I originally intended to focus my research on the subject of migraine headaches. Operating under a mistaken belief, I sought to explain a far more sim- ple occurrence, namely why migraines almost always cause nausea as a secondary effect. In the 17th century, Sir Thomas Willis hypothesized that migraines were
caused by an increased flow of blood to the brain. This increased blood flow caused the tissues of the brain to swell and expand, resulting in pressure on the nerve endings. This was thought to be the cause of all migraine pain until as recent as the last decade (Loder 4). Yet new research over the last ten years has led many researchers to believe that there is a far larger pic- ture. Migraine headache is a more complicated issue than previously believed, and is now being tenta- tively linked to other disorders such as depression, anxiety, sleep pattern disorders, and even an increased tendency towards drug and alcohol addiction.
New technological advances such as MRI (Magnetic Resonance Imaging) and PET (Positron Emission Technology) have now proven that previ- ous assumptions surrounding the migraine headache were incorrect. With such tools, researchers have learned that the brain undergoes many physical changes before, during, and after a migraine attack. As a result, investigators are now gaining a better understanding of brain chemistry and the biochemi- cal process involved in pain. A new theory which is gaining support is centered around a bio-chemical called Serotonin. Serotonin is defined as a neuro- transmitter, or a body chemical which relays infor- mation from one neuron in the brain to another (Hockenbury 48). Serotonin, in particular, has been associated with sleep, moods, and emotional states which include depression (48).
New research shows that during a migraine attack, Serotonin levels in the human brain drop as well. Researchers believe that this causes the trigeminal nerve to release substances called neu- ropeptides. These in turn cause blood vessels in the brain to become dilated and inflamed. This results in severe head pain (The Mayo Clinic 3) and states of confusion.
At this point in my research, I forgot my original question and turned instead to further study Serotonin itself. As a person who has been diag- nosed with depression, I recognized this particular bio-chemical as being one of the primary suspects which doctors have long felt to cause mood swings and erratic thought patterns. Was there a connection between depression and migraines? It seemed as if there may be, for as I looked again to my migraine research I realized that many of the secondary symptoms listed for head pain were also familiar to me. Indications such as drowsiness and irritability are listed as possible warning signs that a migraine is about to begin; they are also classic signs of clini- cal depression.
Further research supported this assumption. New studies are now showing that there may be a correla- tion between migraines and certain mood dis-
orders – particularly depression, anxiety, and possi- bly panic attacks. These studies show thatmigraineurs (patients who are prone to migraine headaches) are up to four times more likely to suffer a major depression than those who do not suffer from migraines. Conversely, individuals who are depressed or are anxious are more likely to have migraines than those who do not (Matthew 3). Tentatively, some researchers have gone so far as to suggest that depression and migraines are a co-mor- bid mood disorder, meaning that they may be one and the same physical, neurological condition.
I also learned another fact: antidepressants have been shown to help not only with depression, but they also seem to combat many secondary symp- toms as well. Prozac, a popular example, increases the availability of Serotonin in the brain. It works by insuring that messages are able to be relayed proper- ly through the brain, preventing interruptions or mis-relayed information which medical science already knows to be the root cause and effect of depression. Yet at the same time, many patients have reported a decrease in migraine frequency and sity as a secondary benefit. This has led some researchers, such as James Hudson and Harrison Pope of Harvard Medical School, to suggest that these drugs work by effecting what they call an 'affective spectrum disorder.' Many conditions respond to the same type of drug because similar brain processes are functioning abnormally in all of them. Certain neurotransmitters are just not doing what they are supposed to be doing – in depression, just as in migraine, or bulimia or even panic disor- der. The central connection among all these disor- ders is the chemical Serotonin (Dowling 13). When levels of Serotonin are increased to normal amounts in patients who suffered multiple conditions, the effect seems to be a general relief all the way around the board.
As a result of such new discovery, many disor- ders which have long been thought to be only in the mind are now being regarded as more biochemical than psychological. They are not necessarily mental disorders; they are not curable by talking or by hours spent upon a couch with a therapist who's diagnosing a patient's innermost thoughts. Many previously assumed mental disorders are now treat- ed on the basis of being an actual physical medical condition. For example, migraine is now listed as a primary disorder, meaning that it is a physical ill- ness and not a secondary effect. To patients who have been told for years that it was 'all in their head' or led to believe that they were somehow mentally 'unbalanced,' this comes as good news. As neurolo- gist Michael Cutrer, who has himself suffered migraines since the age of 14, explains,
If someone gets kicked in the knee, they feel that stimulus as pain; that's rational... But what we find in people with chronic head-aches is the pain without the physical stimulus; that's irrational... Since doctors didn't know what the problem was, they would sometimes blame the patients for imagining things. Now we know that the brain itself is the new arena for headache research. (Curtis 2)
Like migrainuers, patients with severe depression or anxiety have also faced the same false assumptions that it was all in their mind.
To this date, further research on the effects of Serotonin as a possible connecting factor between migraine and mental disorders has been complicat- ed. Serotonin has been divided into at least five dif- ferent sub-classifications of receptors, each seeming to target a different aspect of the whole picture. For example, lack of sub-type 5HT(lb) in laboratory mice has been shown to increase aggressive behav- ior as well as preferences to alcohol. Sub-type 5HT(2c) has been linked in experiment to migraine, sleep pattern disruption, and increased food intake to the point of obesity (Kennet 3). Medications that are effective in increasing levels of one sub-type might inadvertently lower other sub-types, creating or complicating side-effects. Thus far, a combination which would be beneficial on all levels is yet to be discovered. In the future, the potential for a univer- sal treatment and cure is impossible to ignore.
However, the idea of a 'wonder pill' has made many in the physiology field nervous. That so many complex issues might one day be resolved by a sim- ple daily medication seems almost too good to be true. As the very concept of neurosis itself comes under fire, years of thinking must be changed to adapt to the new possibilities. And yet, to patients such as myself, it is a tremendous relief that cannot easily be placed into words. That there may some- day soon be hope at last and finally an end in sight, is too exciting not to want to jump and cheer about it.
I have migraines, severe enough that I have come under fire on my job for missing work. I have been told that a little headache is nothing, and that I am over-reacting or even somehow weak. Yet until a person has had to live with continuing pain for three days, sometimes more, they cannot understand what the word 'migraine' truly means. Until they have felt themselves hitting the floor with sudden and intense pain that is so violent they cannot even remember their own name, or that of their child, they cannot identify or truly understand what these advances mean to those of us who have been there more times than we want to count.
I have been diagnosed with depression; I was accused of seeking attention again, of exaggerating my problems, even making them up to have a reason to complain. Yet though I cannot tell you why I sometimes cry for no reason, or why I will walk the floor at night unable to sleep for days at a time, I can say that this is real. My moods swing every win- ter; I start to gain weight and loose the energy to even get up and take care of simple tasks. Sometimes I will wake up in the morning feeling 'bouncy' and happy, knowing that nothing in the world can bring me down. Only to find that an hour later I am screaming at anyone and everything that gets in my path, unable to stop myself or say what it
is I am angry about. An hour after this, I will be locked in my own dark room crying again because I know that I am not right, and yet no one will believe me or listen to what I am trying to say.
Yes, a universal wonder pill to solve all my prob- lems does seem too good to be true. Yet so does the idea of being able to live a normal life. No more counseling and rehashing my past over and over to an uncaring psychiatrist who tells me I can 'cure' myself by rethinking my attitudes. No more good intentioned souls telling me that all I have to do is quit smoking, or get married, or find a better job and it will all go away. My problem is not stress; I am not crazy, or a hypochondriac whining so that the world will notice her. It is not my fault; I did noth- ing to cause this upon myself. My condition is phys- ical; I am no more to blame than a person who dis- covers they have cancer or a heart condition.
This ends a bit more personally than I intended; however, I feel like Alice in Wonderland, when she suddenly woke up on the grass to know it had all been just a dream. A bad dream, maybe. But I will wake up, and I will finally have help. As researchers learn more about the effects of Serotonin and the real causes of my problem, I will be able to live fully. I will be able to help my child, if it happens that he has inherited this same condition. Already, the relief I have found from even this simple re- search makes it all seem somehow easier to manage.
I am not crazy. And that is making all the differ- ence in how I look at myself.
Dowling, Colette. You Mean I Don't Have to Feel This Way? New Help for Depression, Anxiety, and Addicion. New York: Maxwell Macmillian International, 1991.
Hockenbury, Don H., and Sanda E. Hockenbury. Discovering Psychology. New York: Worth, 2001.
Kennet, G.A. "Serotonin Receptors and their Functions." SmithKline Beechum Paharmaceuticals. Oct. 3, 2001. <http://www.tocris.com/serotonin.html>
Larkin, Marilynn. "The Role of Serotonin in Migraine." Newsline. The Journal of the American Medical Association. 1997. 4 Oct. 2001 <http://www.ama-assn. org/special/migraine/newsline/briefing/serotonin.http>
Rist, Curtis. "The Pain is in the Brain." Discover 21 (Mar 2000): pp. 56-63.
The Mayo Clinic. “Diseases and Conditions A-Z.” September 20, 2001 <http://mayohealth.org/home?id=DSS00120>
Jennifer B. Nelson is pursuing a degree in Graphic Arts at Clovis Community College [New Mexico] and is interested in obtaining a Bachelor’s in English Literature.