International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 09 Issue 12, June, 2017

Pages: 23-26

Date of Publication: 24-Jun-2017

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Correlation of Stress with Migraine - A Review

Author: Monika Kajal, Manoj Malik, Reena Kumari

Category: Healthcare

Abstract:Migraine is a widespread and debilitating neurological disorder that has been recognized since antiquity. The World Health Organization has listed migraine as a significant public health concern and major cause of years of life with disability. It is aperiodic disorder that comprises paroxysmal and blinding hemicranial pain, nausea/vomiting, photophobiaand phonophobia. Stress is often linked to the occurrence of migraine headaches. Stress may interact with migraine in several ways that predisposed to migraine attacks. Stress is considered as a most common trigger for their attacks and high level of stress are reported in migraine patients. Migraine attacks themselves can act as a stressor, thereby potentially leading to a vicious cycle of increasing migraine frequency. This review provides an overview that both stress and migraine are reciprocally related i.e. cyclically influencing each other across time.

Keywords: Headache, Epidemiology, Trigger factors

Full Text:


Migraine is one of the most common neurological headache disorder and cause of significant disability for many patients1 with substantial personal and societal burden2. The term migraine has been derived from Galen’s usage of hemicranias, to describe “a periodic disorder that comprises paroxysmal and blinding hemicranial pain, vomiting, photophobia, recurrence at regular intervals, and relief by darkness and sleep”3. Migraine is an inherited and episodic disorder that involves sensory sensitivity.


The prevalence of migraine has been extensively studied4. Migraine is ranked 19th among all diseases world-wide that cause disability. The global prevalence of the adult members of the population with an active headache disorder is 11% for migraine5. The prevalence of migraine is age and gender-dependent6. It is more common in boys than in girls before puberty. As adolescence approaches, the incidence and prevalence of migraine increases more rapidly in girls than in boys. In women, prevalence increases throughout childhood and early adult life until approximately age of 40 years, after which it declines4. It is most commonly experienced by individuals between the ages of 15 and 55 years and 70% - 80% of migraineurs have a family history of migraine7. Prevalence rates of International Headache Society - defined migraine are relatively consistent in Western countries, varying from 4% to 9.5% in men and from 11.2% to 25% in women21. In United States population prevalence of migraine is approximately 18% in women and 6% in men that affects 28 million Americans. The data of United Kingdom shows that the overall prevalence of migraine ranged from 3.7% to 4.9%. In Saudi Arabia prevalence for migraine in subjects aged 6 to 15 years was 6.2%. Migraine prevalence was inversely related socioeconomic status4. The prevalence of migraine in London was women and 19.5% in men. In the Isles of Scilly the prevalence was 23.7 and 15.2% respectively8. In India prevalence was greater among females 31.6% than males 18.5% for migraine subjects aged between 35-45 years in both genders22. In the global burden of disease 1990, these disorders accounted for 10.5% of the worldwide from all diseases and injuries and the re-estimate of global burden of disease 2000 was 12.3% and it is evident that this burden will increase rapidly in the future, with projections indicating 15% by the year 202021.Global figures reveals a rapid rise in migraine, it is shown in figure 1.


International Headache Society has laid down the criteria which classifies migraine on the basis of International Classification of Headache Disorders9. Classic migraine (migraine with aura) denotes the syndrome of headache associated with characteristic premonitory sensory, motor, or visual symptoms; common migraine (migraine without aura) has no focal neurologic symptoms precede the headache. Complicated migraine is generally describing migraine associated with dramatic focal neurologic features, thus overlapping with classic migraine3. Migraine may be divided in to 2 broad groups based on the number of headache days. If attacks occur less than 15 days per month then termed as episodic migraine (or simply migraine), while headaches occur on 15 or more days per month the terms chronic or transformed migraine20.


Migraine is a complex genetic disorder with heritability estimates as high as 50%11 and associated with chromosome 1 and 19. Chromosome 19p13 gene mutation is linked to CACNA1A (calcium voltage-gated channel subunit alpha 1 A) and chromosome 1q23 gene mutation linked to Na/K+ ATPase. Dysfunction of neuronal calcium channel might impair serotonin release and predispose patients to migraine12,13. Psychophysical and neurophysiological studies have provided clear statement that the migraine sufferer’s brain stays in a continual state of neuronal hyperexcitabilty7. Migraine pain is caused by inflammation and dilation of meningeal arteries located within dura mater as stated in trigeminovascular hypothesis. Migraine attacks may be precipitated by a number of constitutional and environmental factors, which are often termed migraine triggers1,17. Common migraine triggers are stress1,10,14,15,16,17, hormonal changes in women1,15, certain foods (cheese, chocolate, fruit)1,10,15, missing meals1,15, sleep disturbances, weather changes, alcohol1,10,15, minor trauma10, strong smells, bright light10,15, neck pain, exercise, sexual activity, smoking, heat15. Frequencies of triggers percentage are given in figure 215.

Signs and symptoms:

The sign and symptoms of migraine seem to differ with age. Migraine attacks in children and adolescents differ from those in adults, as the younger often have attacks of shorter duration and bilateral location3. Migraine attack consists of four phases that include premonitory prodrome, aura, headache and postdrome7. Frequency of attacks varies enormously, one or two attacks per months is a common pattern. Repeated episodes of headache (4-72 h) with any two of the features i.e. unilateral, throbbing, worsened by movement, moderate or severe or any one i.e. nausea/vomiting, photophobia and phonophobia are the most characteristics clinical phenotype of migraine23. Typically pain is unilateral and significant number of cases becomes bilateral often, late in an attack. Headache build up to maximum over about 30 minutes and last from hours to one or two days. In majority of cases nausea occurs but in about 50% is there vomiting. Vasomotor changes includes pale face, cold extremity, may be subconjunctival hemorrhage or bruising around eyes. Visual disturbance usually homonymous lasts for 15 to 20 minutes. Symptoms of paraesthesiae and numbness occur in cortical distribution, involving the periphery of the limbs and circumoral region. The lip, face, and tongue may be subsequently affected on one side on one or both sides. Aphasia is usually of the expressive type and accompanied by dysgraphia. The characteristic feature of migraine attacks is the slow speed of the developing neurological disturbance at a rate of about 3 mm/minutes10.


Stress is viewed as a transactional process between an individual and his or her environment in which the individual makes a response to an internal or external constraint. It is trigger for migraine attacks, and is present in approximately 70% of individuals. High levels of stress are reported in migraine patients, particularly in those suffering from chronic daily migraine. Both endogenous (eg, hormone) and exogenous (eg, physical stressors [eg, light]), or psychological stressors add to the burden of the disease. Emotional or physical trauma (eg, abuse, particularly in childhood), and socioeconomic or social stress are examples of psychological stressors16. A study done by Kelman L et al 2007, evaluate and define the triggers of the acute migraine attack. One thousand two hundred and seven patients were evaluated, of whom 75.9% reported triggers (40.4% infrequently, 26.7% frequently and 8.8% very frequently). Study concluded that the trigger frequencies of stress in migraine were 79.7% and triggers were more likely to be associated with a more florid acute migraine attack and stress was one of the most common trigger15.Biology of stress and migraine may be linked on several levels. The first of these is the physiological stress response, which involves both the hypothalamic-pituitary-adrenocortical axis, and sympathetic nervous system including adrenal medulla. Activation of both these system leads to the behavioral and physiological changes observed in response to stress, and these in turn could potentially trigger migraine attacks1. A study done by Martenson M.E et al 2009, indicate that the neural circuitry responsible for stress-induced hyperalgesia. The dorsomedial nucleus of the hypothalamus is a critical component of the central mechanisms mediating neuroendocrine, cardiovascular and thermogenic responses to various stressors. It also contributes to stress-induced hyperalgesia through direct and indirect connections with the rostral ventromedial medulla, a region long implicated in descending control of nociception24. Sauro K.M et al 2009, reported that chronic stress leads to hyperalgesia may include potential mechanism of N-methyl-D-aspartate receptors and the µ-opioid receptor activation. Another way that chronic stress may physiologically impact headache is through alteration of the immune system in such a way that pain transmission is facilitated at the neuronal level and inflammatory mediators such as tumor necrosis factor alpha, interleukin-1 beta, interleukin-6, and nitrous oxide may act as pain mediators that can sensitize the pain matrix1. Schoonman G.G et al 2007, studied the temporal relationship between changes in stress-related parameters and onset of a migraine attack. Study concluded that stress-sensitive patients, in contrast to non-sensitive patients, may perceive more stress in the days before an impending migraine attack14.WacogneC et al 2003, study investigated the intensity of stress, anxiety and depression. Stress was measured using the Perceived Stress Questionnaire, and anxiety and depression using the Hospital Anxiety and Depression Scale. Study concluded that stress is a primordial factor in the triggering and perpetuation of migraine attacks. Women and men display differences in the prevalence of many disorders that could be considered to be stress- related, including migraine18. A study was done by Hedborg K et al 2011, Study was performed on 150 persons, 106 women and 44 man, suffering from at least two migraine attacks a month. All of them answered validated questionnaires regarding personality traits of Swedish universities scale of personality, life events, and perceived ongoing stress. There were high mean scores for psychic and somatic anxiety in women. Study showing that stress is an important factor in migraine. Stress susceptibility, life events, and concomitant psychosomatic illnesses should be considered important when evaluating individuals with migraine, and gender aspects need to be taken into account17. Some studies shows temporal relationship with stress in migraine. A study done by Holm J.E et al 1997, objective of study was examined daily temporal relationships between stress, cognitive appraisal, coping, and migraine. Studied concluded that stress and migraine are reciprocally related (i.e. cyclically influencing each other across time) along with cognitive appraisal and coping are also related to migraine activity in reciprocal fashion19.


Based on comprehensive literature review it is concluded that stress is a major trigger for migraine attacks and high level of stress are reported in migraine patients. Both stress and migraine are reciprocally related i.e. cyclically influencing each other across time. Thus stress management approaches like cognitive behavioral therapy, various forms of biofeedback and relaxation training can also be incorporated during migraine treatment along with pharmacotherapy.


I hereby acknowledge my co-authors and Jaspreet Kaur for constantly encouraging and supporting and helping me find my literature for this review article. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Source of Funding: None                                                                                    

Conflict of interest: There is no conflict of interest.


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Awards, Research and Publication incentive Schemes by IJCRR

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to for more details.

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This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to for more details.

Best Article Award

A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by situs slot and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. situs slot "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma situs slot entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by situs slot et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
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Egg a day tied to lower risk of heart disease situs slot
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A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

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