Let-down headaches

Many migraine sufferers complain of headaches on weekends, vacations, or after a period of stress. Researchers at the Montefiore Medical Center in the Bronx confirmed this observation by observing 17 migraine patients. The patients completed over 2,000 twice daily diary entries about their headaches and the amount of stress they had. The doctors found that patients had 20% higher chance of developing a migraine 12 to 24 hours after their mood changed from “sad” or “nervous” to “happy” or “relaxed”. There are several possible explanations for this phenomenon. One, is that some people have a certain amount of control over their headaches and do not allow themselves to have a headache when they know that they have to perform important functions, but as soon as this demand ends, they pay for the stress by getting a headache. Another possibility is that sleeping longer on weekends, vacations, or after the stress is over, triggers a migraine. Migraine sufferers can be very sensitive to changes in their sleep schedule with both too much and not enough sleep being a trigger. Weekend headaches can be also triggered by caffeine withdrawal – drinking your first cup of coffee at 10 instead of 8 in the morning.

  1. Dr. Mauskop says: 04/24/201512:10 pm

    If your insurance allows only 9 tablets a month you can get more generic Imitrex (sumatriptan) for $1.50 a pill – check GoodRx.com for a local pharmacy that has this price (with a coupon offered on this site). You do need a doctor’s prescription.

  2. Minnie says: 04/24/201511:38 am

    I have the same migraine schedule (and theories) as Nicole above. It’s Friday morning, I’m at work, and I can feel the migraine already starting up. Last Friday I was so sick with one, vomiting and the whole thing, I couldn’t make it to work. Unfortunately my boss never gets headaches so he thinks I’m just angling for a 3-day weekend. I also don’t have migraines on vacation or even if I’m just home from work a few days. I don’t really sleep more on those occasions, but I do get up a lot later, just waking up naturally at a decent hour. I really believe it has to do with the hour I’m forced to get up (4:00 a.m.). After 5 consecutive days of it, my head just says “exploding, in one…two…” Imitrex works only about half the time, and being only given 9 pills a month, that never even covers it. I just wish doctors would take this more seriously. Thankfully my allergist has no qualms about prescribing it, but internists I’ve seen are always hesitant. I don’t get it.

  3. Tamara Schmitz says: 02/15/20153:23 pm

    I also suffer from let down migraines. they usually start on sat night or early Sunday morning and continues into Monday, and sometimes Tueday. Then I’m good again until Sat or sun . It’s very frustrating and would do anything to stop this cycle.

  4. Nicole Kitson says: 08/09/20124:25 pm

    Todd, You do have a good point about migraine sufferers not really being able to control their headaches. If I had a choice, I would not spend every Friday evening in bed with a migraine but instead with family or friends doing something fun. It’s good for my career that I don’t miss a lot of work for migraines but not so great for family life and marriage that I suffer on weekends and those areas are the most important in my life. I actually think it is likely that I get them on the weekend as I’m just tired out from the week but who knows. Before I was on Topomax I got them during the week as well but now typically just on Friday evenings. Although lately sometimes on a Thursday or Saturday evening instead of the Friday. I just had two weeks off work and was migraine free. Not sure if was the increase in sleep I got, the lack of sitting at a desk all day, better climate on the west coast where I was or the lack of stress. My new migraine strategy is to win the lottery so I can quit working, lol!

  5. Todd says: 08/03/20124:50 pm

    It’s nice to see discussion & recognition/acknowledgement of “Let-down headaches.” As a migraine headache sufferer for more than 30 yrs and having an extensive family history of migraines (apparent FHM w/aura variant that becomes chronic migraine for those that have it in my family), it has been frustrating to see how this can be sometimes easily dismissed. I can understand how changing everyday routine can affect triggering a migraine, but to say that some people have a certain level of control seems unlikely to me even if it the “control” could be unconscious. There are similar things that “need to get done” on the weekends just like during the week, but I might get a migraine on the weekend regardless. Not to mention, if there is something planned that I view as enjoying, I still have the same chance of getting a migraine no matter how much I would like to have control over not having it. Like Adam above , my weekend/weekday routines are very similar -same amount of sleep, caffeine, etc. Also, while I understand the literature around exercise and biofeedback, I have not found these to be effective for me. To argue that we (migraineurs) are able to control the migraines in some fashion or another is frustrating in the sense that it blame on the patient for not taking appropriate steps that could prevent migraine. For example, it can be construed that a person gets migraine because s/he doesn’t exercise enough or doesn’t eat right. This is very frustrating to someone like me. I get migraine because I am genetically prone to getting them. It’s as simple as that. I wish more (research) would be done to understand this. We spend so much time debating behavior and diet in treating migraine, but so little in actually understanding the pathophysiological roles in triggering them. $15 million/year funding by NIH for research is pathetic for an ailment that affects such a large amount of the population and the possibility that it’s being spent on research where people are telling me that my migraines are essentially my fault because of my lifestyle or that I can control my headaches if I behave differently is extremely frustrating.

    Instead, I wish more would be done to explain why certain anti-epileptic drugs like topamax or lyrica are able to control migraine but other treatments don’t (not even magnesium citrate or CoQ10 or numerous other supplements, in my case -I fall into the ‘you name it, I’ve tried it category’). We really don’t know the answer. What is the role for Astrocyte glial cells? What about other medicines (like naltrexone) that are being found to modulate these (http://www.biomedcentral.com/1741-7015/9/116 or http://www.medical-hypotheses.com/article/S0306-9877%2808%2900541-0/abstract)?

    I apologize for a bit of a rant and truly do thank you for your blog and contributing your time and knowledge. Your efforts to help others and seek out ways to treat such a difficult and confusing condition are greatly appreciated. Please do look into naltrexone as I referenced above. I have been having success with low-dose naltrexone and can’t spread the word fast or loud enough. My only hope is that physicians would become aware of it and consider it in treating their patients. I am NOT a physician, but have a science background. However, I am employed in a field that does not enable me to do migraine research. My neurologist is currently considering treating his other patients with low-dose naltrexone based upon the success I have been having. I sincerely hope it a “real” effect that can be beneficial to others.

    Kind regards,


  6. Dr. Mauskop says: 07/16/20126:29 pm

    Yes, we do not recommend herbal products for pregnant women.

  7. Nicole says: 07/16/20126:18 pm

    Thank you. I will discuss the above wuth my doctor. I notice you didn’t recommend feverfew. Is this because it is not safe for preganancy? Nicole

  8. Dr. Mauskop says: 07/16/20128:52 am

    Regular aerobic exercise and biofeedback are the best antidotes for stress and both have been proven in scientific studies to prevent migraines. In addition, they are free of side effects and are not as expensive as Botox.

  9. Adam says: 07/16/20128:22 am

    Over the past 4 years, I have suffered from letdown migraines persistently. I used to get them every saturday morning, but over time they shifted to Friday mornings. That was a bad shift, because I teach on Friday mornings. If there was a day in the week where I had a break from teaching, the letdown
    Migraine would come on that day. As to the cause, I’ve read many publications that argue a change in stress level is enough to trigger the letdown migraine. Considering I keep everything else constant–no coffee, sleep and wake at the same time, etc–I’ve come to accept this explanation, even if it leaves me helpless to stop the migraine. Do you really believe biofeedback could stop my letdown migraines? How? Why would that stop it when nothing else (frova for days, many different NSAIDs) has?

  10. Dr. Mauskop says: 07/11/20127:20 pm

    I cannot make specific recommendations without seeing you first, so I have to say that you should ask your doctor about these recommendations. I would start with the usual recommendations to get enough sleep, exercise regularly, learn biofeedback or meditate daily (this is probably your best bet), take magnesium, CoQ10, and riboflavin. IF this is not sufficient, try Botox injections. It is approved only for chronic migraines, but it works for less frequent ones as well and it is much safer than Topamax and other drugs. You can also ask your doctor about taking 2 Migralex on Friday afternoons before the headache starts.

  11. Nicole says: 07/10/201210:48 pm

    I get let down migraines on Friday evenings. I think it is because I don’t let myself get a migraine during the week as I don’t want to miss work but by Friday 8 can no longer hold it off. Any advice on how to prevent this? I am on Topamax and want to go off it as I would like to get pregnant but I have tried twice to wean off and the migraines get worse. I have been trying accupuncture abpnd it seems to work if I go on Fridays but I can’t afford to go every week. Thanks

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