The Science of Migraine and Stress
The connection between migraine and stress has been recognized for centuries and is as relevant as ever during today’s COVID-19 pandemic. Acute migraine attacks often cause sufferers to feel anxious and stressed, while on the other side, anxiety, stress and even post-stress are some of the most common triggers of migraine.
Stress and migraine
Migraine sufferers often describe stressful events such as work pressure, debts, difficulties at home, sickness, divorce period, and social isolation as triggers of migraine attacks. Additionally, these stresses are often key contributors to a progression from low-frequency episodic migraine to high-frequency chronic migraine.
Others see their migraines flare up when their stress ends: at the end of the day, when they get home, on Friday night or a weekend that follows a stressful week at work, or on their first day of vacation.
How are stress and migraine related?
Until recently, the mechanism by which stress induces migraine was an enigma. But advances in the neurobiology of migraine and stress have given us an opportunity to more fully understand how these two neurological conditions influence one another.
What is migraine?
Migraine is a complex neurological disorder most commonly recognized as a one-sided headache that is accompanied by throbbing, nausea, and extreme sensitivity to light, noise, and smell. But migraine is more than a headache. It is also associated with difficulty finding words, irritability, anxiety, stress, and countless other symptoms that accompany attacks.
Migraine and mood
In addition to these debilitating effects, the initial headache stage of migraines causes millions of pain signals to originate in the meninges and interfere with the normal functioning of neurons, causing negative emotions and stress in the brain areas that control mood.
Conversely, when the headache ends and no pain signals reach these brain areas, the patient’s mood improves rapidly.
What is stress?
Like migraine, stress is a complicated neurological condition involving abnormal functioning of neurons in multiple brain regions, chemical pathways, and neuronal circuits. Although there is no singular ‘stress center’ in the brain, it is highly likely that the hypothalamus plays an important role in the response to stressful events by adjusting heart rate, blood pressure, attention, and other physiological reactions.
Stress and pain
The same neurons that mediate these responses allow the cortex - the part of the brain that is responsible for our perception of pain - to receive those pain signals that flow from the meninges to the other parts of the nervous system.
Stress and migraine in the time of COVID-19
Uncertainty and fear are key triggers of stress, especially during this onslaught of COVID-19. The very real fears of sickness and death, deciding who is in and who is out of your circle of contact, not knowing when – or perhaps if – you will see loved ones again, and even coping with the imbalance between your level of cautiousness and that of those around you… all of these stressors can bring on migraine symptoms.
The consequences of quarantine on stress and migraine
Needing to care for family members, suddenly being forced to be home rather than at school or work, supervising children 24/7 and worrying about their quantity and quality of screen time can make daily life feel overwhelming. Add to any of these stresses the fear of losing one’s job, level of income, ability to pay for housing and food, and the conditions for stress-induced migraines are ripe.
Psychological approaches to coping with stress
The improved understanding of how stress can trigger migraine symptoms has paved the way for a variety of new approaches to treatment beyond medication. Some of the most promising new therapies attempt to achieve relaxation through psychological techniques such as meditation, cognitive behavioral therapy, biofeedback, and life-style adaptation.
While these approaches have all helped some migraine sufferers, not all stressful events can be solved by psychological treatments alone - especially during a period of heightened anxiety - and most require a great deal of mental effort, commitment, time, and money.
Phototherapy and stress
Another approach recently discovered by my team at Harvard involves phototherapy in the form of exposure to a narrow band of green light. The light, as emitted by the Allay Lamp, has been shown in clinical studies to reduce cortical responses to pain to the extent that participants have seen a decrease in anxiety, stress, tension, and fear and a corresponding increase in calming, relaxing and soothing feelings.
Ways to cope with stress during COVID-19
Certainly, no one is exempt from the stresses of the Coronavirus on our daily lives. Those with migraines tend to be more susceptible to increased bodily responses to stress. Keeping your good habits and using the therapeutic approaches available to you can help keep you at your best and allow you to live your life in the best light possible.
Dr. Rami Burstein a professor of anesthesia and neuroscience at Harvard Medical School and vice-chair of Anesthesia, Critical Care and Pain Medicine Research at Beth Israel Deaconess Medical Center in Boston who’s been studying migraine for over 20 years. He is one of the leading global experts on migraine neurobiology, pioneering new research on how migraine alters the nervous system through light, touch, and triggers.
When was your last migraine check-up?