Mental Health — Page 31

FREQUENCY OF DEPRESSION IN MIGRAINE HEADACHE

AUTHOR:BHURGRIGHULAMRASOOL,BILAWAL,SHAMIM-UR-REHMAN,RAJ KUMAR,ANISREHMAN.

SUMMARY:

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.

INTRODUCTION:

“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)

METHODS:

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.

RESULTS

: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

Cases

Included

Excluded

Total

Percent

Total cases of study * Presence of depression in migraineous female patients

42.2%

57.8%

102

100.0%

Femal patients in study * Presence of depression in migraineous female patients

42.2%

57.8%

102

100.0%

Male patients in study * Presence of depression in migraineous female patients

36.3%

63.7%

102

100.0%

Total cases of study * Presence of depression in migraneous male patients

16.7%

83.3%

102

100.0%

Femal patients in study * Presence of depression in migraneous male patients

16.7%

83.3%

102

100.0%

Male patients in study * Presence of depression in migraneous male patients

16.7%

83.3%

102

100.0%

DISCUSSION:

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.

REFERENCES:

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.

working>as>assitant>professor>inmmc>mirpurkhas>sindh

“In civilized life it has at last become possible for large numbers of people to pass from the cradle to the grave without ever having had a pang of genuine fear. Many of us need an attack of mental disease to teach us the meaning of the word.” William James.

We have all heard the seemingly discriminating remarks that fear is normal and abnormal, and that normal fear is to be regarded as a friend, while abnormal fear should be destroyed as an enemy.

The fact is that no so called normal fear can be named which has not been clearly absent in some people who have had every cause therefor. If you will run over human history in your mind, or look about yea in the present life, you will find here and there persons who, in situations or before objects which ought, as any fearful soul will insist, to inspire the feeling of at least normal self-protecting fear, are nevertheless wholly without the feeling. They possess every feeling and thought demanded except fear. The idea of self-preservation is as strongly present as with the most abjectly timid or terrified, but fear they do not know. This fearless awareness of fear suggesting conditions may be due to several causes. It may result from constitutional make-up, or from long continued training or habituation, or from religious ecstasy, or from a perfectly calm sense of spiritual selfhood which is unhurtable, or from the action of very exalted reason. Whatever the explanation, the fact remains: the very causes which excite fear in most of us, merely appeal, with such people, if at all. to the instinct of self-preservation and to reason, the thought-element of the soul which makes for personal peace and wholeness.

Banish all fear.

It is on such considerations that I have come to hold that all real fear-feeling should and may be banished from our life, and that what we call “normal fear” should be substituted in our language by “instinct” or by “reason,” the element of fear being dropped altogether.

“Everyone can testify that the psychical state called fear consists of mental representations of certain painful results” (James). The mental representations may be very faint as such, but the idea of hurt to self is surely present. If, then, it can be profoundly believed that the real self cannot be hurt; if the reason can be brought to consider vividly and believingly all quieting considerations; if the self can be held consciously in the assurance that the White Life surrounds the true self, and is surely within that self, and will suffer “no evil to come nigh,” while all the instincts of self preservation may be perfectly active, fear itself must be removed “as far as the east is from the west.”

These are the ways, then, in which any occasion for fear may be divided:

As a warning and as a maker of panic. But let us say that the warning should be understood as given to reason, that fear need not appear at all, and that the panic is perfectly useless pain. With these discriminations in mind, we may now go on to a preliminary study of fear.

preliminary study of fear.

Fear is (a) an impulse, (b) a habit, (c) a disease.

Fear, as it exists in man, is a make-believe of sanity, a creature of the imagination, a state of insanity.

Furthermore, fear is, now of the nerves, now of the mind, now of the moral consciousness.

The division depends upon the point of view. What is commonly called normal fear should give place to reason, using the word to cover instinct as well as thought. From the correct point of view all fear is an evil so long as entertained.

Whatever its manifestations, wherever its apparent location, fear is a psychic state, of course, reacting upon the individual in several ways: as, in the nerves, in mental moods, in a single impulse, in a chronic habit, in a totally unbalanced condition. The reaction has always a good intention, meaning, in each case, “Take care! Danger!” You will see that this is so if you will look for a moment at three comprehensive kinds of fear fear of self, fear for self, fear for others. Fear of self is indirectly fear for self danger. Fear for others signifies foresensed or forepictured distress to self because of anticipated misfortune to others. I often wonder whether, when we fear for others, it is distress to self or hurt to them that is most emphatically in our thought.

Fear, then, is usually regarded as the soul’s danger signal. But the true signal is instinctive and thoughtful reason.

Even instinct and reason, acting as warning, may perform their duty abnormally, or assume abnormal proportions. And then we have the feeling of fear. The normal warning is induced by actual danger apprehended by mind in a state of balance and self-control. Normal mind is always capable of such warning. There are but two ways in which so-called normal fear, acting in the guise of reason, may be annihilated: by the substitution of reason for fear, and by the assurance of the white life.

Let it be understood, now, that by normal fear is here meant normal reason real fear being denied place and function altogether. Then we may say that such action of reason is a benefactor to man. It is, with pain and weariness, the philanthropy of the nature of things within us.

One person said: “Tired? No such word in my house!” Now this cannot be a sound and healthy attitude. Weariness, at a certain stage of effort, is a signal to stop work. When one becomes so absorbed in labor as to lose consciousness of the feeling of weariness, he has issued a “hurry call” on death. I do not deny that the soul may cultivate a sublime sense of buoyancy and power; rather do I urge you to seek that beautiful condition; but I hold that when a belief or a hallucination refuses to permit you to hear the warning of nerves and muscles, Nature will work disaster inevitably. Let us stand for the larger liberty which is joyously free to take advantage of everything Nature may offer for true well-being. There is a partial liberty which tries to realize itself by denying various realities as real; there is a higher liberty which really realizes itself by conceding such realities as real and by using or disusing them as occasion may require in the interest of the self at its best. I hold this to be true wisdom: to take advantage of everything which evidently promises good to the self, without regard to this or that theory, and freely to use all things, material or immaterial, reasonable or spiritual. I embrace your science or your method; but I beg to ignore your bondage to philosophy or to consistency. So I say that to normal health the weary-sense is a rational command to replenish exhausted nerves and muscles.

It is not liberty, it is not healthful, to declare, “There is no pain!” Pain does exist, whatever you affirm, and your affirmation that it does not is proof that it does exist, for why (and how) declare the non-existence of that which actually is non-existent? But if you say, “As a matter of fact I have pain, but I am earnestly striving to ignore it, and to cultivate thought-health so that the cause of pain may be removed,” that is sane and beautiful. This is the commendable attitude of the Bible character who cried: “Lord, I believe; help thou mine unbelief.” To undertake swamping pain with a cloud of psychological fog that is to turn anarchist against the good government of Nature. By pain Nature informs the individual that he is somewhere out of order. This warning is normal. The feeling becomes abnormal in the mind when imagination twangs the nerves with reiterated irritation, and Will, confused by the discord and the psychic chaos, cowers and shivers with fear.

I do not say there is no such thing as fear. Fear does exist. But it exists in your life by your permission only, not because it is needful as a warning against “evil.”

Fear is induced by unduly magnifying actual danger, or by conjuring up fictitious dangers through excessive and misdirected psychical reactions. This also may be taken as a signal of danger, but it is a falsely-intentioned witness, for it is not needed, is hostile to the individual because it threatens self-control and it absorbs life’s forces in useless and destructive work when they ought to be engaged in creating values.

Frequency of Depression in Migraine Headache

FEAR AND REASON.