The evidence connecting migraine and mental health

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Migraine and mental health are intimately related. According to a 2021 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.

Anxiety and depression are more common in individuals who experience migraine than those who do not. According to 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.

A 2020 study also found that people with anxiety and depression were more likely to experience migraine.

Migraine is also common among people with bipolar disorder. Some research suggests that around 30% of people with bipolar disorder will experience migraine at some point, while around 5.9–9% of people with migraine also have bipolar disorder.

Migraine with bipolar disorder may be more likely to affect young people and people assigned female at birth.

There may also be links between post-traumatic stress disorder (PTSD) and migraine. One study suggests that 30% of people with PTSD experience persistent post-traumatic headache (PPTH), which can increase the risk of migraine.

Stress is a possible trigger for migraine. The pain associated with migraine can also contribute to stress. Taking steps to manage stress can help to prevent this or reduce the likelihood of migraine headaches.

The cause-and-effect relationship between mental ill-health and migraine is unclear.

Studies suggest that depression is a strong predictor of the progression from episodic to chronic migraine. However, 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 on siblings and twins have shown that migraine and mental health problems tend to cluster together in families.

For example, a 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.

Hormones may also play a role. Although migraine occurs more frequently in people assigned female at birth, migraine with comorbid anxiety is more common in males.

Furthermore, some females 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.

Antidepressants can help manage depression and anxiety. Healthcare professionals also consider antidepressants an effective preventive 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 (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), 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 often pairs 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 combined with certain medications, 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 also improved symptoms of stress, depression, and anxiety.

There are 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 a 2020 analysis of approximately 30,000 adults in Japan, people with migraine are over twice as likely to miss work and report more frequent interruptions 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.

A doctor may recommend integrating behavioral therapy that focuses on participating in enjoyable or rewarding activities.

The relationship between migraine and mental ill-health is complicated. A combination of genetic, hormonal, and environmental factors likely drives it.

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.