You wake up refreshed from a good night’s sleep and are ready to face another day.
Then, you feel it. The tingling sensation you get or flash of light you see before a migraine headache starts. What began as a good day now has you feeling stressed, worried, and anxious about when the pain will hit. And though you woke up ready to face another day, you now just want to go back to bed — not because you’re sleepy but because you’re tired — tired of migraine attacks disrupting your life.
If you’re dealing with chronic migraine and feeling more depressed and anxious, it’s not all in your head — there is a link between mood disorders such as anxiety and depression and migraine.
Keep reading to learn how they’re connected and how you can build your life around them.
Why Migraine, Depression, and Anxiety Often Show Up Together
Doctors aren’t sure what the direct connection is between migraine, depression, and anxiety. All three conditions are fueled by chemicals in the brain that control mood and the body’s response to pain. Studies have shown that having migraine increases the risk for depression, and having depression increases the risk for migraine. Variations in shared genes are suspected. All three conditions — migraine, depression, and anxiety — are linked to genetic and environmental factors.
But what if depression and anxiety aren’t in your genes? It could also be your body’s natural response to constant worry, frustration, and sadness that come with living with a chronic pain condition.
How migraine affects mood disorders
“Migraine and mood are closely connected, but clinical depression and anxiety do not cause migraine or vice versa,” says Simy Parikh, MD, director of the Emory Comprehensive Headache Center and associate professor of neurology at the Emory University School of Medicine in Atlanta, Georgia. “Migraine attacks are much more than head pain. They involve brain regions that affect the body in different ways, including regions that also play a role in mood, such as the amygdala.”
Parikh says depression and anxiety can worsen during the warning phase of a migraine attack (prodrome). You may also feel depressed if you experience fatigue during and after the attack (postdrome).
How mood disorders affect migraine
Changes in the body’s normal balance (homeostasis) can trigger a migraine attack. When this happens, it can set off changes elsewhere in the body that affect your mood. “Mood disorders like depression and anxiety are affected by levels of stress hormones (like cortisol) and brain chemicals (such as serotonin and dopamine),” Parikh says. “Changes in these levels can trigger or worsen migraine episodes as well as mood disorders, creating a two-way relationship between migraine and mood disorders.”
Migraine and Mood Disorder Stats
Depression and anxiety are the two mental health conditions seen most often in people who have migraine. In fact, studies show mood and anxiety disorders are 2-10 times more common in people who have migraine than those who don’t. And 30%-50% of people who live with chronic migraine — 15 or more headache days per month — also have anxiety.
Signs It’s More Than Just a Bad Migraine Day
Sometimes, it might not just be a bad migraine day. Track your mood and behavior over time, as changes could point to a mood disorder. German “Tony” Reyes, MD, a board-certified psychiatrist with Wellstar Psychiatry, an affiliate of Wellstar Medical Group, in Austell, Georgia, says that while migraine pain and symptoms are focused on that day, depression and anxiety symptoms are long-term.
“If you’re having pain, you’ll retreat, but (with depression) it’s not just a day of being withdrawn, it’s days of being withdrawn or several days of social isolation and having less interest in things that brought you pleasure.”
Depression symptoms
Other signs of depression include:
- Generalized fatigue
- Change in appetite
- Trouble concentrating
- Constant sadness
- Feelings of guilt
- Fear when there’s pain
- Loss of interest in activity
- Too much worry
- Changes in sleep
Anxiety symptoms
We all experience anxiety from time to time. If you’re living with chronic migraine, it’s natural to worry about your next attack. But if your worry interferes with your daily life, you may have an anxiety disorder. Symptoms include:
- An impending sense of doom
- Being nervous, restless, or tense
- Trouble sleeping
- An increased heart rate
- Rapid breathing
- Trouble concentrating
- Trouble controlling worry
When to seek help
If you have five or more symptoms of depression or anxiety for at least two weeks, talk to your doctor. They can prescribe medications to help you feel better or refer you to a mental health professional for additional treatment.
Suicidal thoughts and getting urgent help
If you have thoughts of hurting yourself, get help right away. Go to the nearest emergency room, or call or text 988 (Suicide & Crisis Lifeline).
Treating Chronic Migraine, Depression, and Anxiety
If you’re dealing with chronic migraine and mood disorders, help is available. Seeking help is not a sign of weakness. Instead, it’s a sign of strength.
Where do you start?
Reyes says the first step is to talk to your primary care physician (PCP), or your regular doctor. “When we’re experiencing symptoms, there are a number of things our PCP can look at, such as a complete blood count (CBC) panel, to make sure everything is at a baseline.”
If your migraine attacks increase to where you have one to three attacks every four months, Reyes says your next call should be to a neurologist. “They’ll want to assess what’s causing them, and if they haven’t impacted your mood yet, great. If you have depression and also have migraine, ask for medications that can treat both conditions.”
If you’re still having migraine attacks and feeling depressed or anxious, it’s time to see a psychiatrist. “The psychiatrist will manage medications but also can provide cognitive behavioral therapy, which includes healthy ways of thinking and healthy coping strategies,” Reyes says.
What do you say?
Be honest with your doctor about your symptoms. Tell them how often you feel sad, frustrated, or worried about your next migraine attack. If you feel overwhelmed by your symptoms, tell them that, too. The more information they have, the better treatment plan they can create.
What will they do?
As you’re examined, you’ll fill out questionnaires and have physical and neurological exams. There aren’t lab tests to help diagnose these conditions. But, if your doctor thinks it’s needed, you may be sent for imaging tests such as a CT scan or MRI. Based on your symptoms and concerns, your doctor will recommend treatment. Your treatment plan may include medications, therapy, alternative treatments, or a combination of treatments.
Medications
Your doctor can prescribe medications that can help with both migraine and mood disorders. Tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) boost chemicals (serotonin) in the body that affect mood. They also work to block pain signals in the spinal cord.
Medications your doctor may prescribe include:
- Amitriptyline
- Duloxetine
- Nortriptyline
- Venlafaxine
Do you need treatment changes?
Some medications your doctor prescribes for chronic migraine can actually make your depression or anxiety worse. These include:
- Beta blockers, such as propranolol
- Corticosteroids
- Opioids (oxycodone)
Talk to your doctor if you notice any negative changes in your mood caused by medications.
Talk Therapy
Even if your medications are easing your symptoms, your doctor may recommend adding therapy to your treatment plan. A therapist can help you learn ways to manage your condition. Cognitive behavioral therapy (CBT) techniques help change your thought patterns. Studies show that CBT can decrease the number of migraine attacks you get, along with the intensity of them.
Tips for finding a therapist
Your PCP can make recommendations or referrals to a therapist. Ask for a therapist who understands how mental health and migraine are linked. You might also look for a therapist who is experienced in behavioral therapy or mindfulness and relaxation practices. You can also use the “find a doctor” feature on the American Migraine Foundation website to find doctors who treat migraine and mental health conditions in your area.
Other Treatments for Depression and Anxiety
In addition to medication and talk therapy, there are a number of other treatments your doctors may recommend to treat your depression and anxiety.
Transcranial magnetic stimulation (TMS). This is a nonsurgical treatment that uses a magnet to influence your brain’s natural activity. It targets the parts of your brain that relate to mood, feelings of pleasure, and decision-making. The FDA has approved TMS as a treatment for both migraine and major depressive disorder (MDD).
Biofeedback. With this treatment, a doctor uses instruments to monitor your body’s involuntary actions. Those are things you do without thinking or even realizing it — such as your heart beating, breathing, and holding tension in your muscles. Based on your body’s feedback, your doctor recommends ways you can consciously change your body’s involuntary responses. This can be used to treat depression, anxiety, and migraine.
Light therapy. This treatment works by helping control your body’s circadian rhythm (its natural sleep and wake cycle) and other functions such as digestion and hormonal activity. With this treatment, you sit in front of a light source for 30 minutes each morning as soon as you wake up. The light activates your circadian clock. If you respond to this treatment, you may begin seeing improved mood and fewer headaches within a week.
Lifestyle Changes That Can Help With Depression and Anxiety
Reyes says simple lifestyle changes each day can help ease depression and anxiety symptoms. These include:
Maintain a regular schedule. Go to bed and wake up at the same time every day. “Our body craves regular ups and downs,” he says.
Eat regular, balanced meals. “Nutrition is a very big deal. Avoid excess caffeine and skipping meals — this will affect the neurochemicals in your brain.”
Get regular exercise. “I recommend low-impact exercise — yoga, swimming, walking — three to five times a week to regulate endorphins.”
Keep a journal. This helps you track your headaches, identify food allergies and triggers, and watch for changes in your mood. “If you rate your mood from 1 to 10, with 10 being really good and 1 being not good at all, and it’s been a week where you’ve had lots of 3s and 4s, you can be more self-aware.”
Parikh says these lifestyle changes, combined with stress-reduction techniques such as mindfulness, meditation, or relaxation exercises and maintaining social connections, can help reduce not only depression and anxiety but also chronic migraine symptoms. But she says if you’re dealing with chronic depression and anxiety, lifestyle changes alone may not be enough. “It’s important to consult your PCP or psychiatrist to determine whether medication or therapy should be part of the treatment plan alongside these lifestyle modifications,” she says.
When You Feel Overwhelmed
Sometimes, the pain, frustration, and depression that can come with living with chronic migraine can feel like too much to handle. When you feel overwhelmed, try these tips from Parikh to center yourself in the moment:
Practice deep breathing. Breathe slowly and deeply from your belly to trigger your body’s relaxation response.
Focus on your five senses. Notice what you can see, hear, touch, smell, and taste to bring yourself back to the present.
Schedule worry time. Set aside a specific 15-minute period to worry, and write down your worries and concerns on a piece of paper.
If you need further support, pick up the phone and call a friend or loved one. Tell them how you’re feeling and how they can help. If you need urgent help or are having thoughts of hurting yourself, call the 988 Suicide & Crisis Lifeline.
