Although migraine sufferers may try to avoid headaches by reducing stress, new research suggests that decreases in stress levels may actually increase the risk of an attack.
The study, published online on March 26, 2014, in Neurology, analyzed associations between stress and migraine risk using data from electronic headache diaries from a small group of migraine patients from the Montefiore Headache Center in Bronx, New York. Patients recorded information multiple times throughout the day about their stress levels and migraine symptoms. Stress was measured using the Perceived Stress Scale and the Self-Reported Stress Scale.
The results indicated that the level of stress was not significantly associated with migraine onset. When self-reported stress levels decreased from 1 day to the next, however, patients were significantly more likely to experience a migraine over the next 24 hours. A similar association was found for perceived stress levels, although migraine risk was only significantly increased for 18 hours. When stress levels declined by 1 unit on the Perceived Stress Scale, the odds ratio for a migraine increased to 1.92 over the next 6 hours.
In addition, any decline in stress was associated with a greater occurrence of migraine on the Perceived Stress Scale and the Self-Reported Stress Scale when compared with stress levels that did not decrease. The risk for migraine increased more than 4-fold at 6 hours and more than doubled at 12 hours when stress declined any amount on the Perceived Stress Scale. After adjusting for level of stress, reductions in stress were still significantly associated with an increased risk of migraine onset.
The association could be caused by poor eating and sleeping habits individuals practice when they are stressed just before migraine onset, the authors of the study speculate. Alternatively, patients may be more susceptible to stress during the premonitory phase of migraine, followed by a period of decreased vulnerability to stress before an attack. The effect could also be cause by biological changes that occur during stress and stress release.
“Migraine is a complex brain disorder and explanations may require turning over many pieces of the puzzle,” Peter J. Goadsby, MD, PhD, writes in an accompanying editorial.
Although more research is needed to fully understand the implications of the study, the results add to previous evidence suggesting that change triggers migraines.
“I think we can say to patients there is an emerging consensus that the migraine brain is vulnerable to change, such as sleep and stress, and therefore best kept stable,” Dr. Goadsby concludes.