“Proof” that Headaches are caused by Stress?

Whether or not stress causes headaches, a recent study out of Germany is causing a LOT of buzz in the media.  The study, which links stress and headaches, is being hailed by some as “obvious”, and others as the final “proof” that headaches are caused by stress.

But can we really now chalk up our headaches to stress?  Or is there something else going on here?

The study released this week involved a survey of 5,159 people over a two year period.  Each person had to rate their stress level (from 0 to 100) and note how many headaches they had had each month.

The headache types were classified – migraine and tension-type headache (or a combination) being the main culprits.

The study showed that increased stress levels were related to an increased number of attacks (in this case, “headache days” per month).  For example, those with tension-type headache had 6.3% more headaches when their stress rose by 10%.  Those with migraine had 4.3% more when their stress rose by 10%.

Now Jenny Hope, writing for the Mail Online (which has had a lot of good information on headache conditions in the past) came up with the unfortunate headline “It’s official – stress DOES cause headaches“.

Really?

The headline was softened with the subtitle – (and the pain then causes us to become even more stressed)

We should have some serious concerns about headlines like this, but first let’s give the researchers some credit.

What does the study say about headaches and stress?

Study author Dr. Sara H. Schramm isn’t nearly so definite in her comments.  Quoted in Medscape, Dr. Schramm says (emphasis mine):

The results add weight to the concept that stress can be a factor contributing to the onset of headache disorders, that it accelerates the progression to chronic headache, exacerbates headache episodes, and that the headache experience itself can serve as a stressor…

Did you notice?  She’s basically saying that stress is one possible factor, and that the headaches may be causing at least some of the stress!

Filling in a survey on stress and headaches is not going to clearly show what causes what.  Does stress lead to headache?  Or headache to stress?

Now this study was designed to study the relationship between stress and headache.  So it did filter out some factors, such as smoking.  In other words, if you’re stressed and smoke more, that may trigger more headache attacks, but that should have been filtered out of the study.

So this study most certainly adds to the evidence that headache disorders and stress levels are related.

But – a cause?

But saying that this study proves that headaches are caused by stress is highly problematic.  Even if stress adds to symptoms, that’s not to say that the root cause is stress.  And again, how much do the headache symptoms cause the stress?  (If you have headache or migraine issues, you’ll probably say – a LOT!)  What kind of stress?  Why are some people under a lot of stress, and yet they don’t get headaches?

Why all the bother?  So what if stress leads to headache?

So who cares?  Does it really matter if we attribute our headache disorders to stress?

Yes – it matters a great deal.  Even the author of the study admits – this is only one possible factor.

And yet articles online, and doctors around the world, not to mention friends and family of the headache patient – are very quick to say,“It’s just stress”.

But if we look closer at the research over the past few years, we should have a lot less confidence that it is.

Attributing headache disorders primarily to stress is keeping patients from treatments that could be helping them.  It’s keeping them from discovering triggers that may be even more powerful than stress.  And it’s often making patients feel guilty for something that isn’t their fault.

Why is it that there are two people under stress, and one gets severe headaches and the other none?  Why not look for other factors and treatments, rather than writing off the symptoms and saying they’re just due to stress?

What we should learn from the study

Although we shouldn’t be jumping to conclusions based on a survey like this, there are valuable things that can be learned from the study.  Dr. Schramm puts it this way:

These results show that this is a problem for everyone who suffers from headaches and emphasize the importance of stress management approaches for people with migraine and those who treat them…

Is stress a major issue for those with frequent headache symptoms?  There is no doubt that this is commonly the case.  So should we be helping patients manage stress?  Of course!  This should be a part of overall treatment.  And this study shows us once again that there is a clear relationship between tension-type headache or migraine and stress.

This study also points to the need for more studies on stress and headache disorders.  Dr. Todd A. Smitherman, a psychologist from the University of Mississippi who was not involved in this study, gives his suggestion for what’s needed:

Problematically, the overwhelming majority of studies on stress as a headache trigger have relied on either retrospective or prospective patient reports of stress.  What is needed are experimental studies that directly manipulate stress, measure resulting physiological changes, and try to link these changes to subsequent headache activity.

He goes on to point out that the stress-migraine relationship has not always been clear.  We need better measurements of types of stress, changes in stress, and types of headache.  (Read more in More Stress Equals More Headaches from Medscape)

So let’s not take a step back into the world of “It’s just stress”.  Modern science has shown again and again that headache disorders are much more complex, and that the treatment must include but go far beyond “relax and breath deeply”.

Read more on the study from the American Academy of Neurology:  Does More Stress Equal More Headaches?