OsteoVBetween attacks, you may not be free of migraine at all. You are checking the sky, the calendar and your own neck, wondering whether that flicker behind the eye is the start of something. That low hum of waiting is common, it is understandable, and it deserves to be taken seriously.
The link is well documented
Anxiety and low mood sit alongside migraine more often than chance would predict. A 2019 systematic review found depression almost twice as frequent in people with migraine as in the general population, and that anxiety becomes more common the more often attacks occur. The relationship also runs both ways. Migraine raises the odds of anxiety and depression, and anxiety and depression are linked to migraine becoming more troublesome.
None of that means your migraine is "in your head" or caused by worry. Migraine is a neurological condition. It means the systems that handle pain, stress, sleep and mood are closely wired together, so a wobble in one tends to be felt in the others.
Why the waiting is so tiring
Migraine is unpredictable, and unpredictability is hard on any nervous system. If an attack has ever ruined a holiday, a presentation or a weekend with your kids, it is entirely reasonable to start bracing for the next one. You might turn down plans, keep medication within reach at all times, or stay tense "just in case".
The trouble is that constant vigilance keeps the body in a state of alert. Tight shoulders, a clenched jaw, shallow breathing and broken sleep are all common when you are on guard, and all of them are things people with migraine are already prone to. So the worry about attacks can quietly feed the conditions that make attacks more likely. It is a loop, not a character flaw.
What tends to help
The evidence here is more modest than for some other areas of migraine care, and not every approach suits everyone. But there are sensible options worth knowing about.
- Talking therapies. Cognitive behavioural therapy (CBT) helps people work with the thoughts and habits around pain, and can be useful when stress or anxiety is part of the picture. The Migraine Trust notes that you can self-refer to some NHS talking therapy services, or ask your GP.
- Relaxation and biofeedback. Breathing exercises, progressive muscle relaxation and biofeedback are recognised behavioural approaches, particularly helpful if stress is one of your triggers.
- Treating the migraine well. The 2019 review concluded that optimising treatment of either migraine or its psychiatric companions may ease the burden of both. Better control of attacks often takes some of the dread away.
- Steadier foundations. Regular sleep, regular meals and gentle movement calm the whole system, and they are worth protecting even when you feel you have no energy for them.
Where the body comes in
Because vigilance shows up physically, it can help to look at the physical side too. Neck and jaw tension are common in people living on alert, and they can be assessed and treated hands-on. In my experience, people are often relieved to hear that the tightness they carry is a recognised part of the picture rather than something they are imagining. That is a professional observation rather than a research finding, but it is one I see often in clinic.
When to ask for more help
If low mood or anxiety is affecting your daily life, or has lasted more than a couple of weeks, please speak to your GP. It is not a footnote to your headaches. It is part of your health and deserves its own attention. 10 October is World Mental Health Day, which is as good a nudge as any to make that call.
When to seek urgent care
See a doctor promptly, or call 999, if you have a sudden, severe "thunderclap" headache, a headache with fever and a stiff neck, new weakness, numbness or confusion, or a headache after a head injury. New or changing headaches always deserve medical assessment.
If your headaches and your worries have become tangled together, a full assessment can help untangle them and decide where to start. You are welcome to book an appointment or get in touch.
- Dresler T, Caratozzolo S, Guldolf K, et al. Understanding the nature of psychiatric comorbidity in migraine: a systematic review focused on interactions and treatment implications. The Journal of Headache and Pain. 2019;20:51.
- The Migraine Trust. Behavioural therapies for migraine. migrainetrust.org
- National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summaries: Migraine. cks.nice.org.uk