Stress Related Headache is often misunderstood. Stress can cause a headache, but the connection between stress and headaches is more sophisticated.
In fact there are 4 different ways in which headaches and stress play on one another.
- You feel PERMANENTLY STRESSED for no good reason. You think that if you had no headaches you would probably wouldn’t feel stressed.
- Weeks and months after a Major Life Event you get persistent headaches
- An EXTREMELY stressful or emotional event brings on a Thunderclap Headache
- A single stressful event brings on a brief headache episode
If you can understand the connection between different stresses and headache symptoms, you will be better armed to cope with your own headache condition.
Stress Related Headache No.1:
You feel permanently stressed because of severe headaches
What is actually happening is that the distress of pain has led you to feel stressed. This stress in turn tends to increase your perception of pain.
It is a chicken and egg situation – you really do not know what came first – the headache or the stress!
What we do know is that dealing with the way you think or feel in response to headache pain can reduce the amount of pain you feel, or at least prepare you better for living with high levels of pain.
An assessment of your own psychological profile is a useful part of dealing with severe headaches.
Stress Related Headache No.2:
Severe Headaches follow a Major Life Event
After a Major Life Event, headaches will often increase, especially if you have a background migraine problem.
Life events can also cause a change in your thinking and behaviour.
Recent Major Life Events are very common in people who attend specialist clinics for management of severe headaches, as it is usually associated with high impact, disabling headaches such as Chronic Migraine.
Stress Related Headache No.3:
An EXTREMELY stressful or emotional event brings on the worst ever headache of your life
Sometimes during an argument – or some other expression of extreme emotion – a sudden severe headache develops called Thunderclap Headache.
During an intensely stressful or emotional event a sudden severe headache occurs completely out of the blue. The pain goes from zero to maximum (10 out of 10 severity) within 1-2 seconds.
The headache is usually so severe that the person seeks immediate help from a doctor or emergency department.
The most common sudden severe headache associated with emotion is the sudden headache associated with sexual activity.
After a first episode of thunderclap headache a brain scan and lumbar puncture are needed to rule out a brain haemorrhage.
However, only about 10% of people with thunderclap headache actually have a brain haemorrhage diagnosed.
The most recent large studies of sexual activity headache suggest that most are due to a condition called the reversible cerebral vasoconstriction syndrome – this usually gets better itself, but sometimes requires medication for several months to help it settle down.
Although difficult to prove, it is likely that sudden emotion-induced thunderclap headache is also due to reversible cerebral vasoconstriction syndrome.
This second type of stress related headache is very rare – there is about one in a million chance that a person on any given day might experience a pain like this.
Stress Related Headache No.4:
A single stressful event brings on a brief headache episode
It is very true that people who feel stressed experience headaches at the height of their stress e.g. when under pressure at work, or having having an argument.
When the day’s work is over, or the argument is over the headache will settle once more.
If a headache specialist was asked to classify these headaches, most would be labelled ‘episodic tension-type headache’, as often the symptom during stress is a feeling of pressure in the head.
The treatment of this sort of stress related headache is to try and reduce the chance of a stressful event occurring, rather than trying to resort to medication.
Most people who talk about stress related headache are referring to episodes of tension-type headache.
References
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Cathcart S et al. Central mechanisms of stress-induced headache. Cephalalgia. 2009; July 10, 2010
YC Yeh et al. Clinical features, imaging findings and outcomes of headache associated with sexual activity. Cephalalgia 2010;30;1329-1335.
MK NIcholas. Pain Self Efficacy Questionnaire 1989
Wallston KA et al. Development of the Multidimensional Health Locus of Control (MHLC) Scales. Health Education Monographs 6:160-170, 1978.
Spitzer RL et al. A brief measure for assessing generalized anxiety disorder. Arch Intern Med. 2006;166:1092-1097.
Kroenke K et al. The PHQ-9: Validity of a brief depression screening measure. J Gen Intern Med. 2001;16:606-613.
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