People who regularly suffer from migraines often also experience above-average levels of anxiety, depression, and other mental health issues. This blog article from the Institute for Modern Psychotherapy in Berlin explains what you can do to drastically reduce both migraine attacks and mental health problems.
Overview of All Topics
Do Migraines Cause Long-Term Mental Health Problems, or Are Mental Health Issues the Cause of Migraine Attacks?
A thunderous storm in the head, millions of tiny needle pricks, or a sledgehammer pounding on the temple repeatedly: These are just a few descriptions that migraine patients have used to try to convey their suffering. There is no doubt that frequent migraine attacks are an extreme burden for those affected. Moreover, migraine patients often suffer from anxiety and depression more frequently. However, this insight is not new.
At the beginning of the new millennium, the “American Migraine Prevalence and Prevention (AMPP) Study” (2004 to 2009) showed that migraine patients have a significantly higher risk of developing depression, anxiety, and panic disorders. Recent studies from China, Spain, and Germany have reached the same conclusion. For migraine patients, the following summary can be made:
- Anxiety Disorders:
About 50% of migraine patients also suffer from anxiety disorders. - Depression:
Approximately 25% of migraine patients are affected by depression. - Connection Between Migraine Frequency and Mental Disorders:
The more frequent the migraine attacks, the more severe the symptoms of anxiety and depression.
It is scientifically proven that migraines, depression, and anxiety are interconnected in many cases. The big question now is: What came first? Are mental health issues just a symptom of an existing migraine condition? Or do anxiety and depression themselves lead to severe migraine headaches?
The perhaps somewhat surprising answer to this variation of the chicken-and-egg problem is: For most patients, both are true. This was also the case for a Munich patient who sought treatment at the Institute for Modern Psychotherapy in Berlin last December.
Anxiety, Migraines, and the Fear of Migraines
Initially, the patient came to us only for her panic attacks. During the intake interview, it became clear that she also suffered from depressive moods and migraine attacks. Understanding why this was the case and why these issues reinforced each other becomes easier when we look closely at her description of her migraine condition. Pay attention to the thought process typical for migraine patients.
- In a very stressful and anxiety-ridden time at work, I often already feel the harbingers of an approaching migraine attack in the morning. I always think to myself, ‘I have to push through this; I can rest later’.
- Of course, a migraine attack usually comes at the most inconvenient time—and frequently I miss an entire day because of it. I often wonder, ‘Why does this have to happen today, of all days’?
- In addition to the headaches, I am also plagued by shame and negative thoughts, feeling like I am letting down my colleagues and boss.
- Each time, I hope never to end up in such a situation again and secretly start to fear the next headache attack. Thoughts that put additional pressure on me arise: ‘I never want to disappoint my colleagues, my boss, or myself again. This should never happen again.`
- My fear of another migraine, however, is a strong trigger, which is why the attacks now come at increasingly shorter intervals. When I once again do not show up at work ‘just’ because of headaches, I feel the worst guilt and think, ‘Migraine again! My colleagues surely can’t understand this. They must think I’m just faking sick.’
- My fear of failure and the associated fear of the next attack keep increasing. By now, I am even convinced that everyone at work considers me unreliable and I believe that my headaches are seriously endangering my job.
- I am completely desperate. I don’t know what to do anymore. The headaches keep coming back. And even though I am already taking medication, the attacks are increasing in duration and intensity.
Fortunately, this patient’s account is now a thing of the past. She is doing really well again, and her colleagues were much more understanding than she had feared. She rarely has migraine attacks now, and they are not nearly as severe as they used to be. This was made possible because we were able to help her overcome two main triggers of her migraines, namely anxiety and depression, on her own and without medication.
Breaking the Vicious Cycle of Anxiety, Depression, and Migraines
As with many patients, a single stress- and anxiety-induced migraine attack led to this patient finding herself in a real vicious cycle. The increasing fear of new migraine attacks acts as a trigger for many affected individuals and thus promotes further attacks. In this context, one’s thoughts are an underestimated driving force behind these fears and depressions.
The good news is that since your thoughts trigger fears and thus facilitate migraine attacks, you can break this vicious cycle with your thoughts as well. How to do this will be explained shortly. First, I want to discuss the topic of medication for migraines. As mentioned earlier, medications are often an integral part of recurring migraine attacks.
Medications for Migraines Are Not Always a Good Idea
Painkillers (analgesics) and specific migraine medications, called triptans, promise quick relief for impending or acute migraine attacks, especially when certain preparations are combined. For example, the German Society of Neurology recommends combining a triptan with a painkiller from the NSAID group (like naproxen) in their treatment guidelines. Nevertheless, taking medication for migraines should remain an exception and not become the rule. Why? Because frequent use of medication can quickly lead to dependency and, directly into the next migraine vicious cycle. The paradox of painkillers and triptans is that overuse can worsen the migraine. The attacks can increase in both frequency and intensity. In the worst case, migraines can become chronic.
Above all, one should not mix everything recklessly and should always consult a doctor before taking a combination of different medications. Taking triptans and antidepressants from the SSRI group (selective serotonin reuptake inhibitors) or the SSNRI group (selective serotonin and norepinephrine reuptake inhibitors) simultaneously can even lead to the feared and potentially life-threatening serotonin syndrome due to interactions. Considering that migraines and depression often occur together, this danger is all the more serious.
This is another reason why I advocate so strongly for depression therapy without medication. Even seemingly harmless and purely herbal St. John’s Wort should never be underestimated in its serotonin effect and should therefore never be combined with triptans.
No Anxiety, No Migraines: How to Break the Vicious Cycle
Regardless of whether you struggled with anxiety and depression before your first migraine attack, or these issues developed due to the severe headaches: If you manage to overcome your anxiety, the frequency and intensity of migraine attacks generally decrease as well. In my book “Overcoming Panic Attacks and Other Anxiety Disorders” and my online online therapy “Living Without Anxiety and Panic,” I dedicate entire chapters or episodes to teaching you various techniques to overcome your fears.
At this point, I want to give you a small example of such a technique.
Reducing Anxiety and Migraine Attacks with Auditory Shifting Techniques
“Oh no, not another migraine!” Do you know such a thought? If so, you are probably an auditorily inclined person. Your inner dialogues and thoughts are often not only the precursor but actually the trigger for anxiety and panic. However, with a little trick and a bit of practice, it is possible to stop an impending anxiety attack within seconds. This “trick” is called the auditory shifting technique. To do this, focus for a moment on your anxiety-inducing inner dialogues as soon as they arise (like the aforementioned negative thought: “Oh no, not another migraine!”).
This may sound strange, but if you pay close attention, do you hear your inner anxious voice more on the left or right side of your head? If you can determine if one side tends to dominate, even if the difference is minimal at first, try mentally shifting the anxiety-inducing sentences to the other side and listen to them there. If you perform this exercise very focused, you will notice a subtle difference. And if you are like most strongly auditory people, the same sentence on the other side of the head will suddenly be inaudible or sound somehow wrong or distorted. The words’ content might even change, but the most important change is this: The emerging anxiety vanishes instantly or becomes significantly weaker. There is also another positive effect. Those who manage to eliminate their fear of the next headache attack using the auditory shifting technique often experience a noticeable reduction in the frequency and intensity of migraine attacks.
So, if you ask me “What helps against migraines the most?” my clear answer is: Your own thoughts. It is quite possible, however, that you won’t find the auditory shifting technique very useful. For instance, if you are not an auditory but a visual or kinesthetic person. In that case, you will find numerous alternative methods in my books and online therapys. For example, the zoom technique or an extremely effective method for stopping your carousel of thoughts.
Preventing Migraines: Effective Measures at a Glance
Even though current science suggests a biological-genetic predisposition for migraines, it is mainly the triggers that determine whether this predisposition comes into play. If you manage to get rid of anxiety and depression using our neuroscience-based methods, you can significantly reduce your susceptibility to migraine attacks. Additionally, there are a number of other measures that have also been proven to prevent migraines:
- Exercise: two to four times a week for at least half an hour
- Endurance sports: such as swimming, jogging, or walking
- Relaxation exercises like meditation or autogenic training
- Keeping a cool head: Many of our patients have had good experiences with these two products we found for you on Amazon: a cooling headband to stop a migraine from starting and a larger Magic Gel cooling mask for relief if the migraine is already in full swing. By the way, contrary to the recommendation on the package inserts, you should preferably only put both products in the refrigerator and not in the freezer. The gentler cold usually relieves migraine pain more sustainably.
- Individual stress reduction strategies: from relaxing bubble baths to your favorite song
- Conscious nutrition: avoiding certain foods like chocolate, ice cream, cheese, beans, citrus fruits, and of course alcohol can also significantly reduce your susceptibility to migraine attacks
- A regulated lifestyle: especially getting enough sleep and a stress-free daily routine
If you then manage to effectively stop constant brooding and anxiety thoughts with our proven method, you can not only enjoy your life much more, but you also remove a significant foundation for your migraine attacks. This doesn’t necessarily have to be complicated, as you may have already noticed from our small test with the auditory shifting technique. The fact is, whether you are an auditory, visual, or kinesthetic type: You are not helplessly at the mercy of migraines, anxiety, and depression, because there are far more ways to free yourself from them than you might have previously thought.
Troy A.
Tampa, Florida