Chronic migraine—characterized by headaches at least 15 days a month, at least 8 of which have migraine symptoms—is often linked to anxiety and depression. Migraine attacks go far beyond typical headaches, making it difficult to work, socialize, or even go about normal activities of daily living.
Here, we'll explore the connection between chronic migraine, anxiety, and depression, how chronic migraine can impact your mental health and overall quality of life, treatment options for chronic migraine, and how Evidation's MigraineSmart tool can help you understand your triggers, allowing you to make lifestyle decisions that may lessen the days you suffer from chronic migraine symptoms.
Understanding the bidirectional link between chronic migraine and depression
Anxiety, depression, and migraine are linked. Research shows that the more frequently a person experiences migraine attacks, the more likely they are to experience depression. Anxiety and chronic migraine are similarly linked—up to 50% of people who experience chronic migraine also report anxiety symptoms.
The links between anxiety/depression and chronic migraine are bidirectional. This means that people who have anxiety and depression may be more likely to develop or experience chronic migraine, and people who have chronic migraine may be more likely to develop or experience anxiety and/or depression.
Migraine and mental health have biological mechanisms: neurotransmitters, inflammation, and hormonal influences
Researchers aren't totally sure why the conditions are related. Neurotransmitters, especially serotonin and dopamine, play a key role in both depression and migraine. Both chemicals affect pain, mood, and sleep pathways. Inflammation is also a common denominator for migraine and depression. When the body experiences excess stress, it can interfere with the way the brain functions. Inflammation has been linked to both mood issues and migraine frequency.
Hormonal changes also play a role in anxiety, depression, and migraine. Many women experience both migraine and mood changes around their menstrual cycles, during pregnancy, and during perimenopause/menopause.
Migraine, depression, and anxiety can all run in families, indicating that there's a potential genetic component to all three conditions. Migraine and depression have biochemically similar causes, making it possible that people who are predisposed to one condition are also predisposed to the other.
The impact of chronic migraine on mental health and quality of life
As we mentioned, a migraine is more than just a headache. In addition to intense pain, people who experience migraine also experience debilitating nausea, sensitivity to light and sound, dizziness, and an inability to carry out normal daily activities. Many migraine sufferers feel that their pain isn't understood, especially since their symptoms aren't usually visible to the outside world. People who experience migraine may feel defeated, isolated, or hopeless when they aren't able to function normally.
All of these issues can deeply affect mental health. When life becomes unpredictable and painful due to chronic migraine, anxiety and depression can easily creep in, especially for people who may be genetically predisposed to these conditions. Treating migraine isn't just about easing pain—it's also about restoring quality of life.
Depression as a consequence of chronic migraine
Depression doesn't always come first. In many cases, depression develops in people who have dealt with migraine for long periods of time. Chronic pain-induced depression can occur in people living with chronic migraine. Many people who experience chronic migraine find that they experience a frustrating period of grief as they are no longer able to participate with loved ones as they once did.
People who have chronic pain that's severe enough to limit their independence are more likely to become depressed than those who are able to maintain their independence despite chronic pain. Anxiety is also a common response to chronic pain. Many people who experience frequent migraine attacks find that their anxiety doesn't just flare up when they know they're about to have an attack. It can also flare up on good days, as they feel on edge, wondering when the next episode will occur.
Coping with persistent pain
For many people, coping with chronic migraine takes a mix of strategies, including:
- Acknowledge your pain. It's important to acknowledge the pain rather than pretend it doesn't exist. Denial can lead to burnout.
- Seek medical care. While this may sound like a no-brainer, some people try to push through chronic pain, rather than asking a medical professional for help. Seeking medical help for chronic pain can be the first step toward finding a treatment strategy that works for you.
- Manage stress. There's no way around it—chronic migraine is a stressful condition. Using stress management techniques like breathing exercises, meditation, mindfulness, and progressive muscle relaxation can help.
- Track your symptoms. Using a tracking tool like Evidation's MigraineSmart can help you understand patterns and avoid migraine triggers.
- Lean on your support system. It's difficult to live with chronic pain. Talking to a family member, friend, or therapist can help to ease the mental health symptoms that often come with chronic migraine.
Treatment strategies
Your healthcare provider will work with you to develop a strategy that makes sense for your needs. Typically, doctors recommend a mix of medical and nonmedical strategies uniquely tailored to alleviate your migraine pain.
For someone who is struggling with chronic migraines and anxiety and/or depression, treatment goals are twofold: your doctor will work to both support your mental health and reduce migraine frequency and severity. Ignoring one condition can make the other worse, so it's important to get treatment for both issues at the same time.
Pharmacological and non-pharmacological approaches
Some of the pharmaceutical medications your doctor might prescribe to treat anxiety/depression and migraine include:
- Antidepressants: In some cases, antidepressants can offer a one-two punch that can treat both migraines and mental health issues. Tricyclic antidepressants and SNRIs are both known for supporting migraine relief while also relieving anxiety and depression symptoms.
- Anti-seizure medications: Your doctor may prescribe anti-seizure medication to treat your migraine, as some have shown promise in reducing migraine frequency.
- CGRP inhibitors: These new medications are designed to block extra calcitonin gene-related peptides, or CGRPs, in the body. CGRPs are naturally-occurring compounds that can increase the severity or duration of migraines.
- Triptans and NSAIDS: These medications are often used during migraine attacks to reduce the severity of symptoms.
In addition to medications, your healthcare provider may also recommend other types of treatment, including:
- Cognitive behavioral therapy (CBT): This type of therapy can help you gain control over thought patterns and behaviors that may contribute to depression and anxiety, potentially reducing migraine symptoms.
- Meditation and relaxation training: Your healthcare provider may suggest meditation and relaxation exercises to help you control muscle tension, heart rate, stress levels, and other factors that may contribute to migraine attacks.
- Acupuncture: Some people find that acupuncture helps to reduce the severity and/or frequency of migraine.
- Exercise and/or physical therapy: Moderate exercise can help to reduce the symptoms of depression, and may help to reduce the number of migraine attacks you experience.
The role of lifestyle modifications in managing both conditions
Daily habits make a major difference in controlling anxiety, depression, and migraine. Thankfully, there are many habits that can help to reduce the symptoms of all three conditions.
Maintaining consistent, healthy habits in the following areas may help you reduce migraine, anxiety, and depression symptoms:
- Sleep. A consistent, healthy sleep schedule can help to balance your mood, lessen anxiety, and reduce migraine.
- Nutrition: Some foods can trigger migraines. Most people who experience food-based triggers find that processed meats, aged cheeses, and alcohol are particularly likely to cause symptoms. Enjoying a diet rich in lean proteins, fruits, and veggies can support your overall health and may help to reduce migraine and mental health symptoms.
- Hydration: Getting plenty of water (and reducing or eliminating beverages that can dehydrate you, like alcohol and caffeine) can support overall mental health and prevent migraine attacks.
- Exercise: As we mentioned, getting frequent, moderate exercise can help to boost feel-good chemicals and may prevent migraine attacks.
When to consult a healthcare provider
If you're dealing with frequent migraines, or you've noticed changes in your mood, sleep, or motivation, it's important to talk with your healthcare provider. If you have headaches or headaches with migraine symptoms more than 15 days a month, you're frequently relying on over-the-counter or prescription pain medication to control migraine pain, you're struggling to take care of yourself, and/or you feel hopeless or disinterested most days, talk to your doctor or mental health provider.
MigraineSmart: Evidation's migraine symptom tracking tool
Last year, the Evidation team debuted MigraineSmart, our migraine symptom tracking program within the Evidation app. We understand the debilitating effect that migraine can have on day-to-day life, and we're working to help our members track symptoms to find connections between migraine occurrences and lifestyle factors.
When you track your symptoms with MigraineSmart in the Evidation app, you'll get personalized weekly insights that pinpoint connections between symptom logs and lifestyle activities. When you share data from your wearable health tracker and log your symptoms, we're able to find connections between migraine and your daily health choices, making it easier for you to avoid triggers and have more symptom-free days. Click here to learn more, download Evidation, and get started with MigraineSmart today.
