The Link Between Migraine, Depression, and Anxiety

Understanding how these commonly co-occurring disorders interrelate

Migraine is linked to both depression and anxiety. In fact, people with migraine are about five times more likely to develop depression than someone without migraine, according to Dawn Buse, Ph.D., the Director of Behavioral Medicine at the Montefiore Headache Center and an associate professor in the Department of Neurology at Albert Einstein College of Medicine in New York.

“It’s also very logical when you’re living with a chronic disease like migraine, which is affecting your life in such a big way, that you’re going to feel sad, and down, and frustrated about how it’s affecting your life,” she says.

Buse says that about 20% of people with episodic migraine—headaches on 14 or fewer days per month—may also have depression, and that number goes up as the number of headache attack days per month increases. Similarly, about 20% of people with episodic migraine have anxiety. Between 30% and 50% of people with chronic migraine also have anxiety.

What’s the link?

Does migraine cause depression and anxiety, or vice versa? Buse says that doctors aren’t entirely sure.

“We think there might be some underlying reason, maybe a genetic reason, or the fact that both depression and migraine act off similar biochemicals in the brain and in the body that predisposes someone to have one, and then the second,” Buse says.

Common symptoms of anxiety, like excessive worry, fear and irritability, seem to integrate reactively with migraine symptoms: patients worry about when the next attack will come, feel helpless about the unpredictability of their symptoms, and feeling frustration over the many ways that migraine is affecting their life.

“Migraine steals away days, weeks, even months of people’s lives, and it will affect almost every aspect of life,” says Buse. When a person doesn’t know when the next attack is coming, it can cause a great deal of anxiety, and, ultimately, depression.

Symptoms of depression include fatigue, loss of interest or pleasure in things previously enjoyed, changes in sleep, changes in eating habits, and feelings of sadness and hopelessness, which also closely mirror common migraine symptoms like insomnia, loss of appetite and malaise.

Treatment options

The silver lining, Buse says, is that depression and anxiety are treatable in many ways, including medications that target nerve transmitters, as well as non-pharmacological therapies.

Treatments that include cognitive behavioral therapy or CBT help us better manage stress and change the ways that we think and act, which could be contributing to our feelings of depression and anxiety, says Buse.

Relaxation therapies are similarly effective for some in treating anxiety and depression, as well as combating stress, which can exacerbate migraine symptoms. These strategies involve calming the nervous system with meditative exercises like deep breathing or guided visual imagery.

Buse also recommends biofeedback, where patients are connected to a machine that measures different physiological responses compared alongside biological information.

“In biofeedback, you can actually look at a computer screen and see when your nervous system is activated.” From this exercise, patients can learn ways to calm and quiet their nervous systems. This is helpful for anxiety, especially panic attacks or generalized anxiety, as well as insomnia and worry. There is very good evidence for these strategies helping with migraine management, Buse said.

Staying active and healthy is also important for migraine patients with depression or anxiety, as is maintaining a consistent sleep schedule. Finally, patients should keep making plans.

Keep Making Plans

“Keep in contact with friends and family. You may have to cancel sometimes, you may have to leave early, or you may need to go and excuse yourself and go in a dark, quiet room. But don’t stop making plans, because when you start to isolate you get lonely and depressed, and then you can really enter a downward spiral,” Buse says.

More than anything, it’s important to remember that it is not the fault of patient, and that there are treatment options.

“We want to let patients know that improving and lifting their depression and anxiety conditions will also lead to better migraine outcomes, improving their entire quality of life and reducing disability,” she says.