Migraine: the invisible enemy that affects body, mind and life

More than five million people in Spain live with migraine, a complex, common, and deeply debilitating neurological disease.¹ The World Health Organization (WHO) classifies it as one of the leading causes of disability globally.² However, it remains widely misunderstood, trivialized, or underestimated , both in society and, sometimes, even in the medical field.

Migraine is a neurological disorder that manifests with episodic—or, in its chronic form, almost continuous—attacks of intense pain, often accompanied by nausea, vomiting, hypersensitivity to light and sound, and a profound inability to carry on with daily life.³ According to the Spanish Society of Neurology (SEN), although it can affect people of all ages, its prevalence is especially high in young women.

Dr. Jesús Porta, president of the SEN and head of service at the Jiménez Díaz Foundation, points out that it is crucial to understand the complexity of this pathology: "Migraine is a neurovascular process where there is activation of the trigeminal nerve, a release of inflammatory substances in the meninges, and an alteration of neurotransmitters such as serotonin. It is not just a headache; it is a biological phenomenon with many nuances and a significant burden for the patient."

Living with migraines means living with uncertainty: not knowing when the next attack will come, how long it will last, or what its consequences will be. This lack of control has a profound emotional effect. This is explained by Dr. Marina Díaz Marsá , president of the Spanish Society of Psychiatry and head of the Special Units at the San Carlos Clinical Hospital: "Migraines have a significant impact on the mental health of those who suffer from them because they are a chronic, often unpredictable pain that patients experience with great frustration."

According to the specialist, "up to 90% of migraine sufferers experience significant emotional distress , which translates into symptoms of anxiety, depression, sleep disturbances, feelings of guilt, helplessness, or frustration."

Furthermore, "there is a very close, bidirectional relationship between migraine and anxiety disorders and depression ," says Díaz Marsá. "Up to 60% of migraine patients have an anxiety disorder, and the risk of depression is twofold or even fivefold higher than the general population."

This link isn't just psychological. Both disorders share neurobiological mechanisms , such as alterations in neurotransmitters like serotonin and dopamine.

"In migraines, what actually becomes inflamed are the meninges, which are the coverings of the brain and the blood vessels within the skull, due to the release of a series of peptides," Porta explains. "These substances released in the brain also produce depression, so it's possible that high levels of the CGRP peptide produced by chronic migraines make it easier for that person to experience low mood; in other words, there's a genetic but also a pathophysiological relationship ."

The consequences of this disease are not limited to the medical or psychological level: the patient's social, family, and work life are also disrupted.

"The patient lives in a constant state of alert , in a state of hypervigilance, with the anxiety of thinking that any social, family, or work situation could trigger a crisis with all the consequences that this entails," says Dr. Díaz Marsá. "This state of tension, maintained over time, can culminate in depression. The fear of disappointing, canceling plans, or not performing well at work reinforces the feeling of loneliness and guilt."

"Those around them often don't fully understand what's happening to them, and these patients become progressively more alone and isolated," the psychiatrist adds. At home, crises can generate tension, preventing the affected person from fulfilling their responsibilities . At work, the illness is experienced with fear of sick leave, job loss, or professional stagnation.

"It's essential to educate people in the workplace about the importance of migraines," Dr. Porta emphasizes. "It's also important to create spaces in the workplace with limited auditory or visual stimuli, so that in the event of a migraine attack, they can rest and, after taking medication, return to work."

Faced with this situation, a support network—whether professional, family, or social—is essential. Dr. Porta emphasizes the role of the physician in this process: "It's very important to listen to the patient. Sometimes they arrive desperate, misunderstood, frustrated . Knowing they have an illness that isn't imaginary, but biological, helps reduce the emotional burden."

Díaz Marsá also emphasizes the value of education for both patients and their families: "It's essential that they understand that depression or anxiety are associated with migraines ," she says. "And then, we need to help facilitate their social lives, because many of these people are isolated during crises. We need to provide them with strategies and tools to address these social and work situations."

In addition, it proposes creating support groups and facilitating the social and work lives of those living with migraines: from teaching strategies for managing social situations without fear to adapting work environments that understand the reality of the disease.

Over the last decade, migraine treatment has made significant progress . However, as Porta acknowledges, there are still significant challenges ahead: "We have more tools than ever, but we must ensure that they reach all patients who need them and that they are used correctly, from primary care to referral hospitals."

Advances are not only related to new pharmacological treatments, but also to more comprehensive approaches that address migraine from a neurological, emotional, and social perspective.

"Treatment must be individualized, understanding the factors that trigger migraines in each person, and providing support through both pharmacological and psychotherapeutic means. It's not a one-size-fits-all solution," Díaz Marsá concludes.

Migraine remains, for many, an invisible disease . But those who suffer from it are not invisible. They need understanding, research, institutional support, and effective medical tools.

Bringing this reality into the spotlight—through science and empathy—is a first step toward a society that better cares for those living with a disease that, though silent, screams every day in the lives of millions of people.

References:

1. Migraine affects more than 5 million people in Spain. Available here . Last accessed 23/07/2025.

2. What is the burden of headaches? Available here. Last accessed 23/07/2025.

3. Migraine: Not Just a Severe Headache. Available here . Last accessed July 23, 2025.