Stress and migraine: something expected, something unexpected.

Stress seems inescapable, or is that just my perception? This could be a statement about clinical practice, particularly completion of documentation; politics; modern life; or here, the pathophysiology of migraine. Only last year,Neurology® published a very challenging study demonstrating that alleged migraine triggers— flickering lights and strenuous exercise—were only about 10% likely to precipitate migraine in apparently susceptible individuals. This contrasts with nitroglycerin for which 75% of migraineurs are triggered. What of stress: surely, it is a trigger? In this issue of Neurology, Lipton et al. enrolled 22 patients in a 3-month electronic diary study and 17 completed the task of at least 30 days of diary entry, contributing 110 attacks and 2,011 diary entries. Stress was assessed with the Perceived Stress Scale and the SelfReported Stress Scale, and the odds ratio for migraine occurrence was computed as a function of stress across time. The first finding was that the level of stress generally was not associated with migraine occurrence. The main positive finding was that a reduction in stress from one evening diary to the next by the Perceived Stress Scale was associated with increased migraine occurrence for up to 18 hours. This effect was still present when controlling for level of stress at all time points, and the Self-Reported Stress Scale gave the same broad results.