Stress & Let-Down Migraines

Are any of these scenarios familiar to you?

  • You make it through every workweek without a migraine attack, but get at least one every weekend.
  • You spend the first day of most vacations curled up in a dark, quiet room because of a migraine.
  • You feel fine during final exams, but when they’re over, you have to retreat to be with a migraine.

Let-down migraine attacks are a story many migraineurs can tell. While stress is often considered a migraine trigger, many find that the release of stress is an even bigger trigger than the stress itself. In the first six hours of reduced stress, a person’s risk of getting a migraine increases by nearly five times. The let-down effect lasts up to 24 hours. These findings were published online today in the journal Neurology.

Researchers are still trying to figure out why let-down migraines happen. One possible explanation is that the hormone cortisol increases during stress and reduces pain. Cortisol acts as a sort of shield during stressful periods. The hormone’s levels drop when stress is released, which also decreases its protective effect and leaves you open to a migraine attack.


It’s nearly impossible to avoid stress altogether, but learning how to manage it could be the key to reducing let-down migraines. “It is important for people to be aware of rising stress levels and attempt to relax during periods of stress rather than allowing a major build up to occur. This could include exercising or attending a yoga class or may be as simple as taking a walk or focusing on one’s breath for a few minutes,” said study co-author Dawn Buse, PhD, the director of behavioral medicine at the Montefiore Headache Clinic.

If your stress levels do get really high, relaxing gradually rather than all at once might help keep migraines at bay. This is the strategy my husband hit upon to avoid getting a migraine at the end of final exams in college. Instead of melting in relief after the last test was over, he kept himself slightly stressed about packing and traveling home. These things weren’t very stressful (especially compared to finals), but they kept him from letting go all at once. By reducing his stress slowly, he arrived home after each semester both stress-free and migraine-free.

How do you avoid let-down migraines?

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