Many people may have been told that if they just “stop being stressed out,” their headaches would simply go away.  Much of the stigma of migraine comes from this misunderstanding. The truth about the connection between migraine and stress is actually much more complicated and nuanced. The good news, though, is that there are excellent ways to treat both migraine and depression together. 

The Mind and the Brain are the same Organ

Migraine is a neurological condition and depression is a psychological condition - but they do both come from the same part of the body.  Functional neuroimaging studies have shown dysregulation of specific neurotransmitters in people with migraine - some of the same neurotransmitters (like serotonin, dopamine and norepinephrine) that are dysregulated in depression.  Early migraine genetics studies are also discovering links between how both migraine and depression are coded in the DNA. 

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Some of the earliest studies looking at preventive treatments for migraine tried out antidepressant medications. We discovered that some antidepressants work well for migraine, and some don’t.  The SSRI class of antidepressants (sertraline/Zoloft, paroxetine/Paxil, escitalopram/Lexapro, etc.) that are selective for only one neurotransmitter (serotonin) don’t work well enough to prevent migraine, even though they are quite effective for depression.  Antidepressants that have an effect on multiple neurotransmitters (TCA or tricyclic antidepressants, and SNRI medications) are much more effective.   

Preventing Migraine and Treating Depression 

When migraine and depression are both present, it may make sense to consider a preventive medication that can treat both symptoms.  This will be a decision you and your doctor can consider, and you can tailor the specific antidepressant to your underlying symptoms.  TCA medications are really helpful if you have sleep issues and insomnia.  SNRI medications help regulate norepinephrine, helping with chronic fatigue.  Both are used for musculoskeletal pain as well, and can help with muscle spasm and soreness.  

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It might, however, be best to consider separate treatments for migraine and depression.  This is especially the case if your depression is quite severe, or if you have certain subtypes of depression that aren’t well treated with TCA or SNRI antidepressants.  In this situation, your doctor might recommend a separate medication for the depression (such as an SSRI) and migraine (such as a blood pressure medicine, an injectable, or Botox). 

Communication With Your Psychiatrist

If you do have a psychiatrist, it’s important that your headache specialist and psychiatrist confer on which medications they think are best for you.  Sometimes, this might allow you to simplify your medication regimen and use fewer medications, or at other times, this might allow for more precise targeting of your specific symptoms.  Not all medications for migraine can be taken together, and it is important for all of your doctors to know anything else you might be prescribed.  

Depression as a Trigger

Notoriously, migraine has many triggers that cause it to rear its ugly head.  Most triggers are fairly unique and individualized, but stress is considered the “universal trigger”.  Stress will trigger just about anyone who experiences migraine, and depression and stress go hand-in-hand.  

Non-Medical Treatments

Depression is not treated by medication alone - many different non-medical therapies have been studied and seen to be effective for some people with both migraine and depression.  This includes psychotherapies such as cognitive behavioral therapy, as well as mindfulness training and biofeedback.  These can be incorporated into your treatment plan as well. 

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Consulting with the right specialist is essential in your journey to get your migraine treated. If you want to speak directly with a board-certified neurologist specializing in headache care about how your headaches may be related to depression or stress, and what treatments may be appropriate for you, you can do so using the Neura Health app.

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Neura’s approach is a four-step, science-based process that our specially trained board-certified neurologists use to tailor a treatment plan to each patient’s unique issues and needs. 

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1. Receive: Get customized information, education, recommendations and medications by scheduling an initial consultation with your board-certified neurologist.
2. Record: Input your headaches using the built-in tracker in the Neura app; the data is seamlessly shared with your neurologist.
3. Review: Meet with your neurologist to discuss progress, adjust medications and format a long-term treatment plan for your needs to manage headaches over the long term. 
4. Repeat: Track headaches, and meet with your neurologist to discuss progress as many times as you would like. 

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