Headache and Mood
Another key factor in the common pathophysiology of migraine and psychiatric disorders may be the relationship between headache pain and mood. In Dr. Sheftell’s view, there appears to be a disconnect between patients, who emphasize the role that pain plays in their depression, and many psychiatrists, who take a strictly clinical view. “Unfortunately, if you ask a lot of psychiatrists [about] pain, the biology of pain, they would say that … pain is a somatic expression of depression,” Dr. Sheftell noted. “I think there is an interrelationship between the two. The psychodynamics involved can be very important as well.”
Some researchers are focusing on what is known as the “vulnerable” limbic system and its association with “limbically augmented” pain disorders, Dr. Sheftell said. These disorders are characterized by corticolimbic sensitization induced by a phenomenon referred to as “kindling”; chronic pain that is resistant to standard treatments; alterations in sleep, energy, libido, and memory and concentration; behavioral disturbance and stress intolerance; and associations with mood disturbance and anxiety.
Research into the limbic system is benefiting from advances in such forms of neuroimaging as PET, according to Dr. Sheftell. “Investigators are looking for neuroanatomic and neurophysiologic dysfunction that can tie the limbic system and pain mechanisms together.”
—Fred Balzac