Skip to main content

Advertisement

Log in

Stress and Primary Headache: Review of the Research and Clinical Management

  • Psychological and Behavioral Aspects of Headache and Pain (D Buse, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

This review begins with a discussion of the nature of stress and then presents the functional model of primary headache as a framework for conceptualizing the complex relationship between stress and headaches. Research is reviewed on stress as a trigger of headaches and how stress can play a role in the developmental and psychosocial context of headaches. Clinical management of headaches from a stress perspective is considered both at the level of trials of behavioral interventions that broadly fit into the stress management category and the additional strategies that might be useful for individual cases based on the research demonstrating associations between stress and headaches. The review concludes by suggesting that although some researchers have questioned whether stress can trigger headaches, overall, the literature is still supportive of such a link. Advances in methodology are discussed, the recent emphasis on protective factors is welcomed, and directions for future research suggested.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Lazarus RS, Folkman S. Stress, coping and appraisal. New York: Springer; 1984.

    Google Scholar 

  2. Steptoe A. Psychobiological processes in the etiology of disease. In: Martin PR, editor. Handbook of behavior therapy and psychological science: an integrative approach. New York: Pergamon; 1991. p. 325–47.

    Google Scholar 

  3. Kanner AD, Coyne JC, Schaefer C, Lazarus RS. Comparison of two modes of stress measurement: daily hassles and uplifts versus major life events. J Behav Med. 1981;4:1–29.

    Article  CAS  PubMed  Google Scholar 

  4. Holmes TH, Rahe RH. The social readjustment rating scale. J Psychosom Res. 1967;11:213–8.

    Article  CAS  PubMed  Google Scholar 

  5. Martin PR, Milech D, Nathan PR. Towards a functional model of chronic headaches: investigation of antecedents and consequences. Headache. 1993;33:461–70.

    Article  CAS  PubMed  Google Scholar 

  6. Martin PR. Psychological management of chronic headaches. New York: Guilford Press; 1993.

    Google Scholar 

  7. Martin PR. Psychological management of the common primary headaches. In: Caltabiano ML, Ricciardell LA, editors. Applied topics in health psychology. Chichester: Wiley-Blackwell; 2013. p. 462–76.

    Google Scholar 

  8. Lipton RB, Pavlovic JM, Haut SR, Grosberg BM, Buse D. Methodological issues in studying trigger factors and premonitory features of migraine. Headache. 2014, 1661–1669. This review of trigger factors is a unique contribution in a number of ways including providing definitions of terms that are rarely defined, discussing the strengths and weaknesses of the different methodologies used in the literature, and the issues involved in assessing trigger factors. It includes a discussion of ‘protective factors’ as well as trigger factors, which is a recent development.

  9. Turner DP, Smitherman TA, Martin VT, Penzien DB, Houle TT. Causality and headache triggers. Headache. 2013;53:628–35. This paper explores the conditions necessary for concluding that ‘triggers’ really do precipitate headaches by applying a causal model from the field of philosophy of science.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Houle TT, Turner DP. Natural experimentation is a challenging method for identifying headache triggers. Headache. 2013;53:636–43. This paper discusses the challenges in determining causal relationships between triggers and headaches, and applies sophisticated statistical techniques to data collected over approximately three months to support their case.

    Article  PubMed  Google Scholar 

  11. Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007;27:394–402.

    Article  CAS  PubMed  Google Scholar 

  12. Deniz O, Aygul R, Kocak N, Orhan A, Kaya MD. Precipitating factors of migraine attacks in patients with and without aura. Pain Clin. 2004;16:451–6.

    Article  Google Scholar 

  13. Spierings LH, Ranke AH, Honkoop PC. Precipitating and aggravating factors of migraine versus tension-type headache. Headache. 2001;41:554–8.

    Article  CAS  PubMed  Google Scholar 

  14. Karli N, Zarifoglu M, Calisir N, Akgoz S. Comparison of pre-headache phases and trigger factors of migraine and episodic tension-type headache: Do they share similar clinical pathophysiology? Cephalalgia. 2005;25:444–51.

    Article  CAS  PubMed  Google Scholar 

  15. Neut D, Fily A, Cuvellier J-C, Vallée L. The prevalence of triggers in paediatric migraine: a questionnaire study in 102 children and adolescents. J Headache Pain. 2012;13:61–5.

    Article  PubMed  Google Scholar 

  16. Mollaoğlu M. Trigger factors in migraine patients. J Health Psychol. 2012;18:984–94.

    Article  PubMed  Google Scholar 

  17. Santos IS, Griep RH, Alves MGM, Goulart AC, Barreto SM, Chor D, et al. Job stress is associated with migraine in current workers: the Brazilian longitudinal study of adult health (ELSA-Brasil). Eur J Pain. 2014;18:1290–7. This study is interesting because it breaks down stress into the variables that contribute to stress, namely low control, high demand, and low social support.

    Article  CAS  PubMed  Google Scholar 

  18. Tunis MM, Wolff HG. Studies on headache: long-term observations of the reactivity of the cranial arteries in subjects with vascular headache of the migraine type. Arch Neurol, Psychiatr. 1953;70:551–7.

    Article  CAS  Google Scholar 

  19. Levor RM, Cohen MJ, Naliboff BD, McArthur D, Heuser G. Psychosocial precursors and correlates of migraine headache. J Consult Clin Psychol. 1986;54:347–53.

    Article  CAS  PubMed  Google Scholar 

  20. Kohler T, Haimerl C. Daily stress as a trigger of migraine attacks. Results of thirteen single-subject studies. J Consult Clin Psychol. 1990;58:870–2.

    Article  CAS  PubMed  Google Scholar 

  21. Mosley TH, Penzien DB, Johnson CA, Brantley PJ, Wittrock DA, Andrew ME, Payne TJ. Stress and headache: a time-series approach: Paper presented at the 24th meeting of the Association for Advancement of Behavior Therapy, San Francisco, CA; 1990.

  22. Schramm SH, Moebus S, Lehmann N, Galli U, Obermann M, Bock E, et al. The association between stress and headache: a longitudinal population-based study. Cephalalgia. 2015;35:853–63. This study is noteworthy more for its impressive methodology (large sample size, data collection over a long period, three headache types diagnosed, sophisticated statistical analysis) than its results, which were consistent with expectations rather than novel.

    Article  PubMed  Google Scholar 

  23. Schoonan GG, Evers DJ, Ballieux BE, Geus EJ, de Kloet ER, Terwindt GM, et al. Is stress a trigger factor for migraine? Psychoneuroendocrinology. 2007;32:532–8.

    Article  Google Scholar 

  24. Hellhammer DH, Wüst S, Kudielka BM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology. 2009;34:163–71.

    Article  CAS  PubMed  Google Scholar 

  25. Lipton RB, Buse DC, Hall CB, Tennen H, DeFreitas TA, Borkowski TM, et al. Reduction in perceived stress as a migraine trigger: testing the “let-down” hypothesis. Neurology. 2014;82:1395–401. The finding that a reduction in stress from one day to the next is associated with migraine onset the next day is interesting. The small literature related to this finding is not entirely consistent and a strength of this paper is the different mechanisms suggested to account for the phenomenon and suggestions for future research.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Torelli P, Cologno D, Manzoni GC. Weekend headache: a retrospective study in migraine without aura and episodic tension-type headache. Headache. 1999;39:11–20.

    Article  CAS  PubMed  Google Scholar 

  27. Vaitl D, Propson N, Stark R, Walter B, Schienle A. Headache and sferics. Headache. 2001;41:845–53.

    Article  CAS  PubMed  Google Scholar 

  28. Morrison DP. Occupational stress in migraine is weekend headache a myth or reality? Cephalalgia. 1990;10:189–93.

    Article  CAS  PubMed  Google Scholar 

  29. Wöber C, Brannath W, Schmidt K, Kapitan M, Rudel E, Wessely P, et al. Prospective analysis of factors related to migraine attacks: the PAMINA study. Cephalalgia. 2007;27:304–14.

    Article  PubMed  Google Scholar 

  30. Houle TT, Butschek RA, Turner DP, Smitherman TA, Rains JC, Penzien DB. Stress and sleep duration predict headache severity in chronic headache sufferers. Pain. 2012;153:2432–40.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Parashar R, Bhalla P, Rai NK, Pakhare A, Babbar R. Migraine: is it related to hormonal disturbances or stress? Int J Women’s Health. 2014;20:921–5.

    Article  Google Scholar 

  32. Gannon LR, Haynes SN, Cuevas J, Chavez R. Psychophysiological correlates of induced headaches. J Behav Med. 1987;10:411.

    Article  CAS  PubMed  Google Scholar 

  33. Haynes SN, Gannon LR, Bank J, Shelton D, Goodwin J. Cephalic blood flow correlates of induced headaches. J Behav Med. 1990;13:467–80.

    Article  CAS  PubMed  Google Scholar 

  34. Martin PR, Seneviratne HM. Effects of food deprivation and a stressor on head pain. Health Psychol. 1997;16:310–8.

    Article  CAS  PubMed  Google Scholar 

  35. Martin PR, Teoh H-J. Effects of visual stimuli and a stressor on head pain. Headache. 1999;39:705–15.

    Article  CAS  PubMed  Google Scholar 

  36. Martin PR, Todd J, Reece J. Effects of noise and a stressor on head pain. Headache. 2005;45:1353–64.

    Article  PubMed  Google Scholar 

  37. Andrasik F, Blanchard EB, Arena JG, Teders SJ, Teevan RC, Rodichok LD. Psychological functioning in headache sufferers. Psychosom Med. 1982;44:171–82.

    Article  CAS  PubMed  Google Scholar 

  38. De Benedittis G, Lorenzetti A. The role of stressful life events in the persistence of primary headache: major events vs. daily hassles. Pain. 1992;51:35–42.

    Article  PubMed  Google Scholar 

  39. Martin PR, Theunissen C. The role of life event stress, coping and social support in chronic headaches. Headache. 1993;33:301–6.

    Article  CAS  PubMed  Google Scholar 

  40. Holm JE, Holroyd KA, Hursey KG, Penzien DB. The role of stress in recurrent tension headache. Headache. 1986;26:160–7.

    Article  CAS  PubMed  Google Scholar 

  41. Reynolds DJ, Hovanitz CA. Life event stress and headache frequency revisited. Headache. 2000;40:111–8.

    Article  CAS  PubMed  Google Scholar 

  42. Martin PR, Soon K. The relationship between perceived stress, social support and chronic headaches. Headache. 1993;33:307–14.

    Article  CAS  PubMed  Google Scholar 

  43. Yokoyama M, Yokoyama T, Funazu K, Yameshita T, Kondo S, Hosoai H, et al. Association between headache and stress, alcohol drinking, exercise, sleep, and comorbid health conditions in a Japanese population. J Headache Pain. 2009;10:177–85.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Wacogne C, Lacoste JP, Guillibert E, Hughes FC, Le Jeunne C. Stress, anxiety, depression and migraine. Cephalalgia. 2003;23:451–5.

    Article  CAS  PubMed  Google Scholar 

  45. Hassinger HJ, Semenchuk EM, O’Brien WH. Appraisal and coping responses to pain and stress in migraine headache sufferers. J Behav Med. 1999;22:327–40.

    Article  CAS  PubMed  Google Scholar 

  46. Najam N, Aslam S. Perceived stress and coping strategies in headache (migraine and tension-type headache) patients. J Behav Sci. 2010;20:1–15.

    Google Scholar 

  47. Eskin M, Akyol A, Ҫelik EY, Gültekin BK. Social problem-solving, perceived stress, depression and life-satisfaction in patients suffering from tension type and migraine headaches. Scand J Psychol. 2013;54:337–43.

    Article  PubMed  Google Scholar 

  48. Howarth E. Headache, personality and stress. Br J Psychiatry. 1965;111:1193–7.

    Article  CAS  PubMed  Google Scholar 

  49. Henryk-Gutt R, Rees WL. Psychological aspects of migraine. J Psychosom Res. 1973;17:141–53.

    Article  CAS  PubMed  Google Scholar 

  50. Bigal ME, Lipton RB. Modifiable risk factors for migraine progression. Headache. 2006;46:1334–43.

    Article  PubMed  Google Scholar 

  51. Scher AI, Midgette LA, Lipton RB. Risk factors for headache chronification. Headache. 2008;48:16–25.

    Article  PubMed  Google Scholar 

  52. Houle T, Nash JM. Stress and headache chronification. Headache. 2008;48:40–4.

    Article  PubMed  Google Scholar 

  53. D’Amico D, Libro G, Prudenzano MP, Peccarisi C, Guazzelli M, Relja G, et al. Stress and chronic headache. J Headache Pain. 2000;1:S49–52.

    Article  PubMed Central  Google Scholar 

  54. Blanchard EB, Andrasik F, Arena JG. Personality and chronic headache. Progress Experiment Personal Res. 1984;13:303–60.

    CAS  Google Scholar 

  55. Hicks RA, Campbell J. Type A-B behavior and self-estimates of the frequency of headaches in college students. Psychol Rep. 1983;52:912.

    Article  CAS  PubMed  Google Scholar 

  56. Woods PJ, Burns J. Type A behavior and illness in general. J Behav Med. 1984;7:411–5.

    Article  CAS  PubMed  Google Scholar 

  57. Martin PR, Nathan PR, Milech D. The Type A Behaviour Pattern and chronic headaches. Behav Chang. 1987;4:33–9.

    Google Scholar 

  58. Hedborg K, Anderberg UM, Muhr C. Stress in migraine: personality-dependent vulnerability, life events, and gender are of significance. Upsala J Med Sci. 2011;116:187–99.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Holroyd KA, O’Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination. a randomized controlled trial. J Am Med Assoc. 2001;285:2208–15.

    Article  CAS  Google Scholar 

  60. Sorbi M, Tellegen B, Du Long A. Long-term effects of training in relaxation and stress-coping in patients with migraine: a 3-year follow-up. Headache. 1989;29:111–21.

    Article  CAS  PubMed  Google Scholar 

  61. Holroyd KA, Cottrell CK, O’Donnell FJ, Cordingley GE, Drew JB, Carlson BW, et al. Effect of preventive (β blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial. Br Med J. 2010;341:c4871.

    Article  Google Scholar 

  62. Lipchik GL, Holroyd KA, Nash JM. Cognitive-behavioral management of recurrent headache disorders: a minimal-therapist-contact approach. In: Turk DC, Gatchel RJ, editors. Psychological approaches to pain management. 2nd ed. New York: Guilford Press; 2002.

    Google Scholar 

  63. Rains JC, Penzien DB, McCrory DC, Gray RN. Behavioral headache treatment: history, review of the empirical literature, and methodological critique. Headache. 2005;45(S2):S92–S109.

    Article  PubMed  Google Scholar 

  64. Andrasik F. What does the evidence show? Neurol Sci. 2007;28:S70–7.

    Article  PubMed  Google Scholar 

  65. Wells RE, Loder L. Mind/body and behavioral treatments. Headache. 2012;52:70–5.

    Article  PubMed  Google Scholar 

  66. Holroyd KA, Penzien DB, Hursey KG, Tobin DL, Rogers L, Holm JE, et al. Change mechanisms in EMG biofeedback training: cognitive changes underlying improvements in tension headache. J Consult Clin Psychol. 1984;52:1039–53.

    Article  CAS  PubMed  Google Scholar 

  67. Bromberg J, Wood ME, Black RA, Surette DA, Zacharoff KL, Chiauzzi EJ. A randomized trial of a web-based intervention to improve migraine self-management and coping. Headache. 2012;52:244–61.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Marlowe N. Self-efficacy moderates the impact of stressful events on headache. Headache. 1998;38:662–7.

    Article  CAS  PubMed  Google Scholar 

  69. Rowan AB, Andrasik F. Efficacy and cost-effectiveness of minimal therapist contact treatments of chronic headaches: a review. Behav Ther. 1996;27:207–34.

    Article  Google Scholar 

  70. Haddock CK, Rowan AB, Andrasik F, Wilson PG, Talcott GW, Stein RJ. Home-based behavioral treatments for chronic benign headache: a meta-analysis of controlled trials. Cephalalgia. 1997;17:113–8.

    Article  CAS  PubMed  Google Scholar 

  71. Swagemakers OTA et al. Behavioural interventions on migraine: the shorter the more effective? Gedrag en Gezonheid: Tijdschrift voor Psychologie en Gezondheid. 2006;34:61–74.

    Google Scholar 

  72. Ström L, Pettersson R, Andersson G. A controlled trial of recurrent headache conducted via the internet. J Consult Clin Psychol. 2000;68:722–7.

    Article  PubMed  Google Scholar 

  73. Kleiboer A, Sorbi M, van Silfhout M, Kooistra L. Short-term effectiveness of an online behavioral training in migraine self-management: a randomized controlled trial. Behav Res Ther. 2014;61:61–9. This study reported a negative finding – online treatment not significantly different to a waiting-list control condition. Negative findings are generally considered less exciting than positive findings, but given the large sample size and long experience of the research team, the finding demands attention. Internet therapy is being embraced all over the world due to its use of modern technology, far reach, and low-cost administration, but this study encourages pause for consideration.

    Article  PubMed  Google Scholar 

  74. Schmidt S, Simhauser K, Aickin M, Luking M, Schultz C, Kaube H. Mindfulness-based stress reduction is an effective intervention for patients suffering from migraine—results from a controlled trial. Europ J Integrat Med. 2010;2:196.

    Google Scholar 

  75. Cathcart S, Galatis N, Immink M, Proeve M, Petkov J. Brief mindfulness based therapy for chronic tension-type headache: a randomized controlled pilot study. Behav Cogn Psychother. 2014;42:1–15.

    Article  PubMed  Google Scholar 

  76. World Health Organization. Neurological disorders: public health challenges. Geneva: World Health Organization; 2006.

    Google Scholar 

  77. Martin PR, MacLeod C. Behavioral management of headache triggers: avoidance of triggers is an inadequate strategy. Clin Psychol Rev. 2009;29:483–95.

    Article  PubMed  Google Scholar 

  78. Martin PR. Managing headache triggers: think ‘coping’ not ‘avoidance’. Cephalalgia. 2010;30:634–7.

    CAS  PubMed  Google Scholar 

  79. Martin PR. Behavioral management of migraine headache triggers: learning to cope with triggers. Curr Pain Headache Rep. 2010;14:221–7.

    Article  PubMed  Google Scholar 

  80. Martin PR, Callan M, Reece J, MacLeod C, Kaur A, Gregg K, et al. Behavioral management of the triggers of recurrent headache: a randomized controlled trial. Behav Res Ther. 2014;61:1–11. For decades the standard approach to trigger management has been to counsel headache sufferers to avoid the triggers of their headaches. This study evaluates a new approach which in contrast to the traditional approach includes exposure to some triggers with the goal of desensitizing the triggers. The study demonstrated that the new approach was far more effective than the traditional approach for reducing headaches and medication consumption.

    Article  PubMed  Google Scholar 

  81. Martin PR, Callan M, Kaur A, Gregg K. Behavioral management of headache triggers: three case examples illustrating a new effective approach (Learning to Cope with Triggers). Behav Chang. 2015;32:202–8.

    Article  Google Scholar 

  82. Bendtsen L et al. EFNS guideline on the treatment of tension-type headache—report of an EFNS task force. Eur J Neurol. 2010;17:1318–25.

    CAS  PubMed  Google Scholar 

  83. Gaul C et al. Team players against headache. J Head Pain. 2011;12:511–9.

    Article  Google Scholar 

  84. Meichenbaum D. Stress inoculation training. New York: Pergamon Press; 1985.

    Google Scholar 

  85. Richard DCS, Lauterbach D. Computers in the training and practice of behavioral assessment. In: Haynes SN, Heiby EB, editors. Comprehensive handbook of psychological assessment. volume 3. Hoboken: Wiley; 2004. p. 222–45.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Paul R. Martin.

Ethics declarations

Conflict of Interest

Paul R. Martin declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Psychological and Behavioral Aspects of Headache and Pain

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martin, P.R. Stress and Primary Headache: Review of the Research and Clinical Management. Curr Pain Headache Rep 20, 45 (2016). https://doi.org/10.1007/s11916-016-0576-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-016-0576-6

Keywords

Navigation