Migraine and Anxiety: From Awareness to Effective Coping

The Migraine and Anxiety Connection

Do stress and migraines have any connection? “Of course,” you say, “I’ve heard it a thousand times!” Perhaps you have read that as many as 80 percent of individuals with chronic migraine also meet criteria for an anxiety disorder. Or maybe your awareness of the connection comes from your own personal experience. Even among migraineurs who don’t have an anxiety disorder per se, many find that increased stress is at least one of the factors that seem to bring on a headache. Researchers are still working to understand the mechanisms behind the anxiety-migraine connection. The brain’s limbic system, which is largely involved in emotional functioning, likely plays a role. Neurochemicals such as serotonin, which are involved in depression and anxiety, are also believed to influence the onset and pattern of migraines.

The muscle tension that usually accompanies anxiety may also play a role. Headache pain and other stressors often lead to tightening of the muscles throughout the forehead, scalp, jaw, neck, and even shoulders. Resulting muscle soreness, as well as inflammation of the trigeminal nerve, may then perpetuate the cycle by creating more pain, leading to more anxiety, leading to more pain. While the headache patient is busy attending to whatever stressful issues and for the development of headaches or migraines. In addition to tracking headache triggers, tracking your patterns of responsibilities she or he faces, muscle tension builds in a gradual and insidious way. Most likely, it is a combination of these and other factors that moderates the high correlation between anxiety and migraine. While we still don’t fully understand the mechanisms behind the connection, we certainly have established that it exists. If you live with migraine headaches, knowing the causes of the connection may not be as important as knowing what can be done to counter the stress response.

Lifestyle and Habits

It’s easy to discount the important role that lifestyle modification can have in minimizing the effects of stress. We live in a society that values productivity over pacing. For many, hard work is rewarded by a satisfying sense of achievement. It’s important to keep in mind, however, that there is a point at which the drive to achieve can become counterproductive. In an effort to “soldier on,” the migraineur may ignore small opportunities to reduce stress throughout the day. Taking periodic short breaks, avoiding the temptation to over-schedule personal and work events, and maintaining pleasurable leisure activities are all examples of lifestyle factors that can help to control stress in a significant and appreciable way.

Relaxation Training Techniques

Sometimes, even consistent changes in lifestyle habits are not enough to control stress and anxiety adequately. Fortunately, several methods for relaxation are also available to help counter the body’s stress response. Among them are diaphragmatic breathing, progressive muscle relaxation, mental imagery, self-hypnosis, mindfulness practices, and other forms of meditation. Advantages of these skills for headache management include the facts that they are drug- free, fairly simple to implement with regular practice, and require no costly equipment or doctor visits once the techniques are established. You may be able to learn these skills through self-help books or CDs. For many, one-on-one therapy with a counselor or other behavioral health professional may help to more fully develop the necessary skills for relaxation, and to increase awareness of the physiological effects of stress before they trigger yet another migraine.

Some migraineurs may benefit from a more intensive type of relaxation training, known as biofeedback therapy. As the name implies, biofeedback counters stress by providing individuals with information about their physiological functions —such as muscle tension and blood flow—through computer monitoring. With appropriate training and practice in biofeedback, individuals can gain mastery over physical reactions that are normally thought of as involuntary and outside of one’s personal control. With control comes reduced anxiety, and with reduced anxiety comes better migraine management.

written by Luke Patrick, PhD; clinical psychologist with expertise in biofeedback and sports psychology