There is a relationship between PTSD and migraine and headache, according to Natalia Murinova, MD, the director of the UW Medicine Headache Center and an associate professor of neurology at UW Medicine in Seattle. “If you have PTSD, you’re likely to have headaches, but the majority of people with headaches don’t have PTSD,” Dr. Murinova explains. Still, a study published in the journal Headache found that the frequency of PTSD in people with either episodic or chronic migraine is higher than the historically reported prevalence of PTSD in the general population. It also found that the presence of PTSD in a person with migraine is associated with greater headache-related disability. Another study published in Headache found that men with migraine may be more likely than women with migraine to also have PTSD — even though both migraine and PTSD are more common among women generally. And a third study, published in Headache in November 2015, found that people with both migraine and PTSD “may be particularly prone to adverse financial, health, and interpersonal disease burdens.” If you have migraine or another headache disorder, it’s worth knowing about PTSD and its relationship with migraine and headaches.
What Is Post-Traumatic Stress Disorder (PTSD)?
PTSD is a condition that can develop in people who have experienced or witnessed shocking, scary, or dangerous events, according to the National Institute of Mental Health. People may have many different responses to traumatic occurrences, and most people recover from those initial symptoms naturally. People who continue to experience problems, including feeling stressed or frightened when they aren’t in imminent danger, may have PTSD. But understanding and diagnosing PTSD can be difficult, in part because people with PTSD may not develop symptoms until months or even years after the trauma. Women are twice as likely as men to have PTSD, and Latino Americans, Black Americans, and Native Americans all have higher rates of PTSD than non-Latino whites, according to the American Psychiatric Association.
Can PTSD Cause Migraine?
“PTSD can push you into any type of headache,” says Murinova. “People with PTSD are also more likely to have chronic daily headache, especially people who have depression and PTSD,” she says. People who have a history of PTSD often have much more disability with their migraine, in part because they often have other conditions in addition to PTSD and migraine, she adds. Migraine may be brought on by psychological problems such as PTSD, but it’s not the underlying cause, says Loretta Mueller, DO, a headache specialist at Cooper University Health Care in Cherry Hill, New Jersey. “You generally have that migraine vulnerability to start,” Dr. Mueller says. The exact reason that a person has migraine isn’t known, but it’s thought to be a combination of genetics as well as environmental factors, says Kiran Rajneesh, MBBS, a neurologist and pain medicine specialist at the Ohio State University Wexner Medical Center in Columbus, Ohio. “By genetics, we mean something that you’re born with — a propensity for headaches which includes family history, or mutations that involve certain channels in the brain,” Dr. Rajneesh says. People are born with some propensity for migraine, and then there is a threshold; people can reach that threshold when they are exposed to certain environmental factors or lifestyle changes, says Rajneesh. RELATED: Causes and Risk Factors of Migraine
Do We Know Why Migraine Is Associated With PTSD?
It’s not clear exactly why the likelihood of developing migraine and headache is higher in people with PTSD, says Murinova. It’s very common for people with migraine and PTSD to develop hypervigilance in their nervous system, she says. Hypervigilance is when the sensory nerves are in a heightened state of excitability and pain sensitivity, which can be the result of frequent and severe stress, according to a study published in May 2018 in Brain Research. This can lead to a lower pain threshold and lower pain tolerance. Stress can also cause neuroinflammation, which is also thought to contribute to migraine, adds Murinova. Researchers are also studying whether there may be common genes associated with PTSD and migraine. A study published in June 2021 in Frontiers in Neuroscience compared the DNA of several sets of identical twins in which one twin had either PTSD or migraine, and the other twin didn’t. The researchers concluded that their “results suggest that common genes and pathways are likely involved in PTSD and migraine, explaining at least in part the comorbidity between the two disorders.”
Can Migraine Be Caused by Abuse or Childhood Trauma?
“Some people have the genes for migraine, but those genes are not always active,” says Mueller. Just because you inherited the gene doesn’t mean you have the abnormality; sometimes environment, including stressors such as trauma, can set it off and start the whole process, she explains. Physical abuse, sexual abuse, and emotional abuse are definitely linked to migraine, especially in people who bear a high burden of migraine — those with frequent attacks or chronic headaches, says Mueller. Chronic migraine is when a person experiences 15 or more days per month of headache with migrainous features, according to the Migraine Research Foundation. There is also evidence of an association between migraine and childhood trauma, childhood maltreatment, or adverse childhood experiences, including abuse, neglect, household substance abuse, household mental illness, parental separation, and an incarcerated household member, according to research by Gretchen Tietjen, MD, a neurologist at the University of Toledo, in Ohio, and others. There are many factors behind this association, says Murinova. “If you look at children who have trauma, often they don’t have a nurturing environment. Not only do they have hypervigilance of the system, many of these children don’t have proper nutrition, socialization, or adequate sleep. All of these systems that need to support you while you are developing may not be in place, which could make it more likely for migraine to develop,” she says. RELATED: Adverse Childhood Experiences Affect Migraine, Study Says
Can Migraines Be Psychological?
Migraines are a biological and not a psychological disease, because the pain is real and not just “in your mind,” according to a paper published in the Annals of Indian Academy of Neurology. But there are psychological factors that can impact migraine, and psychological stressors can trigger migraine. According to a study published in the Journal of Headache and Pain in July 2017, 50 to 70 percent of people had a significant association between their daily stress level and their daily migraine activity. Having severe migraine can also be a source of stress, which may make migraine even worse. Psychiatric disorders including depression, anxiety, and PTSD are associated with migraine, says Mueller. “People who have these conditions are more likely to experience migraine. There can be a higher vulnerability to the effects of stress for some people with migraine,” she says. A study published in April 2017 in Headache found that depression, anxiety, and pain catastrophizing were strongly associated with severe migraine-related disability, and that depression and what’s known as “chance locus of control” were associated with chronic migraine. Chance locus of control describes the belief that what happens to you in life is determined by chance rather than as a result of your actions.
Traumatic Brain Injury (TBI), PTSD, and Headache
The events preceding a traumatic brain injury can be psychologically traumatic — for example, a car accident, military combat, or physical abuse. In these situations, PTSD may develop in a person with TBI, which can complicate recovery, according to a paper published in the Spring 2018 issue of the Journal of Neuropsychiatry and Clinical Neurosciences. It’s common for people who experience a head trauma to have headache, says Roderick Spears, MD, a neurologist and headache specialist at Penn Medicine in Philadelphia. “If you have a genetic predisposition for migraine, there’s a greater chance of that post-traumatic headache presenting as a migraine headache,” he says. A study published in the American Journal of Psychiatry followed 1,084 people who were traumatically injured and sought hospital care in a trauma center. Researchers found that people with mild TBI were approximately twice as likely to develop PTSD one year later than people whose injury did not involve TBI. People hospitalized due to a mild head injury were more likely to develop new headache suffering or report exacerbation of existing headache compared with the general population, according to a study published in the Journal of Headache and Pain in 2018. For many people who get a TBI, the headache may last or be exacerbated for just a few weeks before it returns to baseline, but in some patients it can become chronic and remain so, says Mueller.
Treatment for Migraine and PTSD
Diagnosing and treating PTSD in people with migraine is important for the management of migraine and could improve their well-being and significantly reduce pain and disability, according to a review published in 2019 in the Journal of Headache and Pain. According to the authors, use of cognitive behavioral therapy (CBT) as a way to manage stress could help with migraine prevention, and could be most beneficial when combined with pharmacological treatment. Two medications that may be effective in treating PTSD and migraine are the tricyclic antidepressant amitriptyline and the selective serotonin and norepinephrine reuptake inhibitor (SSNI) Effexor (venlafaxine), according to the American Headache Society. Amitriptyline has been shown to be of some benefit for treating PTSD in at least three small clinical trials, and venlafaxine has also been demonstrated to be effective for PTSD and may help with migraine prevention.
