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Breaking the stress-headache link

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For many stress and headaches are inextricably linked.

Tension headaches were named for this connection, and stress is a risk factor for migraines, the other main type of headache.

“Pain is what tells us to get out of a situation,” said Robert Cowan, a professor of neurology and chief of the division of headache and facial pain at Stanford University.

Stress causes headaches for evolutionary, physiological, and chemical reasons, he said.

We were wired for a time when loud noises were something to be feared — a lion roaring, for example. Now, they’re far more likely to be a cement truck rattling by, or the shrill ringtone of a cellphone. This can make us more reactive to — and stressed out by — things in our everyday lives, he said.


Many of us spend our workdays at desks. Anatomically, sitting hunched over a computer all day makes headaches more likely. The nerves that send a “tighten up” message to neck and shoulder muscles sit right next to the nerves that mediate pain in the brain, Cowan said.

And chemically, the anxiety hormones of “fight or flight” — serotonin and epinephrine — can spur pain in the head and trouble in the gut.

Breaking the stress-headache connection is particularly important in childhood and adolescence when the brain wiring is laid down, said Alyssa Lebel, a neurologist and pain medicine specialist at Boston Children’s Hospital.

“It’s never too late,” to break this causal link, she said, but it’s easier to snap before adulthood, and doing so prevents a lifetime of suffering.

When pain patterns get set, the agony becomes self-reinforcing. The brain essentially becomes wired for pain, said Carolyn Bernstein, clinical director of the Comprehensive Headache Center at Beth Israel Deaconess Medical Center.

Using a lot of medication — such as Tylenol or ibuprofen — can diminish the pills’ effectiveness, leading to even greater use, Bernstein said.


It’s not yet clear whether nonmedical approaches like relaxation, biofeedback, and meditation are better than pills at treating headaches — but they clearly have fewer side effects, she said.

Healthy habits, like eating well, exercising regularly and getting adequate, consistent sleep are also essential, she said.

“If you have these skills, you’re going to feel you have some control over [the pain],” Bernstein said. “You may not be able to turn it off completely, but you can turn it down.”