From time to time, other people with migraines have mentioned to me that when they called to make an appointment with a new migraine specialist, they were surprised to be told that their first visit would include an evaluation by a psychiatrist or psychologist. Some were, in fact, upset enough that they didn't make the appointment or told the receptionist that they'd think about it and call back.
Fourteen years ago, when I went to see Dr. William B. Young at the Jefferson Headache Center for the first time, I was required to fill out lots of forms for a mental health analysis and to see Dr. Gregory Tramuta. I admit that I had a chip on my shoulder about it, but that was because, at the time, I didn't understand the reasoning for it. Why did I have to see a psychiatrist when I was there for chronic migraine? I was tired of people telling me it was "all in my head." Knowing that, Dr. Tramuta addressed my concerns immediately. He explained that there were two reasons for the screening and seeing him:
The prevalence of depression is much higher among migraineurs than in the general population. It was his job to determine if I had major depressive disorder and, if I did, be certain I was being treated appropriately.
He needed to assess my coping skills for living with chronic migraine so he could be sure I got help with coping skills if I needed it.
Now that I understand the reasoning and know how often migraine and major depressive disorder are comorbid, I think every migraineur should be screened. It's no secret that I have major depressive disorder. Nor is it a secret that I accidentally let it get out of control a while back. You can read about that in Migraines, Clutter, and Medications - I Was a Mess!
May is Mental Health Awareness Month, so it's the perfect time to discuss migraine and comorbid mental health issues. This year's theme is B4Stage4 and will focus on how people can address their mental health early, rather than at "Stage 4" - when symptoms are more severe, and recovery a longer process.
The issue that needs to be addressed is that mental health conditions are illnesses that should be taken as seriously as migraine disease, diabetes, heart disease, and other illnesses. When we think about cancer, heart disease, or diabetes, we don’t wait years to treat them. We start before Stage 4 — we begin with prevention. When people are in the first stage of those diseases, and are beginning to show signs of symptoms like a persistent cough, high blood pressure, or high blood sugar, we try immediately to reverse these symptoms. We don’t ignore them. In fact, we develop a plan of action to reverse and sometimes stop the progression of the disease. The question is why we don't do the same with mental illness. Many people don't seek treatment in the early stages because they don't know and recognize the symptoms. Some people are embarrassed or don't seek treatment because of the stigma that's still attached to mental illness.
Mental illnesses are not only common, they are treatable. There is a wide variety of treatment options for mental illnesses ranging from talk therapy to medication to peer support, and it may take some time for a person to find the right treatment or combination of treatments that works best for them. But when they do, the results can be truly amazing and life changing. For those of us with migraine, there's also a good possibility of getting a "two-fer" from our treatments. For example — some of the antidepressants used for major depressive disorder are also effective for some people for migraine prevention. I take Cymbalta for both major depressive disorder and migraine prevention.
Take a look at Mental Health America's B4Stage4 video:
It’s up to all of us to know the signs and take action so that mental illnesses can be caught early and treated, and we can live up to our full potential. We know that intervening effectively during early stages of mental illness can save lives and change the trajectories of people living with mental illnesses.
Each of us deserves to live as well as we can, with the highest quality of life possible. Please, if you think there's a possibility that you have major depressive disorder or another mental health condition, talk with your doctor. We don't have to "suffer in silence." There are excellent treatments available.