Journal of Behavioral Medicine

, Volume 41, Issue 1, pp 109–121 | Cite as

Psychological generators of stress-headaches

  • Juanita Kay Miller Berry
  • Peter D. Drummond


Psychological stress triggers headaches, but how this happens is unclear. To explore this, 38 migraine sufferers, 28 with tension-type headache (T-TH) and 20 controls rated nausea, negative affect, task-expectancies and headache at 5-min intervals during an aversive 20-min mental arithmetic task with a fixed failure rate. Blood pressure and pulse rate were measured every 3 min and salivary cortisol was sampled before and after the task. Multiple regression analysis indicated that irritation, anxiety and the absence of sluggishness (i.e., alertness) independently predicted increases in headache intensity during the task (p < .001), but increases in headache were unrelated to changes in cardiovascular activity or cortisol. Changes that preceded headache onset were explored in repeated measures ANOVAs, comparing those who developed headache with those who did not. In general, nausea, negative affect and self-efficacy expectancies were higher in participants who went on to develop headache than in those who remained headache-free (p < .05 to p < .001). Together, these findings suggest that headache developed when participants overextended themselves during a stressful task, adopting an information processing style which impeded emotional adjustment to changing situational demands. Learning to modify perceptions of threat, and adopting a more flexible, less outcome-dependent processing style, might help to prevent headache from spiralling upward.


Psychological stress Negative affect Migraine Tension-type headache Efficacy expectancies 


Author contributions

JKMB collected the data, ran statistical analyses and wrote the first draft. PDD designed the study, ran statistical analyses and contributed to the manuscript.

Compliance with ethical standards

Conflict of interest

Juanita Berry and Peter Drummond declare that they have no conflict of interest.

Human and animal rights and informed consent

All procedures performed in this study involving human participants were in accordance with the National Statement on Ethical Conduct in Human Research in Australia, and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study.

Supplementary material

10865_2017_9872_MOESM1_ESM.docx (115 kb)
Supplementary material 1 (DOCX 114 kb)


  1. Andrews, N., Strong, J., & Meredith, P. (2015). Overactivity in chronic pain: Is it a valid construct? Pain, 156, 1991–2000.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Arntz, A., & Schmidt, A. (1989). Perceived control and the experience of pain. In A. Steptoe & A. Appels (Eds.), Stress, personal control and health (pp. 131–162). Chichester: Wiley.Google Scholar
  3. Bandura, A., O’Leary, A., Taylor, C. B., Gauthier, J., & Gossard, D. (1987). Perceived self-efficacy and pain control: Opioid and nonopioid mechanisms. Journal of Personality and Social Psychology, 53, 563–571.CrossRefPubMedGoogle Scholar
  4. Berry, J. K., & Drummond, P. D. (2014). Does attachment anxiety increase vulnerability to headache? Journal of Psychosomatic Research, 76, 113–120. doi: 10.1016/j.jpsychores.2013.11.018 CrossRefPubMedGoogle Scholar
  5. Brandtstadter, J., & Renner, G. (1990). Tenacious goal pursuit and flexible goal adjustment: Explication and age-related analysis of assimilative and accommodative strategies of coping. Psychology and Aging, 5, 58–67.CrossRefPubMedGoogle Scholar
  6. Breslau, N., & Rasmussen, B. K. (2001). The impact of migraine: Epidemiology, risk factors, and co-morbidities. Neurology, 56, S4–12.CrossRefPubMedGoogle Scholar
  7. Cathcart, S., Bhullar, N., Immink, M., Della Vedova, C., & Hayball, J. (2012). Pain sensitivity mediates the relationship between stress and headache intensity in chronic tension-type headache. Pain Research and Management, 17, 377–380.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Cathcart, S., Petkov, J., Winefield, A. H., Lushington, K., & Rolan, P. (2010). Central mechanisms of stress-induced headache. Cephalalgia, 30, 285–295. doi: 10.1111/j.1468-2982.2009.01917.x CrossRefPubMedGoogle Scholar
  9. De Benedittis, G., & Lorenzetti, A. (1992). The role of stressful life events in the persistence of primary headache: Major events vs. daily hassles. Pain, 51, 35–42.CrossRefPubMedGoogle Scholar
  10. de Ridder, D., & Kuijer, R. (2006). Managing immediate needs in the pursuit of health goals: The role of coping in self-regulation. In D. de Ridder & J. de Wit (Eds.), Self-regulation in health behavior (Chapter 7). Chichester: Wiley.CrossRefGoogle Scholar
  11. Di Sabato, F., Buonfiglio, M., & Mandillo, S. (2013). Analytic information processing style in migraineurs. Neurological Sciences, 34, 1145–1150. doi: 10.1007/s10072-012-1193-8 CrossRefPubMedGoogle Scholar
  12. Drummond, P. D. (1982). Extracranial and cardiovascular reactivity in migrainous subjects. Journal of Psychosomatic Research, 26, 317–331.CrossRefPubMedGoogle Scholar
  13. Drummond, P. D., & Granston, A. (2004). Facial pain increases nausea and headache during motion sickness in migraine sufferers. Brain, 127, 526–534. doi: 10.1093/brain/awh061 CrossRefPubMedGoogle Scholar
  14. Drummond, P. D., & Granston, A. (2005). Painful stimulation of the temple induces nausea, headache and extracranial vasodilation in migraine sufferers. Cephalalgia, 25, 16–22. doi: 10.1111/j.1468-2982.2004.00810.x CrossRefPubMedGoogle Scholar
  15. Drummond, P. D., & Passchier, J. (2006). Psychological mechanisms in migraine. In J. Olesen, P. Goadsby, N. Ramadan, P. Tfelt Hansen, & K. Welch (Eds.), The headaches (3rd ed., pp. 385–392). Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  16. Fernandez, E. (2002). Anxiety, depression and anger in pain: Research findings and clinical options. Dallas, TX: Advanced Psychological Resrouces.Google Scholar
  17. Fiedler, K. (2000). Towards an integrative account of affect and cognition phenomena using the BIAS computer algorithm. In J. P. Forgas (Ed.), Feeling and thinking: The role of affect and social cognition (pp. 163–185). Mahwah, NJ: Erlbaum.Google Scholar
  18. Fiedler, K. (2001). Affective influences on social information processing. In J. P. Forgas (Ed.), The handbook of affect and social cognition (pp. 163–185). Mahwah, NJ: Erlbaum.Google Scholar
  19. Fox, S. D., Flynn, E., & Allen, R. H. (2011). Mindfulness meditation for women with chronic pelvic pain: a pilot study. Journal of Reproductive Medicine, 56, 158–162.PubMedGoogle Scholar
  20. French, D. J., Holroyd, K. A., Pinell, C., Malinoski, P. T., O’Donnell, F., & Hill, K. R. (2000). Perceived self-efficacy and headache-related disability. Headache, 40, 647–656.CrossRefPubMedGoogle Scholar
  21. Frew, A. K., & Drummond, P. D. (2007). Negative affect, pain and sex: The role of endogenous opioids. Pain, 132, S77–S85. doi: 10.1016/j.pain.2007.04.010 CrossRefPubMedGoogle Scholar
  22. Frew, A. K., & Drummond, P. D. (2008). Stress-evoked opioid release inhibits pain in major depressive disorder. Pain, 139, 284–292. doi: 10.1016/j.pain.2008.04.022 CrossRefPubMedGoogle Scholar
  23. Harrigan, J. A., Kues, J. R., Ricks, D. F., & Smith, R. (1984). Moods that predict coming migraine headaches. Pain, 20, 385–396.CrossRefPubMedGoogle Scholar
  24. Headache Classification Committee of the International Headache Society. (2013). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia, 33, 629–808. doi: 10.1177/0333102413485658 CrossRefGoogle Scholar
  25. Hemper, K. (2008). Headache in adolescents: Prevention and complementary therapies.
  26. Houtveen, J. H., & Sorbi, M. J. (2013). Prodromal functioning of migraine patients relative to their interictal state—An ecological momentary assessment study. PLoS ONE, 8, e72827. doi: 10.1371/journal.pone.0072827 CrossRefPubMedPubMedCentralGoogle Scholar
  27. Kalman, B. A., & Grahn, R. E. (2004). Measuring salivary cortisol in the behavioral neuroscience laboratory. Journal of Undergraduate Neuroscience, 2, A41–A49.Google Scholar
  28. Karlson, C. W., Litzenburg, C. C., Sampilo, M. L., Rapoff, M. A., Connelly, M., Bickel, J. L., et al. (2013). Relationship between daily mood and migraine in children. Headache, 53, 1624–1634. doi: 10.1111/head.12215 CrossRefPubMedPubMedCentralGoogle Scholar
  29. Koolhaas, J., Bartolomucci, A., Buwalda, B., de Boer, S., Flügge, G., Korte, S., et al. (2011). Stress revisited: A critical evaluation of the stress concept. Neuroscience and Biobehavioral Reviews, 35, 1291–1301. doi: 10.1016/j.neubiorev.2011.02.003 CrossRefPubMedGoogle Scholar
  30. Leistad, R. B., Sand, T., Nilsen, K. B., Westgaard, R. H., & Stovner, L. J. (2007a). Cardiovascular responses to cognitive stress in patients with migraine and tension-type headache. BMC Neurology, 7, 23. doi: 10.1186/1471-2377-7-23 CrossRefPubMedPubMedCentralGoogle Scholar
  31. Leistad, R. B., Stovner, L. J., White, L. R., Nilsen, K. B., Westgaard, R. H., & Sand, T. (2007b). Noradrenaline and cortisol changes in response to low-grade cognitive stress differ in migraine and tension-type headache. The Journal of Headache and Pain, 8, 157–166. doi: 10.1007/s10194-007-0384-9 CrossRefPubMedPubMedCentralGoogle Scholar
  32. Leventhal, H., Brissette, I., & Leventhal, E. (2003). The common-sense model of self-regulation of health and illness. In L. Cameron & H. Leventhal (Eds.), The self-regulation of health and illness behaviour (pp. 42–65). Abingdon: Routledge.Google Scholar
  33. Lipton, R., Stewart, W., Diamond, S., Diamond, M., & Reed, M. (2001). Prevalence and burden of migraine in the United States: Data from the American Migraine Study II. Headache, 41, 646–657.CrossRefPubMedGoogle Scholar
  34. Marlowe, N. (1998). Self-efficacy moderates the impact of stressful events on headache. Headache, 38, 662–667. doi: 10.1046/j.1526-4610.1998.3809662.x CrossRefPubMedGoogle Scholar
  35. Martin, P. R. (2016). Stress and primary headache: Review of the research and clinical management. Current Pain and Headache Reports, 20, 45. doi: 10.1007/s11916-016-0576-6 CrossRefPubMedGoogle Scholar
  36. Martin, P. R., Nathan, P. R., Milech, D., & van Keppel, M. (1988). The relationship between headaches and mood. Behaviour Research and Therapy, 26, 353–356.CrossRefPubMedGoogle Scholar
  37. Martin, P. R., & Teoh, H. J. (1999). Effects of visual stimuli and a stressor on head pain. Headache, 39, 705–715.CrossRefPubMedGoogle Scholar
  38. Martin, P. R., & Theunissen, C. (1993). The role of life event stress, coping and social support in chronic headaches. Headache, 33, 301–306.CrossRefPubMedGoogle Scholar
  39. Massey, E. K., Garnefski, N., Gebhardt, W. A., & van der Leeden, R. (2009). Daily frustration, cognitive coping and coping efficacy in adolescent headache: A daily diary study. Headache, 49, 1198–1205. doi: 10.1111/j.1526-4610.2009.01492.x CrossRefPubMedGoogle Scholar
  40. McCaffrey, R. J., Goetsch, V. L., Robinson, J., & Isaac, W. (1986). Differential responsivity of the vasomotor response system to a “novel” stressor. Headache, 26, 240–242.CrossRefPubMedGoogle Scholar
  41. Montagna, P., Pierangeli, G., & Cortelli, P. (2010). The primary headaches as a reflection of genetic darwinian adaptive behavioral responses. Headache, 50, 273–289. doi: 10.1111/j.1526-4610.2009.01584.x CrossRefPubMedGoogle Scholar
  42. Noseda, R., Constandil, L., Bourgeais, L., Chalus, M., & Villanueva, L. (2010). Changes of meningeal excitability mediated by corticotrigeminal networks: A link for the endogenous modulation of migraine pain. Journal of Neuroscience, 30, 14420–14429. doi: 10.1523/JNEUROSCI.3025-10.2010 CrossRefPubMedGoogle Scholar
  43. Noseda, R., Kainz, V., Borsook, D., & Burstein, R. (2014). Neurochemical pathways that converge on thalamic trigeminovascular neurons: Potential substrate for modulation of migraine by sleep, food intake, stress and anxiety. PLoS ONE, 9, e103929. doi: 10.1371/journal.pone.0103929 CrossRefPubMedPubMedCentralGoogle Scholar
  44. Panksepp, J. (1998). Affective neuroscience: The foundations of human and animal emotions. Oxford: Oxford University Press.Google Scholar
  45. Passchier, J., van der Helm-Hylkema, H., & Orlebeke, J. F. (1984). Psychophysiological characteristics of migraine and tension headache patients. Differential effects of sex and pain state. Headache, 24, 131–139.CrossRefPubMedGoogle Scholar
  46. Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication and self-regulation. New York City, NY: W.W. Norton & Co.Google Scholar
  47. Price, D. (1999). Psychological mechanisms of pain and analgesia (Vol. 15). Seattle: IASP Press.Google Scholar
  48. Schoonan, G., Evers, D., Ballieux, B., Geus, E., de Kloet, E., Terwindt, G., et al. (2007). Is stress a trigger factor for migraine? Psychoneuroendocrinology, 32, 532–538.CrossRefGoogle Scholar
  49. Schramm, S., Moebus, S., Lehmann, N., Galli, U., Obermann, M., Bock, E., et al. (2015). The association between stress and headache: A longitudinal population-based study. Cephalalgia, 35, 853–863.CrossRefPubMedGoogle Scholar
  50. Shirtcliff, E. A., Granger, D. A., Schwartz, E., & Curran, M. J. (2001). Use of salivary biomarkers in biobehavioral research: Cotton-based sample collection methods can interfere with salivary immunoassay results. Psychoneuroendocrinology, 26, 165–173.CrossRefPubMedGoogle Scholar
  51. Siegel, D. J. (2012). Pocket guide to interpersonal neurobiology: An integrative handbook of the mind. NY: WW Norton.Google Scholar
  52. Smith, A. P. (2016). Acute tension-type headaches are associated with impaired cognitive function and more negative mood. Frontiers in Neurology. doi: 10.3389/fneur.2016.00042 Google Scholar
  53. Spierings, E. L., Ranke, A. H., & Honkoop, P. C. (2001). Precipitating and aggravating factors of migraine versus tension-type headache. Headache, 41, 554–558.CrossRefPubMedGoogle Scholar
  54. Spierings, E. L., Sorbi, M., Maassen, G. H., & Honkoop, P. C. (1997). Psychophysical precedents of migraine in relation to the time of onset of the headache: The migraine time line. Headache, 37, 217–220.CrossRefPubMedGoogle Scholar
  55. Stronks, D. L., Tulen, J. H., Verheij, R., Boomsma, F., Fekkes, D., Pepplinkhuizen, L., et al. (1998). Serotonergic, catecholaminergic, and cardiovascular reactions to mental stress in female migraine patients. A controlled study. Headache, 38, 270–280.CrossRefPubMedGoogle Scholar
  56. Viana, M., & Nappi, G. (2014). Chronobiological correlates of headache: Three decades on. Functional Neurology, 29, 213–214.PubMedPubMedCentralGoogle Scholar
  57. Villanueva, L. (2012). How does migraine attack stop? Headache, 52, 188. doi: 10.1111/j.1526-4610.2011.02079.x CrossRefPubMedGoogle Scholar
  58. Wiech, K., Ploner, M., & Tracey, I. (2008). Neurocognitive aspects of pain perception. Trends in Cognitive Sciences, 12, 306–313. doi: 10.1016/j.tics.2008.05.005 CrossRefPubMedGoogle Scholar
  59. Witkiewitz, K., & Marlatt, G. A. (2007). Modeling the complexity of post-treatment drinking: It’s a rocky road to relapse. Clinical Psychology Review, 27, 724–738. doi: 10.1016/j.cpr.2007.01.002 CrossRefPubMedPubMedCentralGoogle Scholar
  60. Wolff, H. (1963). Headache and other head pain (2nd ed.). New York, NY: Oxford University Press.Google Scholar
  61. Zautra, A. (2003). Emotions, stress and health. Oxford: Oxford University Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Juanita Kay Miller Berry
    • 1
  • Peter D. Drummond
    • 1
  1. 1.School of Psychology and Exercise ScienceMurdoch UniversityPerthAustralia

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