Measuring Pre-Migraine Stress Levels

A new study out of Japan is raising questions about the connection between stress levels and migraine attacks.

A little background here.  Headaches have traditionally been connected to stress.  It’s natural that migraine, with the common symptom of headache, has also been connected to stress levels in people’s minds.

But in recent years, the connection between migraine, and even tension type headaches, and stress, has been increasingly questioned.  Part of the reason is that new technology is allowing us to see some of the complex changes taking place in the body during attacks.  We’re even seeing that there are fundamental physiological differences in people with migraine disease.

Research also has failed to show a direct cause and effect between migraine, types of headache, and stress.

However, there is a relationship of some kind.

The Japanese study

This September a small study out of the Toho University in Tokyo set out to find new ways to measure psychological factors and actual stressful events in relation to migraine attacks.

The interesting thing about this study was that they went more in depth with various factors that might relate to migraine.  My greatest hope from a study like this is that it will get researchers thinking about new and better ways to study the relationship between psychology and life events and migraine attacks.  This is not a simple relationship, as many people once thought (ie more stress = more migraine attacks).

The study followed 16 people, studying the 3 days before an attack.  Recorded were: stressful events, daily hassles, domestic stress, non-domestic stress, anxiety, depressive tendency and irritability.

The researchers actually didn’t find a large increase in stressful events in the days before an attack.  There was no significant increase in stressful events.  There was an increase in "daily hassles".  Naturally, there was an increase in stress and some types of life-stresses during a migraine attack.

The researchers concluded that the increase in life stresses in the days before the attack were not as high as had been reported in some earlier studies.

Other studies

I’m not going to do a review of all the studies on migraine and stress, but I was browsing some of the other studies from the 1990s.  One (from the USA) focused more on phsychological factors and suggested that there was increased tension before attacks, and tried to measure when tensions would result in an attack.  The other (from the Netherlands) showed increased daily hassles in the 24 hours before an attack, fatigue and decreased sleep before an attack.

Surprised by the results?

I’m a little surprised that the studies so far have not found more of a correlation between psychological factors and the hours before an attack.  That’s not because I think that stress brings on migraine attacks.

There’s another factor at work here – the premonitory, prodrome or aura phase of the migraine.  It’s hard to tell exactly when the attack starts, because the headache (if there is one) generally comes late in the migraine chain of events.  Mood changes are very often an early phase of the attack, and can start many hours before the headache itself.  So, if we’re talking about how irritable someone is, or how difficult they find daily tasks, one would expect that there would be an increase for many people before the headache phase.

That being said, there are two things to note about this study.  First, I’m glad researchers are getting more specific – types of stress, types of mood changes, etc.  The studies coming out in the 90s were much more basic.  However, it could be a long time before we unravel the connection between life events, stress, and migraine attacks.

Second, this study further weakens the case for a direct and constant relationship between stress and migraine attacks.  It confirms the decision of the International Headache Society to remove stress from the list of migraine triggers to the list of exacerbating factors.

If you want to study the results more closely, read Stress and psychological factors before a migraine attack: A time-based analysis