FAQ Episode 94: PTSD and Migraines

Frequently Asked Questions about Natural Migraine Relief

Jul 04, 2025

Q: A patient of mine shared that: “I was sexually assualted while I was homeless in my early 20’s. I started having migraines a few years later, and sometimes wonder if they are worse when I am triggered about those memories. or am I just imagining that?”

This is a good question, one where a fair amount of research has documented a definite connection statistically. This article will address this question, especially regarding cause and effect relationships that could suggest mutually beneficial therapies.

PTSD, or post-traumatic stress disorder is a term that is often too casually tossed about to describe “feeling stressed about past stress.” More accurately PTSD is a very real group of intense, disturbing thoughts, feelings and behaviours related to past experiences that last long after the traumatic event(s).

For most of us, over time much of the trauma we experienced is integrated into our personality and subconcious and for the most part, not thought about voluntarily. But more often than we realize, the body remembers. Sometimes specific memories are recalled, but one can also have a full blown “shot full of adrenaline” fight or flight response without knowing exactly where it came from.

My patients with migraine tell me that the worst parts of this were:

a) not always knowing what might trigger such a post-traumatic episode or add to a current migraine. “Recurrent and unexpected hyper-anticipatation,” as one patient explained it.

b) “re-remembering” the trauma and having recriminations from what they might have done different before or after that initiating event. This can be especially triggering for those whose stress induced muscle tension headaches often precede their migraines.

c) the emotional depletion of “re-experiencing” the physical response to the original trauma, especially when added to their present migraine experience.

You can have PTSD and migraines independantly, but in this post I’d like to consider how the two are related. And if in your case they are, let’s also look at what you could do to minimize the PTSD related impact on migraine. Please keep in mind that for the purposes of this post, we are not talking about migraines specifically associated with a Traumatic Brain Injury (like after a fall or motor vehicle accident.) I’ll cover that in a separate FAQ post.

Commom symptoms of PTSD

I’ll reference the following list from the Mayo Clinic.1 It groups PTSD symptoms into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Keep in mind that symptoms can vary over time or vary from person to person.

Intrusive memories

Symptoms of intrusive memories may include:

Unwanted, distressing memories of a traumatic event that come back over and over again.
Reliving a traumatic event as if it were happening again, also known as flashbacks.
Upsetting dreams or nightmares about a traumatic event.
Severe emotional distress or physical reactions to something that reminds you of a traumatic event.

Avoidance

Symptoms of avoidance may include:

Trying not to think or talk about a traumatic event.
Staying away from places, activities or people that remind you of a traumatic event.

Negative changes in thinking and mood

Symptoms of negative changes in thinking and mood may include:

Negative thoughts about yourself, other people or the world.
Ongoing negative emotions of fear, blame, guilt, anger or shame.
Memory problems, including not remembering important aspects of a traumatic event.
Feeling detached from family and friends.
Not being interested in activities you once enjoyed.
Having a hard time feeling positive emotions.
Feeling emotionally numb.

Changes in physical and emotional reactions

Symptoms of changes in physical and emotional reactions, also called arousal symptoms, may include:

Being easily startled or frightened.
Always being on guard for danger.
Self-destructive behavior, such as drinking too much or driving too fast.
Trouble sleeping.
Trouble concentrating.
Irritability, angry outbursts or aggressive behavior.
Physical reactions, such as sweating, rapid breathing, fast heartbeat or shaking.

If these apply to you, you can start with a self assessment evaluation tool like the PTSD Self report (click here)2 . You may also benefit from professional help with a structured clinical psychology interview and the use of a tool like the Clinician-Administered PTSD Scale (CAPS-5).

PTSD and Migraine by the numbers

about 5% of the U.S. population will experience some version of PTSD in any given year.3
women are more likely to develop PTSD than men. About 8 of every 100 women (or 8%) and 4 of every 100 men (or 4%) will experience PTSD at some point in their life.4
there’s a five to seven times higher rate of PSTD in those also who also have migraine. In one general population study, the 12-month PTSD prevalence rate in migraineurs was 14.3%, and the lifetime PTSD prevalence rate was 21.5% in migraineurs as compared to 2.1% (12-month) and 4.5% (lifetime) in those without headache disorders.5 I could not determine if this study found out which of the two came first for these individuals.
among those who’d experience childhood trauma, 26% were diagnosed with a primary headache disorder as an adult, compared to 12% of participants who had not reported any traumatic childhood events. Its interesting that different types of trauma also had different levels of impact: The researchers linked threat traumas, such as abuse or violence, to a 46% increased risk in headache disorders, vs linked deprivation traumas, such as neglect or death of a parent, which showed a 35% increased risk of migraine.6
migraineurs report almost twice as many traumatic life events (TLE) than those without headaches 7
a study at Johns Hopkins found that among those with episodic migraine and PTSD, 69% reported symptoms related to PTSD before the onset of a severe or frequent headache8 That doesn’t prove a causal relationship, but it certainly is an interesting correlation.
migraineurs with PTSD have greater collective personal disability than migraineurs without PTSD. Well, I guess that’s no surprise, but sometimes its the 1 + 1 = 3 (or 4 or 5!) version of piling on that is especially difficult to bear.

Although these studies don’t specify the why of this connection, its clear that those suffering from PTSD also have more headaches, particularly migraines.

Variations on PTSD / Migraine connections

If you have both migraine and PTSD, there are four variations to consider:

your migraines started before the PTSD initiating traumatic life events and
are worse now with PTSD, or are precipitated by PTSD symptoms.
your migraines stared before the PTSD initiating life events and there seems to be no connection between the those or subsequent PTSD symptoms and the frequency or severity of your migraines.
your migraines started after the PTSD initiating traumatic life events and are worse or can be initiated by your PTSD symptoms.
your migraines started after the PTSD initiating life events and do not seem to be worse, or connected to you PTSD symptoms.

While Groups 2 & 4 both deserve attention to both their migraines and their PTSD, it is Groups 1 & 3 that I’d like to address in the remainder of this post.

Common pathways for activation of PTSD and Migraine

For most people in this category of overlap, it is the activation of PTSD symptoms that preceed and to some degree precipitate the migraine headache. Let’s look at two key pathways of PTSD activation that may overlap with root cause factor pathways for migraine and therapy options for each of them:

1. Autonomic overflow

The autonomic nervous system is a network of nerves throughout your body that control unconscious processes. In simple terms, it has two parts: an accelerator (the sympathetic nerves) and a brake (the parasympathetic nerves.) Overactive sympathetic activity can lead to hypervigilance and a heightened state of alertness and arousal. This can leave the body feeling like it is continually poised for a “fight or flight” response in the face of perceived threats.

An ongoing state of hypervigilance leaves sensory nerves in a heightened state of excitability and pain sensitivity. This can lead to a lower pain threshold and lower pain tolerance for migraine headaches. The heightened level of alertness and arousal can also allow low grade provocations to more easily become full blown panic attacks. Therapy options include:

a treatment that may be worth trying if you have both migraine and PTSD is the drug class known as beta-blockers. They help to limit the symptoms of autonomic overflow. Usually taken as a low daily dose, this group of meds may be helpful to limit excess sympathetic activity. Your primary care physician should be aware of this therapy option.
Another promising but less well known set of treatment options are known as ganglion blockade therapies. The first I’ll mention, primarily for PTSD, is a SGB block. This involves involves injecting a local anesthetic into the stellate ganglion, a cluster of nerves in the neck, aimed at resetting the body's "fight-or-flight" response. While not an established treatment, SGB shows promise as an add-on therapy for those who haven't responded to traditional PTSD treatments like psychotherapy and medication. I’ve had several patients for whom this therapy has been “life-changing,” to quote their experience.
A similar but anatomically separate therapy for migraine is the SPG block. This procedure can relieve migraine pain by numbing the nerves of the sphenopalatine ganglion, which is located near the back of the nasal cavity. It can be temporary, with a dose of gel-like anesthetic placed in the nose by a snall catheter, or a longer acting version with a physician injected anesthetic into the gangion itself.
In either case, the SGB or SPG blocks limit pain or automomic overflow feedback which propogate the underlying problem. You would usually find this care with either an ENT (otolaryngology) or pain medicine (anesthesiology) specialist.
behavioral treatment can positively influence chronic pain and disability in those with PTSD. Cognitive and behavioural therapy with a psychologist or counselor can help individuals manage symptoms by changing how they think and behave. It involves techniques like cognitive restructuring, exposure therapy, and teaching coping skills to address the negative thought patterns and behaviors associated with past trauma and current symptoms. The use of cognitive or behavioral therapy, alone or in combination with the other measures we’ve discussed can be an useful option for migraineurs whose headaches are promoted by their PTSD.

2. Brain chemistry dysfunction

The neurotransmitters serotonin, dopamine and norepinepherine are considered to play a significant role in the pathophysiology of both PTSD and migraine headaches. Research suggesting that imbalances in this system can contribute to migraine attacks, as well as, promote the heightened arousal, anxiety, and hypervigilance that is associated with PTSD.

Therapy options for brain chemistry support that may help with both conditions include:

medications that support serotonin levels. Two considerations for those with both PTSD and migraine are amitriptyline and venlafaxine. Amitriptyline has been shown to be of some benefit for PTSD and is often used with success for migraine. Venlafaxine has also been demonstrated to be effective for PTSD and is also used for migraine prevention. Your prescribing physician can review these options for you.
low dose naltrexone (LDN.) Naltrexone is an opioid antagonist that can increase dopamine and norepinepherine. It can be used daily in small doses to modulate monoamine brian signaling. LDN has also been shown to inhibit the production of pro-inflammatory cytokines that can aggravate multiple disorders, including migraine. LDN reduces inflammatory cellular signaling to microglia in the brain, which can enhance these cells’ ability to regulate brain development, maintain neuronal networks, and perform injury repair. LDN also enhances endorphins, the peptide hormones that function as natural painkillers. LDN can also reduce gut inflammation via the peripheral nervous system. Case studies indicate low dose naltrexone can also reduce PTSD symptoms, such as anxiety and depression, anger outbursts, nightmares, sleep problems, and more. For more details on LDN, see my post: FAQ Episode 6: Low Dose Naltrexone and Migraine.
You should not take naltrexone if you currently take prescribed opioid medications, use street sourced opiates, are in an opioid maintenance program and/or are taking suboxone or methadone or are in acute opiate or alcohol withdrawal. You may need to talk with a local compounding pharmacist to find a knowledgeble physician prescriber for LDN.
CBD (cannabidiol)
The prime action of cannabis is the modulation of the endocannabinoid CB1 and CB2 receptors to reduce both pain perception and inflammatory pathways. In addition to the endocannabinoid system, CBD can also bind and downregulate several classes of pain reception receptors, enhance natural pain relievers and also influence the levels of brain calming neurotransmitters like GABA and serotonin. CBD is now available everywhere in the U.S., either local or online. Multiple studies have shown that CBD therapy can reduce PTSD symptoms as well as migraine expression. For more details see my article: FAQ Episode 25: Using Cannabis for Acute and Chronic Migraine Relief

If you are one of the roughly one in five migrainuers who also suffer some elements of PTSD, you may want to consider some of the options we’ve reviewed above to address root cause elements from either or both issues.

Always keep in mind that it is rare, if ever, that migraine headaches have only ONE underlying cause, and that other health disorders (see FAQ Episode 4: Migraines and co-morbid medical conditions) often have related clues or overlapping treatment options to consider. Keep searching to educate yourself on the nuances of your story to find that answers that will work for you!

Natural Migraine Relief