Relaxation Followed by Stress Triggers Migraines

Migraine headaches increase significantly after persons relax and then experience heightened stress, according to the results of a new study.

“People with migraine are thought to inherit a predisposition to headaches. Attacks of migraine headache are initiated in vulnerable individuals when they are exposed to a broad range of triggers,” study coauthor Dawn C. Buse, PhD, Director of Behavioral Medicine, Montefiore Headache Center, and Associate Professor, Clinical Neurology, at the Albert Einstein College of Medicine in New York, told ConsultantLive.

“Our study results support the ‘letdown phenomenon,’” she said. “That is, relaxation following high perceived stress is a powerful predictor of migraine onset.”

Dr Buse and colleagues asked 17 patients with migraine to keep electronic diaries for 3 months to examine the relationship of perceptions of stress and relaxation after stress with increased probability of a migraine attack, yielding more than 2000 diary entries, including 110 eligible migraine attacks.

Data were collected using a custom-programmed electronic diary. Each day patients recorded information about migraine attacks, 2 types of stress ratings, and common migraine triggers. Triggers included hours of sleep; certain foods, drinks, and alcohol consumed; and menstrual cycle. They also recorded their mood each day, including feeling happy, sad, relaxed, nervous, lively, and bored.

“We found that a reduction in stress from one day to the next was associated with a nearly 5-fold increased risk of migraine onset within 6 hours,” Dr Buse said.

The biology of stress is complex, including activation of both neuroendocrine and sympathetic mechanisms, she noted.

“Cortisol rises during times of stress. If cortisol falls in periods of relaxation after stress that may contribute to the triggering of a migraine attack,” said lead author Richard B. Lipton, MD, Director, Montefiore Headache Center, and Professor and Vice Chair of Neurology and the Edwin S. Lowe Chair in Neurology at Einstein.

“This study highlights the importance of stress management and healthy lifestyle habits for people who live with migraine,” Dr Buse stated. “It is very important for people to be aware of rising stress levels and attempt to relax during periods of stress rather than allow a major buildup to occur. Strategies to relax could include exercising, attending a yoga class, taking a walk with your dog, or simply focusing on your breath for a few minutes.”

Behavioral interventions that protect against rising levels of stress also may prevent the peak followed by the valley that leads to an increased risk of migraine attack. “There are several approaches to stress management with strong scientific support, including cognitive-behavioral therapy (CBT), biofeedback, and relaxation therapies,” Dr Buse said. “An additional bonus is that these techniques also have scientific evidence for migraine prevention.”

Some approaches require the guidance of a mental health care professional, such as biofeedback and CBT, and some can be self-learned, such as diaphragmatic breathing and guided visual imagery.

“Once learned these techniques can be practiced practically anywhere at any time for the rest of someone’s life,” Dr Buse noted. “Based on these findings, we suggest that health care professionals caring for individuals with migraine should incorporating stress management interventions into treatment plans, especially for patients for whom changes in stress levels are triggers for migraine attacks.”

The researchers published their results online on March 26, 2014, in the journal Neurology.