The Journal of Headache and Pain

Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

The Journal of Headache and Pain Cover Image

Volume 15 Supplement 1

Abstracts from the 4th European Headache and Migraine Trust International Congress: EHMTIC 2014

Open Access

EHMTI-0143. The association between stress and headache: a longitudinal population-based study

  • S Schramm1,
  • S Moebus1,
  • N Lehmann1,
  • U Galli2,
  • M Obermann3,
  • E Bock1,
  • MS Yoon4,
  • HC Diener3 and
  • Z Katsarava5
The Journal of Headache and Pain201415(Suppl 1):F23

Published: 18 September 2014


MigraineVisual Analogue ScaleStress IntensityPercent ChangeGeneralize Estimate Equation


Stress as a trigger for headache is often reported by patients.


We studied the association between stress intensity and headache frequency for tension type headache (TTH), migraine and migraine with coexisting TTH (MigTTH).


The German Headache Consortium studied a population-based sample of 5,159 participants (21-71years) who were asked every three months between March 2010 and April 2012 about headache and stress. Log-linear regression in the framework of Generalized Estimating Equations was used to estimate regression coefficients presented as percent changes to describe the association between stress intensity (visual analogue scale [VAS] from 0-100) and headache frequency (days/month) stratified by headache subtypes and age groups. Percent changes were adjusted for sex, age, frequent intake of acute pain drugs, drinking, smoking, body mass index and education.


TTH was reported in 31% participants (48.1±12.5years, 51.5% women, 2.2±3.9 mean headache days/month, 52.3±26.7 mean stress), migraine in 14% (44.8±11.3years, 73.3%, 4.5±5.2days/month, 62.4±23.3), MigTTH in 10.6% (43.5±11.5years, 61.0%, 3.6±4.8days/month, 58.6±24.1), 23.6% of respondents were unclassifiable, 20.8% had no headache. In participants with TTH an increase of 10 points on VAS was associated with an increase of headaches days/month of 6.0% (fully adjusted). Higher effects were observed in younger age-groups (21-30/31-40/41-50/51-60/61-71years: 9.8/10.2/7.0/6.5/3.5%). Similar effects, though slightly lower were observed for migraine (4.3%, 8.1/5.1/3.4/6.3/0.3%) and MigTTH (4.2%, 5.5/6.8/6.9/5.8/-0.7%).


Our study provides evidence for an association between stress intensity and headache frequency. Our findings are clinically important explaining that patients might benefit from psychological interventions for stress. The benefit might be higher in younger headache sufferers.

No conflict of interest.

Authors’ Affiliations

Institute for Medical Informatics Biometry and Epidemiology, University Hospital, Essen, Germany
Department of Psychology, Center for Psychotherapy University, Zurich, Switzerland
Department of Neurology, University Hospital, Essen, Germany
Department of Neurology, St. Joseph Hospital Ruhr-University, Bochum, Germany
Department of Neurology, Evangelisches Krankenhaus, Unna, Germany


© Schramm et al; licensee Springer. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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