Migraines and Depression: What Is the Relationship?
Medically reviewed by Kira Graves, PhDMedically reviewed by Kira Graves, PhD
Migraines and depression often co-occur. Researchers believe the relationship is bidirectional, meaning that people with depression are likely to experience migraines, and those with migraines are at an increased risk for depression.
Treating one condition can help manage the other. Healthcare providers can tailor an integrated treatment approach that addresses both conditions.
This article explains the links between migraine and depression and discusses strategies for managing these conditions.
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Migraine vs. Headache
Migraine is a neurological disorder that causes attacks of severe headaches along with other symptoms like nausea, vomiting, and light or sound sensitivity.
Headache encompasses a broader set of direct and indirect causes of head pain due to infection, injury, or disorders like tension or cluster headache.
Connection Between Migraines and Depression
Nearly half of people who experience migraines also have depression or have up to 4 times the risk of developing it. In turn, depression can worsen migraines, raising the risk of acute (episodic) cases becoming chronic. It can also cause medication overuse or overuse and make adherence to migraine therapy difficult.
Researchers are still working to understand the exact links between depression and migraine. However, they have found several ways the two conditions are connected, such as:
Heredity: Having close relatives with both migraine and depression raises your risk, making shared heredity a potential factor in these conditions.
Genes: Some of the same genes influence depression and migraine.
Brain structure: Migraine and depression can also affect brain structure. Compared to people without depression or migraine, those with both had lower overall volume, decreased gray and white matter, and less cerebrospinal fluid.
Serotonin: Both conditions feature low levels of serotonin.
Hormones: The female sex hormones estrogen and progesterone influence migraine and depression—which is why both conditions are more common in people assigned female at birth.
Risk factors: Migraine and depression also share risk factors, including obesity (a health condition characterized by excess body fat) and stress.
Hormones and Migraine
The female sex hormones estrogen and progesterone play a significant role in the development of both migraine and depression. Changes in these levels can trigger attacks of both and affect mood. Headaches and depression can be side effects of hormonal birth control or hormone replacement therapy.
How to Manage Depression With Migraines
Depression with migraines can complicate treatment. There is no singular treatment, so healthcare providers tailor therapies to the individual. Management methods may include a combination of medications, procedures, and therapy.
Antidepressants are a primary treatment for depression, with some types also used for migraine.
Abortive medications address migraine symptoms that occur at the onset of an attack. They relieve pain, nausea, and other symptoms alongside other treatment options.
Botox (onabotulinumtoxinA) injection is a preventive treatment for chronic migraine that is effective in reducing the frequency and severity of attacks; researchers found that it is beneficial for comorbid (occurring together) migraine and depression.
Nerve stimulation therapies alter brain activity by stimulating specific nerves using low levels of electricity. Stimulation of the vagus nerve—a paired nerve running from the brain to the abdomen—is an option for complex cases of chronic migraine and depression.
Therapy: Psychological therapy is an additional means of treating depression and chronic migraine. Cognitive behavioral therapy (CBT), a type of talk therapy, is a common approach also used to treat anxiety, chronic pain, or eating disorders and to reduce migraine and depression severity.
Researchers are also exploring the use of monoclonal antibodies—drugs derived from cloned white blood cells—to treat chronic migraine and depression.
Although more research is needed, this therapy has shown promise for those with migraine and depression. In a year-long study of those with chronic migraine and depression, monthly or quarterly Ajovy (framenazumab) injections reduced depression scores and headache days.
Risks of Untreated, Ongoing Symptoms
Depression can worsen migraines and vice versa; over time, they can significantly impact your health. Potential risks of untreated depression and migraine include:
Anxiety and panic disorders: Since migraine attacks can be unpredictable, untreated cases can contribute to anxiety and cause fear, panic, or excessive worry.
Substance use disorder: Untreated depression and migraine are associated with an increased risk of substance use disorder.
Suicidal thoughts: Depression can lead to suicidal thoughts, especially when accompanied by migraine attacks.
Sleep problems: Both depression and migraine cause insomnia—difficulty falling or staying asleep—and changes in sleep patterns. In turn, sleep disruptions may trigger migraine attacks and worsen depression symptoms.
Changes in behavior: These conditions can also cause drastic shifts in behavior and mood, such as irritability, restlessness, impulsivity, and problems with sexual desire or performance.
Seeking Help for Suicidal Thoughts
If you are having suicidal thoughts, contact the 988 Suicide & Crisis Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one is in immediate danger, call 911. For more mental health resources, see Verywell's National Helpline Database.
Benefits of Integrated Treatment
Since depression and migraine are closely linked, healthcare providers may adopt integrated approaches to treatments, relying on a team of specialists (typically neurologists and psychiatrists) to target both conditions. The goals of treatment are to prevent migraine attacks, manage depression, and adopt strategies to promote well-being.
Treating depression without managing migraine resolves only part of the problem and can lead to residual symptoms. Integrated treatments incorporating medications, therapies, and lifestyle changes address these shortfalls.
Managing depression can also be crucial for preventing episodic migraine from becoming chronic.
How to Stay Ahead of Migraine Flares
Alongside medications and other treatments, certain habits and lifestyle changes help to prevent migraines from flaring up. These include:
Staying hydrated: Dehydration can trigger migraine attacks; boost your daily fluid intake.
Stress management: Healthy means of coping with stress include yoga, meditation, mindfulness, or light exercise. Biofeedback therapy—using devices to identify physical signs of stress—may also help.
Trigger avoidance: Track foods, drinks, or other factors that trigger your migraines and work to avoid them. Examples of common triggers include cured meats, red wine, dark chocolate, and certain fermented foods.
Sleep: Since sleep disruption can cause migraine, aim to get seven to eight hours of sleep a night. Go to bed and get up at consistent times.
Eat consistently: Skipping meals is a migraine trigger; plan to have meals at consistent times daily.
Manage weight: Excess weight increases the risk of migraine and depression; incorporating exercise and dietary changes to lose weight may help with prevention.
In Between Depressive Episodes
People with depression often go through periods of more intense symptoms or depressive episodes. Several strategies may help you reduce or prevent depression symptoms, including:
Get regular exercise: Physical activity can boost mood naturally, improve sleep, and reduce stress, all of which can help with depression.
Stay active: Do not stop participating in activities you like; keep up with the hobbies or activities that bring you joy.
Stay connected: Spend time with family, friends, and loved ones.
Manage stress: As with migraine, relaxation methods like meditation or yoga can help manage stress, reducing the chance of depression coming back.
Keep your routine: Ensure you get enough sleep and stay consistent with your habits. Maintain regular meal times and avoid changes.
Talk to someone: If you’re struggling, talk to a loved one or therapist for ongoing support.
Summary
Depression and migraine often occur side by side. These conditions are closely related. Depression raises the risk of migraine and makes it worse, and living with chronic migraine can lead to depression.
Primary treatments for co-occurring migraine and depression involve medications and psychotherapy. Healthcare providers may opt for integrated treatment approaches, which take on both conditions simultaneously. In addition, specific lifestyle changes, such as ensuring quality sleep and physical activity, prevent flare-ups of both conditions.
Read the original article on Verywell Health.
