Depression
"Persistent sadness, emptiness, or feeling 'blue' most of the day, nearly every day"
What is Chronic Migraine?
Depression (Major Depressive Disorder) is a serious mood disorder characterized by persistent feelings of sadness, emptiness, and loss of interest in activities once enjoyed. It involves dysregulation of monoamine neurotransmitters (serotonin, norepinephrine, dopamine), HPA axis dysfunction, impaired neuroplasticity, and disrupted circadian rhythm. The condition significantly affects how a person feels, thinks, and handles daily activities.
Healthy Function
What your body should do
In a healthy mood regulatory system: (1) Monoamine neurotransmission - serotonin, norepinephrine, and dopamine are produced, released, and recycled properly, maintaining stable mood and motivation; (2) HPA axis function - the hypothalamic-pituitary-adrenal axis responds to stress appropriately, with cortisol rising during stress and returning to baseline afterward through proper negative feedback; (3) Neuroplasticity - brain-derived neurotrophic factor (BDNF) supports hippocampal neurogenesis, synaptic plasticity, and healthy neural circuit formation; (4) Circadian rhythm - the suprachiasmatic nucleus coordinates melatonin secretion and cortisol rhythms, maintaining healthy sleep-wake cycles and energy fluctuations; (5) Inflammatory homeostasis - balanced cytokine production without chronic elevation; (6) Healthy gut-brain axis - proper vagal signaling and neurotransmitter production in the gut (95% of serotonin).
When Things Go Wrong
Signs of chronification
- Pain threshold lowers over time
- More frequent attacks
- Brain stays in alert mode
- Medication stops working
How This Develops
Understanding the biological mechanisms helps us target the root cause
Point 1
Understanding the mechanism helps us target the root cause rather than just treating symptoms.
Recognizing All Symptoms
Chronic migraine affects multiple systems. Understanding your symptoms helps us identify the underlying mechanisms.
Physical Symptoms
9 symptoms
- Significant appetite changes (loss or increase)
- Unintentional weight loss or gain
- Sleep disturbances (insomnia or hypersomnia)
- Fatigue and loss of energy
- Restlessness or psychomotor retardation
- Aches, pains, or headaches without clear cause
- Digestive issues (nausea, bloating, constipation)
- Changes in sex drive
- Low immune function
Cognitive Symptoms
8 symptoms
- Difficulty concentrating
- Slowed thinking or speech
- Difficulty making decisions
- Memory problems
- Negative thought patterns
- Thoughts of death or suicide
- Difficulty with problem-solving
- Diminished ability to think or function
Emotional Symptoms
8 symptoms
- Persistent sadness, emptiness, or feeling 'blue'
- Loss of interest or pleasure in all activities (anhedonia)
- Feelings of hopelessness and pessimism
- Excessive guilt or worthlessness
- Irritability and frustration
- Emotional numbness or feeling disconnected
- Crying spells for no apparent reason
- Difficulty feeling positive emotions
Conditions That Occur Together
These conditions often coexist with chronic migraine due to shared mechanisms
Anxiety Disorders
Bidirectional relationship - 50% of depression cases have comorbid anxiety; shared neurobiology including HPA axis dysregulation and serotonin dysfunction; anxiety worsens depression outcomes
Chronic Pain Conditions
Shared inflammatory pathways - elevated cytokines maintain both pain and depression; reduced serotonin and norepinephrine affect pain modulation; pain depletes coping resources
Hypothyroidism
Low T3 impairs neurotransmitter function in the brain; symptoms overlap significantly; thyroid dysfunction doubles depression risk
Type 2 Diabetes
Bidirectional - depression increases diabetes risk 60% and diabetes doubles depression risk; shared inflammatory pathways; hyperglycemia affects brain function
Cardiovascular Disease
Depression increases cardiovascular mortality 1.5-2x; shared inflammatory etiology; reduced BDNF affects both heart and brain; lifestyle factors compound
Gut Dysbiosis
Gut produces 95% of serotonin; dysbiosis reduces neurotransmitter production; leaky gut increases neuroinflammation; vagus nerve signaling affected
Autoimmune Conditions
Shared inflammatory etiology - cytokines cross blood-brain barrier; autoimmune attacks on brain tissue possible; HPA axis suppression from chronic inflammation
Insomnia / Sleep Disorders
Bidirectional - depression causes sleep disruption, and sleep deprivation causes depression; circadian rhythm disruption affects all mood-regulating systems
Conditions to Rule Out
These conditions can present similarly but have distinct features
Major Depressive Disorder (MDD)
Persistent sadness, anhedonia, sleep changes, appetite changes, fatigue
Primary mood disorder - sadness is the dominant mood state; must meet DSM-5 criteria (5+ symptoms, 2+ weeks)
Bipolar Disorder (Depressive Phase)
Depressed mood, anhedonia, fatigue, sleep changes
History of at least one manic or hypomanic episode; family history of bipolar; antidepressants alone can trigger mania
Persistent Depressive Disorder (Dysthymia)
Low mood, fatigue, sleep changes, poor appetite
Milder but chronic symptoms lasting 2+ years; less severe impairment; often develops in childhood/adolescence
Premenstrual Dysphoric Disorder (PMDD)
Depressed mood, irritability, fatigue, sleep changes
Symptoms occur cyclically in luteal phase (after ovulation); resolve with menstruation; linked to serotonin sensitivity to hormonal fluctuations
Seasonal Affective Disorder (SAD)
Low mood, fatigue, increased sleep, carbohydrate cravings
Recurs seasonally (typically winter); correlates with reduced sunlight exposure; often includes hypersomnia and weight gain
Adjustment Disorder with Depressed Mood
Depressed mood following stressor
Symptoms develop within 3 months of identifiable stressor; symptoms exceed expected response; resolves when stressor ends
Hypothyroidism
Fatigue, weight gain, sleep disturbances, cognitive slowing
Elevated TSH, low Free T4/T3; often includes cold intolerance, dry skin, hair loss; responds to thyroid hormone
What's Driving Your Migraines
Identifying the underlying causes allows us to target treatment effectively
Genetic Predisposition
30-40% - Family history increases risk 2-3x; variations in serotonin transporter gene (5-HTTLPR), BDNF gene, COMT enzymeFamily history, genetic testing for 5-HTTLPR, BDNF Val66Met, COMT polymorphisms
Trauma and Adverse Childhood Experiences (ACEs)
30% - Childhood trauma increases depression risk 2-4x; alters HPA axis set-point permanently; affects stress response programmingACEs questionnaire, trauma history assessment, PEDS-QL for children
Chronic Stress and HPA Axis Dysregulation
40% - Prolonged stress exhausts cortisol regulation; flattened cortisol rhythm; impaired negative feedback at glucocorticoid receptors4-point cortisol curve, DHEA-S to cortisol ratio, dexamethasone suppression test
Neuroinflammation
30% - Elevated cytokines (IL-6, TNF-alpha, IL-1beta) reduce serotonin synthesis, impair neurogenesis, and affect mood circuitsCRP, IL-6, TNF-alpha, neopterin; clinical correlation with inflammatory conditions
Circadian Rhythm Disruption
25% - Altered melatonin secretion, flattened cortisol rhythm, disrupted sleep-wake cycles impair mood regulationSalivary cortisol curves, sleep diary, actigraphy, melatonin testing
Neurotransmitter Imbalances
35% - Serotonin, norepinephrine, and dopamine dysregulation at synthesis, receptor, and reuptake levelsNeurotransmitter panel (urine), symptom correlation, response to precursors
Gut-Brain Axis Dysfunction
25% - Reduced serotonin production (95% in gut); dysbiosis affects neurotransmitter metabolism; leaky gut increases neuroinflammationStool microbiome analysis, leaky gut testing, SIBO breath testing
Methylation Dysfunction
20% - Impaired MTHFR reduces neurotransmitter synthesis; affects cortisol metabolism; elevated homocysteineMTHFR genetic testing, homocysteine levels, methylmalonic acid
Nutritional Deficiencies
25% - B12, folate, vitamin D, magnesium, zinc, and omega-3 deficiencies impair neurotransmitter synthesis and functionComprehensive micronutrient panel, vitamin D, B12, folate, magnesium RBC, omega-3 index
Medication-Induced Depression
15-20% - Beta-blockers, corticosteroids, interferon, some chemotherapy agents, benzodiazepines can cause depressive symptomsMedication review, temporal correlation with medication start
Thyroid Dysfunction
15% - Subclinical hypothyroidism and low T3 levels directly affect brain neurotransmitter functionFull thyroid panel (TSH, Free T4, Free T3, Reverse T3, TPO antibodies)
Key Laboratory Markers
These biomarkers help us understand your specific migraine mechanisms
What Happens If Left Untreated
Understanding the consequences helps you make informed decisions about your health
Chronic and Recurrent Depression
Within 1-2 yearsUntreated first episode increases risk of recurrence to 50%; each subsequent episode raises recurrence risk to 70-80%; episodes become more severe and treatment-resistant
Treatment Resistance
After 2+ untreated episodesLonger untreated periods correlate with poorer treatment response; neurobiological changes become entrenched; higher doses needed
Suicide Risk
Increased at any point15% of severe depression leads to suicide; depression is the leading cause of suicide worldwide; 20x increased risk vs. general population
Cognitive Decline and Dementia
10-20 yearsChronic elevated cortisol damages hippocampal neurons; depression doubles Alzheimer's risk; accelerated brain aging
Cardiovascular Disease
5-10 yearsDepression increases heart disease risk 1.5x and heart attack risk 2x; affects heart rate variability and inflammatory markers
Relationship and Career Damage
ProgressiveSocial withdrawal, irritability, and impaired concentration strain relationships; 35% reduced work productivity; increased absenteeism
Substance Abuse and Addiction
Within 1-3 years30% of depressed individuals develop substance use disorders as self-medication; worsens depression outcomes significantly
Physical Health Deterioration
ProgressiveWeakened immune function; increased inflammation; accelerated aging (telomere shortening); digestive disorders
Time Matters
Don't wait for symptoms to worsen. Early intervention leads to better outcomes.
How is Chronic Migraine Diagnosed?
Comprehensive evaluation to identify triggers, contributing factors, and appropriate treatment
Comprehensive Blood Panel (150+ markers)
Purpose:
Baseline assessment of all major systems
CBC, CMP, lipid panel, thyroid panel, inflammatory markers, vitamins, minerals reveal underlying contributors
Advanced Adrenal/HPA Axis Panel
Purpose:
Assess stress response system
4-point cortisol curve, DHEA-S, cortisol/DHEA ratio reveals HPA axis dysregulation patterns and adrenal function
Neurotransmitter Panel (Urine)
Purpose:
Measure neurotransmitter levels
Serotonin, norepinephrine, dopamine, GABA, glutamate levels indicate neurotransmitter imbalances
Inflammatory Marker Panel
Purpose:
Assess neuroinflammation
CRP, IL-6, TNF-alpha, homocysteine reveal inflammatory contributors to depression
Comprehensive Gut Assessment
Purpose:
Evaluate gut-brain axis
Stool microbiome analysis, leaky gut markers, SIBO testing reveal gut-related contributors
Nutrient Optimization Panel
Purpose:
Identify deficiencies
Vitamin D, B12, folate, magnesium RBC, zinc, omega-3 index indicate nutritional contributors
Genetic Methylation Panel
Purpose:
Assess genetic predispositions
MTHFR, COMT, BDNF, and other polymorphisms affecting neurotransmitter metabolism and stress response
Full Thyroid Panel
Purpose:
Rule out thyroid contributors
TSH, Free T4, Free T3, Reverse T3, TPO antibodies reveal thyroid dysfunction as cause or contributor
Our Integrative Approach
A comprehensive, phased approach to treat chronic migraine at its source
Reduce acute symptoms, ensure safety, establish foundation
Reduce acute symptoms, ensure safety, establish foundation
Address underlying biological contributors
Address underlying biological contributors
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Neural pathway retraining and resilience building
Neural pathway retraining and resilience building
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Sustain gains and build long-term resilience
Sustain gains and build long-term resilience
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Supporting Your Treatment
Evidence-based lifestyle modifications to enhance treatment effectiveness
What Success Looks Like
Mood symptom score improves (PHQ-9 score <10)
Cortisol rhythm normalizes (morning peak, evening decline)
DHEA-S to cortisol ratio improves (>200)
Inflammatory markers normalize (CRP <1.0, IL-6 <2.0)
Sleep quality score improves (PSQI <5)
Energy levels return to baseline
Interest and pleasure in activities returns (anhedonia resolves)
Cognitive function improves (concentration, memory)
Social functioning restored
Work and productivity restored
Overall quality of life score improves
Reduced or eliminated need for acute interventions
Frequently Asked Questions
Ready to Find Relief from Chronic Migraines?
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