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NUI Galway on RTÉ Brainstorm: What are the connections between stress and migraine?
Author: Iain Mays, Trainee Clinical Psychologist at the Centre for Pain Research
Opinion: learning more about stress, historical or otherwise, can help people to manage their migraines
Migraine is one the earliest recorded health problems, with descriptions of the condition and its treatment featured in Egyptian papyrus circa 1200 BC and in the writings of Hippocrates circa 400 BC. Impacting roughly one billion people, migraine is the second most common headache disorder in the world after tension-type headache.
While not the most common, it is the most burdensome with recent estimates indicating that migraine causes 29-62.8 million years lived with disability globally, which is significantly greater than tension-type headache (4.6-10.5 million). Despite this impact, migraine has historically been underestimated like all headache disorder, given that they are transient, non-fatal and non-contagious.
Admittedly, the complexity of this condition hinders progress in awareness and treatment, despite the improvements in classifying migraine. The latest edition of the International Classification of Headache Disorders (ICHD-3) does include changes in interpreting and distinguishing migraine. An important change is the introduction of a clearer and more readily available distinction between episodic and chronic migraine. For instance, chronic migraine is now classified as occurring on 15 or more days per month for more than three months, which has the features of migraine headache on at least eight days per month.
From RTÉ 2fm's Jennifer Zamparelli show, Dr Dominic Rowley AKA Dr Dom discusses migraines
These improvements aside, there remains differing theories on the underlying neurological cause of migraine as highlighted on Brainstorm recently. Similarly, different subtypes, symptoms and reported triggers of migraine highlight the individual differences people can have with the condition. Take, for example, the most common migraine subtype known as Migraine without Aura. Even within this group there are varying symptoms (such as nausea, sensitivity to light) and triggers (alcohol, smells, weather etc). These individual differences underline the benefit of migraineurs using a headache diary to capture and monitor their own experiences of migraine.
Recording headache features can be challenging as it can require people to address difficult symptoms that they do not want or otherwise wish to ignore. Consequently, psychological factors, such as a person's history and how they think, feel and manage stress plays a role in how they react to, manage and seek support for a migraine. Research into comorbid mental health problems in migraine indicate higher rates of depression and anxiety in chronic migraine groups compared with episodic migraine groups and the general population. These mental health problems have been argued to impact on quality of life, complicate migraine management and increase the risk of progressing from episodic to chronic migraine, which merits psychological intervention.
Psychological input can also extend to how a person manages stress in relation to their migraine. This is especially the case given that stress has recently been considered the most commonly reported trigger for all primary headache disorders ahead of other triggers like sleep, emotions, weather, food or hormones. However, research in this area has generally focused on day to day stress as an acute trigger rather than stress that is remote and historical.
From RTÉ Radio 1's Today with Sean O'Rourke show, a discussion on migraines with Dr Stewart Tepper from the Dartmouth Medical School and migraine sufferer Angela McCormick
Recent research into stressful childhood events or adverse childhood experiences (ACEs), has documented the detrimental impact child maltreatment can have on future health outcomes in adulthood. Thus far, research has focused more on psychosocial outcomes such as smoking, alcohol use and risky sexual behaviour than medical or laboratory outcomes such as pain, headache, respiratory disease, inflammatory markers and blood pressure. Despite this tendency, studies on ACEs and headaches have documented how physical, sexual and emotional abuse and neglect co-occur in headache samples, how the likelihood of headache is increased when correlated with multiple types of abuse and how this research can help in investigating thebiological causes of this condition.
Regarding migraine specifically, one study highlighted how a history of emotional abuse was more common in persons with migraine (22.5%) than tension-type headaches (16.7%), while another studyidentified childhood abuse as being more strongly associated in chronic migraine than episodic migraine. However, these findings certainly do not apply to all migraineurs given that adverse childhood experiences are only found in a subset of study participants. Furthermore, these studies are retrospective in design, meaning they ask adult participants to recall their childhood and are therefore subject to bias.
Historical stress and migraine can also be researched using attachment theory, which can investigate parent-child relationships in adults. The core tenet of attachment theory is that children with a secure attachment to parents are more likely to have ahealthy development and ability to self-regulate and manage stressful events. Conversely, insecure attachment causesdysregulated responses to stress, and greater susceptibility of and difficulty managing chronic illness. Nine studies have researched attachment and headache in children and adults with mixed results, though there is some evidence to suggest insecurely attached headache participants had increased chronicity and mental health problems.
Given that migraines have a significant hereditary component, stress is not the sole cause of developing migraine. However, learning more about stress, historical or otherwise, can help people to manage their migraines and in doing so help them work towards improving their lives. At the Centre For Pain Research at NUI Galway we are researching historical stressors such as ACE and attachment among other psychological concepts in 5000 participants with chronic and episodic migraine. Further information and access to our online survey is available here.