I was 13 when I was first diagnosed with anxiety disorder and post-traumatic stress disorder. At the time, my severe anxiety caused physical symptoms such as stomachaches and fatigue. I was familiar with the mind-body connection, so when I began experiencing severe migraine attacks in my early 20s, I wasn’t surprised to learn that there’s a link between anxiety disorders and migraine conditions.
My chronic migraine symptoms began at a time when I was in a good place emotionally — but after several months of increasingly frequent and debilitating migraine attacks, my anxiety disorder came back with a vengeance. I returned to therapy and began taking anti-anxiety medication for the first time in several years.
The Migraine-Anxiety Connection
Unfortunately, I’m hardly the only person who is living with both anxiety disorder and chronic migraines. A 2016 study published in the journal Headache found that six percent of people with migraines suffer from generalized anxiety disorder, compared to two percent of participants who don’t experience migraines. Researchers suggested that possible reasons for this link include social, biological, and environmental factors. Dr. Gretchen Tietjen, director of and a member of The American Academy of Neurology, tells SheKnows that anxiety disorder is considered one of the most common migraines co-morbidities, “meaning it’s more than a coincidental relationship.”
Based on her own research and observations, Tietjen believes the connection may be due to a genetic component, an environmental component, or a combination of the two. In particular, Tietjen has studied early life stress in the form of emotional, physical, and sexual abuse. “[I’ve observed that] particularly emotional abuse seems to be something that sometimes precedes the development of anxiety and depression,” she says. “This environmental component can cause changes in the brain and predispose people to conditions like migraines and that’s why it looks like they’re linked. We call that a shared pathogenesis.”
Of course, plenty of people who have no history of anxiety disorder experience migraines — and, although this isn’t the case for all migraine sufferers, many develop anxiety as a result of living with the illness. “Migraines can really change your life, even when you’re not having an attack,” Tietjen says. It’s common for people to become anxious about planning things or going out because they don’t know when they’ll get a migraine. They’re understandably concerned about what they’ll do and how they’ll cope if a migraine strikes when they can’t easily get home to rest in a dark room until it passes. “We often refer to that as catastrophizing, and that makes you more prone to get a bad migraine and it amplifies the pain,” Tietjen says.
How to Address Both Conditions
The anticipation of a migraine attack and not knowing when it will happen has certainly impacted my own anxiety level. I’ve cancelled plans and isolated myself because I’m so worried that I won’t be able to get back to my apartment, which is my safe haven, quickly enough if I get a migraine. And when I begin to experience the symptoms that tell me a migraine attack is imminent, it’s extremely difficult for me to stay calm — and, in turn, my anxiety affects my body and makes the attack even more excruciating. When I first began experiencing migraines, I frequently had panic attacks.
Both Tietjen and Dr. Alison Alford, a board certified pediatric headache specialist, tell SheKnows it’s crucial to address both conditions when patients have both migraines and anxiety. In some cases, one medication can help with both conditions. “I try to offer treatments that might treat both conditions in one pill,” Alford says.
When migraine sufferers experience anxiety, it’s also important to have them work with a mental health professional to develop coping techniques. Tietjen refers patients to psychologists who are skilled in teaching different methods of behavior therapies such as relaxation techniques, guided imagery, and other types of coping strategies to bring down the patient’s anxiety level. “If they practice those things frequently, sometimes when the migraine starts, they feel like they have the tools to keep the anxiety level down. And that might help the migraine,” Tietjen explains.
Alford says the most important thing is to have a good treatment plan in place that will address both the migraines and the anxiety. “I believe the anxiety will improve once you know you have a rescue option that works or at least a life line to the specialist when it does not,” Alford says. She also emphasizes the importance of developing a good doctor-patient relationship. “I think this is key to avoiding that anxiety around the next migraine — [something that is] perfectly normal, by the way. Many patients are afraid of the next migraine that might not resolve.”
Finding the Right Solution
Although I certainly can’t speak for everyone who has anxiety disorder, my own anxiety affects my relationships with my treatment team and having solid, trusting relationships with my doctors has been crucial as I cope with both conditions. Although it’s meant that sometimes it takes me a little longer to find a doctor I “click” with and trust, it’s well worth the effort because, as Alford noted, a good doctor-patient relationship can make a world of difference.
If you experience both migraines and anxiety, the most important thing to know is that you’re not alone and there are medical professionals with experience treating patients who have this dual diagnosis. And although these conditions may not be curable, they are treatable and working with both a migraine specialist and a therapist can help alleviate the severity of both your anxiety and your migraines.
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