Is stress a trigger factor for migraine?

Schoonman, G.G.; Evers, D.J.; Ballieux, B.E.; de Geus, E.J.; de Kloet, E.R.; Terwindt, G.M.; van Dijk, J.G.; Ferrari, M.D.

doi:10.1016/j.psyneuen.2007.03.006

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Volume 32, Issue 5 , Pages 532-538, June 2007

Is stress a trigger factor for migraine?

G.G. Schoonman
- Department of Neurology (K5-Q), Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands
- Corresponding author. Tel.: +31715262895; fax: +31715248253.
D.J. Evers
- Department of Neurology (K5-Q), Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands
B.E. Ballieux
- Department of Clinical Chemistry, Leiden University Medical Centre, Leiden, The Netherlands
E.J. de Geus
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
E.R. de Kloet
- Division of Medical Pharmacology, LACDR, Leiden University Medical Centre, Leiden, The Netherlands
G.M. Terwindt
- Department of Neurology (K5-Q), Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands
J.G. van Dijk
- Department of Neurology (K5-Q), Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands
M.D. Ferrari
- Department of Neurology (K5-Q), Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands

Received 24 October 2006; received in revised form 7 February 2007; accepted 12 March 2007.

Summary

Background

Although mental stress is commonly considered to be an important trigger factor for migraine, experimental evidence for this belief is yet lacking.

Objective

To study the temporal relationship between changes in stress-related parameters (both subjective and objective) and the onset of a migraine attack.

Methods

This was a prospective, ambulatory study in 17 migraine patients. We assessed changes in perceived stress and objective biological measures for stress (saliva cortisol, heart rate average [HRA], and heart rate variability [low-frequency power and high-frequency power]) over 4 days prior to the onset of spontaneous migraine attacks. Analyses were repeated for subgroups of patients according to whether or not they felt their migraine to be triggered by stress.

Results

There were no significant temporal changes over time for the whole group in perceived stress (p=0.50), morning cortisol (p=0.73), evening cortisol (p=0.55), HRA (p=0.83), low-frequency power (p=0.99) and high-frequency power (p=0.97) prior to or during an attack. Post hoc analysis of the subgroup of nine stress-sensitive patients who felt that >2/3 of their migraine attacks were triggered by psychosocial stress, revealed an increase for perceived stress (p=0.04) but no changes in objective stress response measures. At baseline, this group also showed higher scores on the Penn State Worry Questionnaire (p=0.003) and the Cohen Perceived Stress Scale (p=0.001) compared to non-stress-sensitive patients.

Conclusions

Although stress-sensitive patients, in contrast to non-stress-sensitive patients, may perceive more stress in the days before an impending migraine attack, we failed to detect any objective evidence for a biological stress response before or during migraine attacks.

Keywords: Migraine, Trigger factor, Psychosocial stress, Cortisol, Heart rate, Daily Stress Inventory