Kathleen M. Pike, PhD


Having never been prone to headaches, the experience of having one on and off every day for the past two weeks has been quite a jolt to my system. A well-documented by-product of COVID, these headaches can last from a few days to several months.

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The headaches are fatiguing. At times, I find it difficult to concentrate. The whole experience tests my mood, which makes me anxious. While unpleasant, it has given me a glimpse of the intimate relationship between headaches and mental health.

1. Types of Headaches.  Medical experts describe over 150 types of headaches. They are broadly classified as either primary or secondary headaches. Primary headaches constitute the vast majority of headache disorders, with tension and migraine headaches being the most prevalent. Data indicate that about 95% of adults have experienced a tension headache, whereas migraines have a far lower prevalence of 15%, and are significantly more common for women than men (18.3% vs. 7.6%). Tension headaches are typically experienced as an intense, steady pain on both sides of the head. Migraines are typically described as a throbbing, pulsing headache on one side of the head. Secondary headaches are related to other medical conditions such as hypertension, head injury, or brain tumor. They are less common than primary headaches but can be serious, and call for appropriate diagnosis and treatment.

2. Headaches and Mental Health and Substance Use Disorders. Occasional headaches are common in the general population. Significant and enduring patterns of headaches are common among individuals who have a range of mental health conditions. Headaches can be an indicator of depression and anxiety disorders. Tension headaches are most common, but migraines or cluster headaches are also associated with these mental health conditions. People who have bipolar disorder report elevated rates of headaches, especially migraines. The prevalence of cluster headaches appears to be higher in individuals with a substance use disorder than in the general population. The relationship between headaches and mental health conditions is bi-directional, wherein headaches increase risk for mental health conditions and vice versa.

3. Migraines and PTSD Risk. Research suggests that people who have migraines are more susceptible to developing Post Traumatic Stress Disorder (PTSD) when exposed to trauma – like a car accident or interpersonal violence – than people who do not have migraines. Research exploring the co-occurrence of migraines and PTSD suggests that PTSD and migraines share some common genes and pathways, which suggest they also share certain risk factors.

4. Risk and Burden. Our genes and gender play a significant role in terms of risk for headaches, particularly migraines, with women at significantly increased risk for chronic migraine headaches. Although less common, health conditions such as traumatic brain injury and tumors can put individuals at risk for secondary headaches. Modifiable risk factors for chronic migraine include overuse of acute migraine medication, ineffective acute treatment, body mass, depression, and stressful life events. Chronic migraine is the most disabling form of migraine with substantial impact on health-related quality of life. According to the Global Burden of Disease Studies, migraine headaches are the sixth most disabling disease in the world. In fact, headaches are one of the top reasons that people miss work. Without relief, headaches can precipitate a cascade of problems that impact self-esteem, employment, and financial security.

5. Reducing Risk. A variety of strategies help prevent the triggering of headaches. For some individuals, attending to diet and avoiding certain foods can play a significant role in protecting against headaches. Regular exercise can be protective by helping to pump oxygen through the body and keeping the brain well-oxygenated. Reducing exposure to unnecessary stress and engaging in stress management strategies (such as taking a walk outdoors or meditating) can protect against triggering headaches. Engaging in strategies to reduce headache risk also reduce mental health risks, both intrinsically, and by virtue of the fact that chronic pain causes a number of problems that can lead to depression, such as trouble sleeping and stress.

With deepened respect for all who have enduring struggles with headaches, this experience reinforces for me how absurd it is that we talk about physical health and mental health as if they were separate and distinct. It’s time to retire this false dichotomy. COVID and headaches and mental health tell the inextricable story of health.

Picture of Kathleen M. Pike, PhD

Kathleen M. Pike, PhD

Kathleen M. Pike, PhD is Professor of Psychology and Director of the Global Mental Health WHO Collaborating Centre at Columbia University.

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