As if blinding migraines are not bad enough, new research shows that women who get them are more likely than others to suffer from major bouts of the blues, especially if they also have headache-related symptoms like low energy and joint pain.

A study published in the January 9 Neurology found that women who suffer from chronic headaches (more than 15 a month) are four times more prone to major depression than those with episodic headaches (fewer than 15 monthly). Chronic headache sufferers were also three times more likely to report "a high degree" of related symptoms such as fatigue, insomnia, nausea, dizziness, and stomach, back and joint pain. The study found that patients with chronic headaches accompanied by other ailments were 32 times more likely to develop major depression.

"I don't think it's just a coincidence that people with severe headaches have a higher incidence of developing major depression," says study author Gretchen Tietjen, a neurologist at the University of Toledo Health Science Campus.

Nevertheless, she says she was "surprised that major depression was as common in this population" as the research shows.

"Painful physical symptoms may provoke or be a manifestation of major depression in women with chronic headache, and depression may heighten pain perception," she says. "This relation between migraine and major depression suggests a common neurobiology."

Scientists studied 1,032 women who sought care at headache clinics in five states--593 were episodic headache sufferers and 439 chronic headache patients. About 90 percent of them were diagnosed with migraines.

Tietjen says that the research was part of a larger study to determine whether there are genetic and environmental factors that might predispose patients to chronic headaches, related symptoms and depression.

Researchers are now "midway" through a follow-up study, she says, in which they are asking patients when they first developed severe headaches and depression to see if there are certain patterns. They are also probing whether chronic headaches, related physical symptoms and the blues may be tied to a lack of serotonin in the central nervous system. She noted that researchers have already submitted a second paper on findings of a link between sexual and emotional abuse in childhood and chronic disabling headaches.

"If we can figure out what causes people to develop [severe headaches, major depression and related symptoms], we can figure out how better to treat them," Tietjen says. "We want to make sure that we consider a number of different things like depression to help us decide the best choice of treatment."