What Is Stress?
Specifically, stress is a psychological response in the body, and the stressors are the events that trigger a stress response. Sometimes stress responses develop spontaneously, without the need for outside triggers. At a vulnerable time, minor life hassles may trigger a stress response. At less vulnerable times, the same event may be no more than a minor irritant. In fact, research has shown that it is the frequency of minor hassles that appears to have the greatest impact on migraine, while patients may rise to the occasion and effectively cope with a severe stressor (such as a heart attack in a spouse) while maintaining good headache control.
It is often the let down after a stressful period that triggers a headache. Examples include the end of a stressful work week, or the aftermath of a family illness. One of our patients who is a school teacher noted that her headaches often increased in frequency and severity during the summer, when the school period was over.
Her solution was to increase her involvement in outside activities during the summer, such as teaching summer school, which for her actually resulted in less headache activity.
The headache itself is perhaps the most common and difficult stressor that confronts all headache sufferers. Anxiety about possible or impeding headache, including fear of the inability to function, is certainly understandable. Unfortunately, headache-related fear (cephalagiaphobia) can further increase headache vulnerability, aggravate a developing headache, or lead to over-use of analgesic or abortive medications.
What Can Be Done About It?
- Remain open to the possibility that stress could be a factor in your headaches. Try not to be defensive about it. Stress responses are normal, we all have them, and it is only in headache vulnerable individuals that may trigger a headache. Sometimes stress responses occur in situations where we least expect them. Try to take an attitude of "that’s interesting" when you note a stress response. Make an effort to avoid self criticism. It is only when we recognize the presence of a stress response that we can do anything about it.
- If people annoy you by harping on the stress connection, you can tell them "I know you are trying to help, I appreciate your concern, but please stop bringing this up. It is not helpful". You can take steps to educate people who are close to you, and really want to learn more about headaches. With acquaintances, on the other hand, you may want to develop a thick skin and let some of their less helpful comments about your headaches roll off your back.
- Close friends and family members can sometimes alert you to behavioural changes in yourself that may signal a stress response. Whether this is helpful or not depends on your relationship with that person, their willingness to do this in a truly compassionate way, and the extent to which you can be non-defensive about it.
- Learn simple relaxation techniques. One simple but effective technique is to breathe from your abdomen (not your chest), and to slow your breathing down. For example, breathing in for 4 seconds and out for 4 seconds (4x4 breathing) can be a rapid and very effective method of calming yourself.
- Be proactive, not reactive. The best time to manage stress is before you feel stressed. Many stressors are predictable. If you know that you will be confronting a difficult situation, then relax before it happens. Once a stress response becomes full-blown, it is much more difficult to relax- the chemical changes have to run their course.
- Manage stressful behaviour. Our actions can create stress, such as when a headache sufferer tries to get as much done as possible when they think a headache may be coming on. Slow down. Get adequate sleep (remember, sleep disturbance is the most prevalent migraine trigger! Eat regular meals. Take breaks. Give yourself enough time to get things done, and set realistic goals.
- Manage your worries - our thoughts and negative anticipations of events can be just as distressing as the events themselves. Sometimes the anticipation of a stressful event is worse than the event itself. Try catching a stream of negative thoughts early, and ask yourself "is this type of thinking going to hurt me or help me?" Practice thought-stopping - tell yourself "stop!" and then distract yourself with some other activity to get negative thinking off your mind. This takes practice and consistency, but can be very helpful.
- Work on reducing your fear of pain. Self-talk can help - "One step at a time. You can handle this."
- Do not be afraid to seek psychological help. Even a few sessions of professional help in learning biofeedback and stress-management techniques, and talking over your reactions to the stressors in your life, can assist you in further developing your headache-coping skills. We are social beings, and the ability to seek and accept help from others is a strength, not a weakness.
Reprinted with permission from Alvin E. Lake, III, Ph.D. Michigan Headache & Neurological Institute, Ann Arbour, Michigan, USA 1