Anxiety is the most common mental health problem associated with migraine. Anxiety disorders in people affected by migraine are twice as common as depressive disorders. A recent systematic review found the incidence of anxiety in migraine is around four times higher than in those without migraine.

It seems that migraine can lead to anxiety, and anxiety can lead to migraine – there is a complex interplay between the two conditions. If someone has frequent painful headaches, it would not be surprising for this to lead to some anxiety. You don’t know when the attack will strike, how badly you will be affected or whether your treatments will work and this has serious implications for planning work, caring for a family and participating in social activities.

Acute anxiety is a biologically adaptive response to real or potential threats in the environment. If someone experiences prolonged anxiety this affects neuronal pathways, and could influence neuropathological processes leading to the development or the worsening of migraine.

A recent study by Irimia et al. showed that in migraine, as the number of headache days increased there was an increased risk of anxiety and depression. Just having three headache days per month led to a significant increased risk of anxiety. For an increased risk of depression there had to be 19 headache days each month.

As the co-existence of anxiety and migraine is so common, we should always consider whether anxiety is present. Studies have shown pharmacological treatment for anxiety can also reduce migraine attacks. Not diagnosing and managing the anxiety may mean that migraine remains resistant to traditional medical therapies, and people miss out on effective treatments.

Am I experiencing anxiety?

A good tool to test yourself to see whether you might be suffering with anxiety can be found here.

It is well worth everyone with migraine undertaking this self-assessment, particularly if you are finding it difficult to find effective treatment. If it shows any anxiety or depression you can book with your GP to discuss things further if you wish.

Managing anxiety and migraine

Having anxiety doesn’t necessarily mean you have to take tablets. There are plenty of ways to manage mild anxiety without the need for medication. In fact, in mild anxiety non-drug strategies are often more effective than medication. The NHS website has some excellent resources here.

Lifestyle changes

Lifestyle changes that can improve anxiety include:

• Increasing exercise: Trying to find something you enjoy is important, maybe meeting with a friend to exercise, or signing up to a class. Even if you already have an active job, doing some additional more intensive exercise can be necessary – working at an intensity where you can talk to a friend but not sing a song seems to be important for activation of the neuronal pathways which combat anxiety.
• Reduce or stop smoking and drinking alcohol: If you need help do ask your GP practice as support is available.
• Relaxation: Learning how to relax properly can help. This isn’t always as easy as it sounds in our busy modern lives. A nice audio guide is available on the NHS website. Meditation exercises are proven to help stress and anxiety, among other mental health conditions. Some good resources include Headspace and Be Mindful.

Psychological therapies

Psychological therapies (counselling) are also proven to improve anxiety. If you would like to explore face-to-face or one-on-one telephone counselling you should contact your GP practice and ask how to access this in your area. Many services accept self-referrals. For those with special educational needs or wishing to access support in a different language it is a good idea to mention this as there should be local services which you can access.

For young people aged 11-24 Kooth is an online support service for people who have anxiety or many other mental health problems.

Artificial intelligence support is now also an option. For example, Wysa might be helpful. This AI-enabled chatbot can offer mental health support for anxiety and other common mental health problems.

Some people may prefer a good old fashioned book. There is a great selection on the Reading Well website or you can ask in your local library.

Support groups

Support groups for those with anxiety are also helpful for many people. Some which are recommended by the NHS include:

• Anxiety UK
• Mind
• Rethink Mental Illness

In conclusion, managing your migraine involves looking at your whole self. If you’re suffering with other physical or mental health problems which aren’t being treated properly then it is hard to get control of the migraine. Since anxiety is the most common associated mental health condition in migraine I would advise everyone with migraine to test themselves for anxiety. If you find you do have some anxiety and you can improve this then you are very likely to see an improvement in your migraine control as well.

Read Dr Kennis’ recent blog about managing your migraine here.