Migraine disease is a chronic neurological condition that affects millions of people, and stress is one of its most well-known triggers. But what happens when the migraine attack comes not during stressful times, but afterward, when you’re finally trying to relax? This phenomenon is called a stress “let down” migraine attack, and it affects many who live with migraine disease.
Research has shown that relaxation after a period of high stress can actually trigger a migraine attack, making it feel like there’s no escape from the cycle of stress and pain. Learning to manage stress during its build up— and how to come down from it—can make a significant difference in preventing these types of attacks. In this article, we’ll break down what “let down” migraine attacks are, how they’re triggered, and the best ways to reduce their impact on your life.
** While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.
Understanding the Bucket Theory
The Bucket Theory offers a way to visualize the various factors that can trigger a migraine attack. By imagining these triggers and stressors as filling up a bucket, this concept helps illustrate how the cumulative impact of daily life can lead to an attack.
Each day begins with a bucket that’s already partially filled with things that irritate your migraine brain. The bucket doesn’t start empty because certain factors, like hormonal fluctuations, stress levels, or weather changes, are unavoidable. These elements may fill one-third or even two-thirds of the bucket before the day even starts.
As additional triggers—like food, drinks, and scents—enter the bucket, the level rises. Once the bucket overflows, a migraine attack follows. Understanding triggers can help reduce their overall impact, but it’s crucial to remember that migraine is a neurological disease, and attacks can occur even without a clear trigger. Managing stress and other factors can provide some relief, but migraine attacks are never the result of personal failure.
What Are Stress “Let Down” Migraine Attacks?
Imagine making it through a tough workweek or a particularly stressful period of life, only to be hit with a migraine attack as soon as you start to unwind. That’s the essence of a stress “let down” migraine attack. These attacks tend to strike when the brain is transitioning from a heightened state of stress to a more relaxed one.
A study conducted at the Montefiore Headache Center and Albert Einstein College of Medicine tracked 17 people with migraine over three months and found a striking pattern: the risk of migraine attacks significantly increased within the first six hours after stress levels dropped. In fact, participants were nearly five times more likely to have a migraine attack during this “let down” period than at other times. (1)
This pattern can feel particularly frustrating because it’s happening during a time when you expect to feel better—not worse. Many of us live in a constant state of stress, so when we finally get a break, the brain’s response can be to trigger a migraine attack as a result of the sharp contrast in stress levels.
My most reliable stress let down attack would begin the day after we left for family vacation. The stress and excitement of planning and packing for vacation would inevitably fade away and a stress let down attack would occur. Figuring out how to avoid this attack, and others like it, became a long term goal.
The Link Between Stress and Migraine Attacks
Stress has long been identified as a major migraine trigger. What makes it even more complicated is that the relationship between stress and migraine attacks is cyclical. Stress can cause a migraine attack, and the pain and disruption of an attack can increase stress levels, creating a vicious cycle.
But there’s another layer to this: when stress levels drop rapidly—such as when you leave work on a Friday afternoon or start your long-awaited vacation—the brain’s response to that relaxation can also cause a migraine attack. Researchers believe that the hormone cortisol may play a role here. Cortisol is produced in response to stress, and it helps the body manage pain. When stress levels fall and cortisol levels drop quickly, the body’s pain threshold may lower, triggering a migraine attack. (1)
In some cases, even positive stress, like the excitement of a happy event or celebration, can set off a migraine attack. This is why stress management is so crucial for people living with migraine disease—keeping stress levels consistent, rather than fluctuating dramatically, can help reduce the risk of both stress-induced and “let down” migraine attacks.
How to Prevent and Manage “Let Down” Migraine Attacks
Managing stress and finding ways to smooth out transitions between stress and relaxation are key to preventing stress “let down” migraine attacks. Here are some strategies to help you maintain balance and reduce the frequency of these attacks:
1. Consistency is Key
One of the most important things you can do for a migraine-prone brain is to maintain consistency. Routine is crucial for preventing attacks, especially when it comes to things like sleep, meals, and hydration.
- Stick to regular sleep and wake times: A stable sleep schedule helps regulate your body’s circadian rhythms, which are closely linked to migraine patterns.
- Stay hydrated and eat regularly: Skipping meals or becoming dehydrated can trigger migraine attacks, so be sure to drink enough water throughout the day and eat at consistent intervals. This consistency with meals can help to regulate blood sugar levels which can help prevent attacks triggered by a drop in blood glucose.
- Keep caffeine consistent: If you consume caffeine, keep the amount you drink and the time of day consistent. The migraine brain craves consistency.
- Practice good sleep hygiene: Avoid screens before bed, keep your sleep environment cool and dark, and develop a relaxing pre-sleep routine to help your brain wind down gently. The Allay Lamp has also been shown to improve sleep quality and reduce anxiety. (2)
2. Manage Stress Before It Peaks
Rather than waiting for stress to reach overwhelming levels, aim to manage it throughout the day. This can prevent the kind of high-stress periods that lead to sudden, sharp drops in stress—and the “let down” migraine attacks that often follow. (1)
- Take short breaks during stressful periods: Even just a few minutes of deep breathing or a quick walk around the block can help keep stress levels in check. These are quick techniques that seem too simple, but can provide tremendous stress reduction in a very short amount of time.
- Practice mindfulness and relaxation techniques: Techniques like deep breathing, meditation, or yoga can help you manage stress as it happens, instead of letting it build up. Tai Chi is a combination of meditation and movement that has proven to alleviate stress and improve sleep quality. (3)
3. Prioritize and Protect Your Time
Your time is valuable, and learning how to protect it is crucial for reducing stress. Here are some ways to manage your time in a way that lowers your stress levels and could help to prevent stress related migraine attacks:
- Create a priority list: Write down what’s most important to you and focus on those tasks. Eliminate or delegate things that don’t need your attention.
- Schedule breaks for self-care: Block out time each day to focus on yourself, whether it’s a walk, a hobby, or just a few moments of quiet relaxation.
- Learn to say no: Reducing obligations that don’t serve your well-being is an important step in managing stress.
- Plan ahead: Use time management strategies to reduce procrastination tendencies and limit last minute stress due to approaching deadlines. (For me, start packing a week early for vacation!)
4. Maintain Relationships and Connection
Social connections can be a powerful tool in managing stress. Regularly engaging with people who support and uplift you can reduce feelings of isolation and help you navigate life with migraine.
- Prioritize “together time”: Spending time with loved ones, whether through conversation or shared activities, can reduce stress and provide emotional support.
- Engage in fun activities: Doing things you enjoy with others can lift your mood and lower your stress levels, helping to keep migraine attacks at bay.
5. Exercise Regularly, But Gently
Physical activity can be an effective way to manage stress and improve overall health. It’s important, however, to find an exercise routine that doesn’t trigger your migraine attacks.
- Incorporate low-impact activities: Walking, yoga, Tai Chi or stretching are great options that can help reduce stress without triggering an attack.
- Consistency is more important than intensity: Aim for 30 minutes of movement, five days a week, but listen to your body and choose activities that make you feel good.
- Increase activity level slowly: Increase the intensity and frequency of movement gradually to ensure better tolerance.
6. Tackle Anxiety Head-On
Living with the constant worry of when the next migraine attack will come can be stressful in itself. It’s important to find ways to reduce the anxiety of uncertainty so it doesn’t become another trigger.
- Mindfulness and cognitive behavioral therapy (CBT): These techniques can help you manage the fear and uncertainty that often accompany chronic migraine. They focus on changing thought patterns and behaviors to reduce stress and anxiety.
- Focus on what you can control: While you can’t always control when a migraine attack will strike, you can control how you respond to stress and how you prepare your body for relaxation.
Breaking the Cycle of Stress and Migraine Attacks
The relationship between stress and migraine attacks can be complex, but understanding how “let down” attacks happen gives you more tools to manage them. By building consistency into your daily routine, managing stress before it peaks, and incorporating relaxation and mindfulness into your life, you can reduce the likelihood of stress-related and “let down” migraine attacks.
It’s important to remember that everyone’s migraine experience is different. What works for one person may not work for another, so it’s essential to experiment with different strategies and find what works best for you. With the right tools, you can manage stress, prevent “let down” migraine attacks, and live a life with fewer attacks interrupting your plans.
Taking small steps toward better stress management won’t eliminate migraine attacks completely, but it can make a big difference in reducing their frequency and intensity. Your brain thrives on routine, so the more balanced and steady your life can be, the better chance you have at minimizing the disruption of “let down” migraine attacks.
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Many years ago, I was recovering from the stress of a major car wreck, injury and post-traumatic stress. Taking a week away and having a date with my husband, I experienced a hemiplegic migraine, losing my entire left side for about 20 mins. It’s a real thing!!