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MIGRAINE: What's Stress "Let-Down" got to do with it? And, did someone say-Stress management? 


"It isn't stress that makes us fall - it's how we respond to stressful events." Wayne Goodall 

To begin with, stress does not cause migraine. However, a number of studies have shown stress plays an important role in our migraine attacks, which are the episodic manifestations of our neurological disease. It is thought that stress is a contributing factor in the onset of our attacks, exacerbation and frequency of our attacks, and the progression of our episodic attacks to chronic migraine. As well, the headache associated with our migraine attack itself has been shown to be a stressor.

We need to be aware that a recent study, "Association Between Stress and Headache Frequency" (Schramm et al, 2014), showed, "increasing stress resulted in increasing headache days". The participants in this study experienced tension-type headache, headache in migraine, and headache in migraine with coexisting tension-type headache.

What is Let-Down Migraine?

Some studies have shown a reduction in stress to be responsible for the migraine attack known as a "let-down" or "weekend" migraine. In this instance, we need to know that a new study, "Reduction in perceived stress as a migraine trigger" (Lipton et al, 2014), shows reduction in stress from one day to the next is associated with migraine onset the next day.

In a report released by Albert Einstein College of Medicine (2014), the study lead author, Richard Lipton, M.D. stated, "This study demonstrates a striking association between reduction in perceived stress and the occurrence of migraine headaches." That said, to understand how a decline in perceived stress can trigger our migraine attacks, it is wise to be familiar with the stress response. 

Stress Response

To help me understand the stress response, I prefer to think of it in three phases:

  • Alarm,
  • Response, and
  • Relaxation. 

Let's take a look at each of these phases in a bit more detail.

Alarm phase

When we perceive a threat, environmental, chemical, physical, or emotional, our hypothalamus, an endocrine gland deep within the brain that controls and integrates the overlapping functions of the endocrine and autonomic nervous systems, takes charge.

Response Phase

If the threat does not go away, the sympathetic branch of the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal axis (HPA) are activated and a flood of hormones are released from the adrenal glands to fight the "challenger" (stressor). These hormones include, but are not limited to, epinephrine (adrenaline), norepinephrine (noradrenaline), and cortisol. Our heart rate, blood pressure, respirations, and alertness increase; our senses become sharper; and, glucose and fats are released from storage sites in our bodies to provide energy. The function of our immune systems is enhanced and ant-inflammatory actions are increased to fight infection. As well, an increase in endorphins, our bodies' natural pain relievers, decreases our perception of pain. We know this as the "fight or flight" response, or acute phase, of stress. As long as the threat is perceived as dangerous, levels of these hormones stay elevated and we remain energized and on high alert. 

Relaxation phase

Once the threat has passed without harm, our parasympathetic branch of the (ANS) dampens our stress response and levels of our hormones return to normal. We may find ourselves fatigued, our minds and bodies exhausted. It is in this phase that our complaints show up. For example, if a stressor such as a traumatic injury has caused us pain and the sensation has been diminished, we feel it now.

For those of with migraine, we need to be aware that it is here, over 6 to 24 hours, when acute stress ends, HPA activation declines, and cortisol (glucocorticoid) and other hormone levels fall, a let-down migraine has been shown to occur. In addition, we should know that other factors and triggers may be responsible for an increased probability of a migraine in this phase. These include missed medications, skipped meals, dehydration, or disturbed sleep during the stressful event.

As I reflect on my forties, let-down migraines were the pattern of my life. I would power through a stressful event and the day after experience incredible fatigue, unexplained irritability and a debilitating headache phase accompanied by nausea and vomiting and several other associated symptoms. As the years passed, the stressful events, followed by the migraine attacks, increased. Without effective intervention, I rapidly progressed from episodic to chronic migraine and medication overuse headaches (Imitrex). 

"Hope is beng able to see that there is light despite all of the darkness." -  Desmond Tutu

Stress Management

To appreciate the necessity of stress management in our treatment programs, we need to know that migraine attacks with recurrent episodes of pain, central sensitization, and accompanying hormonal and inflammatory changes may alter our brain structure and function. The more frequent our attacks are, the more we are at risk for these changes.

In the study, "Association Between Stress and Headache Frequency", the authors mention in the conclusion  that their findings are important for tailored anti-stress treatment approaches in headache patients. In the study "Reduction in perceived stress as a migraine trigger", according to a report by Albert Einstein College of Medicine, the study co-author Dawn Buse, Ph.D., stated, "This study highlights the importance of stress management and healthy lifestyle habits for people who live with migraine".

Given this information, it is in our best interest to include stress management strategies in our migraine treatment programs to help reduce stress and decrease the frequency of our attacks. Techniques and therapies that helped me achieve these goals, and that I continue to practice daily to control my stress level and keep it from building up, include: positive thinking, prayer, daily biofeedback exercises, deep breathing techniques, diaphragmatic breathing, guided imagery, meditation, and healing touch (energy healing technique). As well, regular exercise (moderate) and acupuncture sessions are beneficial. Along with these, others that may assist you, include: cognitive behavioral therapy, yoga, tai chi, massage, physical therapy, chiropractic, reflexology and, energy healing techniques like Reiki. 

Although more research is necessary to provide evidence of effectiveness for some of these strategies, many of them have been shown to be effective by

  • relaxing tense muscles in our neck and shoulders,
  • reducing muscle spasm and inflammation and relieving pressure on adjacent nerves,
  • balancing the sympathetic and parasympathetic branches of our ANS and promoting calmness,
  • quieting our mind and calming our bodies,
  • stabilizing our stress hormones and neurotransmitters like serotonin,
  • increasing our endorphin levels,
  • balancing the flow of energy in our bodies,
  • increasing self-awareness, and
  • balancing our emotions.

We need to be be aware that these techniques and therapies have an even better effect when they are practiced at regular intervals over time; combined with trigger management, a healthy diet and lifestyle practices; and, for some people, with a preventive medication. As well, it is great for us to know that after initial instruction, a number of them can be practiced in the comfort of our own homes or offices to protect against increases in stress and keep our attacks at bay. 


Albert Einstein College of Medicine (2014, March 27). "Migraine attacks Increase Following Stress Let-Down". Albert Einstein College of Medicine.

Lipton, R. L., M.D., Buse, D. C., PhD., et al (2014). "Reduction in perceived stress as a migraine trigger". Neurology. Published online before print March 26.

Schramm, S., Lehmann,N., Bock, E., Katsarava, Z., & Moebus, S. (2014). "Association Between Stress and Headache Frequency". Neurology. April 8, vol. 82 no. 10 Supplement S41.007.

Sharron Murray MS, RN is an author and coauthor CaMEO Study, "Life With Migraine". Currently, Sharron is active in the migraine community as a writer, advocate, American Migraine Foundation Partner, moderator for the American Migraine Foundation "Move Against Migraine" Facebook Group, and member of the National Headache Foundation Patient Leadership Council. 

Follow Sharron on twitter @murraysharron, her Facebook page: Sharron Murray, M.S., R.N.   

This article is not intended as a substitute for medical advice. If you have any specific concerns about your health or nutrition, please consult a qualified health professional.

Updated November 28, 2018

Copyright March 29th, 2014, Sharron E. Murray

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