Treating Depression-Related Headaches and Pain

Depression and pain can often co-exist. Learn why they're linked, and find out about depression treatments that can also ease headaches and other chronic pain.

By Elizabeth Shimer Bowers

Medically reviewed by Farrokh Sohrabi, MD

As many people with depressionknow, the mind and the body are intricately connected. When you’re depressed, pain can feel worse for you than it might for someone who doesn’t have depression.

“When people have both depression and pain, it’s hard to tell which came first,” says Ian Cook, MD, an associate professor in residence in the department of psychiatry and bio-behavioral sciences at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA) and a research scientist at the UCLA Neuropsychiatric Institute.

What scientists do know is that depression and pain are clearly linked. “Pain and mood are actually regulated by the same part of the brain,” says Joseph Hullett, MD, senior medical director for clinical strategy at OptumHealth Behavioral Solutions in Golden Valley, Minn. Hullett says the loss of certain neurotransmitters in the brain can cause depression symptoms and make pain feel even more uncomfortable.

Depression seems to be especially closely linked to certain kinds of chronic pain in the body, including migraine headaches, severe non-migraine headaches, and lower back pain. As a result, depression and pain treatments often overlap.

Depression and Headaches

Depression is linked to both migraine headaches and non-migraine headaches, although the strongest relationship is between depression and migraines.

“People with migraines are two to three times as likely to have depression as the general population,” says Richard B. Lipton, MD, a professor and vice chairman of neurology and a professor of epidemiology and population health at the Albert Einstein College of Medicine and director of the Montefiore Headache Center in New York City. People who have chronic migraines — those who experience migraines 15 or more days of the month — are about twice as likely to have depression as people with episodic migraine, meaning those who experience migraines less than 15 days a month.

The research on migraines and depression shows that the relationship goes both ways: People with depression are more likely to get migraines, and people with migraines are more likely to become depressed. In fact, 40 percent of people with migraines also have depression. "Migraines and depression have common underpinnings in the brain, which can develop due to environmental factors, genetic causes, or a combination of both,” Dr. Lipton says. “Migraine pain and depression are also linked because both conditions respond to some of the same medications.”

However, the link between depression and pain from non-migraine headaches isn’t a two-way street. “Severe non-migraine headaches clearly increase your risk for depression, but depression doesn’t increase your risk for non-migraine headache,” Lipton says. A study published in the journal Headache showed that people with a form of non-migraine headache called cluster headache are more likely to have depression than people who don’t have cluster headaches.

Depression and Pain Treatment: “Overlap” Medications

There are a number of medications that can help ease both depression and pain. “Whether you’re depressed or not, antidepressant medications seem to have some ability to turn down pain signals, so they’re usually part of a treatment plan for back pain, migraines, and other forms of chronic pain,” Dr. Hullett says.

Antidepressants work for both depression and pain because they act in the same parts of the brain where mood and pain tend to overlap. For both migraine and non-migraine headaches coupled with depression, an older class of antidepressants called tricyclic antidepressants can work well. “Interestingly, in people who have both migraine pain and depression, a small ‘anti-migraine’ dose is usually sufficient for depression treatment as well,” Dr. Cook says. “This may be because when the pain gets better, the depression often gets better, too.”

However, other types of pain require different solutions. “If you have arthritis, muscle strain, or pain from a recent surgery, using a medication that works at the site of the pain or injury is important,” Cook says. Luckily, some of the medicines that affect pain in the body also affect mood areas of the brain, and thus work as depression treatments, too. “Opiate medications such as codeine can do this, for example,” he says.

Other Options for Treating Depression and Pain

“Non-drug treatments can be very effective in making both depression and pain less severe and incapacitating,” Hullett says. These treatment options include:

• Cognitive behavioral therapy (CBT). This is one of the best-studied treatments for depression and pain. “CBT is specifically designed to deal with the emotions, sensations, and anticipations that occur in the mind because of pain,” Hullett says.
• Psychotherapy. Experts say you’re more likely to feel pain in response to negative feelings. For people who see the world through physical sensations rather than emotional ones, Hullett says that psychotherapy, or talk therapy, can help with both depression and pain.
• Relaxation therapy. “By activating what is known as the ‘relaxation response,’ relaxation therapy can be of great benefit in treating both depression and pain because it changes the steroid hormone response in a way that allows the body to repair itself,” Cook says. “Plus, it affects the way you experience pain in a positive way.”
  
  One form of relaxation therapy that may be particularly useful as a treatment for depression and pain is progressive muscle relaxation. “Chronic pain often involves muscle spasms or muscle tension," Hullett says, "so it’s great if you can learn how to relax those muscles.”
• Complementary therapy. If you’re open-minded about complementary therapies, Hullett says that acupuncture, acupressure, yoga, massage, and hypnotherapy can all help treat depression and pain.
• Support groups. “People who have depression and pain should recognize that they’re not alone,” Cook says. “In addition to the professional help you may be able to get from your primary care physician, psychiatrist, or pain specialist, you may also find benefit in support groups.” To find a support group in your area, refer to the American Chronic Pain Association. For online support, check out the Everyday Health Managing Pain group.