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Why Do Migraine Attacks Often Occur After Stress Is Over?

“Let-down” migraines are much more common than you might think.

Key points

  • Many migraine sufferers develop attacks following, not before or during, a stressful or exciting event.
  • Dramatic changes in cortisol levels may trigger the migraine attack.
  • Managing stress and finding emotional balance may help reduce "let-down" or "weekend" migraines.
Source: Jorge Franganillo/Unsplash
Man hiking with a migraine.
Source: Jorge Franganillo/Unsplash

Whew! You survived the interview after all of the stress anticipating it.

You planned the wedding for months, and all the stress was worth it once the big day came.

You had a weekend of back-to-back events and were on the road taking your kids from one event to another.

You got through the crunch of final exams.

You loved your surprise birthday party… All without a migraine!

But then… hours later, a day later, after you thought the stress and anxiety were over, the migraine hits you hard, really hard.

Why should this be?

Why would the attack come later?

You are having a “let-down migraine.”

The period of relaxation right after stress is just as big a trigger as stress itself. According to researcher Dr. Dawn Buse, Ph.D., professor of neurology and Board Member at Large of the American Headache Society, “People have a 20 percent increased likelihood of having a migraine in the 12 to 24 hours after their mood shifts from ‘sad’ or ‘nervous’ to ‘happy’ or ‘relaxed'” (Dumas).

I remember taking my exams for my master’s degree. The stress as I prepared all summer (reading the numerous books I was required to, researching critical theory and commentary) had been overwhelming and consuming. I was certain I would suffer a migraine attack either just before or during the exams, and then I felt so grateful I hadn’t. In fact, I felt really good afterward—there was only a tremendous relief and a weight off my shoulders.

The next morning, though, at about 5:00 a.m., I started feeling the pain in my neck and felt as though it was moving right up the side of my neck to the back of my eye before I could even take action. In fact, I feared lifting my head off the pillow to get to my rescue medications, as the pain was coming faster than usual. This is a classic “let-down migraine attack”: According to Dr. Richard B. Lipton, director of the Montefiore Headache Center and the author of a study on stress and migraine, “Results [of the study] were strongest during the first six hours where a decline in stress was associated with a nearly five-fold increased risk of migraine onset. The hormone cortisol, which rises during times of stress and reduces pain, may contribute to the triggering of headache during periods of relaxation” (Dumas).

What about those migraines that set in after a period of great joy, though?

Why would we be hit so hard after the excitement and a wonderful experience? Actually, for the same reasons we are after stress and great anxiety in the above examples. The cortisol levels rise during these periods as well and, again, may trigger a very unexpected attack, just when you least expect it: “Research has shown a five-fold increase in attacks during this time period. This has led some experts to suggest that let down or relaxation is a more prominent cause of attacks than stress itself” (Bullock).

The “let-down migraine” actually has a number of behavioral changes during the stressful/excited period associated with it as well, all of which can be contributing factors to a degree:

  • Changes in sleep patterns
  • Changes in eating and drinking patterns
  • Changes in routine
  • Lack of exercise
  • Forgetting to take medications on time
  • Reduction in regular stress managementmeditation, yoga, quiet walks

So, what can we do to avoid “let-down,” sometimes also known as “weekend,” migraines?

First of all, we obviously recognize that many stressful situations come on unexpectedly and cannot be avoided. Also, we must realize that some of us are more prone to high levels of anxiety and stress, so eliminating “let-down” headaches for many is not possible.

However, there are steps we can take to alter our lifestyles that can help us manage stress better. In doing so, we learn how to better adapt to stressful situations, so we minimize the drastic change in hormone levels that comes from the final relaxation after the stressful or joyous event. The idea is to seek more balance, so the “crash” in cortisol levels doesn’t take place and lead to a migraine attack.

Some of these lifestyle changes include:

  • Keeping a similar sleep pattern (don’t sleep too long on weekends, for instance), but get enough sleep each night.
  • Trying to exercise, even walking, on a regular basis. This activity can be valuable following a stressful event, as it helps you gradually return to normal cortisol levels.
  • Eating regularly and staying as close as you can to your normal healthy diet.
  • Learning a new relaxation technique—yoga or meditation, for instance.
  • Learning to play an instrument.
  • Seeking help from a cognitive therapist who can teach us to better manage the stress and negative thought patterns we can easily get into, given that we live with chronic illness.

I recall my initial surprise in discovering that others suffered from let-down migraines, as I thought it was unusual to suffer migraine attacks after rather than before or during a difficult event or really happy one. I found real relief in learning, once again, that I was not alone—and neither are you.

References

Bullock, Greg. “Stress and Migraine Connection.” Theraspecs. January 2018. Theraspecs.com. Accessed 10 August 2021.

Dumas, Paula. “Migraine at Work: 8 Tips to End the Let-down Headache.” Migraine Again. October, 19, 2020. https://www.migraineagain.com/migraine-work-7-tips-end-letdown-headache. Accessed 9 August 2021.

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