Headache, Stress and "Moods"

Stress and Headaches

Stress is by far the most common headache "trigger." Both female and male headache sufferers report that headaches are more likely to occur during or after periods of stress. Major life-changing events like marriage, birth of a child, or career changes all are sources of stress. However, research has found that it is actually the day-to-day stress or chronic "hassles" that are important in triggering headache. Compared to men, women often experience more of the types of stress that provoke headache.

Identifying the Most Common Stresses

(1) Multiple-Role Stress: Women are likely to have "multiple-role" which is stress due to managing many different roles and responsibilities. Common roles include being a mother, wife, professional working woman, and caretaker of the home. Often these important roles conflict with one another, and women are forced to make tough choices between competing demands. Sometimes, women overextend themselves trying to do it all. Other times, women suffer disappointment and guilt if they are not able to meet all of the demands of family, home, and work.

Learn to Make Time for Yourself

Women that overextend themselves might find it helpful to actually schedule time for themselves (yes, mark it on the calendar, and put it in the daily planner...). One easy way to do this is to make an appointment with "yourself", and show up on time as one would with any other appointment. Should someone ask for "this or that," the answer is "I am sorry, I have an appointment." Women with migraine do not need to make themselves more important than anyone else, but they need to consider themselves at least as important as everyone else.

(2) Workplace Stress: The majority of women in America today work outside the home. Although some women hold high-status and powerful positions, many more women have jobs with high demands and low control. These jobs can lead a woman to feel "helpless" in the workplace. Helplessness worsens the physical and emotional effects of stress, and also prevents individuals from even trying to improve their situation.

(3) Financial Stress: Women on average earn less money than men and have a lower overall standard of living. Therefore, women often feel pressures from inadequate housing, poor access to healthcare, and fear of unexpected expenses. In such cases, women also have fewer opportunities for recreation and escape from day-to-day stress.

(4) Caregiver Stress: Women are likely to be the primary caretaker in the family. Though many men are taking active roles in parenting, women still provide the majority of childcare. There are great joys in parenting, but it can also be a physically and emotionally taxing responsibility. Women also are more likely to be the primary caregiver for aging parents and ill family members. Providing family care does not end at the close of a 40-hour workweek. Instead, the caretaker sometimes needs to provide 24-hours care on a daily basis.

Stress Management

Headache sufferers can learn skills to identify the stress that triggers their headaches. Sometimes the stress can be removed or resolved. In cases where the stress is uncontrollable, a woman can learn to change her own physical and emotional reactions to stressful situations. Individuals learn to recognize and change their own reactions to stress through a variety of stress-management techniques. Techniques such as biofeedback and relaxation training are effective in reducing headache frequency and pain in many sufferers.

Other techniques can help cope with headaches while they are occurring such as taking charge of headache. This involves keeping track of headaches, monitoring success and failure of therapies, identifying and monitoring things that may "trigger" headache, and making and keeping appointments with health care providers.

The Impact of Mood on Headaches

Headache and Psychological Symptoms

(1) Personality: Headache is not a psychological disorder, and the majority of headache sufferers do not have significant psychological problems. Physicians in the 1800s and early 1900s suggested that headaches were related to a particular personality pattern. Headache researchers have now collected over 200 scientific studies examining the personality and behavior of headache sufferers.

In most studies, headache sufferers tend to have increased daily stress, more difficulty coping with stress, and more mild symptoms of depression. However, there is no good evidence for a particular headache-prone personality.

(2) Depression: Women have a higher risk for depression than men. In fact, women are three times more likely to experience an episode of depression than men are. The reason for the increased risk is not entirely clear, but may relate to a combination of biological (such as hormones, pregnancy, genetic predisposition) and environmental factors (stress, allergies, sleep).

Depression also is known to occur more often in headache sufferers than non-headache sufferers. The stress of coping with a chronic painful medical condition, like headache, increases the risk of depression. Even low levels of depression can reduce the effectiveness of medication and behavioral (biofeedback or relaxation training) or cognitive (behavioral) treatments for headache. Therefore, it is very important to recognize the signs of depression and discuss them with the physician. This information can help the physician select treatments that can relieve symptoms of both headache and depression.

Symptoms of possible depression:

• Sad, depressed, or irritable mood
• Loss of interest or pleasure in activities
• Weight loss (when not dieting) or weight gain
• Sleep disturbance (insomnia, early morning awakenings, increased sleeping)
• Feeling agitated or feeling sluggish
• Feelings of worthlessness
• Inability to concentrate
• Recurrent thoughts of death or suicide

(3) Anxiety: As with depression, women are at a greater risk than men are for anxiety. Anxiety involves a state of tension or fear that occurs without clear cause. Anxiety can lower one's threshold to stress so that even small amounts of stress can be difficult for these sufferers to manage. Anxiety also can increase the level of pain or reduce the pain tolerance threshold during a headache that can undermine the effectiveness of traditional headache treatments. For some sufferers, it is necessary to treat both the anxiety and the headaches in order to get both under control.

Symptoms of Possible Anxiety:

• Feeling restless, keyed up, or on edge
• Being easily fatigued
• Difficulty concentrating, or mind going blank
• Muscle tension
• Sleep disturbance (difficulty falling asleep or staying asleep)

Source: American Council for Headache Education, 2000