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

Area of Science:

• Neurology
• Psychology

Background:

• Migraine is a common neurological disorder.
• Stress is a known migraine trigger, but the relationship between stress levels and migraine onset is complex.

Purpose of the Study:

• To investigate the association between perceived stress levels and reductions in stress with migraine onset.
• To determine if stress reduction, termed "let-down," predicts migraine attacks.

Main Methods:

• A 3-month electronic diary study involving patients with migraine.
• Daily tracking of migraine attacks and subjective stress using the Perceived Stress Scale and Self-Reported Stress Scale.
• Logit-normal, random-effects models were used to analyze the odds of migraine occurrence based on stress levels.

Main Results:

• A decline in perceived stress from one day to the next was significantly associated with increased migraine onset within 6 to 18 hours.
• Odds ratios for migraine onset after stress reduction ranged from 1.5 to 1.9 (p < 0.05).
• These findings held true even after controlling for the overall level of stress.

Conclusions:

• A decrease in daily stress levels is a significant predictor of subsequent migraine attacks.
• Stress reduction may serve as a valuable marker for impending migraines, enabling preemptive interventions.