Cognitive or daily stress association with headache and pain induction in migraine and tension-type headache patients: a systematic review

ABSTRACT

Introduction

Primary headache disorders, such as migraine and tension-type headache (TTH), represent a significant public health concern. Besides, cognitive/mental stress was suggested to contribute to TTH and migraine physiopathology. Thus, this study aimed to evaluate the existence of a causal relationship between stress (mental/cognitive or daily stress) and headache or pain improvement in migraine and TTH patients.

Areas Covered

We developed a systematic review of the literature, including studies that utilized mental/cognitive stress tasks or daily stress by lifestyle questionnaire in migraine and TTH patients. Necessarily, these studies should have healthy patients and a pain measure (quantitative sensory tests or headache/migraine detection). PubMed, EMBASE, and SCOPUS were searched, using terms about stress and primary headaches.

Expert opinion

Both mental/cognitive stress and daily stress (perceived) were related to an increase in pain perception and related to the development of headache or enhanced transient pain intensity in migraine and TTH patients. Different factors could enrich the comprehension of the influence of stress on pain/headache induction in migraine and TTH patients, including methodological standardization, consistency of assessing, and isolating the many headache triggers in randomized controlled trial studies.

KEYWORDS:

• daily hassles
• headache frequency
• mental stress
• pain
• quantitative sensory tests

Declaration of interests

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• This study provides the first qualitative synthesis of a causal relationship among mental/cognitive or daily stress with pain measures observed in migraine and TTH.

• Even using different groups of patients (CTH, TTH, migraine, and MigTTH), both mental/cognitive task induction or daily stress enhancement seem to have a relationship to higher pain and headache levels.

• Enhancing methodological standardization, consistency of assessing, and isolating the many headache triggers in randomized controlled trial studies would enrich the comprehension of the influence of stress on pain/headache improvement in migraine and TTH patients.

Data availability

The data that support the findings of this study are available from the senior author ([email protected]) upon reasonable request.

Additional information

Funding

Fellowships from the Conselho Nacional de Desenvolvimento Científico (CNPq) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) are also acknowledged. F.T.V. and P.R. are recipients of a fellowship CAPES [#88887.501615/2020-00] and G.T. is a recipient of a fellowship from CNPq [process #303531/2020-7].