Stress and fasting for inducing migraine attacks: A randomized 2 × 2 factorial crossover trial

Area of Science:

• Neurology
• Migraine Research
• Experimental Medicine

Background:

• Stress and fasting are commonly reported migraine triggers.
• Limited experimental data exists on their independent and combined effects on migraine onset.

Purpose of the Study:

• To investigate the individual and combined effects of acute stress and fasting on migraine headache onset.
• To evaluate the likelihood of headache attacks under different stress and fasting conditions.

Main Methods:

• A partially randomized 2x2 factorial crossover trial in a controlled laboratory.
• Participants with episodic migraine underwent stress (Trier Social Stress Test) or control tasks.
• Participants were exposed to 12-hour fasting or non-fasting conditions.

Main Results:

• Eight incident headache attacks (6%) were observed among 131 sessions.
• The Stress/Fast condition showed the highest cumulative incidence of headache attacks.
• Fasting and stress individually showed modest alterations in migraine risk, with a potential synergistic effect when combined.

Conclusions:

• Fasting and stress are associated with modest changes in migraine risk.
• The combination of stress and fasting suggests a greater likelihood of acute headache onset.
• Findings indicate preliminary evidence for a synergistic interaction between stress and fasting in migraine.