Can post-traumatic stress disorder (PTSD) contribute to the development or exacerbation of migraines?

From the Guidelines

Yes, PTSD can contribute to the development and exacerbation of migraines. The relationship between PTSD and migraines is complex and bidirectional, with shared neurobiological mechanisms such as dysregulation of the stress response system and neurotransmitter abnormalities playing a crucial role 1. Key factors to consider include:

• The impact of PTSD on stress levels, anxiety, and sleep disturbances, which can trigger or worsen migraines
• The importance of addressing both conditions simultaneously with treatments like trauma-focused psychotherapies (Cognitive Behavioral Therapy or Eye Movement Desensitization and Reprocessing) and migraine management strategies (preventive medications and lifestyle modifications)
• The potential benefits of stress management techniques (mindfulness meditation, progressive muscle relaxation, and regular exercise) in reducing overall physiological arousal and stress reactivity, thereby helping to manage both conditions. Given the challenges in managing chronic migraine, as outlined in recent guidelines 1, it is essential to recognize the role of comorbidities like PTSD and to incorporate this understanding into comprehensive treatment plans.

From the Research

Association between PTSD and Migraines

• Studies have investigated the relationship between post-traumatic stress disorder (PTSD) and migraines, with evidence suggesting a significant association between the two conditions 2, 3, 4, 5, 6.
• Research has shown that individuals with PTSD are more likely to experience migraines, and that the presence of PTSD can exacerbate migraine symptoms 3, 5.
• A study published in 2014 found that PTSD is often comorbid with chronic migraine and chronic tension-type headache, and that treatment of PTSD can help alleviate migraine symptoms 2.
• Another study published in 2017 found that PTSD symptoms were associated with higher odds of experiencing frequent headaches or migraines, with a standard deviation change in PTSD score corresponding to over twice the odds of having trouble with frequent headaches or migraines 3.

Mechanisms underlying the association

• The exact mechanisms underlying the association between PTSD and migraines are not fully understood, but it is thought that stress and anxiety related to PTSD may contribute to the development and exacerbation of migraine symptoms 4, 5.
• Research has also suggested that PTSD may be associated with changes in pain processing and sensitivity, which could contribute to the development of migraines 5.
• A study published in 2018 found that PTSD was significantly more common in migraine patients, and that females in the migraine group had higher incidences of aura 4.

Clinical implications

• The association between PTSD and migraines has important clinical implications, as it suggests that individuals with migraines should be screened for PTSD and vice versa 2, 6.
• Treatment of PTSD may help alleviate migraine symptoms, and clinicians should be aware of the comorbidity between the two conditions when developing treatment plans 2, 6.
• A study published in 2015 found that individuals with both migraine and PTSD (Mig+PTSD) were more likely to experience adverse financial, health, and interpersonal disease burdens, highlighting the need for comprehensive treatment approaches 6.