The Often-Overlooked Mental Health Impact of Migraine

Created for an Innovative Medicine Canada member biopharmaceutical company  

Maya Carvalho’s first migraine attack was in 2005. She had just returned from the gym when she was hit by an overwhelming feeling of nausea and an intense head pain that was unlike any she’d ever experienced. Within a year, her disease had become chronic, and she was enduring 20 to 25 attacks every month. “Migraine is an unpredictable and debilitating disease,” says the former marketing executive and founder of the Canadian Migraine Society. “It affects every facet of your life.”

Those who suffer from migraine know that there is physical pain associated with the disorder. In addition, for some, there is a significant, often unrecognized, mental health impact.

Carvalho is fortunate to be one of the small percentage of people with chronic migraine who don’t have mental health issues. She is, however, well aware of its prevalence. “I run a patient advocacy organization and almost all of my members do have mental health challenges,” she says. 

Her involvement in the community—in speaking and coaching patients every day—has meant witnessing the emotional toll that migraine can take. “There’s a huge amount of grief and loss that comes with the disease.” It can derail careers, cause friction in families, lead to shrinking social circles and increase isolation. “You lose an enormous amount of control, freedom and independence,” Carvalho says. 

One billion people in the world suffer from migraine (it’s the third most common medical condition after dental cavities and tension headaches) and, according to Migraine Canada, it affects approximately 25 per cent of Canadian households. But, despite how common it is, for someone with migraine it could take up to 10 years to be properly diagnosed and effectively treated, says Dr. Christine Lay, professor of neurology and founding director of the headache program at the University of Toronto. 

Although a painstaking search for a specialist and an accurate diagnosis can impact mental well-being, Dr. Lay says that migraine often has comorbidities, meaning it’s often accompanied by other clinical medical conditions—including depression, anxiety and insomnia. In fact, the American Migraine Foundation reports that people with migraine are five times more likely to develop depression and up to 50 per cent of chronic migraine sufferers also have anxiety. 

According to Dr. Lay, the mental health component of migraine presents extra challenges for both patients and doctors. “We need to get better at recognizing that it isn’t cause and effect,” as if your symptoms of depression will suddenly go away once your headaches are better, she says. “Migraine and depression or anxiety are brain diseases and we need to treat them simultaneously.”

She recommends that migraine patients—and their families and friends—be on the lookout for signs that they may also be struggling with their mental health. While it’s normal to have days where you feel sad or low energy, it’s important to talk to your doctor if you see a pattern, she says. Then, it’s about partnering with your doctor to find a holistic approach to treatment. “We’re getting better at tackling all the issues a migraine patient might be dealing with and getting to a point where the whole person is treated,” she says. 

In addition to medication that reduces the frequency of migraine attacks and options that treat the migraine attack, a holistic approach might include cognitive behavioural therapy, meditation, exercise, mindfulness training, nutritional support and maintaining healthy sleep habits.

Carvalho agrees that a holistic approach to treating the disease is the key to relieving symptoms and ensuring better quality of life. She encourages other migraine sufferers to reach out for support. “It can make all the difference in the world, both to the physical aspects of the disease and to your mental health,” she says. The Canadian Migraine Society runs national support groups and also commits to answering questions within an hour. “I want every person living with this disease to be empowered to advocate for themselves,” Carvalho says. “And I also want them to understand that there is a lot of hope and support available to them.”