Migraines and Depression

From a Western biomedical standpoint, migraine and depression are interlinked by shared neurobiology, behavior, and environment. Serotonergic signaling modulates both mood and trigeminovascular pain pathways; stress-axis hyperreactivity and limbic–hypothalamic circuit dysfunction further couple affect and nociception. Inflammatory mediators and neuropeptides (notably CGRP) contribute to sensitization and allodynia, while chronic pain predictably reduces activity and sleep quality—potent drivers of depressive symptoms. Large epidemiologic cohorts show that each condition elevates the risk of the other; the relationship strengthens as headache frequency increases, making chronic migraine a high‑yield population for depression screening. Management is optimized by integrated care. Screen systematically (e.g., PHQ‑9) and set dual targets: reducing monthly headache days and improving mood/sleep. Combine foundational lifestyle and behavioral strategies (CBT or mindfulness, aerobic exercise, and CBT‑I for insomnia) with pharmacotherapy chosen to serve both conditions when possible—amitriptyline or venlafaxine are pragmatic options. For chronic migraine, onabotulinumtoxinA or CGRP‑pathway preventives can substantially reduce headache burden; quality of life and mood often improve as pain recedes, though these agents are not antidepressants. Avoid medication overuse and review drugs that may aggravate mood (e.g., topiramate in susceptible patients). Educate patients that the serotonin‑syndrome risk from triptan plus SSRI/SNRI is very low; prudent monitoring usually suffices. Coordinated primary care, neurology, and mental‑health follow‑up improves adherence and outcomes.

Traditional East Asian medicine views migraine and depression as manifestations of disrupted qi and blood flow, often centered on the Liver’s role in regulation and the Heart’s stewardship of the spirit (shen). Emotional constraint, irregular sleep, and dietary stagnation produce Liver qi stagnation and, with time, internal wind or rising yang that triggers head pain. Concomitantly, the shen becomes unsettled, presenting as low mood, irritability, and sleep disturbance. Treatment seeks to restore harmonious flow and calm the mind. Acupuncture protocols that pair distal regulation (LR3, LI4) with local points for head pain (GB20, Taiyang) and calming points (Yintang, PC6, HT7) aim to relieve constraint and reduce pain sensitivity while improving sleep. Clinical trials support acupuncture’s role in preventing episodic migraine and suggest adjunctive benefit for depression, though herbal evidence remains less definitive and pattern‑dependent. Frequently used formulas, such as Xiao Yao San or Chai Hu Shu Gan San, are selected after individualized assessment to soothe Liver, move qi, and nourish blood. Lifestyle practices—regular routines, mindful breathing, tai chi or qigong—reinforce treatment by gently mobilizing qi and stabilizing mood. Integrative care can safely combine these approaches with conventional therapy, offering patients additional avenues for symptom relief and self‑management when guided by qualified practitioners.