The association between stress and headache: A longitudinal population-based study

Introduction We studied the association between stress intensity and headache frequency for tension-type headache (TTH), migraine and migraine with coexisting TTH (MigTTH). Method We studied a population-based sample of 5159 participants (21-71 years) who were asked quarterly between March 2010 and April 2012 about headache and stress. Log-linear regression in the framework of generalized estimating equations was used to estimate regression coefficients presented as percent changes to describe the association between stress intensity (modified visual analog scale (VAS) from 0 to 100) and headache frequency (days/month) stratified by headache subtypes and age groups and adjusted for sex, age, frequent intake of acute pain drugs, drinking, smoking, BMI and education. Results TTH was reported in 31% participants (48.112.5years, 51.5% women, 2.2 +/- 3.9 mean headache days/month, 52.3 +/- 26.7 mean stress), migraine in 14% (44.8 +/- 11.3years, 73.3%, 4.5 +/- 5.2 days/month, 62.4 +/- 23.3), MigTTH in 10.6% (43.5 +/- 11.5 years, 61.0%, 3.6 +/- 4.8 days/month, 58.6 +/- 24.1), 23.6% were unclassifiable, and 20.8% had no headache. In participants with TTH an increase of 10 points on VAS was associated with an increase of headaches days/month of 6.0% (adjusted). Higher effects were observed in younger age groups (21-30/31-40/41-50/51-60/61-71 years: 9.8/10.2/7.0/6.5/3.5%). Slightly lower effects were observed for migraine (4.3%, 8.1/5.1/3.4/6.3/0.3%) and MigTTH (4.2%, 5.5/6.8/6.9/5.8/-0.7%). Conclusion Our study provides evidence for an association between stress intensity and headache frequency.