Stress and Headache.

Stress is the most frequently cited precipitant of both migraine and muscle-contraction headache. Although stress is thought to play a causal role in the etiology of headache, past research has relied solely on cross-sectional designs and between-subjects data analytic techniques, thus severely restricting conclusions regarding causality and obscuring potentially meaningful individual variability. The present investigation provided a partial replication and extension of prior research on the relation between minor stress and headache and attempted to redress a number of prior methodological shortcomings. A longitudinal design and within subject, lagged, time-series regression analyses were employed. Migraine (n = 26) and muscle-contraction (n = 20) headache sufferers recorded their stress, headache activity, and medication intake daily for 31 days. Both frequency and subjective ratings of stressful events were found to be significantly predictive of headache intensity, headache duration, and headache index for many muscle-contraction (55 to 70%) and migraine (39 to 46%) headache sufferers. However, subjective ratings of stressful events correlated more strongly with headache activity than frequency. The magnitude of stress-headache associations varied broadly across individuals. Social support appeared to account for at least some of this variability; patients reporting the lowest levels of support evidenced the highest stress-headache associations and patients reporting the highest levels of support evidenced the lowest stress-headache associations, suggesting that social support may provide some protection against the negative effects of stress. Diagnostic group differences were observed with respect to the predominant temporal relation between stress and headache. For muscle-contraction headache sufferers, headache activity was best predicted by stress occurring concurrently with headache, but for migraineurs, headache activity was best predicted by stress that occurred one to three days earlier. Muscle-contraction headache sufferers also obtained larger stress-headache correlations than migraineurs. Finally, no differences were found between the headache diagnostic groups or between headache sufferers and headache-free controls in the number or subjective ratings of stressful events. The findings of the present study appear to support either a model of stress causing exacerbation of headache or a model of reciprocal causality. Implications for treatment and directions for future research were discussed