ArticleNeurology2014
Reduction in perceived stress as a migraine trigger: testing the "let-down headache" hypothesis.
Article in Neurology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
57 citing papers in PubMed, 3 syntheses or guidelines pooled it, 142 citations in OpenAlex.
- The chronobiology of migraine: a systematic review.The journal of headache and pain · 2021Pooled it
- Perceived triggers of primary headache disorders: A meta-analysis.Cephalalgia : an international journal of headache · 2018Pooled it
- What turns on a migraine? A systematic review of migraine precipitating factors.Current pain and headache reports · 2014Pooled it
- Stress and fasting for inducing migraine attacks: A randomized 2 × 2 factorial crossover trial.Headache · 2026Trial
- Trial
- Analysis of Trigger Factors in Episodic Migraineurs Using a Smartphone Headache Diary Applications.PloS one · 2016Trial
- A Global Perspective on Migraine Attack Triggers: Understanding Differences Across Lifestyles, Religions, and Regions.Current pain and headache reports · 2026Review
- Soldier's Heart and a Gifted Mind: Additional Considerations for Atatürk's Cardiac Symptoms.Anatolian journal of cardiology · 2025Article
- Can smartwatches predict migraines?Research square · 2025Article
- Acute neuroendocrine challenge elicits enhanced cortisol response and parallel transcriptomic changes in patients with migraine.Pain reports · 2025Article
- Forecasting migraine attacks by managing daily lifestyle: a systematic review as a basis to develop predictive algorithms.Pain reports · 2025Article
- The Glymphatic System and its Relationship to Migraine.Current neurology and neuroscience reports · 2024Review
- Glucocorticoid signaling mediates stress-induced migraine-like behaviors in a preclinical mouse model.Cephalalgia : an international journal of headache · 2024Article
- Sleep Symptoms in Migraine.Current neurology and neuroscience reports · 2024Review
- EEG Changes in Migraine-Can EEG Help to Monitor Attack Susceptibility?Brain sciences · 2024Review
- Female-selective mechanisms promoting migraine.The journal of headache and pain · 2024Review
- Sleep Symptoms and Disorders in Episodic Migraine: Assessment and Management.Current pain and headache reports · 2023Review
- Central generators of migraine and autonomic cephalalgias as targets for personalized pain management: Translational links.European journal of pain (London, England) · 2023Review
- Observational
- Intensive Mindfulness Meditation Reduces Frequency and Burden of Migraine: An Unblinded Single-Arm Trial.Mindfulness · 2023Article
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
Abstract
objectiveTo test whether level of perceived stress and reductions in levels of perceived stress (i.e., "let-down") are associated with the onset of migraine attacks in persons with migraine.
methodsPatients with migraine from a tertiary headache center were invited to participate in a 3-month electronic diary study. Participants entered data daily regarding migraine attack experience, subjective stress ratings, and other data. Stress was assessed using 2 measures: the Perceived Stress Scale and the Self-Reported Stress Scale. Logit-normal, random-effects models were used to estimate the odds ratio for migraine occurrence as a function of level of stress over several time frames.
resultsOf 22 enrolled participants, 17 (median age 43.8 years) completed >30 days of diaries, yielding 2,011 diary entries including 110 eligible migraine attacks (median 5 attacks per person). Level of stress was not generally associated with migraine occurrence. However, decline in stress from one evening diary to the next was associated with increased migraine onset over the subsequent 6, 12, and 18 hours, with odds ratios ranging from 1.5 to 1.9 (all p values < 0.05) for the Perceived Stress Scale. Decline in stress was associated with migraine onset after controlling for level of stress for all time points. Findings were similar using the Self-Reported Stress Scale.
conclusionsReduction in stress from one day to the next is associated with migraine onset the next day. Decline in stress may be a marker for an impending migraine attack and may create opportunities for preemptive pharmacologic or behavioral interventions.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.