Managing Stress to Prevent Headaches: What the Research Says

What stress does to us

Stress can affect both body and mind in many ways. Possible reactions include stomach problems, heart and circulation changes, anxiety, panic attacks, sleep problems – and headaches, as already mentioned.

A key player is cortisol, a hormone made by the adrenal glands. Cortisol is often called ‘the stress hormone’. When the body senses a threat, cortisol levels in the blood rise quickly. This often happens due to emotional crises, extreme pressure, feeling overwhelmed, intense environmental stimuli, and genuine danger.

Who needs stress?

Our stress response is as ancient as the human race. Long ago, cortisol helped humans to survive by preparing the body to fight or flee. We still have this instinct, but life today is very different. Modern stress rarely involves immediate danger. Cortisol did not evolve to meet the challenges we face today. However, our bodies still produce it. Since we do not fight or run away, we do not use up the cortisol in our blood. Cortisol levels remain high, leaving us feeling overstimulated and unsettled, and disturbing the balance of our mind and body.

Cortisol, migraine and headaches

Research shows that people with migraine already have higher cortisol levels when at rest. In other words, their bodies have more cortisol even when calm. Genetics may play a role here. Because of this higher baseline cortisol level, stress can easily push cortisol past a critical level, triggering a migraine attack. Tension-type headaches, the most common type, are also often stress-related. Stress can trigger attacks in these patients too. This highlights the close connection between stress and headaches. The fact that headaches are so common today is partly because modern life is putting our stress response to work in ways it did not evolve for, leaving us with high, headache-triggering levels of cortisol.

The science of stress management

Researchers recognised the close connection between stress and headaches early on. For many years now, scientists have been looking for ways to help headache patients manage stress. Research teams all over the world are working to develop effective methods to help relieve or prevent headache attacks.

Mindfulness-based stress reduction (MBSR) is one such approach. MBSR was developed by US molecular biologist Jon Kabat-Zinn in the 1970s. Kabat-Zinn extensively studied how physical processes and mental activity are connected. He proposes that deliberately focusing and guiding attention is an effective way to achieve calmness and inner balance. Kabat-Zinn suggests a programme made up of different types of meditation, elements of yoga, and other exercises. These are practised daily for eight weeks. This programme is now offered in several hundred hospitals across the United States. Adopted a little later in Germany, MBSR is now available at specialised psychosomatic clinics.

Scientific evidence for headache relief

A review of ten studies indicates that there is convincing scientific evidence for mindfulness-based stress reduction as a treatment for both tension headaches and migraines. Both the intensity of pain and the frequency of attacks were shown to decrease, according to the data analysis. Another positive effect, often seen with non-drug approaches like this, is an increase in self-efficacy. Self-efficacy is the extent to which patients believe they can influence their symptoms through their own actions. In other words, practising mindfulness-based stress reduction made patients feel more confident that their own efforts could make a real difference to their symptoms.

However, from a scientific point of view the authors of the review paper point out a limitation: the reviewed studies used very different methods, making comparisons difficult and results less reliable. This is a more common situation with this type of newer research than with established studies, for example those centering on pharmaceutical products. Standardised, widely accepted research methods still need to be developed in this relatively new field.

Breathing techniques to combat stress

Breathing training is another good way to improve stress management. Special breathing exercises can improve the oxygen supply to the body in a sustained way. This helps prevent ‘oxygen debt’, which can occur when breathing does not supply enough oxygen to meet the body’s needs. This happens especially when you push your body too hard during a workout.

Mindful, ‘correct’ breathing also benefits the immune system, researchers say. Breathing training can also lower blood pressure. It slows the resting pulse and heart rate. Researchers were also able to prove that breathing training helps reduce stress, in turn helping to prevent headache attacks. All this indicates that breathing exercises can play an important role in preventing headaches.

A regular routine helps reduce stress and prevent migraine attacks

Research repeatedly shows that sudden changes in routine are very likely to bring on migraine attacks in susceptible individuals. Unexpected events or a disrupted routine can act as highly unwelcome, dangerous stressors for people living with migraine.

Especially if you get migraines, keeping a consistent daily routine with a regular, predictable structure is very important. Building healthy habits can noticeably reduce the headache burden. Helpful strategies include eating meals at regular times (see here), keeping a consistent sleep schedule (see this article), taking breaks during the day, and ensuring that you do not skip planned relaxation periods. For people prone to migraines, maintaining a consistent routine always reduces stress. And less stress means effective prevention of headache attacks.