It is not stress, but relaxation after is what triggers a migraine

Stress is considered to be one of the main migraine triggers. However, a study just published in the journal Neurology suggests that it is the period after stress when people are more likely to develop a migraine.

A group of doctors at the Montefiore Hospital in the Bronx led by Dr. Richard Lipton enrolled 22 participants, of whom 17 completed their diaries. These migraine sufferers made 2,011 diary entries including 110 migraine attacks eligible for statistical analysis. Level of stress was not generally associated with migraine occurrence. However, decline in stress from one evening diary to the next was associated with an increased chance of migraine over the subsequent 6 to 18 hours. The authors concluded that the reduction in stress from one day to the next is associated with migraine onset the next day. They said that “The decline in stress may be a warning sign for an impending migraine attack and may create opportunities for preemptive drug or behavioral interventions.”

What they meant is that people could try meditation and other relaxation techniques or, if that is ineffective, they could take a medication ahead of time. Taking medication before headache starts is often more effective and requires milder and fewer drugs than if a migraine is already in full bloom.

Many migraine sufferers know that changes in sleep, meal intake, weather, and stress can trigger an attack. So, it is important to keep your life stable as much as possible. Biofeedback, meditation and other relaxation techniques, as well as regular aerobic exercise, magnesium and other supplements, all could improve the resistance against migraine attacks.

The accompanying editorial in Neurology mentioned that migraine is the single biggest source of neurologic disability in the world and any practical finding that helps people avoid migraines can have a major impact on lives of millions of people.

3 comments
  1. Adam says: 06/04/20159:44 pm

    Hi again. Still struggling with stress letdown migraine. This may seem far-fetched, but if it’s true I think would help a lot of people with stress letdown migraines. Research on amitriptyline has shown that it affects Heart Rate Variability (http://www.ncbi.nlm.nih.gov/pubmed/19698338). Through biofeedback, I’ve seen this occur in my own HRV. Is it possible that migraine patients on amitriptyline would be more susceptible to the effects of stress? In that case, I worry that the 10 years I’ve been on the drug actually perpetuate my weekly stress letdown migraines.

    And maybe more generally, is there a connection between poor HRV and stress letdown migraine?

  2. Dr. Mauskop says: 04/23/20149:17 am

    Yes, there are other medicines that can be tried to prevent a headache besides NSAIDs like Aleve, aspirin, and Advil. Triptans often help and if Frova did n’t help, Imitrex (sumatriptan), Maxalt (rizatriptan) or another triptan might. If these headaches are frequent a prophylactic medication such as Neurontin (gabapentin) or Cozaar (losartan) or Botox injections should be tried.

  3. Adam says: 04/22/20149:26 pm

    I’m grateful for this study. It formalizes something I’ve been struggling with for 5 years. I hope that this study provides neurologists a window into medicinal treatment options for that letdown period. Dr. Mauskop, are there medicines other than nSAIDs or Frova that you’re considering for your patients to prevent the headache from the stress letdown? I’ve tried that combination Wednesday – Friday along with yoga, massage, baths, and meditation, and there’s still no stopping the migraine. I’ll keep working to manage the stress of my job, but I believe my body needs some assistance.

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