The effects of migraine can be debilitating, often affecting many aspects of daily life.
Whether they occur chronically or are episodic, migraine episodes can cause a lot of stress. Stress can also trigger migraine episodes, thereby leading to a vicious cycle that may feel hard to escape from.
Migraine and mental health are intimately related. According to a survey of over 6,000 adults, people with migraine are over twice as likely to report mental ill-health as those without migraine.
Understanding the potential effects of migraine on mental health, and vice versa, is important. Managing one often involves managing both.
In this article, we will examine the relationship between migraine and mental health, as well as some steps a person can take to regain control of their mental well-being.
Anxiety and depression are more common in individuals who experience migraine than those who do not. According to experts at the American Migraine Foundation, people with migraine are five times more likely to develop depression than those without migraine.
People with migraine may be at even higher risk of anxiety. A 2017 study found that, compared with those without migraine, individuals with migraine were 25 times more likely to feel nervous or anxious on a daily basis.
These effects are compounded as the frequency of migraine episodes increases. According to a study in the Journal of Neurology, Neurosurgery & Psychiatry, people with chronic migraine — which means experiencing headaches on 15 or more days per month — are twice as likely to have depression and anxiety as those who experience less frequent episodes.
Migraine is also common among people with bipolar disorder. In a meta-analysis of studies examining the relationship between bipolar disorder and migraine, approximately one-third of those with bipolar disorder I and half of those with bipolar disorder II experienced migraine.
People with post-traumatic stress disorder (PTSD) may also be at increased risk of migraine. However, it is possible that those with PTSD may also develop persistent post-traumatic headache (PPTH), which is similar to migraine but clinically distinct. People with PPTH may be at increased risk of mental health problems compared with those with migraine.
The cause-and-effect relationship between mental ill-health and migraine is unclear. Does migraine cause mental ill-health, or does mental ill-health cause migraine?
The answer is complicated. Studies suggest that depression is a strong predictor for the progression from episodic to chronic migraine, but the treatment of migraine does not necessarily improve measures of anxiety or depression.
The relationship is likely bidirectional, with both contributing a little to the development of the other.
Studies in siblings and twins have shown that migraine and mental health problems tend to cluster together in families.
For example, one 2021 sibling study found that individuals who have siblings with migraine were 40% more likely to develop depression than those without affected siblings, even if they did not have migraine themselves. Similarly, those with siblings with depression were 45% more likely to develop migraine.
These results suggest that both migraine and depression may be caused by an underlying genetic cause, an environmental trigger, or both.
There is a well-established role for serotonin dysfunction in the development of anxiety and depression. Scientists have identified genetic mutations that disrupt serotonin signaling in individuals with anxiety as well as those with migraine.
Additionally, certain drugs that treat migraine headaches (triptans) function by targeting serotonin receptors in the brain. It is likely, therefore, that serotonin also regulates the relationship between migraine and mental health.
Hormones may also play a role. Although migraine occurs more frequently in females, migraine with comorbid anxiety is more common in males.
Furthermore, some women report the occurrence of “menstrual migraine,” which occurs immediately before or during menstruation. Estrogen levels during this period are low, which suggests that estrogen deprivation may play a role in the development of migraine as well as mental ill-health.
There are many medications available that can manage depression and anxiety, such as antidepressants. Healthcare professionals also consider antidepressants an effective treatment option for some cases of migraine. For others, a combination of antidepressants with another medication that directly treats migraine may be more effective.
However, it is very important that people discuss medications with their healthcare professional. This is because studies have shown that, in some rare cases, triptans may not interact well with selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors, both of which can treat depression.
There has also been increasing interest in the use of biofeedback therapy to reduce migraine.
Biofeedback therapy uses a machine to measure stress signals, such as muscle tension or body temperature, to help people recognize the causes of their stress so that they can respond in real time to promote relaxation.
Biofeedback therapy is often paired with relaxation training, in which an experienced therapist teaches proven techniques to reduce stress. These include:
- deep breathing
- progressive muscle relaxation
- relaxation routines
According to the American Migraine Foundation, biofeedback therapy alone can reduce the frequency of headaches by about 45–60%. When used in combination with medication, those results can improve to about 70%.
In a randomized clinical trial, biofeedback therapy not only reduced the frequency and intensity of migraine headaches, but it also improved symptoms of stress, depression, and anxiety.
There are also plenty of lifestyle changes that people can make to prevent or mitigate migraine headaches. These include eating a healthful diet and avoiding stress triggers.
However, when a person has depression, anxiety, or both, it is important that those lifestyle changes do not compromise their mental health in the process.
According to an analysis of approximately 30,000 adults in Japan, people with migraine are over twice as likely to miss work and report more frequent interruption of their daily activities.
Migraine can be very disruptive to everyday life, but it is important to stay engaged with friends or family as much as possible. Isolation can lead to depression or make depression or anxiety worse.
Experts recommend integrating behavioral therapy that focuses on participating in enjoyable or rewarding activities.
The relationship between migraine and mental ill-health is complicated. It is likely driven by a combination of genetic, hormonal, and environmental factors.
An effective treatment plan should address both migraine and mental health concerns, and it may involve a combination of medication and lifestyle interventions.
Focusing on total well-being is key to maintaining both physical and mental health.