Why do I get migraines when I’m stressed or dreading something?

Migraines occur when you can least afford them. Often before an exam, or a major work deadline. Knowing you’re about to spend the next few hours — or more — in intense pain is awful. It’s even more inconvenient when stress is what brought your migraine on in the first place. Why do migraines and stress go together so often?

What is migraine?

Migraine is a condition characterized by severe, recurrent headaches, but migraine symptoms aren’t confined to just throbbing head pain. Many people who experience migraines also report nausea, vomiting, sensitivity to light and sound, and even sweating and diarrhea. They often experience something called a migraine aura as a precursor to their episode. These auras often manifest as visual disturbances, dizziness, or ringing in the ears.

While different people report different triggers for their migraines, we don’t yet know what migraines’ underlying cause is. Scientists speculate that it might be due to abnormal brain activity affecting the nerves and blood vessels of the brain. In spite of the knowledge gap on their cause, we know that migraines are pretty common — more than 8% of Canadians have one at some point or another. They’re also more likely to affect women — especially those in their 30s and 40s. 

Are migraines serious?

If you don’t get migraines, you may think they’re “just” headaches. But migraines can range in both severity and frequency, and are often debilitating. While some people who experience migraines report infrequent headaches, others find themselves afflicted much more frequently, with a subset reporting daily migraines. While many migraines might last for a few hours, some remain for days at a time. People who experience migraines often report that they’re unable to work, drive or participate in their usual activities when an attack comes on. In fact, migraines are the third leading cause of missed workdays in Canada, coming in after back pain and mood disorders — which they often go hand-in-hand with. 

Stress and migraines

About 70% of people who experience migraines report stress as one of their triggers, especially when it comes to those experiencing daily migraine attacks. One theory is that the migraine brain is hypersensitive — potentially one of the reasons why light can make a migraine attack so much worse. 

Migraines and stress can often become a vicious circle; stress precipitates migraine, and the migraine episode itself causes more stress. We know that people who experience migraines are more likely to have depression or anxiety, but much like the connection between stress and migraines, it’s unclear how exactly they’re related. In other words, are the anxiety and depression related to the way the migraine brain works, or does living with migraine cause those disorders? Either way, be sure to tell your doctor if you have both migraines and another condition such as anxiety. It’s often beneficial to treat the two in tandem.

What else can trigger migraines?

While stress is a major contributor to migraines, it’s only one of a number of triggers — even weather changes can bring on a migraine episode. Recording your migraine attacks and what preceded them may help you to narrow down your triggers, especially if they include food or certain activities. Other potential migraine triggers include:

• Hormonal fluctuations, like getting your period.
• Certain medications, including the combination pill.
• Alcohol.
• Lack of sleep or changes in sleep patterns, like jet lag.
• Certain foods, especially ones containing nitrates.
• Dehydration.
• Staring at a screen for too long.
• Too much caffeine. 

How to prevent a stress migraine

The best way to prevent a stress migraine is to deal with your stress preemptively, whenever possible. Start by making sure you’re getting enough sleep. Next, make a list of any potential stressors and see if you’re able to break them up into smaller, more manageable pieces. Set aside time for stress-busting activities like exercise, meditation, and quality, screen-free time with your nearest and dearest. Dysregulation can be a migraine trigger, so sticking to a sleep schedule and eating regular meals made from whole foods is also crucial.

If you feel an attack coming on, you can try to head it off by lying down in a darkened room, or drinking a caffeinated beverage. Once your migraine is in full effect, however, many report that the only thing that offers relief is medication.

When to worry about your migraine

If you experience regular migraines, it’s best to speak with a healthcare provider — if you haven’t already — to rule out any other potential issues. You should also see a doctor if you develop migraine auras in your 40s or later, if you’ve never had them previously. As well, if your migraines have become more frequent or debilitating, cause personality changes, or prevent you from completing daily tasks, it’s time to see a doctor.

Stress is fine in small doses, but too much stress, over too long a period can wreak havoc on you. For people who experience migraines, dealing with stress before it overwhelms you is one of the most powerful tools you have. Life — especially pandemic life — makes it impossible to avoid stress. But you can stop your stress from getting out of control.