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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?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Lipton RB, Buse DC, Hall CB, Tennen H, DeFreitas TA, Borkowski TM, Haut SR. Reduction in perceived stress as a migraine trigger: Testing the “let-down headache” hypothesis. Neurology. Published online before print March 26, 2014.

Comments

  • Livvy
    4 years ago

    My ambition is to try to stay as close to the middle as possible. Not too high, not too low. Not overly excited or overly lethargic. It’s a real challenge. People have often upset me as I think my natural inclination is to be somewhat quiet with mini bursts of joy and abandon, but in my own unique way. When I was younger and tried more to be “happy” and “up” to fit in, going to a pub and drinking too much, trying to be funny in order to be part of the crowd, I often felt emotionally let down after. When I was just myself I was sometimes startled because certain people would find me funny or amusing. Haha. Only when I didn’t try to be.

    I am going on about this because when I stop worrying about what people think and I do my own natural meandering, a little up, a little down, occasionally just nothing, just existing, being but not aware one way or the other, I think my body and mind and brain are doing the best. This was a very interesting article. Thank you.

  • Livvy
    4 years ago

    Sorry, that should be people have often upset me from my natural kind of balance and that has pushed my emotions beyond normal, usually down. Other times I have pushed myself too hard to be more “exciting” or something and that was no good either.

  • notemily
    4 years ago

    I’ve only just learned that this can be a factor in migraines and it’s a revelation for me since I’ve started to get them every single weekend. It’s so frustrating because all week I wait for the weekend so I can relax and then when it gets here I have to deal with a migraine. It makes it hard to plan social activities and get things done on the weekends! Haven’t found a solution yet but I’ll keep trying.

  • Kayakerjo
    5 years ago

    This is a classic in my family. Thankfully I benefitted from my dad figuring this one out for himself. His migraines were a classic at the start of family vacations. One thing he noticed, which really helped, was he drank a lot of coffee when working then dramatically less on vacation. Reducing his coffee consumption helped. I’ve found avoiding caffeine all together is best…although it’s often tempting when a little would help that first feeling of pain.

  • Ron
    5 years ago

    This is a constant problem for me, I always crash after social gatherings, stressful situations or even physical stress. I’ve found it helpful to completely clear my calendar the day before and at least two days after an event. This way when I crash I don’t have any other stressors adding to the problem. This works most of the time but unexpected stressors are always around the corner and I don’t have a chance to plan for them. In those situations I just let things go and concentrate on getting back on track. I try not to worry about the things I need to do or places I need to go to.

  • stacysillen
    5 years ago

    I noticed this as a child! I used to tell people that I’d never get a migraine during a stressful time; I’d get one the next day! I connected them with the day after an intense argument with a parent (I was a teenager after all)! And it kind of stunk to have that drama followed up with a stupid migraine!

  • Dr. Romie
    5 years ago

    Hello Kerrie, I am a neurologist with expertise in mind-body medicine and a migraine sufferer. Thank you for addressing the all important issue of stress causing migraine headaches.
    There are many studies that highlight stress as a trigger for migraine and tension headaches, yet so many physicians ignore this factor.
    Regarding “let down headaches”. The brain’s stress and relaxation response are complicated, and cortisol alone is not “protective” of migraine headaches. Repeated stressors can alter the normal response of physiological systems, and this concept has been termed “allostatic load.” In the case of the brain, the effects of repeated stress may lead to alteration in brain networks both functionally and structurally. As a result, the brain responds abnormally to environmental conditions (psychological or physiological).
    But hope is NOT lost. The brain structures can and do change to various therapies that are scientifically proven to alter how we respond to stress. You eloquently mentioned yoga. Meditation is also very effective technique. Acupuncture is also of benefit. Multiple studies have shown reduced stress related headaches (both migraine and tension) with yoga, meditation, and acupuncture.
    Thanks for a great article.
    Dr. Romie http://www.brainbodybeauty.com

  • Marsha
    5 years ago

    I definitely suffer from “let down” migraines and will try your suggestion. I find that, during periods when I’m working under deadline or otherwise experiencing an especial level of stress, I eat less regularly, neglect to hydrate, and lose sleep — all migraine triggers by themselves. With the deadline over, everything comes crashing down.

    Thanks for the reminder that we need not only to manage our stress, but to “come off” the stress in a gradual way. Great suggestion!

  • pipatootie
    5 years ago

    Great tip about gradually coming down from a stressful situation……that is, if you are aware ahead of time that you’re going into a stress-filled situation, or aware at the time of the event that you are stressed; but managing a stressful situation? Isn’t that nearly impossible? And isn’t telling a Migraineur that they should “manage” their stress level during a stressful situation, the first of “12 Things to Never Say to a Migraineur?” Most of the stresses in my life are things/people I have no control over. Yes, theoretically, I can control how I respond to the stress, but in reality, as a chronic Migraineur, I find my inner resources for coping with stress more and more depleted as I grow older. As a matter of fact, my reserves are thoroughly depleted. I can no longer deal with ANY kind of stress.

  • Kerrie Smyres moderator author
    5 years ago

    I don’t see this advice as the same as just telling someone to lower their stress. Learning to deal with stress can improve anyone’s life and could potentially make a huge difference for those who have stress-triggered or let-down migraines. There’s more and more research to back up this idea and, while it may not be true for everyone, it may help some. This isn’t because they don’t cope “correctly,” but perhaps because of physiological changes in their bodies.

    I also have chronic migraine and know what you mean about being completely depleted. While learning to better cope with stress didn’t change my pain levels, it has made migraines themselves much less stressful and, thus, a little less of a burden on my life. It was more work in the beginning, when I was learning to listen to my body and apply new techniques, but the end result has been a positive gain for sure.

  • Stacey Dee
    5 years ago

    Thank you for reveling how complex this disease can be. I find many medical practitioners, who have limited acceptance of this disease trying to simplify the causes and triggers. This article draws attention to the fact that it is not as simple as “Stress” or hormones, or weather, those of us who network with a migraine community understand is can be a plethora or things, places, environments, emotions chemical reactions or a recipe of things. So to attempt to classify a trigger is a simple a pinning down water. BUT DON’T STOP TRYING TO FIND THE ANSWERS.

  • Kerrie Smyres moderator author
    5 years ago

    I love “to attempt to classify a trigger is a simple a pinning down water” — thanks for sharing your perspective!

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