Clinician's Manual on Migraine by Todd A. Smitherman

Author:Todd A. Smitherman
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

3.3.3 Stress

Stress involves an imbalance between a potential challenge and one’s perceived ability to cope with that challenge. Patients typically describe stress as emotional strain resulting from an ongoing major life event or frequent minor hassles. Stress is the most commonly reported trigger of migraine [4], though stress may not precipitate headache immediately upon exposure; attacks are also sometimes precipitated by declines in stress from one day to another (i.e., “let-down” headache) [6]. Despite its relevance, many migraineurs do little to deliberately manage stress. They usually acknowledge stress as a trigger of their attacks but are unaware of why stress perpetuates migraine or else view their stress as uncontrollable.

Educate the patient about the numerous ways in which stress affects migraine, including how stress can predispose a vulnerable individual to developing migraine, promote progression from episodic to chronic migraine, and trigger individual headache attacks. Stress also influences other migraine triggers, such as when high stress is accompanied by poor sleeping and eating habits. Over time, experiencing repeated migraine attacks comes to function as an additional stressor, which maintains sympathetic arousal and further sensitizes the nervous system. Encourage the patient to devote time on a regular basis to stress management: exercise, relaxation training, daily meditation or yoga, or other deliberate activities to promote rest and recovery. Patients with significant life stress or poor coping skills are appropriate candidates for the behavioral therapies discussed in Chap. 5.

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