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Reduction in perceived stress as a migraine trigger: testing the "let-down headache" hypothesis.

Lipton RB; Buse DC; Hall CB; Tennen H; Defreitas TA; Borkowski TM; Grosberg BM; Haut SR
Neurology 2014 Apr; 82(16):1395-1401
OBJECTIVE: To test whether level of perceived stress and reductions in levels of perceived stress (i.e., "let-down") are associated with the onset of migraine attacks in persons with migraine. METHODS: patients with migraine from a tertiary headache center were invited to participate in a 3-month electronic diary study. Participants entered data daily regarding migraine attack experience, subjective stress ratings, and other data. Stress was assessed using 2 measures: the Perceived Stress Scale and the Self-Reported Stress Scale. Logit-normal, random-effects models were used to estimate the odds ratio for migraine occurrence as a function of level of stress over several time frames. RESULTS: Of 22 enrolled participants, 17 (median age 43.8 years) completed >30 days of diaries, yielding 2,011 diary entries including 110 eligible migraine attacks (median 5 attacks per person). Level of stress was not generally associated with migraine occurrence. However, decline in stress from one evening diary to the next was associated with increased migraine onset over the subsequent 6, 12, and 18 hours, with odds ratios ranging from 1.5 to 1.9 (all p values < 0.05) for the Perceived Stress Scale. Decline in stress was associated with migraine onset after controlling for level of stress for all time points. Findings were similar using the Self-Reported Stress Scale. CONCLUSIONS: Reduction in stress from one day to the next is associated with migraine onset the next day. Decline in stress may be a marker for an impending migraine attack and may create opportunities for preemptive pharmacologic or behavioral interventions.
Psychology; Physiopathology; Physiology; Humans; Men; Women; Epidemiology; Etiology; Pituitary-gland-disorders; Pituitary-glands; Risk-factors; Stress; Brain-function; Psychological-stress; Psychological-effects; Questionnaires
Publication Date
Document Type
Journal Article
Email Address
Funding Type
Cooperative Agreement
Fiscal Year
Identifying No.
Cooperative-Agreement-Number-U10-OH-008242; M062014
Issue of Publication
Source Name
Performing Organization
New York City Fire Department
Page last reviewed: May 11, 2023
Content source: National Institute for Occupational Safety and Health Education and Information Division