This is another draft extract from a book based on my personal experience of migraine which I am currently writing and hope to publish next year. I would like to include some short contributions from other people too, so if you have anything you would like to share about this or any other aspect of migraine, please leave a comment below or write to me through the contact page of my website jenniferbarraclough.com.

Stress is known to contribute to many medical disorders, presumably because of the impact of hormones such as adrenaline and cortisol, generated through the sympathetic nervous system, upon the body and brain. Many migraineurs cite stress as their top trigger factor, while others vehemently deny that stress has anything to do with it at all. Some of my own attacks have clearly been induced by stress, whereas others have apparently come out of the blue. Many people talk of stress without really thinking what they mean, and it is too easy to say of migraine or any other condition “It’s due to stress” or worse “It’s just due to stress”, when this may not be the case at all and is certainly not the whole story.

Feelings of stress are usually blamed on outside circumstances, the negative events and ongoing difficulties which are an inevitable part of life. But it is individual responses which determine how stressful these experiences are perceived to be. Responses depend both on mental attitudes and physical constitution. There is evidence that the sympathetic nervous system tends to be overactive in migraineurs even between attacks, causing them to live in a state of chronic low-grade physiological stress, perhaps without knowing it. This would explain why therapies which promote relaxation, such as biofeedback, are effective for migraine prevention.

One common source of stress is an accumulation of the hassles and demands of everyday life in the modern world – juggling work, household and family responsibilities, financial strain, discord in relationships, transport delays, a deluge of emails and media posts. Pressure can intensify at times which are supposed to be enjoyable, such as holidays or Christmas, when organising the preparations is combined with changes to routine and possibly physical stress from lack of sleep, unfamiliar foods or missed meals, and excessive exertion.

Even when there is no external cause, people can generate stress for themselves by setting unrealistically tight deadlines or high standards, mulling over regrets about the past or anxieties about the future.

Migraine itself is a potent source of stress, and vicious circles can develop, as in the case of someone who is worn out after a busy period at work, gets a severe migraine and has to take a few days off. There is nobody else to cover for them, so on returning they find a backlog of tasks has built up so that the workload intensifies, and leads to another attack. After this scenario has been repeated a few times they either lose their job because of being unreliable, or feel compelled to resign, and then experience the stress of unemployment and financial hardship. 

The relationship between stress and migraine is not straightforward. It is recognised that some migraineurs manage to cope with intense pressure during the week, but get an attack at the weekend when in theory they have time to relax. Not all stress is bad. In the days when I was prone to severe migraines, I found that working very hard on a project that was important to me did not bring on an attack. Situations in which I felt frustrated and not in control, for example having to attend long meetings of little interest or wait hours in airports for delayed flights, often did.

I may be wrong but I have the impression that major crises, stressful though they are, do not necessarily trigger migraines and might even protect against them. A woman once told me that her severe and frequent attacks had stopped for several months following the sudden death of her child. I experienced something similar a few years ago when my husband was critically ill at the same time as my mother was dying. Although I became unwell myself with other mental and physical symptoms during this period, I did not get any migraines. I have never seen this phenomenon described in the literature and would be interested to know if others have experienced it.