Which came first, the anxiety or the headache? It’s an impossible question because they’re both inextricably linked.

A headache can be a physical symptom of underlying anxiety, while chronic headaches like migraine can cause anxiety. What we know for sure is having one makes you more likely to experience the other.

A quick overview of the research

Scientists think that having depression or anxiety can make headaches more intense, longer lasting, and recurrent. Peeps with generalized anxiety disorder or panic disorder are more likely to get headaches.

In one study, 13.7 percent of neurology patients with headaches were also diagnosed with anxiety. What’s more, sleep disruption and disability due to headaches were found to be predictors of anxiety or depression.

What do anxiety, depression, and headaches all have in common? They’re all impacted by neurotransmitters and stress. Let’s unpack how headaches and anxiety go hand in hand.

Migraines and tension headaches are the two types most commonly associated with anxiety. Here’s how to tell which type you have.

Tension headache

Symptoms of a tension headache include:

  • band-like (or squeezing) pain around the head
  • tense muscles around your head, face, or neck
  • mild to moderate pain
  • dull, aching pain
  • scalp, neck, or shoulder tenderness

About 15 to 20 percent of people experience tension-type headaches. Whether anxiety causes this type of headache or vice versa is unclear, but it probably works both ways.

Tension headaches can be episodic, meaning they occur occasionally for 15 minutes or longer, or chronic, meaning they occur more than 15 days a month.

More anxiety, more migraines

Symptoms of a migraine include:

  • severe pain on one side of the head lasting a few hours to a few days
  • nausea or vomiting
  • visual disturbances (aura) before the headache
  • sensitivity to light or sound

According to the American Migraine Foundation, about half of people with migraines also have anxiety.

Anxiety may ramp up as a result of living with migraine, or it may exist before headaches become a problem. People with untreated anxiety respond less successfully to treatment.

Here are some likely reasons anxiety triggers headaches.

That magical mystery chemical, serotonin

Serotonin is a workhorse hormone that regulates moods and impacts processes throughout the body. Low levels of serotonin are associated with depression, anxiety, suicidal behavior and obsessive-compulsive disorder.

Fluctuating serotonin levels can cause blood vessels to constrict and muscles to tighten, triggering both migraines and tension headaches.

Your shoulders are up to your ears

Tension builds up in muscles of the head, neck, and shoulders during times of stress. Muscles may also contract during long periods of working at a desk, driving, or sleeping in an uncomfortable position.

Tense muscles can lead to tension-type headaches.

Not enough Zzz’s

Wouldn’t you know it — poor sleep is a factor for both headaches and anxiety. A 2016 study of headache patients confirmed that poor sleep quality can increase risk of having an anxiety disorder.

According to the American Migraine Foundation, getting too much or too little sleep are both headache triggers, and peeps with migraines are more likely to experience sleep disorders.

About half of folks with tension headaches or migraines also have insomnia.

The root of all evil: Stress

Regular life can feel like running around to put out fires without a cooling-off period in between. Trying to function with a headache on top of it is even more stressful.

The American Migraine Foundation says almost 70 percent of people with migraine are triggered by stress. They recommend making a list of known stressors and making a plan to reduce their impact on your daily life.

You’re too sensitive?

People who have headaches seem to be more sensitive to pain in general.

Researchers have demonstrated that people with migraine and tension headaches have increased sensitivity to pain and lower pain tolerance than people without headaches.

Pain from touch that would not normally be painful (aka allodynia), is a symptom of migraine. That’s not to say that people with headaches are super sensitive, but rather that their nerves work differently and pick up sensation at much lower levels.

It’s like a superpower that also sucks. Throwing in stress and anxiety only increases the perception of physical pain.

Fortunately, relief comes in a variety pack.

Get some (pain) relief!

Over-the-counter (OTC) pain meds like aspirin, acetaminophen, and ibuprofen are commonly used to treat headache pain.

Having fewer headaches could feed the cycle in a positive way and lead to less anxiety and fewer headaches, etc.

And here’s a lucky break: Some prescription medications — like anxiolytics, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs) — can treat anxiety and also alleviate pain.

Get your chill pills here!

Consider anxiety meds and muscle relaxants, especially if headaches don’t respond to other treatments. Ask your doctor about prescription options, and keep them updated if any new meds worsen headaches.

Going the alternative route

The National Center for Complementary and Integrative Health outlines these possible alternative treatments for headaches:

  • acupuncture
  • biofeedback
  • massage
  • spinal manipulation
  • tai chi
  • dietary supplements, including butterbur, coenzyme Q10, feverfew, magnesium, and riboflavin

Talk it out

Talk therapies like cognitive behavior therapy can help with the treatment of anxiety disorders and improve related headache episodes.

The only thing better than relief is preventing pain in the first place.

Know your triggers

In addition to the common causes of anxiety headaches listed above, the American Migraine Foundation lists these common migraine triggers:

  • Hormones. Because of fluctuating hormones, women are way more likely to have migraines. Some hormonal birth control methods may help.
  • Caffeine and alcohol. Both substances may trigger migraines, but caffeine will alleviate pain for some people. Keep track of caffeine and alcohol intake to figure out if they’re linked to your headaches.
  • Changes in the weather. Track weather changes happening when you experience a headache. Heat, humidity, or changes in barometric pressure may be triggering for you.
  • Diet. Certain foods trigger migraines for different people. Again, the best way to identify your triggers is with a headache log.
  • Dehydration. Even if you don’t have headaches, there are plenty of reasons to drink enough water. Just H2O it.
  • Light. Bright sunlight, strobing light, car headlights, glare, and fluorescent lights can all trigger a migraine. Bulbs or shades that emit green light or block other light colors may tame that trigger.
  • Smell. Some smells like perfume, food, or chemicals can cause a headache or make an episode worse.

Seriously, relax

Relaxation will help with stress, anxiety, headaches, and probably all your other problems. Try deep breathing, meditation, progressive muscle relaxation, and yoga.

Self-care to be your best (headache-free) self

If you’re the kind of person who gets anxiety headaches, you may not be practicing the self-care you deserve. Here’s a reminder of all the ways you can treat yo’ self.

  • Stick to a regular sleep schedule and aim for 7 to 8 hours per night.
  • Do some movement that makes you happy! Try to do it most days.
  • Eat regularly. Eat stuff that makes your body feel good and avoid the stuff that gives you headaches.
  • Drink 👏more 👏water 👏.

Keep calm and carry on.