You need to know a hidden fact about your Migraine.  It’s something that is rarely discussed openly. It’s alarming. It’s heartbreaking.

More than 20% of people that suffer from migraine have thought about suicide.  Twenty percent!

Moreover, more than half of your loved ones with migraine experienced depression according to the Migraine and Mental Health Survey 2018 conducted by Axon Optics.  

It’s the same story again and again. You have yet another migraine attack which means you have to call in sick to work, miss out on a family event, or cancel plans with friends. You feel like you should be able to “buck up” and go anyway, but you just can’t. This leaves you feeling inadequate, like you are letting everyone down.

The physical pain in your head is now compounded by disappointment, guilt, and deep sorrow.

It’s hard enough to tell others you have yet another migraine.  Telling them you have depression too is even more difficult. Despite increased awareness and education, mental Health conditions are still taboo in many segments of our society.

It is only recently that you may have felt any degree of comfort in discussing your mental health struggles publicly regarding depression, anxiety, and suicidal thoughts.

You may have felt alone, but know that as these issues have been brought further into the light, researchers have been able to draw distinct lines between them chronic conditions such as migraine and mental health.

At Axon Optics, we work hard to raise awareness about migraine as well as educate patients about their treatment options, coping strategies, and breaking news regarding migraine. As part of our continuing effort to help people with migraines, we conducted a survey exploring the link between migraine and mental health. You can view the results within this article. We interviewed a medical expert and reviewed 15 articles and studies, gleaning vital information about migraine and mental health. We have also compiled a number of resources for finding free or low cost mental health clinics as well as free or low cost prescriptions.

You no longer make plans because you know you're going to have to cancel them. You go broke trying every homeopathic method out there. It causes rifts in relationships because people don't understand chronic illness. People don't want to hear about a sick person. It touches every aspect of your life, job, marriage, kids, family and you feel like they are traveling with you through this illness because they're affected also. Final word... Exhausting!!! ~ Anonymous: Migraine and Mental Health Survey 2018

The State of Mental Health and Migraine

Migraine is a significant problem on a global scale. The World Health Organization (WHO) lists migraine among the top 20 causes of disability worldwide. Every year in the United States and Europe individuals miss 250 million days from work due to migraine. It can impact a person’s life in every imaginable way, including relationships and social activities.

People with chronic migraine report feeling confined and anxious. They feel trapped in their own homes, afraid to venture out lest they suffer an attack. Lost days from work often mean decreased income and for many means work conflicts, tension at work, and fear of job loss.

The environment that migraine cultivates in a person can cause them to withdraw from family and friends, especially if they feel that their condition is not understood. They use words like hopeless, disabled, burdened, trapped, and alone to describe their migraine experience. This places them in a very vulnerable, isolated state – an environment ripe for depression and anxiety. Some studies show that 10% of people with migraines suffer from depression, anxiety, and suicidal thoughts and even attempts. Some studies report even higher numbers.

Suicide and Migraine

Suicide is a valid concern among people with migraines. Mental health treatment is available and can help significantly, but all too often it is abandoned. The major prohibitive factors in seeking both migraine treatment and mental health treatment are cost and time. Doctor’s visits, treatments, and medication can be expensive, but when you factor in time off work and other expenses involved in seeking treatment, the cost is just too great for some and they crumble under the burden.

The inability to get needed treatment is discouraging enough, but many people report going to the emergency room in a desperate attempt to get relief only to be treated as a drug seeker. Any hope they had of getting an abortive treatment for their migraine is shattered and all too often they are sent home feeling worse than before.

Of course, this is not always the case, many times treatments are administered, often a “migraine cocktail” which may include an antihistamine, a pain medication, and nausea medication. But even the treatment can lead to depression as patients battle side effects and medications that are known to cause depression. In turn, depression and anxiety can increase pain and make it last longer. It is a vicious cycle.

Empowerment for Migraineurs

We interviewed Dr. Farrah Hauke, Psy.D, a licensed psychologist in Scottsdale, Arizona about this critical situation. Her input is invaluable and she provides practical, effective coping strategies that you can put to work in your life today. Her message is one of empowerment, hope, and positivity which she says is instrumental in combating the mental health effects of migraine pain, and even provide some degree of pain management.

“Research shows that we respond to and cope better with pain and stress when we have a positive and optimistic, or at the very least more neutral, approach to thinking about it,” Dr, Hauke says. “For example, the person who tells themselves ‘this is awful, it always will be awful, and my life is terrible’ will feel emotionally and physically worse than another person who has a more realistic appraisal about their pain, like ‘ouch this hurts, but I know it will pass and I know there are things I can do to help myself during this time period’.”

For intractable migraine and others with ongoing pain, this may be easier said than done, but celebrating the little victories, the little glimmers of good or progress can do a long way in boosting your spirits which, in turn, will lessen your pain.

Migraine Medication and Mental Health Implications

Anticonvulsant medications are commonly prescribed to people with migraines and for many people they work. Some of the more common ones used for migraine include Topiramate (Topamax), Carbamazapine (Tegretol), and Gabapentin (Neurontin). It is important that patients taking these are any prescription medications for their migraines work with their doctor to closely monitor their condition and any side effects that the drug may produce.

A 2010 study explored the effects of these anticonvulsant drugs, particularly regarding an increased risk of suicide or attempted suicide as a side effect. The study found that the medication may be associated with an increased risk of suicide and attempted suicide. Other side effects reported include extreme anxiety, racing thoughts, and paranoia.

The anticonvulsant medications used for migraine that are associated with the highest suicide risks are:

• 6.2% - Valproate (Depakote)
• 7.5% - Lamotrigine (Lamicital)
• 19.4% - Topiramate (Topamax)
• 48% - Gabapentin (Neurontin)

It should be noted that some people can take these medications and never experience any ill effects. However, for those that do it can be a terrifying experience. People who seem particularly prone to these types of side effects are typically those who have a history of anxiety, depression, or mood disorders. The medication seems to exacerbate the existing condition in many cases.

Some migraine medication side effects can be very scary.

This should not deter you from trying medication to get control over your migraine, but it is intended to provide awareness of potential problems with certain drugs. You need to be very honest with your doctor when discussing a treatment plan and let him or her know of any depression, anxiety, or mood disorders that you have experienced, especially if suicide was a component.

Medication cannot bear all the blame for mental health issues though. Another study published in the journal Pain, identified anxiety and depression as a significant problem among people with migraine. Their findings showed that 50.6% of subjects who had active migraine were also depressed or anxious or both. They also found that migraine patients who were also anxious and/or depressed perceived their treatment to be less effective than those who were not anxious and/or depressed.

This indicates that anxiety and depression could indeed affect not only the pain of the migraine, but also the perception of how well that pain is managed. A 2012 study published in Headache: A Journal of Head and Face Pain presented research that suggests an increased risk of suicide attempt with migraine that may be influenced in part by the severity of pain that the person experiences.

According to a 1991 study in Psychiatry Research, people who had migraine with aura seemed to have a higher risk of a psychiatric comorbidity than those who had migraine without aura. It also found that patients who had anxiety prior to a migraine attack were more likely to experience major depression. Suicide attempt rates were also higher in people who had migraine than those who did not.

This paints a vicious cycle for the person with chronic migraine, especially if they are prone to depression and/or anxiety. They take the medication for the pain but that medication may have side effects that exacerbate their psychiatric conditions. On the other hand, the severity of their pain may also exacerbate their psychiatric condition. It is a classic Catch 22.

Migraine Medication Side Effects and Psychiatric Consequences

Other possibilities must be factored into this though, because not everyone reacts the same to medication or pain. Some people may be able to tolerate the medication and experience no side effects, but can be crippled by pain that increases their depression and anxiety. Likewise, a person may be able to handle the pain without lapsing into a depressive episode or experiencing anxiety, but have terrible adverse reactions to certain medications.

There are no effective predictors at this time that would indicate whether or not a person will have an adverse reaction to a medication. The decision to try a drug is a very personal decision that should be between patient and doctor. Some people may feel the possibility of psychiatric related side effects outweigh the efficacy of the drug while others feel that pain relief is more important. Only you can decide whether or not you want to try a medication despite possible side effects and only you can decide if it works for you.

It is also important to note here that if you decide to stop using a medication you should only do so under the supervision of your doctor. Never abruptly stop taking a prescribed medication unless your doctor tells you to do it. You could make your migraines worse, experience increased anxiety and/or depression, or have other harmful effects including withdrawal. Work with your doctor to get off the medication; that is the safest way.

Migraine and Mental Health Survey 2018

There were 410 people who responded to our survey so they could tell us about their migraines. Of those respondents, 69% have received a diagnosis of migraine by a medical professional such as a doctor. Nearly 24% were self diagnosed, while 7% were seeking a formal diagnosis at the time they took the survey.

Frequency of migraine was also examined. Our respondents experienced migraine:

• 13.4% - Less that once a month
• 12.4% - 3 or more times a month
• 14.4% - Once a week
• 15.4% - 1-2 times a week
• 23.2% - 2-4 times a week
• 11.5% - 5-6 times a week
• 9.8% - Daily

The focus of the survey was to explore a potential link between migraine and mental health. Of the respondents who had migraine:

• 70% experienced anxiety
• 60.2% experienced depression
• 21.5% had suicidal thoughts
• 5.9% had formulated a plan for suicide
• 4.1% had attempted suicide

It is difficult to determine whether the migraine is the cause of the mental health issues or if they are independent conditions. However, We asked respondents to briefly describe the impact that the chronic pain of migraine has on their lives.

These sobering statements highlight the need for more research in migraine relief as well as help for those who are struggling with migraine and mental health issues. 80.5% of respondents stated that they felt their migraines decreased their quality of life.

Anxiety and depression seem to be very real components of migraine. When left unchecked, these issues can spiral out of control, but getting help for mental health issues is not always easy. 45% of respondents reported that they had sought treatment for their depression and anxiety, but 53.9% said that financial cost was a barrier to seeking mental health help.

Anonymous Mother of 3, one of the respondents to our Migraine and Mental Health survey, summed up her heartbreaking experience that was echoed by so many of the people who participated:

Anxiety that I had as long as I can remember before migraines got worse after they started about 2 years ago. Then the depression started about 4 months ago due to constant pain and the struggle of balancing daily life (work, kids, husband, House, etc.). When the migraines increased in frequency and intensity and stopped responding to treatment I had to stop working. I felt worthless, guilty, I felt hopeless, lonely, scared, and worst of all fed up and at my wits end; this all leads to suicidal thoughts.

Although I would never act upon it, I have children and a husband who needs me, the thoughts sometimes fleetingly cross my mind until I snap back. All because I suffer from this invisible pain. What is even worse is the stigma we have from others who don’t understand.” It’s only a headache” “ it can’t be that bad” “ oh I get headaches too and still work” “just take a Tylenol” All of that weighs down on you like a sack of negativity. You became emotional drained just socializing with people so you don’t, which means, chronic migraines also keeps me isolated and relying on a very close-knit support group of people, mostly family.

Lastly, migraines have taken away my intimate relationship with my husband, my bonding time with my children, and my ability to complete schoolwork towards my doctorate degree, which adds only more to the anxiety and depression. Chronic migraines make me feel like a failure as a mother, a wife, a friend, a teacher (my job), a student (Ph.D) an overall human being.

Strategies for Coping with Migraine and Mental Health Issues

Dealing with chronic, debilitating pain like migraine can be exhausting and lead to depression, especially if you feel that your quality of life has been impacted. Anxiety can also become a problem as you worry about when the next attack will occur as well as having to cancel plans because of an attack.

Dr. Hauke has this advice for people with migraine who are battling depression and anxiety:

• Be proactive and mindful of what causes or exacerbates your migraines and take steps to avoid, alter, or adapt to these triggers.
• Join support groups to recognize that you are not alone in your pain and that others understand and want to help you cope. This type of support can help individuals feel validated as well as allow them to learn from and associate with like-minded others.  
• Seek psychological treatment, in addition to medical treatment.
  • For example, Cognitive Behavioral Therapy (CBT) is one of the most empirically validated methods of treating depression and other emotional concerns. This type of treatment addresses dysfunctional and/or unhelpful thought patterns and beliefs that one might have about their pain or migraines.
  • Psychotherapy in general, no matter the modality, is helpful in that it provides an outlet for non-judgmental and emotional validating support and advice.
• Integrate mind-body techniques.
  • Yoga, relaxation breathing, progressive muscle relaxation, and meditation activate the relaxation response in the brain as well as draw focus from the external to the internal
• Adopt an internal locus of control (belief that I can make things happen) versus an external locus of control (belief that things just happen to me).

It is so easy to get caught up in taking care of others - kids, spouse, parents, family - that it’s easy to forget to take care of ourselves. Self care should be at the top of your list though. It is so important that you be good to you.

Empowerment through an internal locus of control

In life there are some things in your world that you can control, and some you can’t. What many people don’t realize is that they have more control over the outcome of events and circumstances in their lives than they may realize. This is the core of internal locus of control. It is an element of your personality that is the amount of control you believe to have over the things in your life, particularly your health.

Many people default to an external locus of control, meaning that they blame outside forces like luck or fate for their circumstances. However, the healthier option is to take some role, some responsibility over what happens to you. It is that self-control, that self-determination that will help you overcome many obstacles.

“I often tell clients that although pain may be ‘happening to them,’ they play more of a role in addressing it than they may realize, says Dr. Hauke. “In other words, while relying on medication is important, it is vital that they (the client) see themselves as being responsible for addressing their pain in other healthy ways. This might include exercising, abstaining from alcohol, drugs, junk food, or caffeine, eating well-balanced meals, avoiding their migraine triggers, and not going for too long without eating, receiving adequate rest, hydrating sufficiently, and engaging in self-care.”

Yes, there are external forces that are beyond your control; some things just happen. However, in many cases, you do have a certain degree of power over your circumstances. While it isn’t healthy or realistic to assume a completely internal or external locus of control, it is good to accept that you can do certain things in your life that will influence what happens to you. You are not some hapless spectator to your own life. Your values, beliefs, attitudes, and actions all play a very big part in influencing and directing your outcomes.

This is a common element of therapy for those with chronic pain. Instead of just giving up and allowing yourself to be a slave to the pain, your internal locus of control will compel you to take control over what you can – and accept what you can’t. A good therapist can help you draw that line, so you know what is possible and realistic and what isn’t.

When you find that balance, it can be empowering. You may even find that you are better able to manage your pain because you know if you have two drinks or skip a meal you will likely get a migraine, so you take control and avoid those things. It can also help you feel better about self care because you understand that it is something necessary for your wellbeing and you must take care of yourself before you can take care of a spouse, children, or anyone else.

Finding free or low cost mental health care

Cost is often cited as a barrier to seeking treatment, particularly for mental health issues. However, many cities have free mental health clinics and there are also a number of clinics nationwide that offer low cost mental health treatment or allow payment on a sliding scale. These are some very good resources so that you can find the help you need.

• National Association of Free & Charitable Clinics (NAFCC)
• National Alliance on Mental Health (NAMI)
• Substance Abuse and Mental Health Services Administration (SAMHSA) - You can also call SAMHSA's National Helpline at 1-800-662-HELP (4357) or 1-800-487-4889 (TDD) for information on free or low cost clinics.
• Mental Health America (MHA)
• Anxiety and Depression Association of America (ADAA)
• Teladoc

There are also programs that will help you get free or low cost prescriptions.

If you feel that you are in crisis, in immediate distress, or that you may harm yourself or others  call the National Suicide Prevention Lifeline at 1-800-273 TALK (8255). You can also chat with them online. The Lifeline is confidential and free with counselors available around the clock every day of the week. They can not only provide immediate support if you are having a difficult time, but are also able to refer you to mental health services in your area.

Resources for Migraine and Mental Health

Support can be very helpful for those who experience depression and/or anxiety with migraine. There are a number of very good resources available. These are a few of our picks:

• New Chronic Migraine Support Group (Facebook)
• Living with Chronic Pain Support Group (Facebook)
• Depression Support for those with Chronic Pain or Illness (Facebook)
• Migraine + Chronic Pain + Depression/Anxiety etc Support Group (Facebook)
• Migraine Research Foundation – Resources and Links
• Anxiety and Depression Association of America Online Support Group
• ADAA Support Group Listing

The link between migraine and mental health is quite complex but that doesn’t mean you have to become a statistic. Awareness of potential complications allows you to stay ahead of any problems.

If you feel depressed, anxious, please don’t wait. Get help right away. Call a friend or family member, talk to someone in your support group. If the feelings persist, talk to your doctor. The remedy may be as simple as changing your medication. If you feel you may hurt yourself or someone else, seek emergency medical treatment immediately.

Nothing, nothing is more important than your wellbeing.