I Had Headaches All the Time in Quarantine. So I Asked Doctors Why
Does stress cause headaches? My headaches increased during quarantine, so I asked headache medicine specialists the reason why—and what I should do about it. As it turns out, this type of stress-induced pain is pretty common.
To say 2020 has been stressful is an understatement. From the global pandemic to massive protests and marches against racial injustice across the world, it’s safe to say that for most people it has been a challenge to maintain physical and mental health.
When New York City (where I live) went into a shelter-in-place mode in March, I could already feel the side effects of a new way of life. Since then, I’ve gotten headaches more frequently than ever.
Sometimes they’ve been manageable enough that I don’t have to pop a pain reliever and other times it distracts me from my work so much that I need something to ease the discomfort. Thinking the stress and added screen time surely had something to do with it, I figured I wasn’t alone in my newfound headache problem. As it turns out, this type of stress-induced pain is pretty common.
How common are headaches?
In general, about one-half to three-quarters of adults across the globe, ages 18 to 65, have had a headache in the last year, and about 30 percent of those were migraines, according to the World Health Organization. Up to 4 percent of the population also experiences headaches 15 or more days of each month. Migraines are three times more common in women than in men. Migraines, in particular, are also the third-most-prevalent disorder worldwide.
So how does stress factor into all these statistics? I asked a few experts to explain the connection and offer strategies for controlling the discomfort.
Why does stress lead to headaches?
“We know that migraines are really influenced by changes in hormones, especially the stress hormone cortisol, as well as estrogen, so fluctuations [in those hormones] can trigger a migraine attack,” says Mia T. Minen, MD, MPH, headache medicine specialist at NYU Langone Medical Center in New York City, who has studied the link between migraines and psychiatric conditions like depression, anxiety, and post-traumatic stress disorder.
While heightened stress can change cortisol levels (and may, therefore, lead to headaches), so can a sudden drop in cortisol levels, say when you take a vacation or actually take time to unwind, Dr. Minen says.
Similarly, anxiety plays a role in triggering headaches, Dr. Minen says, and headaches can also trigger anxiety. (Check out the other common things that can trigger anxiety.)
Certain neurotransmitters—chemical messengers in the brain that include serotonin, epinephrine, and dopamine—are also involved in both headaches and mental health conditions like depression, Dr. Minen says. The firing of these neurotransmitters may play a role in triggering head pain.
In stressful times, some people also tend to grind teeth or clench their jaw, which can also lead to headaches. Talking to your dentist about this is probably your best bet for a fix, as they can offer a night guard to help curb the grinding, Dr. Minen says.
Frederica B. Angel, MD, assistant professor of clinical medicine at Vanderbilt Health in Nashville, says that muscle tension in the head, neck, and shoulders—which can stem from stress, but also staring down at a screen—can also increase the risk of headaches. Plus, having a furrowed brow or clenched jaw for an extended period of time might lead to some discomfort too, she says. (Here’s what doctors want you to know about TMJ disorder.)
PhotoAlto/Frederic Cirou/Getty ImagesShould I know what kind of headache I’m having?
There are several kinds of headaches, like tension-type, migraine, or cluster headaches. (Here’s exactly how to tell the difference in headache type.) But many headaches happen on a spectrum, says Paul Dash, MD, assistant professor of neurology at the University of Maryland School of Medicine and headache specialist at the University of Maryland Medical Center Midtown Campus.
A migraine usually comes with severe pain and other symptoms like sensitivity to light, noise, and sometimes nausea. These are often also debilitating and can keep people from working or participating in daily activities.
Tension-type headaches are generally milder, with no sensitivity to light.
What’s more important than distinguishing what type of headache you have is determining how it’s affecting your daily life and ability to function, Dr. Dash says. If you need help figuring out if you should talk to a doctor and ask about medications or other treatments, Dr. Dash suggests rating your headache each night on a scale of 0 to 4.
Zero means no headache, level 1 is a nagging headache but no need for medication, level 2 is a headache that’s bad enough that you need meds, 3 means it’s disabling, and 4 is so bad that you have to go to urgent care or the ER.
“Over the course of a month, people can sum up how many days they have in level 0, 2, 3, 4. And see a snapshot of what their headache burden was and then use those numbers to track interventions for their headaches,” he says. It could be a key tool to take to your doctor to figure out next steps.
How can I deal with stress to lower risk of headaches?
Stress reduction plays an important part in preventing and treating headaches. Some of the best ways to address stress-related problems are with cognitive behavioral therapy (a type of therapy that focuses on identifying and changing negative thoughts), progressive muscle relaxation techniques (focusing on relaxing different muscle groups), and biofeedback.
“Those three modalities help target pathways of the central nervous systems to reduce headache days,” Dr. Minen says. You’ll get a benefit from each one of those practices, but the most advantages come from combining them, she adds. Dr. Minen recently studied the use of progressive muscle relaxation via an app and found that those who used it twice a week had four fewer headache days per month.
New research also found that yoga specifically works as a complement to medications for managing migraines. Mindfulness meditation and tai chi may also help prevent headaches, experts say. And science also points out the benefits of regular aerobic exercise as a way to reduce tension-type headaches and control migraines, including their frequency, intensity, and duration. (Try this 10-minute yoga routine you can do every day.)
Acharaporn Kamornboonyarush / EyeEm/Getty Images
Can other lifestyle changes help reduce headache risk?
Sleep also plays an important role in headache relief, so make sure you’re getting those coveted seven hours and have a regular sleep schedule, Dr. Minen says. That means going to bed and waking up at the same time each day. Laying off of caffeine and alcohol before bed can also help improve sleep quality, Angel says, as will avoiding the news at night or any form of social media before bedtime. Check out the habits that could be ruining your sleep.
Most experts also suggest focusing on hydration, eating at regular times, and maintaining a regular exercise schedule. Angel recommends holding a warm compress on the neck or shoulders to help to release some tension, too. And Dr. Dash mentions some vitamins like riboflavin, magnesium, or vitamin B12 might help reduce head pain.
“For most people, their schedules are completely distorted [right now], so be mindful of the fact that routine is disrupted and evaluate potential changes in sleep, eating, and hydration,” Dr. Minen says. Then consider where you can make some changes. Just keep in mind that focusing on stress management should be a part of those changes: “Taking time out of your day to do relaxation exercises and just calm down and try to detach from the situation may help prevent stress from causing headaches,” Dr. Dash says.
Any other ways to treat headaches?
Of course, medications are also an option. Besides over-the-counter pain relievers, doctors can write prescriptions for medicines that can prevent or treat frequent headaches, particularly migraines. Medicines that affect serotonin, anti-nausea medicines, or those that address blood pressure, as well as anti-seizure, or anti-depressants can all help with migraines, Dr. Minen says. But the best form of treatment is a combination of medication and behavior therapy, like those stress-relieving tactics mentioned above, she says.
You definitely want to talk to your doctor if you’re feeling a new type of headache (say it’s in a different spot), you have a history of cancer, HIV, or you’re waking up with a headache every morning, or your headaches aren’t responding to medications, Dr. Minen says, as those are all red flags that you need care. Don’t be afraid to talk to your doctor if you have concerns. Read the 15 signs your headache could be more serious.
- World Health Organization: "Headache Disorders."
- The American Journal of Medicine: "Headache."
- Mia T. Minen, MD, MPH, headache medicine specialist at NYU Langone Medical Center in New York City.
- Frederica B. Angel, MD, assistant professor of clinical medicine at Vanderbilt Health in Nashville.
- Paul Dash, MD, assistant professor of neurology at the University of Maryland School of Medicine and headache specialist at the University of Maryland Medical Center Midtown Campus.
- Nature Partner Journals Digital Medicine: "Smartphone-based migraine behavioral therapy: a single-arm study with assessment of mental health predictors."
- Neurology:. "Effect of yoga as add-on therapy in migraine."
- Cephalalgia: "The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain. A randomized, controlled, clinical trial."