The Relationship Between Migraines and Depression

Their Connection and How to Effectively Manage Both Conditions

If you have migraines, you're more than 2 1/2 times more likely to develop depression than people who don't have migraines. And if you leave depression untreated, your risk of going from episodic migraines (fewer than 15 per month) to chronic (15 or more per month) increases.

The biological link between migraines and depression is complex and may be related to genes, low serotonin production, or other factors. They are worth understanding more about, especially when working to manage both conditions effectively.

Close-up of sad woman lying on sofa at home
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The Link

Scientific studies reveal that the relationship between migraine and depression is a two-way street: Having one puts you at a higher risk of the other. No one knows exactly what causes either migraines or depression, but there are a few theories about why the two are linked.

Shared Genes

Genetics appear to play a role in the development of both migraine and depression individually. Thanks to twin and family studies, experts believe that at least part of the relationship between migraine and depression is that they seem to share some genes that are responsible for triggering the development of these conditions.

Although no definitive genes have been identified to prove this shared genetic link, the major suspects are genes that affect several chemical messengers in your brain called neurotransmitters, specifically serotonin, dopamine, and gamma aminobutyric acid (GABA). Variants in the MTHFR and BDNF genes are also believed to play a role.

Some research also suggests that migraines and depression don't always occur as a consequence of the other. The genetic pathways associated with either condition can allow you to develop both migraine headaches and depression independently.

Serotonergic Dysfunction

Low serotonin levels in the brain have been linked to depression. Likewise, a drop in serotonin levels may trigger a migraine attack in some people. Because serotonin appears to play a large role in both conditions, another hypothesis for the relationship between migraine and depression is dysfunction of the system responsible for producing serotonin.

Hormonal Influences

Female hormones are also thought to contribute to both migraine and depression since the rates of both conditions are around twice as high in women as in men. This is likely due to hormonal fluctuations during menstrual cycles, menopause, pregnancy, postpartum, and perimenopause. Interestingly, after menopause, a woman's risk of depression decreases and migraines also tend to get better for many women, probably thanks to decreased levels of estrogen.

HPA Axis Dysfunction

A dysfunctional hypothalamic-pituitary-adrenal (HPA) axis may also contribute to migraines and depression. The HPA axis involves interactions between the part of your brain called the hypothalamus, your pituitary gland, and your adrenal system. It controls how your body responds to stress and regulates various functions in your body.

Scientists are still trying to understand the role of HPA axis dysfunction in a number of health conditions, but it has been linked to all sorts of issues besides migraine and depression, such as fibromyalgia, anxiety disorder, restless legs syndrome, chronic fatigue syndrome, and irritable bowel syndrome (IBS).

Recognizing Depression

Migraine symptoms may be quite obvious to you, but symptoms of depression may be harder to identify.

Depression is a serious condition that requires medical attention. Common symptoms to look out for include, but are not limited to:

  • Feelings of sadness, worthlessness, or pessimism
  • Heightened agitation and restlessness
  • Loss of interest in activities that were once enjoyed
  • Extreme fatigue and loss of energy
  • Changes in sleep pattern (either too much or too little sleep)

If you have signs or symptoms like these for more than two weeks, be sure to see your healthcare provider. Treatment can greatly improve your quality of life and, as noted earlier, leaving depression untreated may increase your risk of developing chronic migraine.

Establish a Healthcare Team

The mechanisms of migraine and depression go hand in hand, so it's important to choose a neurologist and psychiatrist that will work together to fully evaluate your symptoms and treatment options. Remember, migraine is not simply a symptom of depression, but its own disorder.

In addition to working with your healthcare providers, you might want to also enlist the services of a psychologist or therapist to help manage your health and lifestyle. Behavioral treatment (like biofeedback, cognitive-behavioral therapy (CBT), and progressive muscle relaxation) combined with medication has been shown to be the most beneficial treatment for migraine, so it follows that this combination may be equally successful in treating co-occurring depression and migraine.

In fact, a 2015 pilot study used a CBT program designed to treat both headaches and depression in 12 weekly, 50-minute sessions focusing on components like relaxation training, education about depression and headaches, social skills training, lifestyle management, and pain management training. By the end of treatment, not only were participants' headaches and depression significantly reduced compared with the control group (which received regular care under a primary care practitioner without CBT), but they also reported less anxiety and a better quality of life. At a four-month follow-up after treatment, these improvements were still ongoing.

Evaluate Your Medication Options

When it was discovered that the biological factors that make some people more vulnerable to depression can also make them more vulnerable to migraines, it was also uncovered that some antidepressants can also reduce the severity and frequency of migraines.

In cases where your depression is mild, using just one medication for both your depression and migraines may work for you.

Two examples of antidepressants that may work to both ease your migraines and improve your mood include:

  • Elavil (amitriptyline), a tricyclic antidepressant
  • Effexor (venlafaxine), a serotonin-norepinephrine reuptake inhibitor (SNRI)

However, it may instead be more effective—and minimize your chance of side effects—to use different medications for each condition. This is partly because a single medication is usually given at different doses with different adjustments for each condition.

For example, Elavil is effective for migraine at low doses with few side effects, but it takes higher doses to be effective for depression, resulting in more side effects.

Because of this, your healthcare provider may instead prescribe more traditional migraine medications, like non-steroidal anti-inflammatories (NSAIDS) or triptans, along with an antidepressant. This is likely to be more effective in targeting your symptoms while also making sure you have the fewest side effects.

A Word From Verywell

It's important to seek out help if you're suffering from symptoms of depression or another mental health concern, like anxiety, in addition to your migraines. While treating one may help the other, these are two complex diseases that require the careful attention of a healthcare provider. Take good care of your body and your mind. There are a number of effective therapies out there that can help you live your best life.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.