Migraine, anxiety and depression: why they so often go together

A migraine day is lost to pain, noise and dark rooms. Then come the days around it. You are afraid to plan anything, because it might happen again. You feel on edge, or flat, or tired of explaining yourself. Some people begin to wonder if the headaches are 'all in the mind', or if their low mood is just 'a result of the pain'. Neither is quite right.

Migraine is a neurological condition with real biology behind it. And it often sits alongside anxiety or depression. This article explains what research shows about that link, what may help, and when to get support. It cannot tell you whether you have any of these conditions. A doctor or mental health professional can do that.

How common is the overlap?

Numbers differ between studies, so treat them as a rough guide. A 2019 meta-analysis of 16 studies (Amiri and colleagues, Neuropsychiatrie) found that adults with migraine had about twice the odds of depression compared with others (pooled odds ratio 1.95, 95% confidence interval 1.61 to 2.35; 1.81 in cohort studies and 2.00 in cross-sectional studies), with high variation between studies. Its searches ran to January 2018. A 2020 systematic review of eight studies (Karimi and colleagues, Frontiers in Neurology) found that anxiety and migraine occurred together with an average odds ratio of 2.33 (2.20 to 2.47) in prevalence and cross-sectional studies, and a relative risk of 1.63 (1.37 to 1.93) in two cohort studies. The authors noted that the included studies had small samples and did not adjust well for other factors.

A 2011 review by Antonaci and colleagues in the Journal of Headache and Pain reached a similar view. General population studies generally show a higher risk of mood and anxiety disorders in people with migraine, and the review found the link mainly with migraine with aura. They also said the reasons are still poorly understood.

In India, a 2013 headache-clinic study in Neurology India (Sharma and colleagues) compared 71 newly diagnosed people with migraine to 71 healthy people. Clinically significant anxiety symptoms were found in 48% and depressive symptoms in 41% of the migraine group, more than in the comparison group. It is a small study from one hospital, so it cannot show how common this is across India.

A two-way street

One of the clearest findings comes from a 2003 study in Neurology (Breslau and colleagues). It followed adults aged 25 to 55 for two years. People with major depression at the start were more likely to have a first-ever migraine (odds ratio 3.4). People with migraine at the start were more likely to have a first episode of major depression (odds ratio 5.8). The authors called it a bidirectional association. It was not seen to the same degree for other severe headaches. A 2019 systematic review of 178 studies (Dresler and colleagues) also described a bidirectional link of migraine with major depression and panic disorder.

This does not mean one condition is the other's fault. It means the two are connected, and a person with one deserves a gentle check on the other.

Why might they go together?

Research suggests several overlapping reasons. None is proven as the whole story.

• Shared biology: a 2019 review (Zhang and colleagues) describes possible common mechanisms including shared genetic factors, brain chemical messengers, sex hormones and stress. Breslau's earlier work suggested migraine, depression and anxiety might share common predispositions.
• Pain and disability: migraine takes away days. The Indian clinic study above found lower quality of life in people with migraine, and that more severe anxiety and depressive symptoms predicted worse mental wellbeing scores. Missing work, study or family time is hard on anyone.
• Sleep: sleep problems and migraine seem to affect each other in both directions, as a 2026 systematic review (Sforza and colleagues, European Journal of Neurology) describes. Poor sleep is also tied to anxiety and low mood.
• Stress: the NHS lists stress, anxiety and depression among common migraine triggers. In a 2018 meta-analysis (Pellegrino and colleagues), stress was the trigger people named most often (58%).

When worry about the next attack becomes its own burden

Many people with frequent migraine live with a background dread, sometimes called anticipatory anxiety or fear of attacks. You may avoid travel, exercise, weddings or deadlines. You may keep checking your body for warning signs. A 2013 pilot study (Giannini and colleagues) used the word 'cephalalgiaphobia' for the fear of having an attack during a pain-free period. It found that moderate to high migraine frequency was linked to a higher risk of this fear. It was a pilot study of 126 people, followed for two years, at one headache centre, so it cannot show that fear causes more attacks.

A 2025 German review (Klan and colleagues) says excessive fear of attacks may worsen the course of migraine, that behavioural treatments are available and have few side effects, and that existing evidence is sparse. In other words, this fear is recognised, it is worth mentioning to your doctor, and it may be treatable.

Does treating one help the other?

The 2019 review by Dresler and colleagues concluded that optimising treatment of either migraine or the mental health condition might help reduce the burden of both. That is why a doctor should know about both.

• Psychological approaches: a 2016 systematic review of 24 papers (Sullivan and colleagues, Journal of Neurology) found that 15 of 18 studies measuring headache outcomes reported significant improvements with psychological treatments, and that these also improved psychological outcomes. A 2021 review of 11 randomised trials (Bae and colleagues, Medicina) found that CBT reduced headache frequency and disability scores, though two trials reported side effects such as a worsening of migraine or distressing memories.
• Biofeedback: a 2007 meta-analysis of 55 studies (Nestoriuc and Martin, Pain) found a medium effect on migraine, strongest for attack frequency. It was strongest for how often attacks happen and for people's sense of self-efficacy. Biofeedback uses a device to show body signals while you learn to relax.
• Medicines: the NHS lists antidepressants, beta blockers and epilepsy medicines among the types of medicine used to help prevent migraine. So some preventive medicines belong to classes also used for depression. Whether any of this suits you is a decision for a doctor, who should know about your mood. NICE says to take extra care when choosing a preventive medicine for someone who has both depression and migraine. Please do not start, stop or change any medicine on your own.
• Having a mood or anxiety diagnosis does not mean migraine treatment will fail. In a 2012 trial analysis (Seng and Holroyd, Headache), people with a mood or anxiety diagnosis had larger reductions in migraine days than those without.

Small steps with Manas tools

These are coping aids, not treatments. Try them when you are well enough, and stop if anything makes the pain worse. Tensing muscles may not feel right during an attack, so you may prefer to use it between attacks.

The body scan and the grounding exercise may also help when worry spirals, or when pain makes it hard to be present. Manas also has two short self check-ups, the PHQ-9 for low mood and the GAD-7 for anxiety, at /track/phq9 and /track/gad7. They are screening questionnaires and not diagnoses. Your scores can be a starting point for a conversation with a doctor.

Pain, hopelessness and thoughts of ending your life

This part is hard to read, and it matters. A 2020 meta-analysis of 15 studies (Pei and colleagues, Journal of Affective Disorders) estimated that about 15.5% of people with migraine had had thoughts of suicide and about 3.9% had attempted suicide, with very large variation between studies. A 2023 review (Giakas and colleagues, Frontiers in Neurology) found higher odds of suicidal thoughts and attempts in people with migraine than in people without pain (pooled odds ratio 2.49 for the two combined). A 2023 review of chronic pain in general (Kwon and Lee) found high pooled rates too, about 1 in 4 people with chronic pain had had suicidal thoughts in the last 2 weeks, though study quality was not optimal and results varied a lot.

These are group results. They do not mean you will feel this way, and they do not mean it is inevitable. They do mean that long-term pain can wear down hope, and that thoughts of suicide in someone in pain are worth taking seriously, not hiding.

Signs it is time to talk to someone

The NHS says to see a doctor if you have symptoms of depression for most of the day, every day, for more than two weeks. Signs include persistent low mood, hopelessness, loss of enjoyment, withdrawing from people, appetite or sleep changes and low energy. For anxiety, the NHS lists worry that is hard to control, restlessness, trouble concentrating, poor sleep and feeling tense. Because migraine can cause tiredness and trouble concentrating itself, it helps to tell your doctor about all of it, so they can look at the whole picture.