Advertisement

Would You Talk To Your Doctor About Migraine Depression And Anxiety?

a doctor in a white coat
Aldo Murillo/Getty Images

According to a new survey, no, most of us would not feel comfortable talking about our migraine and mental health with our doctor. A whopping 77% of people with migraine and depression or anxiety say they hesitate to talk about their mental health with their medical provider, according to the survey released Thursday by the American Migraine Foundation (AMF).

Meanwhile only 45% of headache practitioners think their patients with migraine would hold back talking to them about their mental health for fear of stigma.

Larry Newman, MD, professor of neurology at NYU Grossman School of Medicine and chair of AMF, said of the gap, “I think we need to educate the patients that there are several medical and psychological conditions that are comorbid with migraine, that these disorders occur together, not that they are caused by each other (you are not depressed because you have migraine, you live with migraine and depression).”

Migraine and Mental Health Survey Infographic
Migraine and Mental Health Survey Infographic
American Migraine Foundation
Dr. Newman said it’s important to discuss if you have migraine, depression and/or anxiety because “the more proactive you are, the better chance that you will receive the proper diagnoses and treatment.”

Can Migraine Cause Anxiety or Depression?

“The ‘mental health issues’ that are overrepresented with migraine are depression and generalized anxiety disorder,” explains Newman. “They are comorbid with migraine, meaning that they occur at a rate greater than would be expected by chance. So, although migraine isn’t the result of anxiety or depression (not the cause), there can be a relationship. Frequent migraine may trigger a person with those tendencies to experience a worsening of either condition, and vice versa.”

Pharmacological treatments may be necessary to treat both anxiety or depression and headache disorders like migraine or tension-type headaches. People who include a psychological component to their treatment, however, tend to have better outcomes than those who rely on medication alone. There's growing evidence to suggest adding psychological approaches to medication can decrease the frequency, duration, and intensity of migraine pain — while also improving mood
Migraine Again Verified Source

Brown, H., Newman, C., Noad, R., & Weatherby, S. (2012). Behavioural management of migraine. Annals of Indian Academy of Neurology, S78-S82

View Sourcecitation-arrow
.
More from Migraine Again

Anxiety Disorder

According to the Anxiety and Depression Association of America (ADAA), generalized anxiety disorder, also known as GAD, is characterized by excessive, persistent, unrealistic worry about everyday things, including family, work, money, health, and more.

You may have an anxiety disorder if you
Migraine Again Verified Source

ADAA. Generalized Anxiety Disorder.

View Sourcecitation-arrow
Migraine Again Verified Source

ADAA. Symptoms of GAD.

View Sourcecitation-arrow
:
  • Find it difficult to control worry on more days than not for at least six months
  • Have a frequent sense of impending doom, danger, or panic
  • Frequently feel nervous, irritable, or on edge
  • Have trouble sleeping
  • Have difficulty concentrating (which could also be a symptom of migraine!)

It makes sense that anxiety is a common side effect of living with an unpredictable disease like migraine.

Many people experience migraine anxiety because they don’t know when the next attack will strike or they feel frustrated by the many ways migraine impacts their life (
Migraine Again Verified Source

American Migraine Foundation. The Link Between Migraine, Depression, and Anxiety. May 8, 2018.

View Sourcecitation-arrow
). Anxiety can occur during and in between migraine attacks. Find out how to break the migraine and anxiety cycle here

Migraine Depression

Migraine, especially chronic migraine, is a debilitating disease that often comes with depression. Depression is more than just feeling under the weather. The National Institute of Mental Health describes depression as a mood disorder that causes severe symptoms that affect how you feel, think, and handle daily activities
Migraine Again Verified Source

National Institute of Mental Health. (2016, May). Depression.

View Sourcecitation-arrow
.

Symptoms of Depression Include:

  • Persistent sad mood
  • Feelings of hopelessness
  • Irritability, guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Fatigue
  • Restlessness or having trouble sitting still
  • Difficulty concentrating or making decisions
  • Difficulty sleeping or oversleeping
  • Appetite or weight changes
  • Aches or pains without a known physical cause
  • Thoughts of death or suicide

Symptoms will vary depending on the individual and the stage or degree of depression. If you or someone you love is considering suicide, dial 988 for the national Suicide and Crisis Lifeline. The lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources, and best practices for professionals in the United States.

4 Ways to Treat Depression and Headaches at the Same Time

Whether you have migraine, vestibular migraine, cluster headache, tension-type headache, post-traumatic headache, or another type of headache disorder, psychological approaches can help you get more functional hours back in your life.

1. Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a type of psychotherapy that is proven to be effective for treating depression. CBT usually includes both behavioral and cognitive techniques:

  • Behavioral interventions include biofeedback and implementing lifestyle changes and routines. This may include diet changes and eliminating habits that are suspected to trigger migraine.
  • Cognitive interventions include increasing awareness, observing you thinking styles, increasing motivation for change, and boosting your sense of empowerment and control.

2. Biofeedback

In addition to CBT, biofeedback is a commonly used behavioral therapy for the treatment of migraine and headache disorders. Biofeedback treatment focuses on your active role in managing pain, and it is often combined with relaxation and cognitive-behavioral techniques to reduce stress
Migraine Again Verified Source

Nestoriuc, Y., Martin, A., Rief, W., & Andrasik, F. (2008). Biofeedback Treatment for Headache Disorders: A Comprehensive Efficacy Review. Applied Psychophysiology & Biofeedback33(3), 125-140

View Sourcecitation-arrow
.
"Biofeedback also has been demonstrated as useful in the treatment of tension-type headaches," according to the National Headache Foundation. "Some scientists have reported a reduction of the levels of depression in patients with tension-type (muscle contraction) headache following the use of biofeedback. However, in their work, the categorizing of the depression was unclear
Migraine Again Verified Source

Depression and Headache. National Headache Foundation.

View Sourcecitation-arrow
."

Thermal biofeedback and passive relaxation techniques are more effective at treating migraine than relaxing without instructions or feedback. Thermal biofeedback involves hooking your finger up to a machine and learning relaxation techniques to increase your finger temperature. Passive relaxation consists of auditory guided imagery.

Major life events and stress can intensify anxiety and depression. In people with migraine or other headache disorders, anxiety and depression can also influence changes in frequency and intensity of pain.

Biofeedback training is thought to work by teaching you how to decrease your sympathetic (fight-or-flight) response, which can reduce depression and anxiety
Migraine Again Verified Source

Vasudeva, S., Claggett, A. L., Tietjen, G. E., & McGrady, A. V. (2003). Biofeedback-assisted relaxation in migraine headache: Relationship to cerebral blood flow velocity in the middle cerebral artery. Headache: The Journal of Head & Face Pain43(3), 245-250

View Sourcecitation-arrow
.

3. Interpersonal Therapy

In addition to CBT and biofeedback, interpersonal therapy (IPT) has been found to be effective in treating depression. IPT differs from CBT in that it emphasizes improving social support, communication style, and relationships to improve depressive symptoms.

Chronic pain, like that experienced with migraine or headache, is an invisible disorder that can often lead you to feel isolated and misunderstood. IPT focuses on connecting mood and relationships and taking the active steps necessary to relieve depression
Migraine Again Verified Source

Poleshuck, E. L., Gamble, S. A., Cort, N., Hoffman-King, D., Cerrito, B., Rosario-McCabe, L. A., & Giles, D. E. (2010). Interpersonal psychotherapy for co-occurring depression and chronic pain. Professional Psychology: Research and Practice41(4), 312-318. doi:10.1037/a0019924

View Sourcecitation-arrow
.

You may be confronted with multiple stressors related to your headache or migraine experience, including job loss, disability, and disruption of other life roles. These stressors often take a toll on relationships with friends, family, and healthcare professionals.

In addition to psychotherapy, medication is often needed to address medical needs along with psychological needs. Many antidepressants are also used for migraine prevention, like amitriptyline, nortriptyline, and venlafaxine.

If you have depression and migraine, discuss your medication options with your healthcare provider. Psychotherapy is most effective when used along with medication.

Therapy Plus Medication Works Best for Depression and Headache

The best way to treat depression and headaches is through a multipronged approach. There are many different treatments available for depression, and they have good outcomes. But you can get even better outcomes by combining treatments, like psychotherapy and medication
Migraine Again Verified Source

Harris, J. E., Kelley, L. J., & Shepard, L. M. (2015). Multitheoretical psychotherapy for depression: Integrating strategies from evidence-based practices. Journal of Psychotherapy Integration25(4), 353-367. doi:10.1037/a0039565

View Sourcecitation-arrow
.

"Nonpharmacological approaches like progressive muscle relaxation, biofeedback, cognitive-behavioral therapy, exercise, and mindfulness-based stress reduction are reasonable to consider as part of an overall migraine management plan and may be helpful in combination with other approaches," said Andrew Charles, MD, professor of neurology at the David Geffen School of Medicine at UCLA and director of the UCLA Goldberg Migraine Program.

Work with your healthcare provider to come up with a treatment plan that is tailored to your own personality, preferences, and needs. A holistic, long-term approach is best for managing chronic conditions like depression and headache disorders.

Achieving better health and happiness is a marathon, not a sprint.

For more, don't miss:

Additional research featured in this article comes from Immaculata University Psychology Doctoral Student Patricia Snyder's dissertation about migraine and depression. Migraine Again Executive Managing Editor Suzanne Marmion contributed to the report. 

https://image-api.migraineagain.com/images/angieglaserheadshotjune2022

Angie Glaser

Angie Glaser is the Senior Digital Producer and Editor at Migraine Again and author of the blog Chronic Migraine Life.  She has been featured on the Migraine World Summit and PBS News Hour as a patient advocate, and she has advised industry and nonprofit leaders on patient needs.

Read More
Advertisement