Association between Stress and Headache Frequency (S41.007)

Abstract

OBJECTIVE: We evaluated the association between stress intensity and headache frequency for tension type headache (TTH), migraine and migraine with coexisting TTH. BACKGROUND: It is supposed that stress can be a predisposing factor contributing to the onset of headache disorders, that it accelerates the progression to chronic headache, provokes and exacerbates headache episodes and that the headache experience itself can serve as a stressor. METHODS: We analyzed data of the population-based German Headache Consortium Study, which included 5,159 participants aged 21-71 years. The participants were screened quarterly from 2010-2012, using validated questionnaires. Headache subtypes were defined according to the criteria of the International Headache Society. Poisson log-linear regression in the framework of Generalized Estimating Equations was used to estimate the effects of stress intensity on headache frequency (days/month) for different headache subtypes, using a visual analogue scale (VAS) from 0-100. Percent changes with 95% confidence intervals (95%CI) were adjusted for sex, age, frequent intake of acute pain drugs, drinking, smoking, body mass index and education. RESULTS: TTH was reported in 1,598 (31%) participants (48.1±12.5 years, 51.5% women, 2.2±3.9 mean headache days/month, 52.3±26.7 mean stress), migraine in 14.0% (44.8±11.3, 73.3%, 4.5±5.2, 62.4±23.3), migraine with coexisting TTH in 10.6% (43.5±11.5, 61%, 3.6±4.8, 58.6±24.1), unclassifiable headache in 17.3%. Participants experienced an increase in headache frequency with increasing stress intensity independent of headache subtype. The highest effects were observed in participants with TTH: increase of 10 points on the VAS in stress intensity was associated with a 6.3% (95%CI: 4.3-8.3%) increase in headache days/month, migraine 4.3% (2.4-6.2%), migraine with coexisting TTH 4.0% (1.8-6.3%). CONCLUSIONS: This large prospective population-based cohort study provides evidence for an association between stress intensity and headache frequency. Our findings are of importance for stress management approaches in headache patients.

Disclosure: Dr. Schramm has nothing to disclose. Dr. Moebus has nothing to disclose. Dr. Lehmann has nothing to disclose. Dr. Galli has nothing to disclose. Dr. Obermann has received personal compensation for activities with Biogen Idec, Novartis, Sanofi-Aventis Pharmaceuticals Inc., Pfizer Inc., and Teva Neuroscience. Dr. Obermann has received research support from the German Federal Ministry of Education and Research, and Allergan Inc. Dr. Bock has nothing to disclose. Dr. Yoon has nothing to disclose. Dr. Diener has received personal compensation for activities with Merck & Co., Inc. Allergan, Inc., Electrocore, Amgen Inc., and Novartis. Dr. Diener has received research support from Merck & Co., Inc., Allergan, Inc., Weber & Weber, and Electrocore. Dr. Katsarava has received personal compensation for activities with Allergan Inc., Bayer Pharmaceuticals Corp., Biogen Idec, and Merck & Co. Inc. Dr. Katsarave has received research support from Allergan Inc., Bayer Pharmaceuticals Corp., Biogen Idec, and Merck & Co. Inc.