The convergence of depression and pain is reflected in the circuitry of the nervous system. In the experience of pain, communication between body and brain goes both ways. Normally, the brain diverts signals of physical discomfort so that we can concentrate on the external world. When this shutoff mechanism is impaired, physical sensations, including pain, are more likely to become the center of attention. Brain pathways that handle the reception of pain signals, including the seat of emotions in the limbic region, use some of the same neurotransmitters involved in the regulation of mood, especially serotonin and norepinephrine. When regulation fails, pain is intensified along with sadness, hopelessness, and anxiety. And chronic pain, like chronic depression, can alter the functioning of the nervous system and perpetuate itself.
The mysterious disorder known as fibromyalgia may illustrate these biological links between pain and depression. Its symptoms include widespread muscle pain and tenderness at certain pressure points, with no evidence of tissue damage. Brain scans of people with fibromyalgia show highly active pain centers, and the disorder is more closely associated with depression than most other medical conditions. Fibromyalgia could be caused by a brain malfunction that heightens sensitivity to both physical discomfort and mood changes.
When do I need to see a health practitioner about my headaches?
• When it is the “worst headache” you have ever had, go to emergency room
• When it occurs 3 times a week, even if relieved by OTC medications
• When it is not readily relieved with OTC medications, i.e. ibuprofen, Tylenol, Aleve
• When it is accompanied by nausea, vomiting, photophobia (sensitivity to lights) or phonophobia (sensitivity to sounds)
General types of headaches
• Primary –no underlying cause can be found, i.e. hereditary
o Rebound headache – caused by frequent use of short acting acute treatment
• Secondary –caused by tumor, hemorrhaging (bleeding in brain), blood pressure, other underlying cause
Treatment for headaches:
o Hydration, mainly water
o Ice pack or cool rag to forehead and/or neck
o Muscle rubs to neck, if muscle tension present (Ben-Gay, Icy Hot)
o Acute/abortive medications: OTC –naproxen (Aleve), ibuprofen (Motrin), acetaminophen (Tylenol); Rx –Triptans (sumatriptan, zolmitriptan), ergotamines (DHE)
o Prophylactic/preventative: (usually prescribed for >= 2 severe headaches per week or headaches significantly affecting quality of life)
Anti-convulsants/neuroleptics- valproic acid (Depakote), topiramate
o Anti-hypertensive –beta-blockers, calcium channel blockers
o Antidepressants –SSRIs (Effexor, Lexapro), TCA (amitriptyline)
o Anti-emetics –ondansetron (Zofran), promethazine (Phenergan)
o Opioids- usually not first line treatment, but should be reserved for rare use or for intractable migraines/status migrainous, can cause rebound headaches
Gilmore B, Michael M. Treatment of acute migraine headache. Am Fam Physician. 2011;83:271-280.
Silberstein SD, Holland S, Freitag F, et al. Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78:1337-1345.