How To Treat Your Anxiety and Migraine at the Same Time

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Coping with Anxiety and a Migraine. Paul Bradbury/Getty Images

Many migraineurs suffer from psychiatric disease, especially depression and anxiety. The precise link between migraines and these mood disorders is unclear. It's likely complex and involves both an individuals' genetic makeup and their environment.

Let's take a closer look at the relationship between migraines and generalized anxiety disorder, a common type of anxiety, and how they can be treated simultaneously.

What is Generalized Anxiety Disorder (GAD)?

GAD is a type of anxiety disorder characterized by excessive worry over family, work, finances, and health. This mood disorder affects approximately 3% of the population and is more common in women. Patients with GAD have difficulty controlling their worried thoughts, causing an impairment in their relationships, daily activities, and overall health. While it is perfectly normal to worry—we all do it—the intensity and frequency of concern experienced by those suffering from GAD are out of proportion to the actual threat.

In addition to concerned thoughts, patients with GAD often complain of physical ailments like:

  • fatigue
  • muscle tension or pain
  • restlessness
  • increased physiological arousal (e.g. increased heart rate)

How is GAD Diagnosed?

Doctors commonly use the Generalized-Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire (PHQ9). Both are filled out by the patients and easily scored by the doctor.

Is GAD More Common in Migraineurs?

Yes. GAD is more common in migraineurs than in individuals with no headache disorder. In one study in Neurology of over 5000 patients in the United States, 7.2% of migraineurs had GAD compared to 2.3% of those without headache. Additionally, migraineurs with anxiety may have more headache disability, which is impairment in relationships and daily functioning.

What is the Treatment for Migraineurs with GAD?

For GAD, therapy commonly entails a combination of cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs). But for migraineurs, while cognitive-behavioral therapy is an effective intervention, SSRIs are of little use.

Fortunately, venlafaxine (Effexor), a selective serotonin-norepinephrine reuptake inhibitor (SNRI), is FDA approved to treat GAD and may be also helpful in migraine prevention.

So if you have both anxiety and migraines, CBT and Venlafaxine could be good options. Other medications that may be beneficial in preventing migraines, while treating GAD at the same time, are gabapentin (Neurontin) and buspirone (BuSpar).

Take Home Message

Do not feel alone if you suffer from both migraines and an anxiety disorder like GAD, or think that you might. The good news is that treating one may help the other. This might be especially true if you find that your headaches and "anxieties" are connected, meaning one seems to trigger the other in a vicious cycle.

Speak with your headache doctor or primary care doctor to formulate the best treatment plan for you.

Sources

American Headache Society: Generalized Anxiety, PTSD, & Migraine. http://www.americanheadachesociety.org/assets/1/7/B._Lee_Peterlin_-_Generalized_Anxiety,_PTSD_and_Migraine.pdf. Accessed March 1st 2015.

Griffith JL, Razavi M. Pharmacological management of mood and anxiety disorders in headache patients. Headache 2006;46[S3]:S133-41

Kavan MG. Generalized Anxiety Disorder: Practical Assessment and Management. Am Fam Physician. 2009 May 1;79(9):785-91.

Saunders K, Merikangas K, Low NCP, Von Korff M, Kessler RC. Impact of comorbidity on headache-related disability. Neurology 2008;70:538-47.

DISCLAIMER: This site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.

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