PHILADELPHIA – A 10-point increase in headache patients’ perception of life stress was associated with up to a 10% increase in the frequency of tension-type headache, according to Dr. Zaza Katsarava.
A somewhat attenuated, but still significant relationship was observed with migraine, said Dr. Katsarava of the University of Essen (Germany).
Dr. Zaza Katsarava
"This is a confirmation of what we see every day in clinical practice. It’s an added piece of information suggesting that we need a comprehensive approach in how we treat our headache patients," he said at the annual meeting of the American Academy of Neurology.
He discussed findings of the German Headache Consortium study, which followed more than 5,000 people for 2 years. During that time, the subjects, aged 21-71 years, completed surveys every 3 months. Once a year, this was a long survey that let researchers identify headaches as tension type, migraine with coexisting tension type, migraine only, or unclassifiable. The long surveys also inquired about age, sex, body mass index, socioeconomic status, depression, stress, and medications.
Every 3 months throughout the study period, respondents completed a short questionnaire asking whether they had experienced headache during the prior 3 months and if so, how many headache days occurred during that time. Subjects also rated their perceived stress level over the same period, using a 0- to 100-point visual analog scale. The data were adjusted for sex, age, frequent intake of acute pain drugs, drinking, smoking, body mass index, and education.
About a third of respondents (31%) reported tension-type headache, with a mean of 2 headache days per month and a mean stress level of 52. Migraine with coexisting tension-type headache was present in 11%, with a mean of 4 headache days per month and a mean stress level of 59. Migraine occurred in 14%, with a mean of 4.5 headache days per month and a mean stress level of 62. Headache was unclassifiable in 17%.
Among those with tension-type headache, every 10-point increase on the stress measure was associated with an overall 6% increase in monthly headache days. The association also occurred among those with migraine, although it was somewhat attenuated (4% overall).
There were some significant differences in the association when the groups were broken down by age, however. For those with tension-type headache, younger people experienced the biggest effect. For those in their 20s and 30s, every 10-point increase in perceived stress was associated with a 10% increase in headache days. For those in their 40s, headaches increased about 7% for every 10-point stress increase. The increase dropped to 6% for those in their 50s, and to 3% for those in their 60s.
Among those with migraine, the 10-point stress increase was associated with an 8% increase in headache days for those in their 20s, and a 5% increase for those in their 30s. The associated increase was 3% for those in their 40s, 6% for those in their 60s, and less than 1% for those in their 70s.
The findings beg that never-ending question of whether tension begets headaches, or headaches beget tension, Dr. Katsarava said. This study, with its cross-sectional design and lack of a control group, can’t answer that question. It does, however, paint a clear picture of a very real relationship, he concluded.
The study was sponsored by the German Ministry for Education and Research. Dr. Katsarava disclosed that he has received honoraria from Allergan and Amgen.
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