Perceived stress is significantly higher in individuals with high migraine frequency than in those with low migraine frequency, according to study results published in Frontiers in Neurology.

In this cross-sectional case-control study, researchers screened and interviewed 557 patients who experienced migraines with and without aura. Patients were sorted into chronic (n=100), high (n=97), medium (n=93), or low (n=174) migraine frequency groups. An additional 93 individuals without migraine or family history of migraine were also selected.

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All study participants were interviewed by specialists to confirm migraine diagnosis and exclude emotion-related headache. Participants were instructed to complete a questionnaire packet containing the Perceived Stress Scale (PSS), Beck Depression Inventory, Hospital Anxiety and Depression Subscales, restless legs syndrome screening questionnaire, Pittsburgh Sleep Quality Index, and Migraine Disability Assessment questionnaire. Researchers used multivariable linear regressions to identify whether migraine frequency was linked to perceived stress based on PSS scores. They also looked for trends in migraine frequency and perceived stress when stratifying by gender and aura.

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Perceived stress was significantly higher in patients with high (mean ± standard deviation [SD], 23.3±8.7) frequency of migraine than in patients with medium (mean ± SD, 21.9±9.2) and low (mean ± SD, 21.2±9.5; P <.05) frequency of migraine. This phenomenon was seen only in men (P =.04), and the presence or absence of aura had no effect on the association between migraine frequency and perceived stress. Additionally, there were no significant differences in the total PSS score between chronic (mean ± SD, 24.8±9.4) and high frequency migraine groups.

This study had 4 limitations. First, researchers used a cross-sectional design that limited their ability to confirm causal relationships. Second, all participants were patients from a single tertiary hospital in Taiwan, which limits the generalization of the findings. Third, perceived stress was evaluated using a self-rated PSS instead of an objective assessment. Fourth, the majority of patients with chronic and high migraine frequency treated their migraine using medications that may induce or contribute to psychiatric comorbidities.

The study researchers concluded that higher perceived stress is associated with higher frequency of migraine, but not in women or those with chronic migraine. Psychiatric comorbidities and adaptation to migraine may contribute to this association. 

An YC, Liang CS, Lee JT, et al. Effect of sex and adaptation on migraine frequency and perceived stress: a cross-sectional case-control study [published online June 5, 2019]. Front Neurol. doi: 10.3389/fneur.2019.00598