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Mental Health and Headaches


Updated June 03, 2009

For years, physicians have suspected that mental health and headaches have a close connection. Research is beginning to show that many people who suffer from various types of mental illness will also have headaches or migraines. It can be quite frustrating to deal with pain and depression at the same time since often it seems that the situation has a kind of “chicken and egg” type quality. Whatever your specific circumstances, know that mental illness can affect the way you feel pain, especially headaches. Consider the following three examples.


Many people with depression report experiencing physical symptoms such as fatigue, sleep disturbances, and insomnia. Headaches and other types of chronic pain are frequent complaints as well. It is thought that tension-type headaches most commonly accompany depression, although depressed individuals can suffer from migraines or other types of headaches as well. When possible, your healthcare provider will try to select a medication or treatment that can address both the depression and headaches. Commonly used medications include the tricyclic antidepressants, like Elavil, or selective serotonin reuptake inhibitors (SSRIs) such as Paxil or Zoloft.

Post-Traumatic Stress Disorder

Research shows that when headache sufferers also have PTSD, they tend to have a higher degree of disability than those without PTSD. In patients with migraines and depression, PTSD occurs at a higher rate in patients with chronic daily headaches (CDH) than in those with episodic migraines (EM). Given the prevalence of PTSD and its co-occurrence with headaches, it is important to raise our awareness of this connection to better treat both conditions.

Bipolar Disorder

Bipolar disorder is a condition that consists of both periods of depression and mania. Studies have shown that people with bipolar disorder are commonly affected by headaches, especially migraines. Typical migraine treatments are usually effective in patients with Bipolar disorder.

Treatment Considerations

As always, special care is necessary when considering treatments for mental disorders due to drug interactions. Imitrex, one of the “triptans,” can contribute to the development of Serotonin Syndrome when combined with one of the SSRIs, for example. Your healthcare provider can best determine what treatment protocol is best for you.

Sometimes it is difficult to identify all the underlying causes of headaches. Hopefully you and your healthcare provider can examine your headache symptoms and determine the best treatment course for you. In the end, it can be helpful to know that you are not alone in your suffering, and that maybe that pharmaceutical company is right: Depression hurts.


Fasmer, Ole Bernt, M.D., et al. Are Migraines and Bipolar Disorder Related? Psychiatric Times. Vol. 19 No. 8.

Headaches and Depression.” National Headache Foundation Website. Accessed: May 31, 2009. http://www.headaches.org/education/Headache_Topic_Sheets/Depression_and_Headache

Peterlin, Lee, D.O., et al. Posttraumatic Stress Disorder in Migraine. Headache. Volume 49 Issue

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