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What You Need to Know About Migraine and Depression

What You Need to Know About Migraine and Depression
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Updated on February 14, 2025
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If you have migraine and a mood disorder such as depression, you may wonder if these conditions are somehow connected. Although there is evidence that they have a genetic component, environmental factors can also contribute to the likelihood of having depression alongside migraine.

For one thing, the reality of living with the pain and disability that migraine — particularly chronic migraine — causes may contribute to depression. Likewise, increased stress can worsen both disorders.

But is there more to the connection? Learn what the experts say about the link between migraine and depression, as well as what treatment options can help you manage both.

Can Migraine Cause Depression?

It's common to live with both migraine and depression. Indeed, depression is a comorbidity of migraine, meaning the two conditions are known to occur together.

“Migraine and depression have bidirectional relationships,” says Mia Minen, MD, MPH, a neurologist and an associate professor of neurology at the NYU Grossman School of Medicine in New York City.

While migraine isn’t the sole cause of depression — and vice versa — having one condition increases the likelihood you'll develop the other. According to one review, people with depression are twice as likely to get migraine disease.

 Likewise, another study showed those with migraine have a 2 to 4 times greater risk of developing depression than the general population.

In some cases, people may experience depression after living with migraine for years. For others, migraine onset may occur after depression.

This could occur for a number of reasons. For example, migraine attacks often cause people to miss work as well as social activities, which can have a major impact on mental health. Interestingly, research shows that depressive symptoms can increase during a migraine attack, particularly in the headache phase, which is characterized by severe, unilateral head and facial pain.

Migraine and depression also involve similar biological mechanisms, which could account for their frequent co-occurrence.

Additionally, migraine — like depression — is a stigmatized disease.

 People with either condition may experience shame, guilt, self-blame, and discrimination, all of which could affect mental and physical health.
Migraine combined with comorbid depression can be taxing, and they can form a cyclical relationship, with each one worsening the other. Research shows people with migraine and depression have a lower quality of life than those without comorbid depression.

Chronic Migraine and Depression

Anyone with migraine could experience comorbid depression, but Dr. Minen says those with more headache days are at greater risk for depression.

Specifically, people with chronic migraine are more susceptible than those with episodic migraine.

Per the International Classification of Headache Disorders, chronic migraine is defined as follows:

  • Attacks on 15 or more days per month for three months or more
  • Attacks characterized by typical migraine symptoms, such as sensory sensitivities, unilateral pain, nausea, or vomiting, on 8 or more days per month
  • Attacks lasting 4 to 72 hours
Several factors could account for the chronic migraine and depression link. Chronic migraine can affect emotional well-being, leading to frustration, worry, and loneliness.

 In addition to these emotional impacts, chronic migraine is linked to a process called central sensitization. This phenomenon, in which the central nervous system becomes sensitive to pain and other stimuli,

 also plays a role in depression.

What About Other Types of Headache and Depression?

In addition to chronic migraine, cluster headache and migraine with aura are closely associated with depression.

As the name suggests, cluster headache comes in clusters — daily for a month or more, for example, and then none for a year. The headaches occur suddenly, often waking the person from sleep, and last between 15 minutes and three hours. A runny nose and tears in eye on the side with the pain is also common.

According to a study, people with cluster headache are at a higher risk of depression, especially when they also have coexisting migraine. This study also found that depression can improve in people with both cluster headache and migraine during periods of remission.

 
Similarly, a review found migraine with aura is more closely associated with depression than migraine without aura.

 Auras are visual or sensory disturbances that precede the pain phase of a migraine attack. Symptoms can last anywhere from a few minutes to an hour.
As for tension-type headache — a common type characterized by mild to moderate pain on both sides of the head — research of a pediatric population showed it’s more closely linked to anxiety, rather than depression.

 Nonetheless, tension-type headache can still affect quality of life.

Shared Risk Factors for Migraine and Depression

Migraine and depression have common risk factors, which may be biological or environmental in nature.

“Both migraine and depression run in families,” says Minen. In fact, one gene in particular, MTHFR, has been linked to both disorders.

Genes contain the instructions for chemical messengers called neurotransmitters, which are believed to be dysregulated in both disorders. Serotonin is one particular neurotransmitter involved in this.

“I like to tell patients it's one brain, the same organ, and many of the same neurotransmitters are affected. We see overlapping parts of the brain light up on neuro-imaging studies in people with migraine and in people with depression,” says Minen.

Additionally, hormones — like estrogen and progesterone — play a role, as migraine and depression occur more often in women.

 Research also shows women with migraine experience depression more often.

As for environmental components, Minen says that “stress and trauma are risk factors for migraine,” and “up to 30 percent of people with chronic migraine have a history of trauma.” In migraine, emotional abuse is a particularly strong risk factor.

The effects of trauma are multifold. First, chronic stress can overactivate the body’s stress response system, or hypothalamic-pituitary-adrenal (HPA) axis. As a result, the nervous system can become easily excitable, which can contribute to migraine and depressive symptoms.

Secondly, trauma or adverse childhood experiences can affect how genes function. These modifications, called epigenetic changes, can be passed on to offspring.

Other risk factors for migraine and depression include obesity

 and poor sleep quality.

Lastly, some research suggests certain personality traits, like neuroticism — the tendency to experience negative affects, including anger, anxiety, self‐consciousness, irritability, emotional instability, and depression — are associated with migraine and comorbid depression.

 But it’s important to note that personality traits don’t cause migraine, and suggesting otherwise can result in stigma, shame, and self-blame. With this being said, fear and worry are natural responses to living with debilitating and unpredictable pain. If you struggle to cope with these emotions, contact your healthcare provider for help.

How Do You Treat Migraine and Depression?

Both migraine and depression can be treated with pharmacological and nonpharmacological treatments, such as:

  • Medication
  • Psychotherapy
  • Healthy lifestyle changes

Can Antidepressants Help With Migraine?

Antidepressants are one way to treat migraine and comorbid depression simultaneously.

Although it may seem unusual to treat migraine with medications designed to treat depression, it’s not uncommon to use off-label medications in migraine prevention. In fact, one antidepressant — amitriptyline (Elavil) — has been used in migraine treatment since the 1970s.

While there are several classes of antidepressant, these three types may be used to treat migraine and comorbid depression:

“SNRIs such as venlafaxine (Effexor) and duloxetine (Cymbalta) are a class of medication that are helpful for treating migraine, and they are also helpful for treating depression and anxiety,” says Minen.

When talking to your doctor, it’s important to let them know about any medications you take.

For example, triptans are a class of medications commonly used to treat acute migraine attacks. They work by mimicking the effects of serotonin, a chemical messenger involved in pain, mood, and other important bodily functions.

 Taking other drugs that increase serotonin — such as TCAs, SSRIs, and SNRIs — raise the risk of developing serotonin syndrome, a potentially life-threatening reaction.

What About Psychotherapy or Mindfulness to Help With Migraine and Depression?

“Cognitive behavioral therapy (CBT) has Grade A evidence for migraine prevention. It is also evidence-based treatment for depression,” says Minen. This type of therapy can help you recognize the relationship between your thoughts, feelings, and behaviors.

Mindfulness-based stress reduction (MBSR) can also be beneficial. “Mindfulness training may be helpful for people with migraine because it may shift pain appraisal (or pain perception),” says Rebecca Erwin Wells, MD, MPH, a professor of neurology and social sciences and health policy at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

Dr. Wells was the lead author in a study published in JAMA Internal Medicine that tested the effectiveness of eight-week MBSR in people with migraine. According to the results of the study, Wells says MBSR “decreases headache-related disability and improves quality of life, self-efficacy, pain catastrophizing, and depression scores.”

Lifestyle Modifications Can Help Migraine and Depression

Both migraine and depression can be addressed with a holistic approach. Routine and consistency are especially important for migraine management, and it also provides structure and a sense of control.

Since migraine and depression share a bidirectional relationship improving the symptoms of one disorder can help the other.

Here are some lifestyle changes that help migraine and complement any behavioral or pharmacological interventions:


  • Eat a well-balanced diet.
  • Don't skip meals.
  • Stay hydrated.
  • Incorporate movement or exercise into your routine.
  • Maintain proper sleep hygiene.
  • Manage stress.
  • Keep a headache diary to identify triggers.
  • Utilize relaxation techniques, such as biofeedback and progressive muscle relaxation.
  • Build social support, which could include family, friends, or support groups.

Other Medical Conditions and Migraine Treatments

When treating migraine, it’s important to take into account any other comorbidities or health issues a person may have.

In addition to depression, other psychiatric comorbidities that may accompany migraine include:

Additional health conditions associated with migraine include:

If you have migraine and any of its comorbidities, talk to your healthcare provider. Some migraine medications are contraindicated for certain conditions. For example, certain types of antidepressants may not be recommended for people with bipolar disorder because they can trigger mania.

On the other hand, your provider will recommend treatments that can safely address migraine and any comorbidities you have.

It's also important to note that research shows migraine

 and depression are associated with a greater risk of suicidal behaviors.

 If you’re struggling with suicidal thoughts or behaviors, talk to your healthcare provider or seek immediate medical attention.

What Is the Role of Sleep in Migraine and Depression?

Sleep plays an important role in our physical and mental well-being. Good quality sleep can increase pain tolerance,

 reduce inflammation, and improve mood, focus, and memory.

 Poor quality sleep can do just the opposite.
Sleep disorders, which refer to difficulty falling or staying asleep, have a bidirectional relationship with both migraine

 and depression.

 This means sleep difficulties can worsen migraine and depression, and, conversely, migraine and depression can negatively affect sleep quality.

How does sleep interact with migraine and depression?

In migraine, sleepiness or fatigue is a common symptom, either occurring at the beginning

 or end of an attack.

 Along the same lines, inadequate or poor sleep may be triggers or symptoms of an attack.

 Interestingly, sleep could also help relieve a migraine attack.

Since sleep disorders are considered a migraine comorbidity, rates tend to run high in the migraine community. According to research, people with migraine are between 2 and 8 times more likely to have a sleep disorder, and people with chronic migraine report having almost double the rate of insomnia compared with people with less frequent headaches.

As for depression, the relationship is similar. Sleep difficulties may be a symptom of depression, or — as in the case of insomnia — they may be a risk factor for developing depression. Like migraine, sleep disorders are comorbid with depression, and research shows it increases the risk of developing depression or migraine. Inconsistent sleep patterns can also increase the risk of developing depression, as well as migraine.

Furthermore, some medications used to treat migraine or depression can impact sleep. For example, certain antidepressants can make you sleep more, while others have an activating effect, increasing the risk of insomnia.

If you have insomnia, cognitive behavioral therapy for insomnia (CBTI) is considered a first-line treatment option. This type of therapy focuses on the behaviors and thoughts that affect quality sleep. Research also shows it may help prevent mood disorders and symptoms of depression.

Make sure you share any sleep issues with your healthcare provider so that it can be factored in when deciding on a treatment strategy.

The Takeaway

  • Migraine and depression have a bidirectional relationship, which means having one can increase the chance of developing the other.
  • Both disorders share similar risk factors, including genetic predispositions, hormonal influences, history of abuse, increased stress, obesity, and poor sleep.
  • Migraine and comorbid depression can be treated with antidepressants, cognitive behavioral therapy, mindfulness-based stress reduction, and healthy lifestyle modifications.
  • If you have migraine and depression, reach out to your healthcare provider for help.

Find Help Now

If you or a loved one is experiencing significant distress or having thoughts about suicide and needs support, call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24/7. If you need immediate help, call 911.

For more help and information, see these Mental Health Resources and Helplines.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
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Michael Yang, MD

Medical Reviewer

Dr. Michael Yang is a neurologist and headache specialist at Emplify Health, and an adjunct professor of neurology at the University of Wisconsin Madison School of Medicine.

He completed his residency in neurology at University Hospitals Case Medical Center in Cleveland, and went on to complete a headache fellowship at Dartmouth Hitchcock Medical Center in New Hampshire. He is certified in headache medicine by the United Council for Neurologic Subspecialties.

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Becky Upham, MA

Becky Upham

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Becky Upham has been professionally involved in health and wellness for almost 20 years. She's been a race director, a recruiter for Team in Training for the Leukemia & Lymphoma Society, a salesperson for a major pharmaceutical company, a blogger for Moogfest, a communications manager for Mission Health, a fitness instructor, and a health coach.

She majored in English at the University of North Carolina and has a master's in English writing from Hollins University.

Upham enjoys teaching cycling classes, running, reading fiction, and making playlists.

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Crystal Llamas

Author

Crystal Llamas is a freelance writer and editor who is passionate about migraine advocacy, mental health, and neuroinclusion. She received a bachelor's degree in biology and a minor in neuroscience from the University of San Francisco. In addition to Everyday Health, Crystal also contributes to Migraine Again. She previously wrote for the Migraine World Summit, and her work has been published in UK Fibromyalgia.

Crystal’s writing reflects her approach to life: Utilize pain as a source of creativity and an opportunity to deepen the connection to self and others. She values safety, self-awareness, boundaries, stimulating conversations, and fulfilling relationships.

Born and raised in San Bruno, California, Crystal grounds herself through gardening, forest bathing, hiking, and meditation. When she’s not writing, you can find her listening to music, playing the guitar, enjoying her backyard, or walking her dog, Sadie Rose.

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