The Migraine Brain
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Perhaps it isn’t the sex triggering your migraine but stress. Are you anxious during sex: worried about the kids coming in, thinking about work, worried the phone is going to ring? If so, consider how to de-stress your sex life so you can focus on yourself and your partner.
When Sex Cures a Migraine
For some people, sex is a wonderful antidote to migraine because it actually makes them go away. This is probably because sex floods your body with endorphins, a natural painkiller, and with serotonin, which may counteract the serotonin abnormalities of a migraine attack.
It turns out that many migraineurs have more sexual desire than average, a 2006 study at Wake Forest University School of Medicine found. In fact, on average, they have a 20 percent higher sex drive than other people, and they are aware they have more sexual desire, too.
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In the seventeenth century, Thomas Willis—considered the father of modern neurology (who happens to be an ancestor of Bruce Willis)—treated a patient, Lady Catherine, who had a notably energetic libido.
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The study found that men, in general, have a 24 percent higher sex drive than women. That means that many women with migraines have a sex drive equal to that of men who don’t get migraines, it concluded.
An orgasm works as an abortive for about 20 percent of migraineurs, according to Dr. James R. Couch, a migraine specialist who has studied this effect. If this is true for you, it’s a healthy way to end a migraine attack.
Mental Health and Migraine
One morning, I arrived at the Women’s Headache Center to find a middle-aged Cambodian woman sitting in an examining room, struggling to communicate with my nurse. As we waited for the Khmer interpreter to arrive, I read the report from the woman’s primary care doctor, who wrote that she suffered from painful, frequent headaches that were getting worse. The doctor had tried several medications to help her but nothing worked. On this day, the woman was clearly distressed. Her face had an incredibly sad expression, and she moved very slowly, as if she had no energy at all.
When the interpreter arrived, I asked the usual questions: what her head pain felt like, when it came, what seemed to trigger it. We covered all the bases, including whether the woman was safe at home, and she nodded yes. But it seemed to me there was something more here. I asked about her family. As the interpreter translated my words, the woman’s face fell. She said she hadn’t seen her two children in ten years. They were still in Cambodia, and she had no idea if they would ever be able to join her in the United States. She looked close to tears.
I was certain she was severely depressed. When I asked if she had considered suicide, she paused and then nodded her head. I gently explained that she needed medical help and sent her for an evaluation at the hospital’s psychiatric unit. I told her that a psychiatrist and I would work together because her headaches weren’t going to improve until she got help dealing with her tragic personal situation.
Scientists and medical doctors have known for a long time that there is a connection between migraine and certain psychiatric disorders including depression. We are still learning what the link is, but it may be related to certain neurotransmitters, including serotonin and norepinephrine, which are key components of both migraines and some mental illnesses. To feel as well as possible, you and your doctor have to explore all aspects of your health, including emotional and mental health.
A new study of Iraq veterans has documented the migraine–mental health connection more strongly than ever, as well as raising other questions about the genesis of migraines. Soldiers returning from combat in Iraq have more than twice the prevalence of migraines as the general population, and the soldiers with migraine have double the risk for certain mental health issues including depression, posttraumatic stress disorder (PTSD), and anxiety. This report, the first to document a migraine-PTSD connection, is important as we work to understand more about migraine and how to treat it.
Conducted by military doctors at the Madigan Army Medical Center in Tacoma, Washington, and presented at the 2007 annual meeting of the American Academy of Neurology, the study gathered information about headache symptoms and mental health from more than 2,100 American soldiers who served in combat in Iraq. The group was 96 percent male, with an average age of twenty-seven.
Among the findings:
At least 19 percent of Iraq combat veterans suffer from migraines. Only 5 percent of the soldiers had previously been diagnosed with migraine.
50 percent of the soldiers with migraine also suffered from clinical depression, compared to 27 percent of soldier without migraines.
39 percent of soldiers with migraines are also suffering from PTSD, compared to 18 percent of soldiers without migraines.
22 percent of soldiers with migraines have anxiety disorders, compared to 10 percent without migraines.
The migraines continued and often got worse after the soldiers returned to the United States.
Only a tiny fraction of soldiers with migraine were using triptans, the most effective migraine treatment.
Soldiers with migraine and depression or PTSD—but not anxiety disorders—had more frequent migraines. But the pain and duration of their migraines was not different from migraineur soldiers without these disorders.
Why are these soldiers suffering migraines at a higher rate than the civilian population? The researchers offer various theories including exposure to chemicals, extreme heat, dehydration, lack of sleep, and irregular meals, all well-established migraine triggers. They suggest that migraines may lead to psychiatric disorders, and mental disorders may lead to migraine. This is called a bi-directional influence, a theory supported by prior studies of migraine and depression.
This research raises many questions. Do combat conditions create migraines in people who otherwise aren’t disposed to get them? Is the brain chemistry of combat soldiers altered by their experiences? Do combat conditions lower the migraine threshold and the susceptibility to cortical spreading depression? What is the precise link between migraine and depression, PTSD, and anxiety?
Obviously, more study is needed in both military and civilian populations in order to understand the relation between migraine and mental health, the biochemical basis of each of these, and other factors. More effective treatment for all migraineurs, and soldiers in particular, would likely follow.
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Of people with migraine, 54 percent are also clinically depressed, and 34 percent have anxiety disorder.
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As you think about your migraines, please consider your mental and emotional state. It is something your headache specialist should explore, too, since the rates of depression and anxiety are so high among migraineurs. The good news is, there are many excellent treatments for these disorders. With help, you can feel much better.
If you are generally unhappy, anxious, have recurring difficulty in relationships, are in an unsafe relationship, or have other problems of this sort, I strongly encourage you to seek professional help. It can be invaluable in not only treating your headaches but improving your life in very significant ways.
Depression
“I started on preventive meds in July, and went forty-two days without a headache! Then, sometime after the holidays, I started to feel fatigued and my headaches began intensifying. I’m a positive person, happy, always feeling great. But I was exhausted all the time. So I was being tested to see, was it my thyroid, was it anemia? Because I couldn’t figure it out. People would say, ‘Of course you’re exhausted, you’re a caregiver to your family.’ I take care of my developmentally disabled brother, my husband, my kids. And I’d say, ‘But I’ve always done those things.’ I was still doing everything in my life, nothing was being left behind, but it was almost like it wasn’t my life. I felt I was living through Plexiglas, like I was in a fishbowl, that I wasn’t connecting to anybody.
“I thought I’d snap out of it. Then my doctor goes, ‘Do you think you’re depressed?’ Here I am, a soci
al worker, and I just didn’t think I was depressed. I said, ‘I don’t believe so. How can I be depressed? I’ve got a great life, nothing major has happened.’ But a week or so goes by, and I’m thinking, depression doesn’t have to be the result of some catastrophe in your life. It can be a chemical imbalance. So I went back to the doctor, and I said, ‘I can’t believe it, but I really do think I am depressed.’
“She started me on a low dose of Celexa on a Friday, and by Wednesday I could feel myself, like a fog being lifted. Here I am now, six weeks later, and I feel so great. And I’ve been thirty-five days without a headache.”
—Tammy, 38, social worker
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Sigmund Freud suffered from migraines and depression. He used cocaine to treat his migraine pain, and also underwent nasal surgery, which failed to help.
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Your chances of having a major depressive episode are three times higher if you are a migraineur, according to a major study. And the relationship goes both ways: If you get migraines, it’s likely you’ll one day suffer from depression; if you are depressed, it’s likely that you will one day suffer from migraines. Women with chronic headaches are four times more likely to have symptoms of major depression. And if these migraineurs also have other physical symptoms, such as trouble sleeping, nausea, or back or joint pain, their risk of major depression is a remarkable thirty-two times that of other women.
Teens with chronic migraines are at a much higher risk of depression and other psychiatric problems, as well as suicide. Nearly half of teens with migraine had at least one psychiatric disorder, a rate three and a half times higher than other teens, according to a 2007 study. Among teen migraineurs, 21 percent suffered from depression, 19 from panic disorder, and 20 percent were considered a suicide risk, all significantly higher rates than their peers without migraines. Teens with migraine with aura had an even higher rate of mental illness, including a risk of suicide that’s an astonishing six times higher than other teens.
We are pretty certain that there is some biological link between these two illnesses although we’re not sure what the relationship is. For one, the neurotransmitter serotonin is involved in both migraines and depression. Treating depression may help your migraines. Patients who use antidepressants, especially the class called SSRIs, often find major improvement in their migraines, too.
Depression affects millions of Americans, with women twice as likely as men to experience it. Symptoms may include sleep problems (insomnia or sleeping too much), appetite problems (no interest in eating, or overeating), trouble concentrating or making decisions, feeling worthless, feeling tired, and lack of interest in sex. Depression can present differently in men and women. Women who are depressed may feel sad or downhearted; men may share those symptoms, but their depression may manifest as anger or irritability.
One of my patients said she wasn’t able to sleep at night or eat much, and had no energy. When I brought up the possibility of depression, she adamantly denied that it was possible. So I suggested we together fill out the standard depression index, an online version that would provide an automatic response. After she answered them, within seconds, there was the answer: Her score indicated that she was severely depressed. She was surprised—and persuaded. With concrete results before her, she decided to see a psychiatrist. After therapy and medication, her depression began to lift, and her migraines began to get better, too. I’ve had this same experience with several other patients where we do a self-assessment together and find out that, by all indications, they are suffering from depression as well as migraine.
There are tests online that you can take to find out immediately whether you may be at risk for depression, including one from the NYU Medical Center/NYU Medical School: www.med.nyu.edu/psych/screens/depres.html
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For Help with Depression
Depression is a treatable illness. Please don’t suffer needlessly.
Many excellent organizations, such as the National Alliance on Mental Illness www.nami.org, and the National Institute of Mental Health www.nimh.nih.gov/publicat/depression.cfm, offer resources and information on depression.
Screening for Mental Health, Inc., holds a National Depression Screening Day each year, with screening services at many sites around the country (www.mentalhealthscreening.org). It offers an online depression self-screening test, which asks you a series of questions and gives you an immediate score on whether you’re at risk.
If you’re feeling suicidal or desperate, please call the emergency room at your local hospital. You can also call the national Suicide Hotline at 800-784-2433. Another resource is www.healthyplace.com/Communities/Depression/suicide/crisis_centers.asp
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If your score suggests that you are depressed, or you already suspect that you are, please contact your doctor. You don’t have to suffer needlessly. Fortunately, depression often responds very well to treatment. Treating depression, in turn, may help with your headaches. Please be kind to yourself and be open to feeling better. You have a right to a healthy, happy life.
Anxiety Disorders
Migraineurs also have a very high rate of anxiety disorders, a category of mental illness that includes a variety of conditions including PTSD and obsessive-compulsive disorder. About one-third of migraineurs have one or more of these, it’s estimated. Serotonin, once again, seems to be the common link, since an abnormality in a serotonin transporter gene is related both to migraine and to anxiety disorders.
If you have migraines, please consider whether you may also have:
panic disorder (panic attacks)—incidents of feeling intense fear along with symptoms such as dizziness, shortness of breath, sweating, and chest pain
obsessive-compulsive disorder (OCD)—persistent thoughts or images, and rituals such as repetitive hand-washing
posttraumatic stress disorder (PTSD)—frightening thoughts or images as a result of a personal trauma such as violence or combat
social phobia (social anxiety disorder)—persistent fear of being in social situations, such as meeting people or public speaking
specific phobias—severe fear of snakes, flying, etc.
generalized anxiety disorder—excessive worrying and anxiety, usually without reason, with such physical symptoms as sweating, trembling, and irritability
Anxiety disorders affect 40 million Americans. Fortunately, there are many excellent treatments, including medications that can work very well. Please talk with your doctor if you believe you are at risk. You can find more information on the website of the National Institute for Mental Health, www.nimh.nih.gov/healthinformation/anxietymenu.cfm
Domestic Violence and Migraine
There are no definitive studies at this time linking domestic violence and migraines. But we do know that people who are battered emotionally and/or physically tend to get sick more often and suffer more from chronic illnesses.
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Domestic Violence Hotlines
If you are in immediate danger of physical abuse, please call 911.
For information and support, call the National Domestic Violence Hotline: 1-800-799-SAFE (7233), or go to the website of the National Coalition Against Domestic Violence, www.ncadv.org. They also have a list of associated organizations in every state, at www.ncadv.org/resources/StateCoalitionList
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Unhealthy Relationships and Migraine
An unhealthy relationship can have a substantial negative effect on your migraine wellness. Unhappy relationships are stressful, can lead to depression, and, especially if domestic violence is involved, can lead to PTSD—all conditions directly connected to migraine.
“A few months ago I’d fallen into a deep depression and was suicidal, and things were very bad for me. It hit me really bad one Saturday. I took an Imitrex and it improved a little but that didn’t solve it. I kind of decided to just power through it. Then Sunday morning it was still there, and I just didn’t want to get up or do
anything. But I had to check on something at church, where I work part-time as an administrator. On the way to church, I was trying to sit quietly and just be, and my boyfriend picked a fight. I didn’t want to deal with this nonsense, I tried really hard to just be quiet and calm and breathe. I sat in the chair in the church office with my sunglasses on and earplugs, and I was curled up with the lights off to try and rest. Every noise and every light just felt like knives all over my head. He was banging stuff around and being loud and obnoxious. I took another Imitrex and some water and just waited until we could go home, and I spent the rest of the day lying in bed with my earplugs in and my sleeping shades to keep the light out. Then that evening, I was feeling better enough to get out of bed and move into the other room. And then we broke up, right then.
“The suicidal thoughts ended the day I was out of the relationship. I was on the road to recovering from depression pretty quickly. I’ve had far fewer migraines since.”