Migraine Impact and Depression

What to do when you feel hopeless or helpless

Q&A with Dr. Dawn Buse, Albert Einstein College of Medicine

As a person living with migraine, every aspect of your life can be impacted. Maybe your migraine attacks last for days, hindering your ability to succeed at work or spend time with your family. Or else, the sensitivity to light, sound and noise, means skipping out on social gatherings altogether. The extent to which migraine can disrupt the lives of those living with the disabling disease is vast, so it’s no surprise that migraine oftentimes comes with feelings of hopelessness and helplessness, which can be signs of depression.

That might not have to be the case though, according to Dr. Dawn Buse, a clinical psychologist who is the Director of Behavioral Medicine at the Montefiore Headache Center and an associate professor of neurology at the Albert Einstein College of Medicine in the Bronx. She’s worked on several large migraine studies, including those that look at depression and anxiety associated with migraine or chronic migraine.

We sat down with Dr. Buse to talk about how to combat feelings of hopelessness and other methods of coping with migraine.

AMF: Through your studies, what have you found life like for those who live with migraine?

DB: Migraine can affect every aspect of someone’s life, including work, school, leisure and social activities. It can also have a big impact on families. We have heard from the thousands of people who have participated in our studies that that migraine negatively impacts important and major parts of their life causing them to not be able to participate fully or to miss out on activities completely. My patients often tell me that they feel like life is passing them by. This can lead to feelings of frustration and anger, anxiety and worry about when the next attack might come and what it will impact, and depression which may include feeling helplessness and hopelessness.

AMF: Who is most impacted by migraine?

DB: Work and school are also significantly affected by migraine. It can be very difficult to function at one’s best when living with migraine. People may miss work or school, may not be able to take on roles or responsibilities or may feel that they cannot even continue school or work. I have talked with people who have told me that they had to leave their career or drop out of school due to migraine and that is a major loss. It’s heartbreaking for people to not be able to pursue their dreams because of this chronic debilitating disease. In addition to the big impact migraine can have on the life of the person living with the disease, the effects of migraine can spread further, like ripples in a pond. Family members including spouses and children can be very impacted by migraine. They person with migraine may not be able to participate in family roles and responsibilities. This can affect everything from daily household routines and activities to cancelling or not being able to plan a family vacation or major event. Family members may feel like they do not get to spend time they want with that person and the stress of migraine can impact every member of the family.

AMF: What lifestyle changes can people with migraine adopt early on after a diagnosis to help curb the onset of depression?

DB: Maintaining a healthy lifestyle is critical to living well with migraine and avoiding depression and anxiety. This includes a good balance of sleep, healthy eating, exercise or staying active as much as possible, and managing stress. A key to stress management is that while we can’t always control what happens to us or what is happening in the world, we can control how we react to it. Some people will observe that there are reliable triggers for their attacks. Sometimes these conditions are within our control and sometimes they’re not. Something not within our control may be a weather change, like a big storm coming and a drop in barometric pressure. Something within our control might be managing stress that happens during a big project at work, planning a wedding, or finals week. One of the biggest stressors may be worrying about migraine itself- not knowing when the next attack might strike, wondering if a treatment will help and worrying about what the future holds. There are several ways to manage stress both during major events and on a regular daily basis. Focus on activities that you find enjoyable and relaxing such as participating in a hobby, spending time with a friend or your pet or taking a walk around the neighborhood. Try to incorporate these activities into your regular schedule. In addition, practices that calm your nervous system are scientifically proven to help migraine. These include diaphragmatic breathing, guided visual imagery, and other forms of relaxation such as meditation and yoga. People often feel that they are too busy to participate in relaxing activities; however, even a few minutes can have an important benefit for the nervous system. However, if you feel like stress, depression or anxiety have become overwhelming or family relationships are suffering due to migraine talk to a psychologist or other mental health professional who can help.

AMF: Are there any support groups people with migraine can join?

DB: The American Headache and Migraine Association (AHMA) is the patient organization of the American Headache Society (AHS). They offer both online and in person activities, communities and education including an annual conference held each June. In addition, organizations such as the American Migraine Foundation not only work to advance research but also offer educational materials. People with migraine often feel alone and that others do not understand what they are going through. This can lead to feelings of loneliness, isolation and shame. On the contrary, there are literally 1 billion people in the world living with migraine. The more you start to reach out, whether online or in person, the more connected, empowered and hopeful you may feel.

AMF: What can friends, family members and loved ones do to help the person in their life who experiences migraine?

DB: Open communication is essential. One component of communication is planning ahead as a family so that everyone knows what to do during a migraine attack and having plans in place to care for family members and manage household responsibilities. It is important to speak openly with family and friends about your experience with migraine. Let people around you know how they can help you and accept help when it is offered. So often friends and family want to help, they just don’t know what to do. This can help loved ones feel more knowledgeable and empowered about how they can help, which makes everyone feel better. For example, you could tell your child, “When I am having a migraine attack, please bring me a cold wash cloth or can you play quietly in another room as I start to feel better?” Giving people something to do makes them be part of your team instead of feeling like they’re isolated or separated from you, and may also reduce your own feelings of sadness, guilt or isolation. And having backup plans in place to take care of family responsibilities during an attack may reduce your worry so that you can just focus on feeling better.

AMF: What can people with migraine do to cope with the feeling of hopelessness?

DB: While sometimes it may not feel like it, there are many reasons to feel hopeful. Unlike most many other diseases, migraine tends to get better over the lifetime on its own. In addition, this is a very exciting time for migraine treatments. There are currently a number of new medications, devices and non-pharmacologic therapies being developed and tested for migraine. There are many things that you can do now to help lessen the negative impact of migraine on your life and your well-being. While it may feel like migraine has taken over your life and taken away so many good things, there are treatments and steps you can take either on your own or with the help of a professional that can give you back some feeling of control over your life. And with that feeling of control comes hope and optimism for the future.