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It’ s hard to imagine a time when Seymour Diamond, MD, was not focused on headache. But in 1960, the executive chairman and founder of the National Headache Foundation( NHF) and director emeritus of the Diamond Headache Clinic in Chicago, spent his time in general medicine.
“ I had a large family practice and I did research, but I knew nothing about headache,” he laughs.
That year, Dr. Diamond was approached by Merck, Sharpe, and Dohme( now Merck & Co.), a pharmaceutical company that was investigating the use of amitriptyline( a tricyclic antidepressant) to treat somatic complaints, or those relating to the psyche. The drug was marketed for treatment of depression in 1961, and Dr. Diamond undertook a study to examine the positive impact amitriptyline had on his own patients’ somatic complaints. During a presentation of his results, he
was approached by Lester Blumenthal, MD, then secretary of the American Association for the Study of Headache( now the American Headache Society), who wondered if Dr. Diamond had considered the use of those same tricyclics to treat headaches. That inspired Dr. Diamond to examine the drug’ s benefits for both headache and depression.
Today, the ties between major depression and migraine are well documented. The conditions share some symptoms: trouble sleeping, decreased energy, decreased concentration, pain. But it wasn’ t until the early 1960s, when Dr. Diamond’ s research was published in the journal Headache, that the world learned that the very medication that brought positive responses for depressive patients was also effective at treating migraine.
Major depression and migraine are two pain-filled, stigmatized conditions. But people who experience the comorbidity
Julie’ s Story
Julie McDonald, 35, has had migraines since childhood. But after she finished high school, she finally saw a headache specialist who diagnosed her with migraine and chronic daily headache. By her mid-twenties, the pain intensified.
“ I was in constant pain and felt really helpless and hopeless,” recalls McDonald, who lives in Green Briar, Ark.“ It felt like everything I wanted in life was slipping away from me. I was in law school at the time and couldn’ t complete school; I couldn’ t really enjoy my marriage or my friends.”
That hopelessness was later diagnosed as clinical depression.
“ It’ s a paralyzing and suffocating feeling, and it feels like it will never end,” McDonald says.“ It disrupts everything in my life: how I sleep, how I eat, who I want to be around and what I feel like doing, how I feel about myself. It’ s a crushing weight.”
Despite the need for support, McDonald says she felt the stigma associated with depression and hid it for fear that others would see her as sick. But“ you can’ t just will yourself to get better,” she says.
McDonald manages her headache and depression with support from her husband and parents as well as a cadre of medications. She also had a manual vagus nerve stimulator implanted in her chest. McDonald wasn’ t sure if the device was relieving her pain until the battery began to weaken last year and her depression came back with a vengeance. Dr. Diamond noted that this stimulator( a battery-powered device attached to a wire that runs up to the vagal nerve in the neck and stimulates it to relieve pain) is a last resort for treatment.
For others experiencing this comorbidity, McDonald recommends meeting with a psychologist as soon as possible to discuss ways to cope and to find a way to contribute to society on your good days. McDonald volunteers for non-profits and says her volunteer work has helped her overcome feelings of powerlessness. She also recommends building a support system and letting your family know what you’ re going through.
“ For my family, it has brought a different depth of understanding,” she says.“ It forces me to let my guard down and that’ s good for relationships.”
28 HEAD WISE | Volume 2, Issue 2 • 2012