Common Stressors
Stress and the stress response
How the body’s stress system works, why the let-down after stress can trigger attacks, and what helps.
5 min read · 7 research sources · Based on the Mastering Migraine courses by Dr. Adam Harcourt
Stress is the factor people with migraine most often name as a trigger 1. Understanding how the stress response works makes it much easier to manage.
The stress response is meant to protect you
When the brain senses a threat, it activates the HPA axis (hypothalamus, pituitary and adrenal glands) and the “fight or flight” nervous system. Stress hormones like cortisol and adrenaline rise to help you through the challenge. Ideally they then settle back down. Scientists call this “stability through change,” or allostasis 2.
When stress does not switch off
Hans Selye described three stages of the stress response: alarm, resistance and, if the stress continues long enough, exhaustion 2. Excessive, prolonged or poorly regulated stress responses lead to health problems over time. For a migraine brain, which already sits closer to its threshold, that ongoing load fills the bucket 3.
The “let-down” migraine
Many people get attacks not during a stressful period, but right after it: the first day of a vacation, or the weekend after a deadline. A sudden drop in stress hormones, along with changes in sleep and meal timing, is thought to play a role 1.
Stress and hormones are connected
The stress system and the reproductive hormone system are closely linked. Long-term stress can shift estrogen, progesterone and other hormones, which matters a great deal for migraine 4. This is one reason Dr. Harcourt evaluates stress and hormones together. See Hormones: testing and balance.
What helps
- Mindfulness and meditation have been shown in studies to reduce migraine frequency and medication use in some people 5,6.
- Behavioral therapies such as acceptance and commitment therapy can reduce disability 7.
- Regular routines for sleep, meals and exercise help buffer the let-down effect.
- Community and purpose: connection and meaning are part of resilience in Dr. Harcourt’s lifestyle model 2.
See Mind-body tools and self-management.
This article is educational and does not replace a personal evaluation. Talk with your clinician before making changes to medications, supplements or diet.
Research cited on this page
- Goadsby PJ, Holland PR, Martins-Oliveira M, et al. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiol Rev. 2017;97(2):553-622. PubMed 28179394 · DOI
- Guilliams TG. The Role of Stress and the HPA Axis in Chronic Disease Management. Point Institute. 2015. Source
- Calabrò C, Di Tillo E, Pensato U, et al. Migraine chronification as an allostatic disorder: a proof-of-concept study. Neurol Sci. 2024;45(6):2775-2782. PubMed 38261154 · DOI
- Li W, Diao X, Chen C, et al. Changes in hormones of the hypothalamic-pituitary-gonadal axis in migraine patients. J Clin Neurosci. 2018;50:165-171. PubMed 29366620 · DOI
- Grazzi L, Sansone E, Raggi A, et al. Mindfulness and pharmacological prophylaxis after withdrawal from medication overuse in patients with Chronic Migraine: an effectiveness trial with a one-year follow-up. J Headache Pain. 2017;18(1):15. PubMed 28161874 · DOI
- Wachholtz A, Vohra R, Metzger A. A reanalysis of a randomized trial on meditation for migraine headaches: Distraction is not enough but meditation takes time. Complement Ther Med. 2019;46:136-143. PubMed 31519270 · DOI
- Huddleston C, Martin L, Woods K, et al. One-Day Behavioral Intervention for Distressed Veterans with Migraine: Results of a Multimethod Pilot Study. Mil Med. 2018;183(7-8):e184-e192. PubMed 29420786 · DOI
Mastering Migraine is an educational resource and is not a substitute for individualized medical care. Always talk with your own doctor before changing medications, starting supplements, or beginning a new treatment.
