Migraine, anxiety & depression: How it is connected and how to manage it

Migraine is a challenge not only for our body but also for our mental health and social wellbeing. During the World Migraine Summit 2021, Dr Noah Rosen explains how our physical and emotional wellbeing is connected and what we can do to improve both. Here’s our summary from his interview

What comes first: Migraine, anxiety, or depression?

Experiencing anxiety when living with migraine is 2-5 times the risk than the risk of those who don’t have migraine. For depression, people with migraine are at 2-2 ½ times the risk. Yet, the question is, what comes first? Experts look at that from several perspectives: 

  1. It’s happening by chance that you experience both. 
  2. There is an underlying process in our brain taking place in an area, the limbic structure, that is responsible for processing pain and emotions. 
  3. Causation, meaning that one comes first and influences the other (although there is no clear evidence for that). 

For Nr. 3 we have to be cautious because this is subject to our interpretation which can lead us astray. What can be said, however, is that anxiety and depression are a predictor for episodic migraine transforming to chronic migraine (= experiencing headache days more often than not). 

When to treat anxiety, depression, and migraine

Migraine and mental health should be treated at the same time. Even if physical symptoms seem more important when somebody starts to experience migraine, addressing the influence of mood early is essential. While there are medications for both mental health disorders and migraine, acquiring coping and pain management strategies from the start can improve treatment outcomes. 

How to build resilience against the fear of a migraine attack

Numerous studies have shown positive effects of techniques such as cognitive behavioural therapy, biofeedback, progressive muscle relaxation, or mindfulness. None of those will work universally. You have to find what fits your needs and train your resilience like a muscle. 

We all start to build resilience as children, learning from positive experiences and the strategies we use to overcome negative experiences. Supporting this natural process with the strategies named above can be very helpful for young people who have migraine and their families. 

How do neurologists view mental health and migraine?

Due to the evidence on behavioural and coping techniques, the scientific community generally accepts the relationship between migraine and mental health. Why then, might neurologists not sign-post you to mental health support? 

Neurologists who are not specifically trained in mental health support might feel uncomfortable with giving you advice on the topic. The time they have for each patient is limited and they prioritise talking about the physical challenges of migraine and their treatment. 

This does in no way mean that you should postpone learning coping techniques and seeking support for your emotional wellbeing. A simple start is talking with your family, friends, or your community about the challenges you face. Additionally, you can find several resources for mental health support & pain management and also reach out to professional psychologists or psychiatrists. 

Reach out if you need help with finding the right resources! 


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