Megan Brooks

February 21, 2014

Results of a new study may come as no surprise to headache sufferers: More stress means more headaches.

"The results add weight to the concept that stress can be a factor contributing to the onset of headache disorders, that it accelerates the progression to chronic headache, exacerbates headache episodes, and that the headache experience itself can serve as a stressor," Sara H. Schramm, MD, from University Hospital of University Duisburg-Essen in Germany, said in a statement.

"Our results underline the need for stress management strategies in people with headache, independent of the headache subtype," she added in comments to Medscape Medical News.

"Research suggests that mind/body treatments, including meditation, yoga or tai chi, and behavioral treatments such as stress management, coping skills, biofeedback and relaxation training may decrease headache frequency by 35% to 50%," Dr. Schramm noted.

The results were released February 19 and will be presented at the upcoming 66th Annual Meeting of the AAN annual meeting in Philadelphia, Pennsylvania, in April.

Support for Stress as Headache Trigger

The study team investigated the association between stress intensity and headache frequency in 5159 adults aged 21 to 71 years in the prospective, population-based German Headache Consortium Study.

Participants were screened quarterly from 2010 to 2012 about their stress levels and headaches using validated questionnaires. The researchers estimated the effects of stress intensity on headache frequency (days/month) for different headache subtypes, using a visual analogue scale from 0 to 100.

Tension-type headache (TTH) was reported by 31% of participants, migraine by 14%, and migraine combined with TTH by 11%. For 17%, the headache type was unclassifiable.

Those with TTH rated their stress at an average of 52 out of 100. For migraine, it was 62 out of 100; for migraine and TTH, 59.

For each type of headache, an increase in stress was associated with an increase in the number of headaches per month, the researchers found.

The highest effects were seen in the TTH group, where a 10-point increase in stress level was associated with a 6.3% increase in the number of headache days per month (95% confidence interval [CI], 4.3% - 8.3%).

For migraine, the number of headache days per month went up by 4.3% (95% CI, 2.4% - 6.2%) with a 10-point increase in stress and by 4.0% for migraine with TTH (95% CI, 1.8% - 6.3%).

The results were adjusted to account for factors that could affect the number of headaches, such as drinking, smoking, and frequent use of headache drugs.

"These data confirm those from other prospective studies suggesting that stress is a common trigger of headache, with the added strength that the authors controlled for several other variables that influence headache activity," Todd A. Smitherman, PhD, assistant professor and licensed psychologist, Department of Psychology, The University of Mississippi in Oxford, told Medscape Medical News. He wasn't involved in the study.

"Problematically," Dr. Smitherman said, "the overwhelming majority of studies on stress as a headache trigger have relied on either retrospective or prospective patient reports of stress. What is needed are experimental studies that directly manipulate stress, measure resulting physiological changes, and try to link these changes to subsequent headache activity."

He noted that the "few studies that have employed these stronger designs have not always found that biological markers of stress are strongly associated with migraine. Other studies indicate that a period of low stress after a period of high stress is also predictive of migraine, or the so-called 'let-down headache.'"

The study was supported by the German Federal Ministry of Education and Research. The authors and Dr. Smitherman have disclosed no relevant financial relationships.

66th Annual Meeting of the American Academy of Neurology (AAN), April 26 to May 3, 2014. Abstract 344.

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