Anxiety, Depression, and Migraine

Migraine and mental health are strongly tied together. You can really see that tight correlation when it comes to the trio of depression, anxiety, and migraine, which go together like chocolate, vanilla, and strawberry. People with migraine are much more likely to have depression and anxiety than people without migraine, and vice versa: Having depression puts you at three times the risk of developing migraine than people without depression, and anxiety puts your migraine risk even higher.

The numbers are overwhelming: 50.6 percent of migraine patients have anxiety, depression, or both. Compared to people without migraine, people with migraine have three times the risk of developing major depression as their non-migraine peers, and are more than three times more likely to have anxiety. As if that wasn’t already the bad news, the mental health disorders worsen your migraine condition, increasing the frequency, duration and intensity of attacks.

The Links Between Migraine, Anxiety, and Depression 

It feels tempting, even logical, to say that migraine causes anxiety or depression, since migraine creates so much pain, unhappiness, and worry, and many people develop mood disorders after living with migraine for some time. Who wouldn’t be upset? In addition, people with chronic migraine, who suffer from more migraine attacks, have anxiety and depression at higher rates than their episodic peers — so it would add up to think that more pain would lead to more depression. Right?

Actually, no! People with other chronic pain conditions, like back pain, don’t get depression nearly as often as those with chronic migraine. Plus, lots of people start out with anxiety and depression but no migraine, only later “graduating” into migraine disease, so it’s clear that migraine isn’t the cause.

Rather, there’s some sort of intimate biological relationship between migraine and mood disorders, which may use the same pathways. Researchers also note that anxiety and depression, like migraine, tend to run in families, and recent studies have suggested a genetic link between them. In other words, mood disorders are the result of a combination of brain chemistry, genetics and environment — just like migraine. 

Let’s take a closer look at how anxiety and depression can manifest in people with migraine: 

• • If you have an anxious personality to begin with — a nervous disposition, with a tendency to worry, or get “stuck” in your own head — that anxiety tends to worsen with migraine.
  • A type of anxiety common in migraine is “adjustment disorder,” when someone has trouble coping after a stressful life event and reacts with overwhelming anxiety. Stressful life events are also correlated with developing chronic migraine.
  • The most common anxiety symptoms in people with migraine are worrying, the inability to stop or control worries, and feeling “on edge” with difficulty relaxing.
  • The most common depressive symptoms in the general migraine population are hopelessness, fatigue, decreased concentration, and irregular sleep or appetite.
  • In people with chronic migraine who then were diagnosed with depression, depression symptoms revolve around mourning their lost quality of life, missing out on activities, and guilt about not spending time with family or excelling in academics/career.

Telltale Signs Of Depression And Anxiety

Migraine, depression and anxiety share a lot of physical symptoms like fatigue, difficulty concentrating, muscle tension, and appetite or sleep issues. Telling the difference between the disorders, then, relies more on examining your emotions and the contents of your thoughts.

Anxiety:

• • Worry often about migraine, even when you don’t have one; obsess over when the next attack will occur
  • “Catastrophizing” (imagining the worst-case scenario) about migraine or other elements in your life
  • Fear or panic about pain, or about missing work/school/events
  • Physical symptoms of panic: heart racing, feelings of going crazy or losing control, sweating, feeling faint, nausea

Depression:

• • Hopelessness about your ability to return to work/school, feel positive emotions, or be pain-free
  • Guilt about missing work/school, fun/important events, not being present/active with loved ones
  • Feeling worthless or like a burden to others because of your migraine needs
  • Disinterest in previously enjoyed activities. This may also look like the belief that it’s pointless to even try an activity because it won’t be as good as before, or it could aggravate a migraine
  • A pattern of sadness and being easily upset/tearful, even when not in pain

Effective Ways to Treat Depression And Anxiety

It’s important for someone with migraine to recognize and treat their anxiety and depression. Not only do the disorders lessen your quality of life, they make migraine worse. In addition, since anxiety and depression are risk factors for migraine, getting early treatment for a mood disorder could reduce the risk of developing chronic migraine later on. Behavioral treatments, lifestyle changes, and medication are all effective for reducing anxiety and depression, including:

Anxiety:

• • Weekly psychotherapy with a focus on cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT)
  • Biofeedback to learn physical and mental relaxation strategies
  • Lifestyle changes: exercise, diet, sleep, relaxation regimen (like meditation or deep breathing)
  • “Worry time”: Schedule time to write out worries. Problem solve for what you can control. Work to mentally let go of that which cannot be controlled
  • Psychiatric consultation for anti-anxiety medication

Depression:

• • Weekly psychotherapy with a focus on cognitive-behavioral therapy (CBT), positive/goal-oriented psychology; trauma-focused if you have trauma history
  • Behavioral activation: Outline your values/passions. Then engage in meaningful and necessary activities daily, even if your mood is low
  • Psychiatric consultation for anti-depressant medication. Important note: some antidepressants are often prescribed for migraine prevention, particularly SSRIs (like Prozac) and SNRIs (Effexor, Cymbalta). For patients with both depression and migraine, this option holds the potential to relieve both problems at once
  • Lifestyle changes: exercise, diet, sleep, hobbies, socializing
  • Crisis plan with resources in case of suicidal thoughts

You can explore any of the above treatment options by themselves, or in combination, to help relieve anxiety and depression. Call your doctor and start on a plan right away. You, and your health, are worth it.

Did you learn some new strategies to improve your mental health? Start putting them to use with “The 4-Step Guide to More Connection (& Less Depression & Anxiety) for Migraine.”