Migraine, Depression, and Anxiety: What You Should Know

Here's the painful truth—migraine headaches, depression, and anxiety frequently occur together and it's a gruesome threesome. But the key to reducing migraines just may lie in treating your mental health. Here's why.

Treating the anxiety and depression that often accompany migraine can reduce the frequency and intensity of the headaches.

If you are living with migraine, you may already know you’re at risk for anxiety and depression. In fact, people with migraine are two to five times more likely to experience one of these mental health conditions, according to the American Migraine Foundation. Some 50% of migraine patients have anxiety while 25% live with depression.1

Migraine can be debilitating and unpredictable, notes Alex Dimitriu, MD, who is double board-certified in psychiatry and sleep medicine and is the founder of Menlo Park Psychiatry and Sleep Medicine in Menlo Park, California.

“Migraine can also create a sense of distrust of self. You don’t know when the next attack may happen and what activity it may interfere with,” he says. “Beyond life interruption, migraine is difficult and painful. There can be anxiety over the next attack and depression because of being unable to get the symptoms fully under control.”

“It’s a big problem,” says Kiran Rajneesh, MD, a board-certified neurologist and pain physician at The Ohio State University Wexner Medical Center. “And while you can treat the migraine, if you don’t treat the underlying anxiety and depression, then the person can’t go back to work or enjoy their life. They also may be at a higher risk for starting to use more alcohol to get relief.”

Chronic Migraine Linked to Anxiety and Depression

People who have chronic migraine (meaning they have migraine more than 15 days each month) as well as those who have migraine with aura, which is disabling and can cause weakness and numbness, are more likely to also have anxiety or depression, says Prerna Malla, MD, a neurologist at MedStar Washington Hospital Center in Washington, DC. “And it can be bi-directional,” she says. “People with anxiety and depression are more likely to have migraine and people with migraine are more likely to have anxiety and depression.”

Exactly why these conditions exist together is not clear, says Dawn C. Buse, PhD, clinical professor in the department of neurology at Albert Einstein College of Medicine in New York City and a member of the Board of Directors of the American Headache Society.

“Rather than one causing the other, it’s possible that migraine, depression, and anxiety may share underlying causes such as a genetic predisposition,” she says. “Or they may all use the same neurotransmitters and systems in the brain.”

Scientists do know that the hormone serotonin, is involved in migraine as well as anxiety and depression, note researchers at Johns Hopkins.2

How Treating Anxiety and Depression Help with Migraine Headaches

Too often, depression and anxiety are underrecognized in people who live with migraine.

“People aren’t reporting it enough and recognizing it is a big problem,” says Dr. Malla. “We screen our patients with migraine for depression and based upon our assessment, we try to use a medication that will work for both migraine and depression.”

It’s certainly easy to understand how the stress and worry when your next migraine will strike can cause anxiety. It’s also easy to see how migraine-related disappointment (i.e., missing family gatherings or a highly anticipated event) can trigger depression. But those dots are not always connected.

The good news is that anxiety and depression decrease with successful migraine management, says Dr. Buse.

And conversely, treating the depression or anxiety can improve the individual’s quality of life and reduce the overall disability of migraine.

Recognizing The Symptoms of Anxiety and Depression
Depression and anxiety can be easy to overlook when you are distracted by the pain and disruption of chronic migraine.

Many people (and some doctors) don't understand the close connection between mental and physical health so they don't  connect the dots.

Some symptoms are fairly obvious, others not so much. Here, both common and less well-known symptoms of anxiety and depression. Some may surprise you.3,4

Common Signs of Anxiety

  • Shortness of breath
  • Racing heart
  • Ruminating thoughts—overthinking and worrying about everything

Lesser-Known Signs of Anxiety

  • GI-related symptoms such as indigestion
  • Fatigue
  • Hot flashes and/or chills from panic attacks

Common Signs of Depression
Persistent feelings of sadness and hopelessness are what most of us picture when we think about  depression but here are some less-obvious signs:

  • Increased sensitivity to pain
  • Stomach aches
  • Headaches
  • Weight gain
  • Anger and/or increased irritability
  • Lack of emotion—feeling numb or just blah
  • Drinking more alcohol 
  • Doing anything in excess (i.e., too much time on Facebook or shopping on line compulsively)
  • Neglecting your appearance
  • Insomnia or disrupted sleep

Treating Migraine, Anxiety, and Depression

Headache treatments and medications work better when depression and/or anxiety are treated in tandem.

Among the benefits of addressing your mental health symptoms—better medication compliance, more energy, and a more positive mood.

Some medication—amitriptyline, for example—can do double duty, treating depression and reducing the frequency of migraine. The same can be said of anxiolytics, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs) which can be prescribed to treat anxiety but also help with headache pain.5

Behavioral therapy such as like cognitive behavioral therapy (CBT) or biofeedback, and relaxation therapies can address anxiety and depression by teaching coping skills.

For long-term relief, behavioral therapies are more effective than medication for anxiety. For many patients, combining medication with behavioral therapy is more effective than using one on its own to treat anxiety, depression, and migraine, according to the American Migraine Foundation.

If you feel that your migraine is making you feel anxious and depressed, Dr. Buse suggests that talking to your primary care doctor is a good starting point. The doctor can perform an assessment and point you in the right direction for treatment. 

“You can also explore some of the techniques such as relaxation therapies on your own, using web-based and app-based programs,” she says. “These treatments can have both quick and long-lasting benefits.”

What You Can Do Right Now

Lifestyle changes such as sleep, exercise, and diet are effective for migraine, anxiety, and depression, says Dr. Rajneesh.

“We look at what we may be able to change in a patient’s lifestyle, such as sleep hygiene,” he says. “It’s important to go to bed on time and to get six to eight hours of sleep. Exercise such as walking or swimming can give you a sense of well-being and work with your medication to give pain control.”

Good quality sleep and enough of it is essential, says Dr. Dimitriu. “Good, refreshing sleep can improve migraine symptoms as well as improve the symptoms of depression or anxiety, whether they are migraine related or not,” he says.

Knowing your limits helps, too, he says. “Try to limit stress and mental or physical overexertion whenever possible,’” Dr. Dimitriu advises.

Updated on: 06/21/21
Continue Reading:
Chronic Pain and Mental Health: The Empowered Patient's Guide