Migraine and Anxiety

Everybody on earth has some degree of stress or anxiety.  They might not be able to talk about it or identify it but anxiety is part of  the universal human condition.  Persons may say that their boss is a “pain in the neck,” for instance, a symptom common with the muscle tension part of Generalized Anxiety Disorder (GAD) which includes tension in the neck and shoulders.  The boss is the problem but the patient gets the pain—in his neck.  This is a backward way of a patient saying they are stressed, especially by their boss who may be demanding and strict.  Half of persons with insomnia have GAD, the most common cause of sleeplessness.  Some people think that have Alzheimer’s dementia because they can never remember things well, yet they test well cognitively and really just have poor concentration, another cardinal GAD symptom.  Mental tension means “time pressure” or the feeling of having to work under the pressure of the clock to get a project done.  Such a person may feel he doesn't have time for lunch and so he misses a meal and gets a "hungry headache."  All these scenarios describe anxiety and below is the check list to make a diagnosis.

Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 Criteria for GAD

Excessive anxiety and worry

Difficult to control

Several subjects

Symptoms occur for more days than not for six months       

Significant distress or social impairment

At least three ancillary symptoms

Ancillary Symptoms

Restlessness/mental tension


Poor concentration


Muscle tension-in neck, shoulders, jaw, or teeth, grinding or bruxism

Sleep disturbance


Focus of anxiety/worry is not another disorder (for example, panic disorder)

Not part of a mood disorder, psychotic disorder, or pervasive developmental disorder

Not substance related

Not organic

GAD and Migraine are 40% comorbid.

See the article "APA guidelines for treatment" on medical management of GAD.