Anxiety Panic Disorders

Anxiety, Panic and Migraine

Anxiety disorder has been reported as being twice as prevalent in migraine sufferers, while panic disorder has been reported as occurring six times as often. Like depression, these are also bidirectional relationships. If you have panic disorder first, you are twice as likely to develop migraine. You are also twice as likely to develop severe headache that does not meet migraine diagnostic criteria.

Anxiety and depression often go hand-in-hand. This is especially true in the migraine sufferer. Both anxiety and depression are more common.

Post-traumatic stress disorder is common in women with migraine. About 42% of women with migraine have post-traumatic stress disorder.

We all know what being nervous feels like, but how do you know if you have an anxiety disorder or a panic disorder? There is no blood test, x-ray, or MRI that can prove you have anxiety. A diagnosis of anxiety is based on your symptoms. There are paper question and answer tests that help to confirm the diagnosis. Anxiety differs from fear because there is no obvious cause for the feeling of fear, such as someone breaking into your house or threatening you. We all experience some anxiety when under stress. It's when it becomes frequent or severe that it becomes an anxiety disorder.

Anxiety disorders are considered mental disorders. There are several different types, and it is possible to have more than one kind. Anxiety can begin at any age, including childhood or adolescence. Anxiety can lead to other problems as well. For example, irritable bowel syndrome can also occur in migraine patients, and most people with IBS also have an anxiety disorder.

Generalized Anxiety Disorder and Other Types of Anxiety Disorders

  • Generalized Anxiety Disorder—this means you worry all the time about everyday life events. You can’t stop worrying about your family, your health, your relationships, money, school, and everything else.
  • Panic Disorder—this means you have panic attacks. This is when you have sudden attacks of panic or feel as if you might be dying. A panic attack can come out of nowhere, and feels like things are out of control. Your heart beats fast, you feel short of breath, you feel dizzy or faint, and you might feel shaky. You may even tremble. You may feel a sense of detachment, and you may have hot or cold flashes.
  • Obsessive-Compulsive Disorder—Some people with this anxiety disorder have more obsessions, and some have more compulsions. This is not very common in migraine sufferers. It involves things like fear of dirt or germs, or fear of thinking evil or sinful thoughts. If you have this, you might wash your hands repeatedly or do laundry several times a day. You might count things all the time or eat foods in a certain order every time. People who hoard things until there is no room left in their homes have a form of obsessive-compulsive disorder.
  • Social Anxiety Disorder—If you have this, you are so afraid of making mistakes or embarrassing yourself in front of others that you avoid social situations. You may be afraid of eating, drinking, or working in front of others. You may avoid talking on the telephone to people you don’t know.
  • Posttraumatic Stress Disorder (PTSD)—PTSD occurs in response to a highly stressful traumatic event, like witnessing war. It can also result from going through sexual assault or natural disaster. There are three kinds of symptoms in PTSD. If you have this type of anxiety disorder, you might notice these:
  1. Re-living:  Anything that makes you live through the initial event or triggers memories is a problem. This might include the anniversary date of the event. Symptoms include nightmares, hallucinations, and flashbacks.
  2. Avoiding:  You might try to avoid places, things, or people that remind you of the original event.
  3. Increased Arousal:  This means you might react too much to trigger events, memories, flashbacks, and nightmares. You might react to little things as if they were life-threatening.  This could make you irritable or have outbursts of anger. It can make your blood pressure too high. It can cause trouble sleeping. It can also make it hard for you to express your feelings to other people.
  • Phobias—Phobias are excessive fears of specific things, like fear of flying or fear of spiders. We all feel a little creepy about spiders. But someone with a phobia will be so afraid they can’t live their life normally.

What Does an Anxiety Attack Feel Like?

In addition to the nervousness that you feel with an anxiety attack, there are physical symptoms that commonly occur. The normal symptoms are a racing heart, rapid breathing, dry mouth, clammy palms, and shaking hands or a shaky feeling inside. Trouble sleeping, nightmares, and insomnia from anxiety are also common.

Anxiety can cause weird symptoms, though, too. It can make you feel restless. It can make your hands or face tingle. You can develop chest pain, stomach pain, nausea, irritability, and dizziness. You may have difficulty thinking or concentrating. Anxiety can make you urinate more frequently. And yes, it can give you a headache.

How do you treat an anxiety attack?

Relaxation techniques can help. You can learn to slow your breathing and deeply relax your muscles. (There are tapes that can help to teach you these things.) You can also picture yourself being successful and overcoming your anxious feelings. Many people have found meditation to be helpful. Then when an anxiety attack hits, you have the tools you need to fight those anxious feelings.

Some people with anxiety disorders require medications. Many people with anxiety do just as well with non-medication psychological treatment. These treatments may involve counseling, or may involve biofeedback, hypnotherapy, or relaxation training.

Avoiding anxiety is also important. Caffeine, alcohol, and nicotine can make anxiety worse. Don’t drink too much, smoke too much, or drink lots of coffee if nervousness and anxiety bother you. Remember that some over-the-counter medications contain caffeine--especially headache medications.

You may feel better if you exercise regularly. This can help regulate anxious feelings.

References:
1. Afari N, Harder LH, Madra NJ, et al. PTSD, combat injury, and headache in Veterans Returning from Iraq/Afghanistan. Headache. 2009;49(9):1267-1276. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19788469
2. Peterlin BL, Tietjen GE, Brandes JL, et al. Posttraumatic stress disorder in migraine. Headache. 2009;49(4):541-551. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19245387
3. Peterlin BL. Post-traumatic stress disorder in migraine: further comments. Headache. 2009;49(5):787. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19456892
4. Peterlin BL, Tietjen G, Meng S, Lidicker J, Bigal M. Post-traumatic stress disorder in episodic and chronic migraine. Headache. 2008;48(4):517-522. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18377377
5. Ruff RL, Ruff SS, Wang X. Headaches among Operation Iraqi Freedom/Operation Enduring Freedom veterans with mild traumatic brain injury associated with exposures to explosions. J Rehabil Res Dev. 2008;45(7):941-952. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19165684    6.Jette N, Patten S, Williams J, Becker W, Wiebe S. Comorbidity of migraine and psychiatric disorders--a national population-based study. Headache. 2008;48(4):501-516.
7. Low NCP, Merikangas KR. The comorbidity of migraine. CNS Spectr. 2003;8(6):433-434, 437-444.
8. Ligthart L, Nyholt DR, Penninx BWJH, Boomsma DI. The shared genetics of migraine and anxious depression. Headache. 2010;50(10):1549-1560.

by Christina Peterson, MD

updated Jan 31, 2010