A depressive headache is usually dull and generalized, characteristically worse in the morning and in the evening. In making the diagnosis of depressive headache, we must be certain to rule out organic causes. These include cervical arthritis, discogenic bony anomalies of the occipitocervical joints, basilar invagination, chronic mastoiditis, malocclusion of the temporomandibular joint and possibly a posterior fossa lesion in the brain. The most popular biologic theories of depression hold that the disorder is associated with depletion of brain monoamine neurotransmitters such as serotonin and norepinephrine. Determining the most important substance in depression is controversial.
Evidence is available to support both the norepinephrine and serotonin hypotheses.
Other neurotransmitters, such as dopamine and endorphin, may also be involved in depression. The discovery of endogenous, opiate-like substances in the brain, the endorphins and enkephalins, has significantly advanced our understanding of pain. Continued . . . However, in their work, the categorizing of the depression was unclear. There may also be a relationship between depression and migraines.