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Williams and colleagues underscore the non-specific relationship
between depression and pain in patients seen early at neurology clinics in
wide range of unconnected disorders; patients with primary headaches
constituted a substantial cohort in this study. This clinical study makes
an important contribution to maintain perspective in primary headache
Several epidemiological studies...
Several epidemiological studies have concluded that a bidirectional
link exists between migraine and depression that, in turn, suggests a
shared pathogenesis.[2,3] In primary headache research it has been assumed
(i) Migraine is the outcome of brain serotonergic hyperactivity; and
(ii) Brain serotonergic antagonism is the probable mechanism of action of
migraine prophylactic agents such as beta-blockers, calcium channel
antagonists, and antidepressants. What has, nevertheless, as yet not been
acknowledged is that both serotonergic antagonists  and serotonin agonists
offer effective migraine prophylaxis. Amitriptyline is a proven agent for
preventive therapy of migraine. In psychiatry, amitriptyline is an
acknowledged brain serotonin agonist. The prophylactic activity of drugs
with opposing brain serotonergic influences indicates that – in contrast
to depression – brain serotonergic dysfunction is not central to migraine
pathogenesis. Second, while propranolol is an established prophylactic
agent for migraine, it is best avoided in depression. Furthermore,
atenolol is included in the list of drugs of first choice for migraine
prophylaxis. Atenolol does not freely cross the blood-brain barrier and,
therefore, cannot critically influence brain neuronal function. Also,
headache remitting influence of neither propranolol nor amitriptyline
correlates with decrease in anxiety or depression. Finally, carbamazepine
effectively manages depression  but is of no value in migraine therapy.
This study  helps to address the apparent disconnect between
epidemiological evidences that suggest an aetiological link between
depression and migraine and pharmacological evidences that do not.
1. Williams LS, Jones WJ, Shen J , Robinson RL, Weinberger M, Kroenke
K. Prevalence and impact of depression and pain in neurology
outpatients. J Neurol Neurosurg Psychiatry 2003;74:1587-9.
2. Low NCP, du Fort GG, Cervantes P. Prevalence, clinical correlates, and treatment of migraine in bipolar disorder. Headache 2003;43:940-49.
3. Breslau N, Lipton RB, Stewart WF, Schultz LR, Welch KMA. Comorbidity of migraine and depression. Investigating potential etiology and
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migraine. J Neurol Neurosurg Psychiatry 1999;66:536-40.