MIGRAINE AND STRESS: What is the relationship? And, why should stress management be part of our treatment programs?
Migraine is a neurological disease with episodic events known as migraine attacks. Although the pathophysiology is not completely understood, recent research has shown it to be a complex brain disorder that involves genetics, hyperexcitable brain cells, several neuronal pathways, neurotransmitters (chemical messengers in the brain), inflammatory mediators, and vascular irregularities. In this article, we will take a look at the role of serotonin, define stress, discuss the stress response, examine the relationship between migraine and stress, and introduce techniques and therapies effective for stress management.
Serotonin is a neurotransmitter found in the brain and in the gut. It helps regulate pain, vessel tone, peristalsis (movement of food through our gut), sleep, mood, and appetite. Serotonin levels are believed to fluctuate during a migraine attack. Some sources indicate that people with migraine may have a low serotonergic disposition. Low levels can contribute to our headache pain, gastric stasis, nausea, vomiting, food cravings, and mood swings.
Stress is defined as the normal physical response of our bodies to any demands or changes. It is our body's way of adapting to internal or external, perceived or real challenges, termed "stressors".
The term "stress" is associated with the exertion of pressure. This pressure can be related to environmental, chemical, physical, or emotional stressors. We need to know that our body does not distinguish between these. For example, it reacts the same way whether we are overcome by toxic fumes, break a leg, having problems with our boss, are worried about mounting bills, or are anxious about a loved one.
When we perceive a threat or feel "stressed" (pressured), our body activates the sympathetic branch of the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis. This causes a flood of hormones to be released including, but not limited to, epinephrine (adrenaline), norepinephrine (noradrenaline), and cortisol to fight the challenger. We know this as the "fight or flight" response, or acute phase of stress. In this phase, stress is good. It keeps us on our toes and allows us to stay focused, energetic, and alert. Levels of epinephrine, norepinephrine, and cortisol are high, giving us the energy to fight the stressor at hand. Once the emergency has passed, the levels of these hormones return to normal.
Symptoms related to acute stress include:
- increased heart rate, blood pressure and respirations,
- dry mouth,
- cold hands and feet,
- facial pallor,
- nausea and vomiting,
- gastric stasis,
- rapid speech,
- anxiety, and
- panic attacks.
Chronic stress is not good for us. In this phase, the HPA axis may wear out and levels of epinephrine, norepinephrine, and cortisol can become depleted. When that happens, levels of dehydroepiandrosterone (DHEA), a steroid produced by the adrenal glands and used to make estrogen and testosterone start to fall and neurotransmitters like serotonin are affected. Our body's metabolism slows down and we may feel tired, fatigued, and gain weight, especially around the middle. A decrease in our sex hormones can cause hormonal imbalances and loss of our sex drive, while low levels of serotonin can contribute to emotional disturbances like anxiety and depression.
Symptoms related to chronic stress include:
- extreme fatigue,
- weight gain (difficulty losing weight),
- cold hands and feet,
- menstrual irregularities,
- loss of sex drive (libido),
- heart burn,
- recurrent infections,
- varicose veins,
- poor concentration,
- intense mood swings,
- anxiety, and
Migraine and stress
Numerous studies have shown that stress plays an important role before the onset of migraine, in the maintenance of the disorder, the frequency of our attacks, and the progression of episodic to chronic migraine. At this point, you should know that several studies have shown stress to be a trigger for migraine attacks. As well, stress is a factor that makes us more susceptible to our triggers (additive effect).
Other factors to consider in the relationship between stress and migraine include
- the perception of stress is unique to the individual (what stresses me may not stress you),
- some people are more sensitive to stressors than others, and
- comorbid illnesses can affect our susceptibility. For example, I have Mitral Valve Prolapse, a condition which makes me extremely sensitive to stressors.
Keeping these things in mind, ways that stress can impact our migraine attacks include:
- If stress is severe, prolonged, and/or frequent, it can affect our sleeping and eating patterns and make us more susceptible to triggers like fatigue and hunger.
- Because stress can affect our estrogen levels and serotonin levels tend to fluctuate with our hormonal levels, it can exacerbate the pain of our hormonal migraines.
- It may also contribute to new onset migraine attacks during menopause or other hormonal changes like initiation of birth control pills or pregnancy.
- Because chronic stress can deplete our serotonin levels, it can increase the frequency, duration, and severity of our migraine attacks, and play a role in the development of chronic migraines.
- The pain of the headache we experience during our migraine attack can itself stimulate the ANS and HPA and initiate the stress response we just discussed. This can not only exacerbate our pain, but other symptoms like nausea, vomiting, gastric stasis (slowed peristalsis or movement of food through the gut), and mood swings including irritability, anxiety and depression. The slowed peristalsis may delay gastric emptying and affect how our oral medications are absorbed, thus delaying our pain relief.
- The relaxation phase following an episode of stress is thought to be responsible for the migraine attack known as a "let-down" or "weekend" migraine.
Effective stress management is essential for those of us with migraine to help quiet our minds and calm our bodies. Behavioral, relaxation and stress management techniques including biofeedback, physical therapies, meditation, prayer, guided imagery, breathing techniques, yoga, massage therapy, reflexology, acupuncture, and energy healing techniques like Reike and healing touch have been shown to help minimize our physiological responses to stress, decrease sympathetic arousal, and stabilize our serotonin levels. These therapies have even better effects when combined with a healthy diet that is free of chemicals and preservatives, avoidance of excessive caffeine and alcohol, no smoking, and a regular sleep schedule and exercise program.
Adoption of stress management techniques has other benefits. Because these techniques and lifestyle modifications involve participation and commitment, our treatment becomes a collaborative process where we partner with our doctor or other health care professional in our care. Besides a feeling of empowerment, when we adopt a healthy lifestyle we can decrease our risk for the progression of episodic to chronic migraine, increase our chances of reverting from chronic to episodic migraine, and decrease our risk for a number of other disorders and diseases like hypertension, stroke, and diabetes.
Lastly, migraine can steal moments and events from our lives that we cannot recreate. Many of us have to give up our careers and our dreams. Feelings of loss of control and helplessness are prevalent. Stress management cannot cure our migraines but it can help us lead more full and happy lives. If you do not have a stress management program in place, you might want to consult with your doctor or other health professional about integrating one into your treatment plan.
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Buse, D. C. PhD. & Andrasik, F., PhD. (2009). Behavioral Medicine for Migraine. Neurol Clin 27, 445-465. doi:10.1016/j.ncl.2009.01.003
Hedborg, K., Anderberg, U. M., & Muhr,C. (2011). Stress in migraine: personality-dependent vulnerability, life events, and gender are of significance. Upsala Journal of Medical Sciences. August, 116(3), 187-199.
Hamel, E. (2007). Serotonin and migraine: biology and clinical implications. Cephalalgia. Nov. 1293-300.
Sauro et al. (2009). The Stress and Migraine Interaction. Headache.: The Journal of Head and Face pain, 49 (9), 1378-1386.
Updated Aug. 29th, 2013
Sharron is a health and wellness author. A migraine sufferer herself, her most recent book, "Migraine Identify Your Triggers, Break Your Dependence on Medication, Take Back Your Life- An Integrative Self-Care Plan for Wellness" (2013), is a Conari Press publication.
This article is not intended as a substitute for medical advice. If you have any specific concerns about your health or nutrition, please consult a qualified health care professional.
Copyright 2013, Sharron E. Murray