Stress and Migraine
Mia Minen, MD MPH
Key Points:
1. Stress is correlated with migraine.
2. Stress can have physiological and behavioral influences on the body which are thought to influence migraine.
3. Talk to your health care provider if you experience these symptoms.
4.There may be techniques you can employ to lower your stress levels.
Introduction
Research shows that the brains of patients with migraine are different from healthy controls. The brains of migraineurs may respond differently to pain, light and smell. Migraineurs’ ability to respond to maladaptive behaviors may be impaired.
The brain is considered the organ of stress. It identifies what is or may become stressful, and it attempts to manage the stress. Its effects may be beneficial or maladaptive to the individual, and its response may be physiological or behavioral.
Stress is a trigger for migraine in almost 70% of people, and one study revealed that 50-70% of subjects had a significant temporal correlation between their daily stress level and their daily migraine activity. Both stressful life circumstances such as childhood abuse, post-traumatic stress disorder and poor socio-economic circumstances are known contributors to stress and its impact on migraine. In addition, every day stressors can also influence migraine.
Research is being done to better understand the brain’s response to stress. Allostasis, or the ability to protect the body through mediators to promote adaptation, is currently being studied. Another term used in this type of literature is the allostatic load, defined as the conditions affecting the brain’s ability to maintain physiologic stability.
Physiologic Effects
Certain physiologic factors can affect the allostatic load. Such factors include impaired glucose tolerance, dysfunction in the autonomic nervous system such as decreased heart rate variability (the heart rate does not adjust as easily as it should to changes in the body’s level of activity) and increased levels of proinflammatory cytokines (chemicals sometimes produced by the body when there is infection or inflammation). Hormone levels are another physiologic factor which influences the allostatic load; Changes in sleep patterns, which in turn affect prolactin, melatonin and cortisol levels, and menses, are two additional examples of neuroendocrine processes implicated in migraine.
It is important to note that medications taken may also influence our body’s physiologic processes, which can in turn, affect allostasis. Research has shown that chronic migraineurs with medication overuse headache have their corticotrophic (a type of hormone) and somatotrophic (another type of hormone) systems dysregulated compared to normal controls.
Treatment Options
Suggestions for minimizing one’s stress:
- Taking some time for yourself each day
- Trying to identify stressful circumstances and developing practical alternative solutions
- Eating healthily
- Ensuring adequate sleep
- Exercising for about 30 minutes each day
- Doing relaxation techniques-such as biofeedback and meditation
It is important to note that sometimes stress can also cause symptoms of anxiety and depression. As noted in the article on migraine, depression, and anxiety, medications and behavioral treatments are available to help with these symptoms. It is important to speak with your doctor if you are also experiencing these symptoms.
Mia Minen, MD MPH, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Boston, MA