From the Guidelines
Yes, PTSD can cause migraines. According to the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache 1, there is evidence to suggest that post-traumatic stress disorder (PTSD) is associated with an increased risk of developing migraines. The guideline highlights the importance of considering the underlying mechanisms of PTSD and its impact on the autonomic nervous system and hypothalamic-pituitary-adrenal axis, which can trigger migraine attacks.
Some key points to consider in the management of migraines in patients with PTSD include:
- The use of preventive medications such as topiramate, valproate, or amitriptyline, which have been shown to be effective in reducing migraine frequency and severity 1
- Lifestyle modifications, such as stress management, sleep hygiene, and regular exercise, which can help reduce migraine triggers and improve overall well-being
- The potential benefits of trauma-focused therapies, such as EMDR or cognitive processing therapy, in addressing both PTSD and migraine symptoms
- The importance of tracking migraine triggers, particularly those related to PTSD symptoms, to identify patterns and improve management of both conditions
It is essential to note that the guideline emphasizes the importance of individualized treatment plans that account for headache type, comorbid conditions, and patient values and preferences 1. By considering the complex interplay between PTSD and migraines, healthcare providers can develop effective treatment strategies that address both conditions simultaneously.
From the Research
PTSD and Migraines
- Post-traumatic stress disorder (PTSD) is often comorbid with chronic migraine (CM) and chronic tension-type headache (CTTH) 2.
- Studies have shown associations between migraine and several psychiatric conditions, including PTSD 3.
- PTSD is disproportionally common among patients in headache clinics, and individuals with migraine and PTSD report greater disability from migraines and more frequent medication use 3.
Association Between PTSD and Migraines
- Migraine was associated with incident PTSD (adjusted relative risk [RR]: 1.26,95% confidence interval [CI]: 1.14-1.39) 3.
- PTSD, but not trauma without PTSD, was associated with incident migraine (adjusted RR: 1.20,95% CI: 1.14-1.27) 3.
- Findings were consistently stronger in both directions among those experiencing migraine with aura 3.
Impact of PTSD on Migraine Burden
- The presence of PTSD increased the burden of migraine, with individuals experiencing both conditions reporting greater disability and more frequent medication use 4.
- Those with both migraine and PTSD were more likely to experience adverse financial, health, and interpersonal disease burdens 4.
Treatment of PTSD and Migraines
- Trauma-focused cognitive behavioral psychotherapies, selective serotonin reuptake inhibitors (SSRIs), and venlafaxine have demonstrated efficacy in the treatment of PTSD 2.
- Amitriptyline, topiramate, sodium valproate, and botulinum toxin A are efficacious for treatment of chronic daily headache (CDH) 2.
- SSRIs improve PTSD symptoms and are first-line agents for the pharmacotherapy of PTSD, based on moderate-certainty evidence 5.