Those who suffer from migraines have likely heard that stress can be a powerful trigger, but new research suggests that it’s the comedown after the craziness that brings on the pain.
In a small study involving 17 migraine patients, researchers at the Montefiore Headache Center in New York City examined headache and stress diaries that patients filled out twice a day for at least 30 days using a smart phone app; they found that migraines were nearly twice as likely to occur within six to 18 hours after a sharp drop in stress—rather than during the anxious period itself.
“Migraines didn’t occur when participants were getting ready for the big test or finishing a big deal,” said study leader Dr. Richard Lipton, codirector of the Montefiore Headache Center. “It’s after they take the test or close the deal that they feel terrible.”
Interestingly, stress levels themselves weren’t associated with migraines, but, rather, it was the size of the shift— from feeling crazed to feeling suddenly relaxed—that brought on the hallmark symptoms of flashing lights, nausea, or a stabbing sensation in a particular spot on the temple or behind the eye.
“I have said for many years to patients: be boring—a little grief regularly and no excesses,” wrote Dr. Peter Goadsby, a well-known migraine researcher at University of California, San Francisco, in an editorial that accompanied the study. “It is silly advice since it would make life less interesting, although it is in keeping with the study findings.”
Neurologists have known for some time about the “let-down” phenomenon associated with headaches from patient reports, but Lipton said this is the first time it’s been quantified. Likely, it’s caused by a deactivation of the body’s stress response. One of the stress hormones, cortisol, dulls pain, so when cortisol levels fall, migraine pain sets in.
To determine whether cortisol is really involved, Lipton plans in future research to measure levels of the hormone in saliva as stress levels rise and fall to see whether a larger cortisol decline is linked to more severe migraines. That wasn’t done in the current study published Wednesday in the journal Neurology.
While migraine sufferers may not want to lead boring, less interesting lives, they can find ways to pace themselves better when they know it’s going to be a busy or emotional week. Building in a few extra days to study, finish a project, or meet that grant deadline would help spread out the stress so it’s easier to manage, recommended Montefiore psychologist Dawn Buse, a study coauthor.
Sounds obvious, but many of us—even with the best intentions—don’t do that. And, thus, we leave too much for the last minute.
“When you’re cramming, take breaks even if you don’t think you have the time,” Buse said. She posted several stress reduction podcasts using breathing and guided imagery on her website that take less than 10 minutes. Even grabbing a few moments to watch a funny video or walk outside into the sunshine can help lower stress levels. Free smartphone apps like GPS for the Soul remind you at certain times to take those breaks and pull back from your stressed-out max— so you don’t pay for it later.