little, which may lead to unintended weight gain or loss
• Change in sleep (Insomnia or hypersomnia)
• Change in activity (psychomotor agitation or psychomotor retardation)
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Diminished ability to think or concentrate, or more indecisiveness
• Thoughts of death or suicide, or has a suicide plan

The next time you go for your physical examination, do not be surprised if your doctor screens you for depression, especially if you have a history of a chronic pain condition, like migraines or cluster headaches. The Patient Health Questionnaire-9 (PHQ-9) is one of the most common tools used to screen for depression. For elderly patients, doctors commonly use the 15-item Geriatric Depression Scale.

When considering depression, your doctor may also screen you for other psychiatric diagnoses that can mimic or coexist with Major Depressive Disorder. Some of these diagnoses include:

• Generalized anxiety disorder
• Bipolar disorder
• Dysthymic disorder
• Schizoaffective disorder
• Schizophrenia
• Bereavement

Your doctor may also test you for these medical conditions that mimic symptoms of depression like:

• Hypothyroidism
• Anemia
• Vitamin B12 deficiency
• Fibromyalgia
• Liver or kidney disease
• High calcium

The treatment of depression often entails a combination of medication and "talk therapy," for a period of at least six months. While traditional antidepressants, like a selective serotonin reuptake inhibitor (SSRI), may be prescribed, your doctor may also consider a drug like Cymbalta (duloxetine), which is an antidepressant that is used to treat pain conditions.

In addition to medication and "talk therapy," there are lifestyle behaviors that you can adopt to help your depression, such as:

• Regular exercise
• Eating regular, nutritious meals
• Seeking out support and comfort from family or friends
• Getting a good night sleep every night and maintaining a regular sleep schedule, even on the weekends
• Avoiding alcohol, which is a depressant

If you think your headaches could be a sign of depression, or if your headaches are triggering sad thoughts, please seek the guidance of your primary care provider, neurologist, or psychiatrist. You are not alone. Be proactive in your healthcare and well-being.