Updated March 07, 2015.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
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 tricky to tease apart, and even scientists are scratching their heads over the precise link.
Let's review the basics of Major Depressive Disorder (MDD), so you can take action if you have sad thoughts accompanying your head pain.
Is Depression Obvious?
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 precipitate depression--depression can precipitate headaches. It's like the chicken and egg theory and can be puzzling for doctors to tease out. Please remember, even if the depression is the root cause for a person's headache, their head pain is still very real!
Besides headache, here are other somatic (bodily) complaints you can experience with depression:
- Pain (neck, back, abdominal)
- Joint aches and pains
- Constipation
- Weakness
What is the Definition of Major DepressionDisorder?
According to the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, 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 5 out of 9 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. appears tearful).
- Decreased interest or pleasure in most activities, most of each day.
- Significant weight change (5%) or change in appetite
- Change in sleep (Insomnia or hypersomnia)
- Change in activity (psychomotor agitation or psychomotor retardation)
- Fatigue or loss of energy
- Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
- Concentration: Diminished ability to think or concentrate, or more indecisiveness
- Suicidality: Thoughts of death or suicide, or has suicide plan
How Will My Doctor Test Me for Depression?
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.
What Puts Me at Risk for Depression?
- Family history of depression
- Having a chronic illness
- Female sex
- Having a chronic pain syndrome
- Having chronic minor daily stress
- Low income/unemployment
- Lack of social support
- Low self-esteem
- Single/divorced/widowed
- History of traumatc brain injury
Do Other Medical Conditions Mimic Depression?
Yes. When considering depression, your doctor may also screen you for other psychiatric diagnoses that can mimic or coexist with Major Depressive Disorder.
Your doctor may test you for these medical conditions that mimic symptoms of depression like:
- hypothyroidism
- anemia
- vitamin b12 deficiency
- liver or kidney disease
- high calcium
What Can I Do?
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 healthcare provider. Your doctor may prescribe a tricyclic antidepressant or a selective serotonin reuptake inhibitor to treat your headache associated with depression. You are not alone. Be proactive in your healthcare and well-being.
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Sources
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text revision. Washington, DC: American Psychiatric Association; 2000.
American Psychiatric Association. DSM-5 development. http://www.dsm5.org/Pages/Default.aspx.Accessed Aug 31st 2014.
Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. In: Brink TL, ed. Clinical Gerontology: A Guide to Assessment and Intervention. London, United Kingdom: Taylor & Francis; 1986:170.
http://www.stanford.edu/~yesavage/GDS.english.short.score.html. Accessed September 2014.
www.phqscreeners.com/. Accessed September 2014.
http://www.headaches.org/education/Headache_Topic_Sheets/Depression_and_Headache. Accessed Aug 31st 2014.
DISCLAIMER: This site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.
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