FAQ Episode 14: Seasonal Affective Disorder and Migraine

FAQs for Natural Migraine Relief for Women

Do you find the winter months challenging? It’s estimated that 20% of Americans are affected by seasonal depression each winter. Also called Seasonal Affective Disorder (SAD), it includes symptoms like:

-fatigue

-oversleeping

-carb cravings and overeating

-difficulty concentrating

-social withdrawal

-problems getting motivated

-decreased sex drive

-irritability and anxiety

-losing interest in activities you normally enjoy

-feeling sad, worthless, or guilty

-thoughts of death or suicide 

It can also include physical problems like headaches. Migraine headaches and depression have what we call a bidirectional relationship, meaning depression increases the risk of migraine and vice versa. Those with migraine are around five times more likely to develop depression, while those with depression are over three times more likely to develop migraine.

Seasonal Affective Disorder (SAD) and migraines are both neurological conditions, and while they are distinct, there can be some connections and interactions between them. These two problems may share some root cause factors that could be promoting either or both of them. Let’s examine how seasonal changes in fall and winter could be a consideration in migraine or SAD, and then some strategies could address either or both of them.

1. Weather changes common during the time of seasonal depression may also affect migraine frequency or intensity for some individuals, with barometric pressure changes and associated storms, wind, or weather extremes. Bright sunlight and glare off of ice or snow can also precipitate migraines. These could explain the overlap between the two but don’t offer easily fixable co-factors.

2. Circadian rhythm changes with shorter and often overcast days means less sunlight hours and intensity in winter than the rest of the year. Most often, SAD symptoms occur in fall and winter when there’s less sunlight; January and February tend to feel the worst (in the Northern Hemisphere, that is). Experts think the shorter days trigger a chemical change in your brain that causes your symptoms. In this regard, it would make perfect sense that rates of SAD vary depending on location, with people living in northern latitudes being most susceptible. For instance, in the U.S., SAD affects ten times as many New Hampshire residents compared to those living in Florida. Unfortunately, moving to Key West is not an open option for most of us.

3. Changes to your sleep schedule when the nights start getting longer. You were designed to go to sleep when the sun sets and wake up when the sun rises. If you stray too far from this biological pattern you will disrupt hormonal cycles, which can affect both your mood and your health.

The link between depression and lack of sleep is well established. More than half of people diagnosed with depression struggle with insomnia. In one study, 87% of depressed patients who resolved their insomnia had major improvements to their depression, with symptoms disappearing after eight weeks. While there are individual differences, as a general rule aim for eight hours of sleep per night.

4. Dehydration can be as or more common in winter than in the summer. This sounds paradoxical, given the generally colder weather. But forced air heating in most homes is usually ‘dry’ or low-humidity air, and your respiratory water loss in humidifying that air can promote low-grade dehydration.

5. Disruptions to your normal routine when you’re on vacation or engaging in holiday activities. This can include “let-down headaches” you may get when you are finally able to relax or decompress from those schedule alterations.

6. Allergy and viral respiratory infections with symptoms like coughing, sinus pressure, and sneezing can promote or aggravate migraine headaches.

7.  Changes in serotonin and melatonin levels: Both SAD and migraines have been linked to serotonin, a neurotransmitter involved in mood regulation and pain perception. In SAD, lower levels of serotonin are often implicated in the development of depressive symptoms. In migraines, changes in serotonin levels can also play a role, and medications that affect serotonin are sometimes used to prevent migraines. It's possible that fluctuations in serotonin levels related to SAD may influence migraine symptoms in some individuals.

8.  Diet

Interestingly, vegetarians are four times more likely to suffer from SAD than nonvegetarians, so a primarily plant-based diet may not be ideal during the winter season. Vegetarians are also twice as likely to suffer from nonseasonal depression which suggests that nutrient deficiencies may be involved in both. B12 and the methylated B vitamins are potential suspects in migraines and potentially SAD as well. Review their roles in migraines in FAQ Episode 3 and FAQ Episode 13. On the other hand, if I had to turn down steak, Chick-Fil-A, bacon and pork ribs (they all have plenty of B’s!) on a regular basis, I know I’d be feeling just a bit blue.

Therapy options considerations:

I’d like to focus first on two of the most important treatment strategies for SAD and migraine: 1) sun (or light) exposure and 2) optimizing your vitamin D level.

1) Light therapy is considered to be the best available treatment for SAD. and I have seen it benefit many patients with SAD symptoms (including myself, some winters). Full-spectrum light therapy alone is more effective for seasonal depression than the antidepressant Prozac. Light therapy can improve mood and normalize sleep patterns in SAD patients, which may indirectly help reduce migraine frequency by the same mechanisms. Sitting ~2 feet away from a light box with 10,000 lux to simulate sunlight for one hour in the morning generally gives the best benefit for SAD. You can generally find a quality entry-level light box online in the $50-70 range.

However, if you have SAD and migraine, and you find that full spectrum light therapy promotes your headache, consider using green spectrum light as an alternative. Green light exposure has been found to release brain opioids and reduce inflammation. Its use has correlated with reduced migraine frequency, as well as improvement in those with fibromyalgia or neuropathy. Green light in the 515-535 nanometer wavelength spectrum at 4-100 lux light intensity has produced the best effects for green light.  Use one hour per day, in a room that is otherwise dark and without active light-bearing electronics. A simple example of this would be the NorbRELIEF “Migraine Reducing Green Light” with Flicker-Free/Narrow-Green at ~$20/bulb. This can be used with any routine activity like reading, writing, listening to music, an audiobook, or a podcast. Green light therapy used in the first hour of a migraine has also been found to lessen the impact of the event.

2) Vitamin D3:   I discuss the well-documented utility of optimal Vitamin D3 levels for migraine frequently in the Natural Migraine Relief course, as well as in this FAQ blog (see Episode 11).   Get a level done and aim for the optimal of 60-80 ng/ml level, not just the ‘getcha by’ level of 30 as the minimal ‘normal level’.

Other measures that could apply to both SAD and Migraine:

3) Melatonin levels

Melatonin is another important player that is influenced by your circadian clock and exposure to bright full-spectrum light. Your master biological clock resides inside the suprachiasmatic nucleus (SCN) of your brain. Based on signals of light and darkness, your SCN tells your pineal gland when it's time to secrete melatonin and when to turn it off. One of melatonin's primary roles is regulating your body's circadian rhythm.

When it gets dark, your brain starts secreting melatonin, which makes you sleepy. Levels typically stay elevated for 8-12 hours and then, as the sun rises, your pineal gland reduces your production and the levels in your blood decrease until they're hardly measurable. In people with SAD, decreased wintertime light can disrupt melatonin production. Some may overproduce melatonin, leading to feelings of sleepiness and lethargy. If you take melatonin to help your migraines but also have SAD, you may need to decrease your wintertime dose.

4) Diet and hydration

-If you’re indoors with forced air heating, you almost certainly need to ramp up your hydration during the winter months.

-Make sure that your diet or supplements supply sufficient B12 and the methylated B vitamins (methylfolate, methyl B12 and methylated B6 known as pyridoxyl-5-phosphate). Deficiencies in either of these are potential suspects in migraines and potentially SAD as well.

-Consider augmenting your omega-3 fatty acid intake. Omega-3s are fundamental brain building blocks for daily brain function and optimal mental health. Studies have shown that those with lower blood levels of omega-3s had more symptoms of depression and a more negative outlook on life, while those with higher omega blood levels reported the opposite. And when it comes to migraines, omega-3 metabolites help protect against and resolve inflammation.

Without sufficient omega-3s, the inflammatory response as a root cause of migraine headaches may persist longer and become chronic. Additionally, optimal omega-3 levels help your mitochondria to produce energy more efficiently. Reduced mitochondrial efficiency can also be a root cause contributor to migraine headaches.

Usually, 1 gram of omega-3s/day, with the DHA/EPA component ratio of ~2:1 (such as DHA 650 mg and EPA 350 mg) is a reasonable target. A test called the omega-3 index can tell you where you are on your omega-3 content in cell membranes. Levels of 8-12% are optimal, while levels trending low toward 4% are associated with a multitude of health issues such as autoimmune and cardiac disease and brain aging disorders. For instance, when it comes to heart disease, having an omega-3 ratio of 4% increases the risk of sudden cardiac death by 90% compared to those having a ratio of 8%.

It's important to note that not everyone with SAD will experience migraines, and not everyone with migraines will develop SAD. These conditions have complex and multifactorial causes, and their relationship can vary from person to person. If you have concerns about either SAD or migraines, it's advisable to consult with your healthcare professional to collaborate on a personalized assessment and treatment plan.

If you are interested in knowing more about the root cause of migraine headaches and how to address them directly with non-drug therapy, you can review the contents and purpose of my online course Natural Migraine Relief for Women, by going to www.naturalmigrainerelief.online