FREQUENCY OF DEPRESSION IN MIGRAINE HEADACHE
In this prospective study migraineous patients were enrolled who wre manifested the symptoms of depression.There was considerable psychiatric morbidity there was necessay find out all migranes aand treated them symptomatically.It proved that we should not bypass the chaces of dpression in cases of migraine especially female patients.
Key words:migraine, depression,psychiatry,males, females,cluster ,tension.
"Migraine is a mysterious disorder characterized by pulsing headache (feeling of weightage,fullness over forehead),usually restrictedto one side,which comes in attacks lasting 4-48hours and is often associated with nausea,vomiting,sensitivity of light, and sound, vertigo,loosemotions and other symptoms."(Tripathi-2006)
"Migraine is very common type of headache,with a prevalance of 10-12%,migraine ranks 19th among disease" (cephalalgia 2004)
"migraine is a complex disorder inwich many psychological,inviromental,biochemical,neurophysiologic,and genetic factors play a role to tiger attacks. The diagnosis is based on headache characetrized and associated symptoms specified internationl headache society" (westermanCJetal 2003)
"The typical headache is unilateral,throbbing and may be severe.If untreated, the migraine attacks typically lasts 4 to 72 hours. The attacks are usually associated with nausea,vomitting, or sensitivity to sound,light and or movement.In addition to this, migraine with aura is characterized by transient focal neurological symptoms,which are usually visual,and may precede,accompany, or flow the headache attacks."(stewart WF et al 1994)
"Thereare two types of migraine headaches.The first migraine without aura(previously called common migraine) is severe,unilateral,pulsating headache that the typically lasts from 2 to 72 hours.These headaches are often aggrivated by physical activity and accompanied by nausea,vomiting,photophobia(hypersensitivity to light) and phonophobia (hypersensitivity to sound.Approximately 85% of patients with migraine do not have aura.In the second type migraine with aura (previously called classic migraine),the headache preceded by neurological symptoms called auras which can be visual, sensory,and or cause speech or motor disturbances. Most commonly these prodromal symptoms are visual, occuring, approximately 20 to 40 minutes before headache pain begins. In the fifteen percent of migraine patients whose headache is proceded by aura,the aura itself allows diagnosis.The headache itself in migraine with or without auras is similar.For both typesmigraines,woman are three folder more likely thanmen to experience either type of migraine.
Migraine-there is chance for family tenency,females are more affected than male,it develops unilateral,variables in onset,characterized by pulsating,throbing.Cluster-ther in family chance,males are more than females it develops during sleep,at behind or around head,characterized by sharp,steady.
Tension-Type-there is family history,it develops understress,bilateralcharacterized by dull,persistentent type.(Richard D etal 2006)
" Depression may means the symptom of feeling of said, meloncholic or low in spirit, or it may mean the syndrome of depression as characterized by low mood,lack of enjoyment, reduced energy and changes in appetite, sleep and libidpolic.(A.W.CLARE 1998)
"Clinically significant depression is often reffered to is as major cause of disability and of succide.Medically unexplained symptoms that may result from depression include chronic fatigue,chronic wide spread pain,weight loss and conginitive impairment (deprssive pseudodementia).Dpression comorbid with a medical condition magnifies any associated disability,diminishes adherence to medical treatment and rehiltation, and may even shortet life expectancy.Recent research suggests that patients who have a major depressive disorder soon after myocardial infarction or stroke die sooner than who do not even when disease severity is controlled.(lloyd& sharpe MC 2002).
"It is widely accepted that the limbic system has a role in control and expression of emotion.These structures from a reverbrating (papez) cercuit inwhich inputs from various cortical areas,especialy those involving in perception, are fed in together with other inputs from the brain system and spinal cord.Output is mainly from the hypothelmus,through releasing hormone, and the reticular formation and autonomic nuclie of the brain stem. The hypothelmus plays a part in hormonal disturbabce in depression.The reticular formation and autonomic nuclie contol aroused and autonomic function,both of which are often altered in depression.The limbic system also contains sructures involved in the control of memory,depressed patients often express their disorder in terms of adversely disorted recollection of past events.The limbic system may act as a regulatory system for emotional states.Noradrenergic and 5HT neurones abuond in these areas of the brain,and the system’s close link with the LHRA axis provides a pictures how disturbance of these systems might be linked in depression."(cantopher1991).
‘Types of depression.Major depression-It is probably one of the most common forms of depression,lack of interest,walk around with weight of world on his or her shoulder, hopeless atate,lack of interest in sexual activity and less appetite and weightloss.
Atypical Depression-individuals somtimes experience of happiness, but fatigue,oversleeping,overeating weightgain.typical depressio can last for months or a suffer may live with it forever.
Psychotic Depression-Individual of psychotic dpression begin to hear and see imajinory things-sound,voicesand visual that donot exist.
Dysthymia-Individual characterized by sad,blue,or meloncholic.it is a condition that people are not even aware of but just live with daily,feel life is unimportant,dissatisfied,frightened and simply donot enjoy their lives.
Manic depression:It is highly exuted,emotional disorder people who suffer from manic depression have an extremely high rate of succide."(Any Berhman 2004)
We interwiewed after informed consent one hundred and two patients reporting atMedical and the psychiatric outpatients Department at Muhammad Medical College Mirpurkhas sindh,between March 2007 to to April 2008.These patients were screened for presence of depression symptoms in concomittently with migraine/half headache in head.Depressive symptoms were measured through depression scale and clinical interview,weeping,lonlelessness,sadness,confusion main questions were asked during interviewed in cases of migraine.
:There were thirty seven males (36.27%)and sixty five females (63.72%)who were examined during attacks of headache,17(45.9%)patients were manifested depressive symptoms and 43 (66.1%)females were developed symptoms of depression in cases of migraine.
Case Processing Summary
Total cases of study * Presence of depression in migraineous female patients
Femal patients in study * Presence of depression in migraineous female patients
Male patients in study * Presence of depression in migraineous female patients
Total cases of study * Presence of depression in migraneous male patients
Femal patients in study * Presence of depression in migraneous male patients
Male patients in study * Presence of depression in migraneous male patients
It was proved that females were more than male in our study.There were 66.1% females,45.9% male depressive symptoms in diagnostic cases of migraines.Majority females patients were malnourished and weeping during taking history and these were main parameters considered depressive symptoms in cases of migranious patients.From summary tables and diagrames it was proved that females were more affected than male in this study.It means that depressive symptoms were more presence in females during interview in this stydy.
"A recent research findings indicated that treatment for both migraine and major depression may benefit patients with both disorder.Astudy was conducted on people with migraine or sever headahes aged between 25to 55.When their psychiatric combordity was assed,resaercher found that the risk of migraine in individuals with pre-existing mjor depression was three times highet than in individuals with no history of major depression.More ever major depression the risk of major depression in people with pre-existing migraine was more than fivefold hiher than in people with no history of headaches.However there were no relation between major depression and other types of severe headaches"(MrMARY Ayres2003)
"Many migraines sufferes have noticed that at times,migraine and depression seems to go together and there is strong evidence to support this,However it is not known whether treating migraine affects depressive symptoms or treating depression affects migraine symptoms"(MMA2008)
"Throbbing migraine headaches and major depression may be related.Infact having one may increase the occurance of other.Migraine sufferers were five times more likely that the headache-free individuals to develop major depression in the study conducted by the Henrry ford Health system.Those who started the study with depression were three times more likely to develop migraines.With major depression was more at risk of suffering a first time migraie than non-dopressed individuals. And people who live with migrains seems to br more at risk for an initial bout of depression.Both disorders are biological linked,possibility with brain chemical or hormones."(PT Staff 2007).
"The overall frequency of recurrent headaches didnot very significantly with age, but girls had headaches are common soatic complaints among Norwegian adolescents,especially among girls"(ZwartJA etal 2004).
"Researchers survey 949 woman with migraine about their history of abuse,deprssion and headaches characteristics,forty percent of woman had chronic headache more than 15 headaches in month,and 72%reported very severeheadache related diability.Physically and sexually abuse was reported in 38%of the womanand 12%reportedboth physical and sexual abuse in the past.The association between migraine and depression is well established, butthe mechanism is un certain.The study found woman with migraine who had major deprssion were twice as likely as a child.If thebabuse coninued age 12 ,the woman with migraine were five times more likely to report depression"(science dily2007).
"Major depression increased the risk of depression,migraine as well same.This bidirectional association,with each disorder increasing the risk for onset of other,was not observed in relation to other severe headaches,both were considered direcly proportional to eachother."(NBreslaw,et al 2003)
It was proved that migraine type of headache bases of depression if it untreated,same mechanism follow the severe cases of depression could lead to migraine type headache.Females were more affected than males.No doubt migranous corelated to depression.
Any Behrman (2004)electroboy:a memoir of mania;published by Random House ,16sep2004 types of depression,medical review board.
Nbreslau,schultz,stewart,RBS lipton (2000)’headache and major depression is association specefic to migraine? Neurology 2000 54,308.American Academy of neuology.
Mrs marry ayres ;to relieve the burden of headache by facilitating informed awareness and encouraging resaerch’
Mary kay betz ;having headache-advisor.
N breslau RB lipton stewart 2003,;comorbidity of migraine and depression investigating potential etiology and prognosis,neurology 2003,60-13-12 American Acadamy of neurology.
Science daily(sept-6-2007)’childhood abuse is more common in woman with migraine who suffer depression than in woman with migraine alones’American Acadamy of Neurology.
Zwart JA,Dyb,Hotman TZ,Stovener LJ,SandT 2004’The prevalences of migraine and tension-type among adolsent in Norway.Cephalalgia2004 May,24(5).373-9
K.Dtripathi2003’migraine drug therapy,essentials of medical pharmacology,5th edition,
DP Headache classification subcommittee of the international headache society.2nd edition cephalalgia 2004,24:1-160
Western CJ,Rosina AF,Deveris vde coteau pa,’The prevalences and manifestation of hereditory hemmorrhage telangiectasia,a family screening.AM J Genet A2003 116 324-28.
Stewart WF, Schechter,AR rasssmussin BK’migraine prevalence, a review of population-based studies-neurology 1994-44 817-23.
Richard .Dhowland,marry j,mycek,2006’drugs used in treatment of migraine’,pharmacology,lipponcottes illustered.
A.W,Clare 1998’clinincal medicine,parveen kumar 4th edition psychological medicine
Lloyd GG SHRPEMC Davidson’s priniples and practics of medicine 19th edition 2004 affective mood disorder
T Cantopher Neurology of depression neuroanatomy of depression medicine digest 1998 7-8.