Let Down Headache and Stress

Migraine attacks often follow a stressful event. Why? This three-part series will explain, as well as provide ways to help reduce let down headache symptoms.  Part one more deeply reveals how stress affects migraineurs.

Do any of the following look familiar?

  • You can get through the week without a migraine, but suddenly have at least one every weekend
  • If you’re in school, you feel okay during the final exams, but once they’re over, you have to turn into a recluse because of a migraine
  • The first day of most vacations can be quite difficult, with you huddled quietly in a dark room to ease the migraine

Many migraineurs can relate to at least one of the above, which are all symptoms of a let down headache.  Stress is the most common trigger for migraines, but many fail to realize that the release of a big stress buildup can be just as bad as the stress itself.  The researchers at Montefiore Headache Center are still trying to figure out the reasons for let down migraines; however, a possible explanation is that cortisol will increase during times of stress and reduce pain, but it is only a short-term shield.  When the level drops after stress is released, the protection goes with it and migraine ensues.

It’s impossible to avoid stress all together.  However, managing stress is possible, and could be the key to preventing let down migraines. If stress levels get exceedingly high, gradual relaxation attempts is far better than a sudden drop in stress levels and can help keep letdown migraines at bay.  Instead of melting in relief when the day is over, try keeping yourself a little stressed.  For example, instead of letting everything go when you leave work for a few drinks at happy hour to wind down, try stressing just a little about cleaning up the house when you get home.  This may seem counterproductive, but it is actually very helpful in ensuring that sudden drop in cortisol doesn’t cause you any pain!

The Stress Response in Let Down Headache

let down headacheStress doesn’t actually cause the migraines, although many studies have shown that stress plays a significant role in migraine attacks.  Migraines are “episodic manifestations of our neurological disease.”  Stress is just a contributing factor to the onset of attacks, the frequency and exacerbation, as well as the progression of the episodes.  The headache associated with the migraine attack is a stressor or trigger.

Letdown headache shows us that a sudden reduction in stress can be a trigger.  To better understand how this is possible, it’s best to start with understanding the stress response.

There are three phases of the stress response:

  1. Alarm
  2. Response
  3. Relaxation

In the alarm phase, we perceive an environmental, physical, emotional, or chemical threat, at which point our hypothalamus (the gland in the brain that controls the autonomic nervous system) takes over.

In the response phase, the threat is still there but the sympathetic portion of the autonomic nervous system is activated, along with the hypothalamic-pituitary-adrenal (HPA) axis.  This means the adrenal glands at the top of each kidney release a flood of hormones to challenge the stressor.  Our blood pressure, breathing rate, heart rate, and mental acuity increase to prepare for the flight-or-fight response.  All our senses become sharper, and glucose and fats are released from storage to provide extra energy.  Anti-inflammatory actions are increased to fight any sort of infection or prepare for wounds, and endorphins (the body’s natural pain relievers) are released in excess.  This is the acute phase of stress.  If the threat is perceived as dangerous on any level, then the hormone and chemical release will continue to elevate, and we remain on high alert.

The relaxation phase is where the trouble may start for the migraineur.  Once the threat has passed and there is no harm, the parasympathetic branch of the autonomic nervous system breaks down the stress response and the chemical and hormonal levels attempt to go back to normal.  We often find ourselves exhausted afterwards.  This is when the pain shows up.

For those with migraine headaches, this is the phase of which to be aware.  Over the next 12 to 24 hours, the HPA activation will decline and the cortisol levels will fall.  A letdown migraine is bound to ensue.

The Importance of Stress Management

Frequent migraine attacks with recurrent sensitization, pain, hormonal fluctuation, and inflammatory changes can change the structure and function of the brain.  The more frequent the attack, the more likely these changes will occur.  This is why stress management is so important.

So what are the stress management strategies that can be used to help treat or prevent letdown migraines?  The below are techniques and therapies that I have used myself or recommended for patients over the years.  A combination of any of the following can be extremely beneficial:

  • Prayer
  • Positive thinking
  • Biofeedback exercises
  • Deep breathing
  • Meditation
  • Guided imagery
  • Healing touch and energy healing (Reiki)
  • Regular exercise
  • Acupuncture
  • Cognitive behavioral therapy
  • Hypnosis
  • Tai chi
  • Yoga
  • Physical therapy
  • Chiropractic treatment
  • Reflexology

Of course, more research is needed to prove these measures, but I have found that the above help with the following:

  • Relaxing tense muscles in the shoulders and neck
  • Increasing self-awareness
  • Emotional balancing
  • Stabilization of stress hormones and neurotransmitters
  • Reducing inflammation and relieving pressure on the nerves
  • Balancing sympathetic and parasympethatic branches of the autonomic nervous system, which will promote calmness and peace
  • Quiets the mind

It is important to be open-minded when it comes to treating headaches and migraines.  There are dozens of techniques that you can use that will help prevent these painful attacks, and stress management is probably the most important of these techniques, with many options available to you.  There are no excuses here… all of these measures have been shown to work if you believe in yourself and the treatment.  Get your stress under control, and you will find yourself having far fewer attacks with much less intensity.