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The Link Between Chronic Migraines and Psychological Distress

Mature woman with head in hands
 

If you have ever experienced a migraine, you can understand how painful and debilitating they can be. While there are different types of headaches, each with their own set of symptoms, migraines are a severe variety that can stop a person in his or her tracks. A migraine is a neurological syndrome frequently associated with nausea or vomiting, sensitivity to light, sensitivity to sound, and throbbing pain often felt on only one side of the head (Olesen).

Certain individuals with migraines also experience an aura before or just after a migraine starts (Olesen). An aura is a group of symptoms, such as visual or auditory changes, that signal a migraine is about to begin.

Individuals who experience chronic migraines can spend a great deal of time in pain. Chronic migraines are defined as occurring 15 or more days a month, with headaches lasting at least four hours or longer, for three consecutive months (Olesen). The 2011 American Migraine Prevalence and Prevention study found that 1 to 2% of Americans suffer from chronic migraines, with more women diagnosed than men.

For those who experience them, chronic migraines can disrupt daily activities and reduce quality of life. Recurrent migraines not only cause physical distress, but can also put a strain on relationships and performance at school or work. Individuals with chronic migraines are also 2 to 5 times more likely to have a diagnosis of depression or anxiety (Jette).

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The relationship between migraines and depression has been found to be bidirectional, meaning some people develop migraines prior to depression and others have a history of depression that precedes the development of migraines (Breslau). Research also suggests that the same bidirectional relationship exists between anxiety and migraines, although additional studies are needed to confirm this finding.

These findings do not imply that psychological distress alone causes recurrent migraines, as there are often multiple causes implicated. Other factors that have been implicated in triggering recurrent migraines include diet, hormonal changes, medication overuse, and lack of food or sleep (Kelman). Researchers have also found that genes play a role.

As our understanding of migraines improves, there are important implications. First, it is important for physicians to be aware of the relationship between migraines and mood. Regularly screening those with migraines for problems such as depression and anxiety may assist individuals in getting needed psychological help.

Additionally, treating depression and anxiety in people who have migraines may lead to better physical outcomes. Research has shown that untreated problems with depression and anxiety can interfere with adherence to medical treatments, diminishing their effectiveness.

The bi-directional relationship between chronic migraines and psychological distress also highlights the importance of treating depression and anxiety when these problems first develop. It is common for individuals who are depressed or anxious to experience pain. If psychological problems are left untreated, episodic problems with pain may become more chronic.

It is clear that both the psychological and physical aspects of migraine need to be addressed. The good news is that effective treatments for anxiety and depression exist, such as cognitive behavioral therapy (CBT) and interpersonal therapy.

Some studies have also found that behavioral therapies such as relaxation techniques and biofeedback training are also effective in treating migraines (Blanchard). The goal of these therapies is to help individuals learn how to promote feelings of relaxation and calm. Therapy may be an important addition to the treatment of chronic migraines, providing short-term and long-term benefits to those with migraines and helping to improve their quality of life.

References:

  1. Olesen, J. (Chairman.) Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(suppl 1):9-160.
  2. Jette, N., Patten, S., Williams, J., Becker, W., Wiebe, S. Comorbidity of migraine and psychiatric disorders. A national population-based study. Headache. 2008;48:501-516.
  3. Breslau, N., Davis, G.G., Schultz, L.R., Paterson, E.L. Migraine and major depression: A longitudinal study. Headache. 1994;34:387-393.
  4. Kelman, L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007;27(5):394-402.
  5. Blanchard, E.B., Appelbaum, K.A., Radnitz, C.L., Morrill, B., Michultka, D., Kirsch, C., Guarnieri, P., Hillhouse, J., Evans, D.D., Jaccard, J., & Barron, K.D. (1990). A controlled evaluation of thermal biofeedback and thermal biofeedback combined with cognitive therapy in the treatment of vascular headache. Journal of Consulting and Clinical Psychology, 58, 216-224.

© Copyright 2014 by Magdalene Peter, PhD, therapist in San Jose, CA. All Rights Reserved.

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Comments
  • Lindy March 31st, 2014 at 10:29 AM #1

    I have never personally had a migraine but my mother always had them and I saw how she suffered from them and I only wish that there had been more information available to her them as far as different modes of treatment for them instead of just take an aspirin or two and go to bed.
    We are talking about headaches that would last for days and pretty much left her incapacitated for a week and yet there were never any real answers for her on any good way to treat them.
    I swear that is part of why she died so young because she just couldn’t manage that kind of pain anymore.

  • Carmen March 31st, 2014 at 2:31 PM #2

    The hard thing is that I guess you don’t really have a clear understanding of what comes first, the headaches or the depression, so then you don’t know which could actually be a symptom of the other. And then you have to say, well would you have the headaches if you weren’t depressed or would you be depressed if you weren’t suffering from the headaches? There would have to be some sort of clear answer about what causes what before I would think that you could get a better understanding of the relationship and what treatment is going to be the most effective.

  • Logan April 1st, 2014 at 3:38 AM #3

    I could definitely see how something like relaxation therapy skills or even meditation could help ease migraines. I would rather try anything over having to constantly take medications although I know that for many sufferers this is their only relief.

  • Kelly O'Horo April 1st, 2014 at 10:32 PM #4

    Studies also show that EMDR can address and eliminate chronic migraines. Dr.Uri Burgman (sp) conducted extensive research on the use for treatment and elimination of Migraine headaches.

  • cheri April 2nd, 2014 at 7:28 AM #5

    Having had but one of these migraines in my own life I can tell you that if this was something that I had to live with on a habitual basis then I would indeed be distressed and stressed and would be looking for any way possible to ease that tension and manage the symptoms.
    Migraines are absolutley nothing to fool around with and I know that there are millions of sufferers who are hoping daily for a breakthrough that will offer them some sort of relief from the pain that they can cause.
    Depression, anxiety, the pain that goes along with them, I really don’t know how anyone can live with all of that.

  • Collin G April 3rd, 2014 at 3:36 AM #6

    When I was reading above exactly what chronic meant, just how much time one would sepnd in this kind of pain, that is almost unimagniable to me, especially knowing how much someone is out of commission when they are dealing with migraines.

  • Amy Armstrong April 5th, 2014 at 5:34 AM #7

    I get tension headaches, but I know several people who suffer from migraines and I feel so bad for them. One woman who worked for me several years ago had a “complicated migraine” that landed her in the hospital for a week. According to a lot of the studies, it looks like migraines also tend to beget more migraines, so the focus of a lot of the drug therapies is to reduce the frequency of them, but those drugs don’t work for everybody. There definitely does seem to be a link to emotional health and stress. Almost everyone I know who gets these is empathetic and getting pulled in several directions at once.

  • Thalia April 5th, 2014 at 12:49 PM #8

    I hope that the role of simple genetics will not be discounted as playing a role in migraines.
    I do everything right- watch what I eat, get enough rest, exercise daily, and yet there they are, lurking around the corner when just the right trigger is there to set one off.
    I can try to do everything that I can to avoid it at all costs and they will still happen to me.
    I am not sad or anxious, tired or depressed, but I do suffer from migraines and I do rely on some medications for relief because there are times when I know that if I didn’t I feel like I will die.

  • gretta April 8th, 2014 at 3:01 PM #9

    Migraines are terrible and if anything could lead you to being depressed then this could!

  • Magdalene Peter April 9th, 2014 at 1:04 PM #10

    Lindy, I’m sorry to hear that your mother struggled with migraines during her life. You are right- it is important for people to know that migraines are not just regular headaches and that there may be effective treatments out there.

  • Magdalene Peter April 9th, 2014 at 1:11 PM #11

    Carmen, thanks for sharing. I think that it can be difficult to determine which comes first if individuals are suffering from both migraines and depression. In these cases it would be important to treat both the migraines and emotional distress. Many chronic pain conditions require a multifaceted approach that may involve medical care, lifestyle changes involving diet and exercise, and learning effective ways to deal with stress.

  • Magdalene Peter April 9th, 2014 at 1:21 PM #12

    Thalia, thank you for pointing out the role of genetics in the development of migraines. Research has found that genetics do seem to play a role and individuals with a family history of migraines are more likely to have migraines. It sounds like you are doing a lot to manage your own migraines, living a healthy lifestyle and awareness of triggers. These efforts often help individuals feel like they have some control over their health and migraines.

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