Migraine and your mental health

Carmen BryceBlog posts

To mark European Migraine Day of Action, MyMind has teamed up with the Migraine Association of Ireland to offer advice on how to mind your mental health if you’re living with this condition.

This article, by psychotherapist and mindfulness teacher Iseult White, offers some useful tips on how to look after your wellbeing if you’re living with a chronic health condition such as migraine.

Living with migraine is tough, but life is made more difficult when you are also dealing with mental health issues.

In my psychotherapy practice I help people find practical and creative ways to manage the impacts of chronic health conditions on their quality of life.  Looking after your mental health doesn’t cure the underlying health problem, but it can change how you feel about it, and give you back some of the peace of mind and the joy it drains from your daily life.

The SMILE study conducted among migraine patients in primary care in France found that 50% of people with active migraine were anxious and/or depressed.  In addition to anxiety and depression there is a significant correlation between Post-Traumatic Stress Disorder (PTSD) and migraine.  Lifetime PTSD prevalence is people with headache is almost 5 times that of people without headache, and in one study 42% of episodic migraineurs reported a history of physical or sexual assault.

People who live with migraine deal with feelings of fear, anger, and frustration related to the impact migraine has on their quality of life.  It is hardly surprising that they also experience low mood, worry, and anxiety, yet the links between migraine and mental health are not explained solely by the challenges of living with migraine.

Often people with migraine report an existing anxiety disorder prior to the onset of migraine.  After onset migraine and anxiety co-exist in a complex bi-directional relationship.  Migraine increases feelings of anxiety and panic due to the constant fear of an impending attack.  Anxiety, on the other hand, aggravates the perception of symptoms, leading migraineurs with anxiety to report greater impairment to their quality of life.

Depression can emerge after the onset of migraine and most studies have suggested that it is more likely to be a consequence rather than cause of migraine.  My clients often report a sense that migraine is controlling their life.  It routinely impacts their career and social life and creates tension in relationships with family and friends.  The net result is that people are left feeling isolated and vulnerable.

Stress contributes directly to the frequency and severity of migraine attacks and is related to the levels of anxiety and depression.  Stress precipitates migraine attacks and migraine causes stress by the pain it generates.  In the SMILE study the level of stress reported by participants increased progressively with mood symptoms, from not anxious to anxious to anxious and depressed.

If you are living with migraine you need to consider ways to manage stress, anxiety, and depression.  Here are some of the most important things you can do:

Look after your mental health proactively

Migraine attacks are more likely as levels of depression and anxiety increase so it is vitally important that you learn how to understand and recognise anxiety and depression.

Look out for symptoms such as low energy, problems sleeping, trouble concentrating, dizziness, rapid heart rate, and difficulty breathing.  Too often people attribute these to migraine when they are a result of coexisting anxiety and/or depression.

Discuss your symptoms with your doctor.  Most experts recommend that you are screened for anxiety and depression at an initial consultation for migraine and periodically thereafter.

If you are experiencing anxiety or depression this can be taken into account in your medication, as some anti-depressants and anxiolytic medications are also effective in general pain management.

Use mind/body approaches for stress reduction

Some studies report a 35-50% decrease in migraines and tension-type headaches with mind/body approaches.  There are a variety of approaches that have been studied in relation to migraine – yoga, mindfulness, acupuncture – but the most important thing is to find an approach that you enjoy, and that contributes to your feelings of wellbeing.  There is no one approach that is right for everybody so go with your gut instinct about what will help you.

Make sure you get enough sleep

Get at least 7 – 8 hours of sleep per night.  Poor sleep reduces your ability to cope and significantly increases feelings of anxiety and depression.  If insomnia is a persistent problem for you discuss a referral to a sleep clinic with your doctor or find a psychotherapist who can give you a behavioural program to manage insomnia.  If sleep is an occasional issue then discuss basic sleep hygiene with your GP.

From my experience the most important considerations are:

  1. Switch off all screens such as TV, tablets, smart phones, and laptops at least 1 hour before going to bed
  2. Use blackout blinds to make sure you are not woken early by light
  3. Don’t take caffeine or alcohol after 3 PM
Take regular exercise

While exercise can be a trigger for some migraineurs, aerobic exercise has been shown to increase endorphins and reduce the frequency, intensity, and duration of migraine attacks.  For people dealing with anxiety and depression the benefits are two fold.  Exercise works quickly to elevate low mood, and is as effective as medication for reducing the symptoms of mild to moderate anxiety and depression.

The effects of exercise are short term, more like taking a pain-reliever than an anti-biotic, so frequency and consistency is the most important ingredient in an exercise program.  Choose exercise that is fun and easy to include in your daily schedule, and if you can find some exercise buddies, even better, because social contact is a vital aspect of maintaining good mental health.  10 minutes of exercise a day can make a positive contribution to your mental health, and even better, protects you against dementia in the future!

Find a supportive psychotherapist

Don’t try to deal with anxiety and depression on your own. For mild to moderate anxiety and depression psychotherapy produces results that are comparable to medication.  Psychotherapy will help you identify the behaviours that lock anxiety and depression in place.

Approaches such as CBT, ACT, and MBCT have been shown to be particularly effective, but research consistently shows that the client’s perception of his or her relationship with the psychotherapist is the most important variable in a successful outcome.

A word of caution though!  Psychotherapists are not routinely trained in the management of chronic pain conditions, so take the time to ensure any psychotherapist you are considering working with understands the relationship between migraine and mental health.

Deal with the impacts of trauma

PTSD is frequently under-diagnosed and under-treated and unfortunately most doctors don’t routinely screen for trauma.  If you recognise yourself as somebody who has experienced trauma make sure that you choose a psychotherapist who has specific training in PTSD.  PTSD can develop after witnessing or experiencing any life-threatening event such as assault, sexual or physical abuse, car accident, natural disaster, or combat.

Iseult White, MA, MSc, BA(Mod), MICP

Iseult is a psychotherapist and mindfulness teacher.  She knows what it is like to live with migraine and she specialises in working with individuals who are dealing with anxiety, PTSD, and chronic health conditions.