Sorrow, Stress in Service
Military servicemen and women are no strangers to headache and depression. According to research published in the June 2008 issue of the journal Headache, 47 percent of troops surveyed during the last three months of a one-year combat tour in Iraq screened positive for migraine, probable migraine or non-migraine headache. Furthermore, 18.5 percent of all returning servicemen and women meet the criteria for depression or post-traumatic stress disorder, according to a 2008 study from the RAND Corporation.
tricyclics— the very medications that Dr. Diamond researched in the 1960s. Specifically, pain responds“ quicker and at lower doses” with amitriptyline than what would typically be needed to treat a major depressive episode, Dr. Shulman says. But tricyclics are generic medications, and because there isn’ t a brand name attached to them, Dr. Diamond says most physicians aren’ t aware of tricyclics.
Depression and migraine may also be treated with monoamine oxidase inhibitors( MAOIs) such as Nardil ®. However, MAOIs are rarely prescribed because they come with risk for serious side effects. Dr. Diamond says MAOIs are usually prescribed only for the most well-informed patients.
Dr. Brandes adds that patients who have migraine and depression“ will likely need a preventive medication for migraine and a preventive medication for depression. Using one drug for both is an ideal concept but often does not work, or is simply not likely to result in efficacious outcomes.”
Aside from medication, headache specialists may prescribe transcranial magnetic stimulation( TMS), biofeedback or other behavioral treatment. TMS uses technology similar to magnetic resonance imaging( MRI) to focus the magnetic field on a specific part of the brain, changing the blood flow to alleviate depression. Biofeedback involves tracking the body’ s functions and using visualization and stress-relief techniques to manage them. A psychologist may teach biofeedback, which can help patients“ learn to recognize some of their automatic responses and how to wrestle their thoughts away from them so they can focus on things that are more health related,” Dr. Shulman says.
Exercise and diet, while not curative, can keep depression from worsening and can help prevent new episodes of depression, Dr. Shulman says.
Regardless of how you treat it or prevent it, Dr. Diamond stresses that it is important to catch the comorbidity and treat it early.“ As with any condition, the earlier you treat someone, the less chronic it becomes.” HW
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