Common triggers associated with an increased chance of experiencing a migraine attack include stressful events, hormonal changes, weather changes and certain foods.

In around 80% of patients, stress is reported to be associated with a migraine event, making it the most common trigger reported by migraine patients.

But what type of stress is a migraine trigger? A study published in Neurology in 2014 sought to investigate this further.

Patients were asked to keep a 3 month electronic diary, with daily data entered including migraine attacks and stress measures, assessed using a stress scale.

The results were interesting in that the level of the stress status scores were not significantly associated with migraine occurrence. However, a reduction in stress from one evening to the next was consistently associated with migraine attack onset on the third day.

These findings support the ‘let down migraine’ hypothesis, often observed by migraine patients. In this scenario patients will state that Friday night or the weekends, typically the times of their least stress, are the most likely times for their breakthrough migraine events to occur.

Why does this occur? The exact mechanism is uncertain, however there are some possible biological explanations. Stress can activate the ‘fight or flight response’, with short term elevation of steroids, when the acute stress ends however, steroid withdrawal may produce an abnormally heightened sensitivity to pain.

What does this mean? An awareness of a variation in stress, and the activation of strategies to reduce that stress, may be able to decrease migraine attack frequency in susceptible patients.


Reduction in perceived stress as a migraine trigger: testing the ‘let-down headache’ hypothesis Neurology 2014 Apr 22;82 (16): 1395-401