Experts aren’t exactly sure what causes migraine headaches, but 4 in 5 people identify stress as a trigger. Relaxation after a period of stress may also be a trigger.

Migraine is a neurological condition that can cause a variety of symptoms, including throbbing, pulsing pain on one or both sides of your head. The pain is most often felt around the temples or behind one eye. Pain can last anywhere from hours to days.

Other symptoms that can occur during a migraine episode include nausea, vomiting, and sensitivity to light.

Migraine is not the same thing as headaches. What causes it isn’t well-understood. But there are known triggers, including stress.

According to the American Headache Society, about 4 out of 5 people with migraine report stress as a trigger. Relaxation following a period of high stress has also been identified as a possible trigger for migraine attacks.

So, what’s the connection between stress and migraine? We explain the research, symptoms, and coping strategies to get you feeling better, sooner.

Though what exactly causes migraine hasn’t been established, researchers believe they may be caused by changes in the levels of certain chemicals in the brain, such as serotonin. Serotonin helps regulate pain.

In one study, about 80% of people with migraine reported that stress is a trigger for their migraine episodes.

In addition to the stress itself, some people believe that relaxation after high levels of stress may be a trigger for migraine. Some call this the “let-down” effect.

A 2014 study found that people with migraines who experienced a reduction in stress from one day to the next were significantly more likely to have a migraine the next day.

If stress is a migraine trigger for you, finding ways to lower your stress is worth the effort. The American Migraine Foundation says reducing stress can reduce your symptoms.

You might notice symptoms of stress before the symptoms of a migraine episode. Common symptoms of stress include:

  • upset stomach
  • muscle aches
  • irritability
  • fatigue
  • chest pain
  • high blood pressure
  • feelings of sadness or depression
  • lack of interest in your usual activities

The symptoms of a migraine can begin a day or two before the actual migraine episode. This is called the promonitory stage or prodrome stage. The symptoms of this stage may include:

  • fatigue
  • food cravings
  • mood changes
  • muscle tenderness
  • light sensitivity
  • yawning

Some people experience migraine with aura, which occurs after the prodrome stage. An aura typically causes vision disturbances. In some people, it can also cause problems with sensation, speech, and movement, such as:

  • seeing flashing lights, bright spots, or shapes
  • tingling in the face, arms, or legs
  • difficulty speaking
  • temporary loss of vision

The third phase of a migraine episode is the headache phase. Symptoms of this phase can last from a few hours to a few days, if left untreated. The severity of symptoms varies from person to person.

Symptoms may include:

  • sensitivity to sound and light
  • increased sensitivity to smells and touch
  • throbbing or pulsing head pain, often on one side of your head
  • nausea
  • vomiting

The final phase is called the postdrome phase. It can cause mood changes that range from euphoria and feeling very happy to feeling tired and worn out. You may also have pain in the location where the headache was.

Migraine treatments include medications to relieve your symptoms and prevent future attacks. If stress is causing your migraines, finding ways to reduce your stress levels can help prevent future attacks.

Medications

Medications to relieve migraine pain include:

  • over-the-counter (OTC) pain relievers, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol)
  • prescription pain relievers, such as naproxen
  • triptans, such as sumatriptan (Imitrex), almotriptan (Axert), and rizatriptan (Maxalt)
  • ergots, which combine ergotamine and caffeine, such as Cafergot and Migergot
  • ubrogepant (Ubrelvy), which can be used to treat migraine symptoms during an episode
  • rimegepant (Nurtec ODT), which can be used to prevent migraine episodes or treat the symptoms

OTC migraine medications are available that combine acetaminophen, aspirin, and caffeine, such as Excedrin Migraine. However, these can sometimes cause a side effect known as medication overuse headaches or rebound headaches.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen have been found to increase the risk of gastrointestinal bleeding and ulcers as well as heart attacks. Frequent use isn’t recommended.

You may also be given anti-nausea medication if you experience nausea and vomiting with a migraine episode.

Corticosteroids are sometimes used with other medications to treat severe migraines. However, these aren’t recommended for frequent use because of side effects.

You may be a candidate for preventive medications if:

  • You need to use pain relieving drugs three or more times per week.
  • You don’t get relief from pain-relieving medications.
  • Your attacks make you miss work or social occasions, or otherwise interfere severely with your daily life.

Preventive medications are taken regularly, usually every day. Preventative treatment is intended to reduce the frequency, length, and severity of your migraine attacks.

If stress is a known trigger for your migraine episodes, your doctor may recommend taking the medication only during times of high stress, such as leading up to a stressful work week or event.

Preventive medications include:

Calcium channel blockers such as verapamil (Calan, Verelan) are sometimes prescribed for migraine prevention. This is an off-label use, because they are not FDA-approved to treat migraine.

Other treatment options

There are a few things you can do to lower the risk of a migraine episode from stress. These things may also help relieve the symptoms caused by both stress and migraine. Consider the following:

  • Incorporate relaxation exercises into your daily routine, such as yoga and meditation.
  • Rest in a dark room when you feel a migraine episode coming.
  • Get enough sleep, which can be achieved through keeping a consistent bed time each night.
  • Try massage therapy. It can help prevent migraine episodes, reduce cortisol levels, and decrease anxiety, according to an older 2006 study.
  • Exercise more days than not. It can lower stress levels and may help reduce the frequency, intensity, and length of migraine attacks.
  • Consider seeing a therapist who offers cognitive behavioral therapy. This type of psychotherapy may help migraine episodes happen less often, and reduce their impact on your life.
  • Give biofeedback therapy a try. It teaches technques to help you recognize and manage the physical effects of stress.

If you’re having trouble dealing with stress and find that stress is a trigger for your migraine episodes, speak to your doctor. They can recommend ways to cope with stress.

If stress is a trigger for your migraine episodes, work to reduce or eliminate the source of your stress. Medications and self-care measures can also help you get relief from symptoms and prevent or reduce the frequency of your migraine attacks.