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Migraine Mood Changes: Depression-Like Symptoms

migraine-mood-changesI was standing in the bedroom alone with my eyes closed, taking deep breaths. I didn’t know Hart had entered the room until he asked, “What’s up?” “I’m nervous about you leaving,” I said, and the tears I’d been keeping at bay burst forth.

Even though I don’t have an anxiety disorder, I have subclinical levels of anxiety in two situations: sleeping when I’m home alone all night and when Hart travels long distances. The Fourth of July brought both of those. During a migraine attack. It led to one of a handful of full-blown panic attacks I’ve ever experienced. It was horrible, but made a lot of sense in retrospect. For the few weeks prior to that night, migraine attacks were going straight for my mood.

I first noticed it during a migraine attack on Father’s Day. I had to stop looking at Facebook posts because they made me miss my dad too much. This isn’t abnormal in the realm of grief, but I also cried when I realized that the attack would keep Hart and me from enjoying our day’s plans. Even that’s an understandable reaction to the situation. Becoming racked with guilt when the precarious stack I’d built in the freezer caused Hart to drop a container is not normal. Instability in the freezer is a common occurrence in our household and it’s usually my fault. The container didn’t break and Hart wasn’t upset, but I felt like an utter failure. These are all indications of depression, but my mood returned to normal with that particularly intense migraine attack cleared.

Migraine attacks bring major mood changes for me maybe a dozen times a year. The experience is unpleasant and unpredictable, but never enduring. Until this summer. During many, but not all, of my migraine attacks over a three-week period, I cried at song lyrics that wouldn’t normally make me cry and was quick to anger in low-stakes situations, like not being able to find the pen I wanted to use. These are telltale symptoms of clinical depression for me. So much so that my doctor wanted me to start another antidepressant.

I held off on the meds for a week because it just didn’t feel right. It didn’t follow the pattern for depression. Then again, it didn’t follow the pattern for migraine mood changes, either. Still, I watched and waited. By the time that week was up, mood disturbances were no longer regularly part of my migraine attacks.

Migraine symptoms are so weird. (I swear I say that at least once a month.) They’re both predictable and unpredictable. I expect to have associated mood changes occasionally, but this is the first time I can recall three weeks during which many attacks were accompanied by depression-like symptoms. I’m wondering if the uptick was caused by a short-term change in my brain similar to what my doctor described when I suddenly became sensitive to Wellbutrin’s side effects:

The brain you have after a migraine attacks is not the same brain as you had before it. Any medication that acts on the central nervous system, like antidepressants, could interact with this new brain in a different way than before, causing an increase in side effects. My dose hadn’t changed, my brain had.

The changes to your brain after an attack are not permanent, so please don’t let this scare you. It’s more like a storm with high winds came through and there’s still dirt and debris in the street. The street sweeper will get to it eventually, but it may take some time.

This explanation makes intuitive sense. The Father’s Day migraine attack that kicked all this off was particularly intense and odd. My thinking was way off. Despite being drug-free, I was thinking as if I’d smoked marijuana. That’s never happened in quite this same way before. Perhaps the celery that triggered the attack was genetically modified to have a psychedelic effect.

Whatever the explanation, the problem seems to have subsided for now. My mood has been stable for about a month. I’m grateful for the increased empathy that came from my tiny glimpse of insight into what panic attacks can be like. And I will be grateful if I never have to experience one again.

 

(In case you’re curious, the grief I’ve been wrestling with this summer has been entirely independent of migraine attacks and migraine mood changes.)

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Finding an Effective Migraine Treatment: An Emotional Whirlwind

Hart uses this picture of me in presentations to show his motivation for starting TheraSpecs.

Hart uses this old picture of me in presentations to show his motivation for starting TheraSpecs.

Despite frequently wondering what life would be like if I ever found an effective migraine treatment, I wasn’t prepared for the emotional whirlwind of it.

In the first couple weeks, elation and nervousness dominated my thoughts. Being able to do the normal, mundane things of life felt incredible, but I was also overwhelmed. I kept wondering what life would look like without constant migraines. What would I do with my days? What would work be like? Would I be able to resume friendships that have been on hold? How would Hart and I relate to each other? Would I still want to write about migraine? Nothing bad or worrisome was happening, but I couldn’t wrap my mind around how my day-to-day life would change.

After those first overwhelming, uncertainty-filled weeks, my thoughts mostly settled down, but I experienced four weeks of very strange anxiety. You know that fluttery nervous feeling you get in your stomach? I’d get that for a few seconds with every thought. And I mean EVERY thought, from “I need to downshift” while driving and “So that’s how they’re related” while watching a movie. My reaction to thoughts that actually provoked anxiety was exactly the same. The flutter happened less and less frequently over the four weeks until it disappeared.

Those are the stressful and strange reactions, but I’ve mostly been amazed by two things: how easy everything is and how present I am.

Showering no longer brings imminent collapse. The dining chairs and table are no longer too hard to sit at for meals. Making phone calls is no longer beyond my ability. Going to the grocery store is no longer the sole activity I can do in a day. Such simple things have taken maximum effort for the last 10 years. Without having to psyche myself up before every chore and not being exhausted by minimal tasks, everything seems unbelievably easy. This extends to writing, too — without constant brain fog, writing is so much easier. I’ve even been able to wade through tons of medical journal articles and understand them without trouble, then synthesize the findings into my own words.

And I no longer feel constantly separated from the world, unable to connect with other people or be truly present at any moment. My conversations are more interesting, being with friends is more fun, work doesn’t feel like work, my time with Hart is fantastic. I’ve always struggled to put that sense of disconnection into words — it’s like being at the bottom of a well or underwater. One blog reader said it was like being wrapped in cotton. Whatever the best metaphor is, the sensation of being separate, apart or disengaged is one that many people with chronic migraine seem to share. That was my normal for so long and, while I knew I felt that way, I didn’t know just how removed I was. I’ve been trying to practice mindfulness and presence the last six years without actually having the ability to be fully present.

I’m adjusting to this new normal. It’s exciting and nerve-wracking, familiar and strange. There’s no guarantee I will continue to feel this good indefinitely, so I’m trying to enjoy this time without getting too far ahead of myself. Mostly I’m letting my days unfold organically and approaching all these changes with wonder and awe.

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Migraine Linked to Depression, Anxiety and Other Mental Disorders

People with migraine are likely to have mood disorders, like major depression, anxiety and panic attacks. This is according to a new study, which supports findings of previous studies that have also shown the coexistence, or comorbidity, of migraine and these disorders.

From the current study’s press release (emphasis mine):

Mood Disorders, Migraines Might Be Connected

Migraine headaches can precede the onset of mental disorders, according to a growing body of knowledge that includes a new study in the January-February 2009 issue of General Hospital Psychiatry.

Together, migraine and mental disorders cause more impairment than alone,” said lead study author Gregory Ratcliffe. “Patients who have one condition should be assessed for the other so they can be treated holistically. Although it is important to know that both are present, treating one will have an effect on the other.”

Ratcliffe is with the department of psychiatry at the University of Manitoba in Canada. He and his colleagues analyzed data on 4,181 participants in the German National Health Interview and Examination Survey. Migraines were diagnosed by a physician and trained interviewers evaluated participants for mental disorders.

Researchers found that 11 percent of participants had migraines. Participants had a variety of disorders: major depression, general anxiety disorder, dysthymia, bipolar disorder, panic attacks, panic disorder, substance abuse disorders, agoraphobia and simple phobia.

The authors considered two theories that might explain the relationship between migraine and mental disorders. The first theory is that a common factor influences both conditions, such as low activity of enzymes that deactivate certain chemical messages sent to the brain. They also considered a causal relationship: This study and others found that anxiety often precedes migraine, which often precedes depression.

Frederick Taylor, M.D., director of the Park Nicollet Headache Clinic in St. Louis Park, Minn., said that migraine co-morbidities — depression, anxiety and other disorders — affect 83 percent of migraineurs and explain 65 percent of their inability to function in life, more than the pain itself.

My bouts of depression show this is true for me. It is also true for other headache bloggers, like Diana from Somebody Heal Me. How about you?

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Preventive Drugs Improve Quality of Life for People With Migraine

Preventive medications can significantly improve the quality of life for people with migraine, but their quality of life is still below that of people without migraine. The study tested quality of life for patients taking nadolol (Corgard) and topiramate (Topamax). The article, Impact of Preventive Therapy with Nadolol and Topiramate on the Quality of Life of Migraine Patients, appears in the August issue of Cephalalgia.

[R]esearchers studied 76 consecutive migraine patients at least 16 years of age, evaluating them at the beginning of the study and again after 16 weeks of treatment with nadolol at 40 milligrams per day or topiramate at 100 milligrams per day. The study was completed by 61 of the patients.

The results of the Hospital Anxiety and Depression Scale revealed a mild anxiety state and a moderate depressive state at the beginning of the study, which both remained unchanged after therapy.

The migraine-related quality of life questionnaire score indicated statistically significant improvements with treatment.

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Trapped

For the last few years, we’ve gotten season tickets to the theater. They are less expensive than tickets for individual shows and with them, we always have at least one date night a month. Unfortunately, I’m filled with anxiety in the days before each show. What if my headache is bad? What if I’m stuck next to someone wearing too much perfume? What if…?

Last night was our final play for the season and all my fears were realized. My headache was between a 5 and a 6 before we left, but I wanted to go anyway. The theater was small and our seats were right in the center in the second row of the balcony.

This was exciting on the one hand, terrifying on the other. The show was 90 minutes long without an intermission. If I had to leave, I’d be stepping on the 10 people in my row, blocking the view for the two rows behind them and cause enough of a stir to irritate everyone in the balcony.

While Hart and I were chatting before the show, the smell of cinnamon stopped me in mid-sentence. Four women in the row in front of us had popped cinnamon Altoids in their mouths.

During the play, my headache only got a little worse. The Altoids dissolved and the container wasn’t opened again. No one near me had bathed in perfume. But I still spent the entire show worrying about how I would escape if I had to. I wondered if we should get season tickets again and if I could request seats at the end of an aisle.

I listed off every scenario that could put me in a similar situation — airplanes, concerts, movies — and it became clear that worrying was useless. Headache or not, I’m still going to fly and go to the concerts and movies that I really want to see. If I become too miserable, I move to another seat or leave.

Even though it often feels like it, my body isn’t in total control of me. I’ll do well to remember this as long as I also remember that the comfort of other people doesn’t always take precedence over my needs.