Understanding the relationship between migraine and mental health
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, PhD, 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 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, 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, and between 30% and 50% of people with chronic migraine also have anxiety.
What’s the link?
Does migraine cause anxiety? Can depression cause migraines? Buse says that doctors aren’t entirely sure what the connection is. For many people, depression or anxiety begins months or years after their migraines start—partially because migraine can be so debilitating. Many others, however, develop migraine after living with depression or anxiety for some time. This indicates that depression and anxiety are not always a response to living with migraine. Like migraine, depression and anxiety can also run in families.
“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, can play off of migraine symptoms. Patients worry about when the next attack will come, feel helpless about the unpredictability of their symptoms, and feel frustration over the many ways that migraine is affecting their life.
When a person doesn’t know when the next attack is coming, it can cause a great deal of migraine 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.
Both depression and anxiety disorders increase the risk of suicide. Warning signs of suicide include:
- Talking or writing about death
- Giving away important possessions
- Talking about feeling like a burden to other people
- Increased use of alcohol or drugs
- Reckless behavior
- Extreme social withdrawal or isolation
- Making calls or visits to others to say goodbye
- Thoughts of hopelessness (that things will never get better in the future)
*If you or someone you know has serious thoughts about suicide, share your concerns openly with your healthcare professional or call the National Suicide Prevention Lifeline at 1(800) 273-8255. Depression is rarely permanent, and many effective treatment options are available.
The silver lining, Buse says, is that depression and anxiety are treatable in many ways, including through medications that target nerve transmitters. But there are also nonpharmacological therapies.
Treatments that include cognitive behavioral therapy (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 and compares them alongside biological information.
“In biofeedback, you can actually look at a computer screen and see when your nervous system is activated,” she says. 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 says.
Staying active and healthy is also important for patients who experience migraines and depression or anxiety, as is maintaining a consistent sleep schedule.
Keep making plans
One of Buse’s key pieces of advice is not to withdraw and let migraine keep you from being social.
“Keep in contact with friends and family,” Buse says. “You may have to cancel sometimes, you may have to leave early, or you may need to 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.”
More than anything, it’s important to remember that migraine and anxiety or depression are is not the fault of the 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.
Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.