The Stress–Migraine Connection: It’s Not What You Think

It seems almost obvious: There is a strong connection between migraine headaches and stress. However, the connection isn’t exactly what you might think. and Albert Einstein College of Medicine at Yeshiva University published in Neurology, the journal of the American Academy of Neurology, discovered that it’s not actually stress that causes migraine headaches, but the “let-down” that occurs after the stressful episode that triggers the extreme pain. The study followed 17 migraine sufferers, who recorded their headache symptoms, particularly in how they related to stress and the reduction of stress. In addition to recording mood and stress levels, participants also monitored known migraine triggers such as diet, menstrual cycle, sleep and alcohol consumption. After evaluating the more than 2,000 individual entries, researchers discovered that a reduction in stress after a stressful episode was the single greatest trigger of migraine headaches — a finding that is in stark contrast to the previous assumption that stress itself causes headaches. It’s believed that the stress hormone cortisol is the cause of the headaches. Cortisol, which reduces pain, increases as the body tries to protect itself against the harmful effects of stress triggers. When stress is reduced, cortisol levels go down as well. However, for those who suffer from migraines, the fluctuation in cortisol levels could serve as a headache trigger. The Montefiore study found that the chances of a migraine developing within six hours after a stressful episode was five times greater than any other trigger. In other words, while it may seem that the stressful situation is done and over with, the fluctuations in hormones for several hours afterwards could still cause a painful headache.

The Importance of Stress Reduction

The link between stress and migraines isn’t new, but the new information about how and when stress triggers headaches underscores the importance of stress reduction as part of a migraine management plan. Most migraine sufferers use medication to reduce the pain and other symptoms of the painful headaches, but recognizing stress triggers and taking steps to minimize stress can help prevent the headaches from developing in the first place. According to the National Headache Foundation, people who suffer from migraines tend to be more emotionally responsive to stress than most; they tend to react strongly to challenging situations more quickly than those who do not have migraines. Situations that might cause a slight raise in stress hormones in a normal person — a traffic jam, an argument with a spouse, etc. — are often far more debilitating to a person who suffers from migraines. That’s why it’s important for migraine sufferers to learn to recognize the situations that increase stress — and by extension, cortisol production — and limit the impact they have on their lives. Doctors suggest that migraine sufferers keep detailed journals about their headaches. By keeping track of daily activities, diet, interactions and sleep, it becomes easier to pinpoint those stressors that are likely to cause a painful migraine and mitigate their effects.

Stress Management Techniques

Unfortunately, stress is a part of modern life, and it’s all but impossible to avoid it completely, as most of us don’t have the option of escaping jobs, families, household responsibilities and other commitments on a permanent basis. That’s why it’s so important to develop stress management and coping skills and techniques. Not only does effectively managing stress help keep the migraine monster at bay, it can also improve sleep, reduce the risk of heart disease and major cardiac events and improve overall quality of life. After all, who wants to spend every day on edge, feeling anxious, stressed out and on the verge of a breakdown? Doctors suggest that people who suffer from migraines start by learning the warning signs of stress. Stress can manifest itself physically, emotionally and behaviorally. For example, some people react to stress by getting angry and frustrated, while others sweat, have trouble sleeping or overeat. Keeping track of your symptoms and how you react to stress is the first step in an effective stress management program. The most effective means of managing stress usually depends on the source of the stress. In some cases, simply removing yourself from the source or changing the source of stress can ease the symptoms and prevent it from escalating. However, it’s not always as simple as stopping stress where it starts, and you may need to develop more effective coping mechanisms. These can include:

• Exercise. Exercise is one of the most effective ways to reduce and control stress; not only can you work out your frustrations in a productive manner, exercise increases endorphins, the happiness hormones, that help you feel better.
• Eat right. Over or under-eating can increase stress, as your blood sugar spikes and overall feelings of well-being decreases.
• Sleep. Most adults need 7 to 9 hours of sleep per night. Being overtired can heighten your emotions, causing extreme reactions. Take steps to ensure you get a good night’s sleep each night.
• Avoid caffeine and alcohol.
• Learn relaxation techniques. Focused breathing, yoga, visualization and meditation are all techniques that can help you reduce stress and maintain a balanced, stress-free perspective.
• Get help. Sometimes, asking for help in dealing with a difficult situation or learning how to relax can help you stay calm and reduce stress.

Migraine headaches can significantly reduce your quality of life and prevent you from doing the things you enjoy. While you may not be able to completely eradicate them by reducing your stress, preventing the spikes in stress hormones that stress causes should help reduce how often they occur.