Migraines & Depression

How Are Migraine and Depression Connected? What comes first—migraine or depression? How are they linked, and what does a holistic treatment approach look like? Find everything you need to know about this topic here.

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Last updated: February 6, 2024

The connection between chronic pain conditions like migraine and depression has been studied and debated by researchers and medical professionals for years. Many questions remain unanswered:

Is depression a natural consequence of migraine, or is migraine a result of depression?
Do both conditions share the same root causes and triggers?
Which condition develops first, and how can a dual diagnosis be treated most effectively?

Migraine & Depression: Key Statistics and Facts

In the United States, approximately 51.6 million adults (21% of the population) experience chronic pain. Of these, around 12 million individuals (4.9% of U.S. adults) suffer from both chronic pain and symptoms of anxiety or depression.

A U.S. study conducted by Women’s Health analyzed the migraine history and depression rates of over 36,000 women, including 6,400 women who had experienced migraine. Over a period of 14 years, 4,000 of these women developed depression in addition to their neurological condition. Research from the University of Toronto also found that migraine patients under 30 were particularly at risk—they were six times more likely to experience depression compared to migraine sufferers aged 65 and older.

How Are Migraine & Depression Connected?

The link between migraine and depression is largely due to shared genetic factors and imbalances in serotonin levels.

Serotonin, often called the “feel-good” or “happiness” hormone, is a neurotransmitter that plays a crucial role in pain processing, pain induction, and depression neurochemistry.

Both chronic pain and depression involve an imbalance of serotonin and norepinephrine, two neurotransmitters that normally inhibit pain signals at the spinal cord level before they reach the brain. When these neurotransmitters are out of balance or deficient, the body’s natural ability to suppress pain signals is lost, causing even minor stimuli to be perceived as pain.

This could explain why a specific subgroup of migraine and depression patients might share a common neurological cluster, which, if further researched, could lead to better treatment strategies for individuals suffering from both conditions simultaneously.

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Managing Migraine & Depression with a Holistic Approach

For patients with coexisting conditions, treatment should focus primarily on the underlying illness while also addressing the secondary disorder through a multimodal approach.

Medication alone is not a sufficient solution, as it does not eliminate the root cause or prevent recurrence. Instead, comprehensive pain management strategies should include:

Psychotherapy

Physical therapy

Exercise-based interventions (such as endurance training and yoga)

Relaxation techniques & breathing exercises

Lifestyle changes, including sleep and diet modifications

This holistic approach not only reduces migraine frequency and intensity but also enhances mood and promotes overall well-being.

Nutrition as an Effective Preventative Strategy

Several studies have shown that diet plays a crucial role in both migraine and depression management. Research has found that:

Large fluctuations in blood sugar levels can trigger migraines.¹-⁴

A blood sugar-stabilizing diet can be an effective preventative measure against migraine.⁵-⁷

Excessive sugar consumption is associated with poor long-term mental health outcomes, suggesting that reducing sugar intake may contribute to better psychological well-being.⁸

Whether these findings specifically apply to migraine-associated depression remains unclear, but they highlight the importance of diet in overall brain health.

If you want to learn how to stabilize your blood sugar through diet, try Ebby. This digital health application helps identify which foods and meals keep your blood sugar stable, allowing you to adjust your diet to prevent migraine attacks.

Medication-Based Treatment for Migraine & Depression

When treating both migraine and depression, strict medical supervision is essential to avoid risks and drug interactions. Ebby helps track prescribed medications, providing valuable feedback for doctors and ensuring the optimal combination of treatments.

Triptans are commonly prescribed acute migraine medications (for migraines with or without aura). These drugs work similarly to serotonin, constricting blood vessels to counteract migraine-related vasodilation.

Dual-action antidepressants can be used both for depression and as a migraine preventative, as they regulate serotonin and norepinephrine levels, restoring the body’s natural pain inhibition mechanisms.

The most effective medications for migraine prevention are tricyclic antidepressants (TCAs), which inhibit the reuptake of serotonin, norepinephrine, and dopamine in the brain. Based on individual patient needs, doctors may choose from:

Amitriptyline-type TCAs

Imipramine-type TCAs

Desipramine-type TCAs

However, beta-blockers and flunarizine should be avoided in patients with both migraine and depression, as they may worsen depressive symptoms.

Conclusion

Since migraine and depression often coexist, treatment should always be carefully planned with a healthcare professional. In many cases, it is beneficial to include psychotherapists in the treatment process to address both neurological and psychological factorseffectively.

Sources

Siva, Z.O. et al. (2018): Determinants of Glucose Metabolism and the Role of NPY in the Progression of Insulin Resistance in Chronic Migraine. In: Cephalalgia 38 (11), S. 1773–81. https://doi.org/10.1177/0333102417748928.
Yilmaz, N. et al. (2011): Impaired Oxidative Balance and Association of Blood Glucose, Insulin and HOMA-IR Index in Migraine. In: Biochem. Med., 21, S. 145–151.
Bernecker C. et al. (2011): Oxidative stress is associated with migraine and migraine-related metabolic risk in females. In: European Journal of Neurology, 18(10), S.1233-9.
Gruber, H.-J. et al. (2010): Hyperinsulinaemia in Migraineurs Is Associated with Nitric Oxide Stress. In: Cephalalgia30 (5), S. 593–98. https://doi.org/10.1111/j.1468-2982.2009.02012.x.
Bongiovanni, D. et al. (2021): Effectiveness of Ketogenic Diet in Treatment of Patients with Refractory Chronic Migraine. In: Neurol Sci, doi:10.1007/s10072-021-05078-5.
Evcili, G. et al. (2018): Early and long period follow-up results of low glycemic index diet for migraine prophylaxis. In: Agri.30(1), S. 8-11. doi: 10.5505/agri.2017.62443.
Razeghi, J. S. et al. (2019): Association of diet and headache. In: Journal of Headache and Pain, 20(1), S. 106. doi:10.1186/s10194-019-1057-1.
Knüppel A, Shipley MJ, Llewellyn CH, Brunner EJ. (2017): Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study. In: Sci Rep., 27;7(1), S. 6287. doi: 10.1038/s41598-017-05649-7. PMID: 28751637; PMCID: PMC5532289.

About the Author

Dr. rer. nat. Markus A. Dahlem

Dr. Markus Dahlem was co-founder and CEO of Newsenselab, the start-up behind M-sense. He has been researching the development of migraines for more than 25 years. As a physicist, he is fundamentally interested in whether mathematical calculations can contribute to the basic understanding of diseases.