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The Relationship Between Headaches and Stress

With over two decades of experience in medicine, Melissa Flagg writes patient education articles, keeping you informed about your health.


The Vast Effects of Prolonged Stress

Stress can cause all sorts of problems with our health. Prolonged stress can lead to diseases such as diabetes, high blood pressure, anxiety, and depression. It has also been linked with cancer and heart disease. So, it should come as no surprise that headaches and stress go hand in hand.

What Is a Headache?

A headache, known by the medical term cephalalgia, is pain located in the head or neck area, but not all headaches are created equal. There are several different types of headaches, and they are typically classified into two different categories:

  • Primary
  • Secondary

The primary category of headaches includes tension headaches, migraines, and cluster headaches, as well as a number of uncommon headache types. Cranial neuralgias and facial pain are also a part of the primary headache category and can be extremely painful. Facial pain can be caused by a number of different problems, including trigeminal neuralgia. Cranial neuralgias include:

  • Trigeminal neuralgia (the main cause of facial pain)
  • Occipital neuralgia

Secondary headaches are caused by an underlying disease or another problem, such as injury to the head or neck. These can include (but are not limited to):

  • Cough headaches
  • Exercise headaches
  • Sex headaches
  • Hypnic headaches

As you may have guessed, stress is a factor in only a few of these headaches. Cough, exercise, and sex headaches have specific causes, as their name suggests. Primary headaches such as migraines, tension, and cluster headaches can be caused by stress, but they can also be triggered by other factors. For example, migraines can be caused by fluctuating hormones or triggered by environmental influences.

Stress will typically exacerbate any headache or condition that causes a headache. This is the case with neuralgias. Occipital neuralgia, especially, is exacerbated by the effects stress has on our neck muscles.

The trapezius muscle viewed from the back

The trapezius muscle viewed from the back

Stress and Tension-Type Headaches

Stress can cause headaches in a number of different ways. The most common, tension headaches, account for approximately 90% of all primary headaches.

The most common culprit is spasms in the neck muscles, specifically the trapezius. This muscle connects the shoulder to the base of the skull and is responsible for the majority of tension headaches and occipital neuralgias. However, most people don’t know that it can also trigger a migraine.

When the trapezius muscle is in spasm, the muscle pulls down on the skull causing compression of the cervical vertebrae, specifically C1, C2, and C3. When these vertebrae are compressed, pressure is put on the surrounding nerves, and the flow of cerebrospinal fluid (CSF) is drastically reduced.

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The lack of CSF to the brain can cause an excruciating headache or migraine due to the reduction in serotonin levels the lack of CSF causes. This is a similar phenomenon to that of post-lumbar puncture headaches or severe head pain that occurs after a spinal tap (tapping the spinal cord and taking a sample of the cerebrospinal fluid).

Tension-type headaches can be chronic in nature and occur in approximately 3% of the population. They are caused by chronic spasm of the trapezius and other muscles of the head and neck that become myofascial trigger points, or knots, after long periods.

Tension-Type Headache Pain and Symptoms

Tension-type headaches are bilateral (on both sides of the head), unlike migraines which are typically unilateral (only on one side of the head).

The pain often feels like a constant pressure sensation encompassing the entire head. Many people say it feels as if their head were in a vice. The pain can vary from mild to severe.

The frequency of tension-type headaches can be episodic (less than 15 days a month) or chronic (more than 15 days a month for six months or more). Their duration can last anywhere from minutes to weeks. The typical length of a tension headache is about four to six hours. Lying down can alleviate some of the pain and, sometimes, alleviate the headache entirely.

Tension headaches are not usually associated with sensitivity to light or sound, or nausea and vomiting, which are symptoms usually associated with migraines. But these symptoms can occur with tension headaches.

Occipital Neuralgia

Occipital neuralgia can also be called C2 neuralgia in reference to the vertebra that causes the disorder. It is characterized by chronic pain located behind the eyes, the upper neck and the back of the head. The pain is caused by damage to the occipital nerves, which usually occurs due to trauma.

The spine showing the cervical (neck), thoracic (mid back) and lumbar (lower back) portions of the spine

The spine showing the cervical (neck), thoracic (mid back) and lumbar (lower back) portions of the spine

I actually have personal experience with this type of headache. Due to a neck injury I sustained 13 years ago, I have had chronic, almost daily, migraines.

My trapezius muscles are in full of knots, and this has led to permanent damage to the structure of my neck, including levoscoliosis (irregular curvature of the cervical vertebrae to the left), degenerative disc disease, and osteophytes (bone spurs).

The resulting compression puts pressure on the occipital nerve, causing a headache and sometimes a migraine.

Stress often exacerbates occipital neuralgia because the occipital nerve passes through the trapezius muscle and ascends through the C2 vertebra.

The tenser a person becomes, the tighter the trapezius muscle gets and the more pressure that's put on the occipital nerve. Lying down tends to alleviate the neck pain, but sleeping for four or more hours or taking anti-inflammatory medications will alleviate the headache.

Stress, Headaches, and Other Health Problems

Stress can cause a number of other health problems which can lead to secondary headaches. Stress has been known to cause:

  • High blood pressure
  • Cardiovascular disease
  • Obesity
  • Anxiety
  • Depression
  • Insomnia

One of the symptoms of high blood pressure, which can be caused by chronic stress, is a headache located at the back of the head that usually occurs upon waking. But headaches themselves can actually cause hypertension. (It’s not unusual for pain of any type to cause an increase in an individual’s blood pressure).

This can lead to a vicious cycle in which stress causes a headache, which causes an increase in blood pressure, which causes a secondary headache the next morning, and then the cycle repeats itself.

Many people console themselves by eating when they are under a great deal of stress. This can lead to obesity rather quickly. Obesity can also cause headaches, mainly because of the other health problems it can cause, such as diabetes and hypertension.

One of the symptoms of diabetes is headaches. They are related to the high sugar levels in the bloodstream. Interestingly, there is a theory that stress can also cause diabetes, although there is not much evidence to support this. However, we do know that cortisol levels can cause diabetes.

For example, in patients with Cushing’s syndrome, the body produces too much cortisol because of either a pituitary or adrenal adenoma. Cortisol causes the retention of visceral fat, or fat surrounding the organs, which increases the risk of diabetes. It’s not a far stretch to conclude that high cortisol levels in any individual will have the same effects, and increased cortisol levels are a natural response to stress.

Suffering from chronic stress has significant repercussions on our health, and headaches can be an early warning sign. If you notice a sudden increase in your headaches or a change in the severity or duration of your headaches, contact your doctor right away and let them know. It’s easier to stop the progression of occipital neuralgia or tension-related headaches than it is to fix it once it’s a full-blown problem.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2012 Mel Flagg COA OSC


Darolyn Drewett on December 04, 2018:

I have those c2c3 and c4 herniated disc in my neck.I also have severe chronic migraine,I wake up Every single morning with one.Imatrex eases my pain and I take one loratab for neck pain..For some Reason I do believe they are connected,but my insurance want pay to have neck fixed.So I'm in extreme pain that never stops..I've applied for my disability because I have no choice,I can't work and I'm single.I pray I get some help trying to make it on my own,with no job and severe pain ,always...I feel if I could get the surgery it might help with the every single day,I do believe I will always be a migrainer,but maybe not as intense...Thank you for listening.

Mel Flagg COA OSC (author) from Rural Central Florida on December 02, 2012:

@effer lmao love the pun... I know what you mean though. There is so much research out there now on headaches it's hard to keep everything straight, and keep up on it. Like everything else, if you don't use it, you lose it. I've found writing about it helps reinforce it. Plus it has the added benefit of making uncommon information readily available. With all my health hubs I try to provide all the information including the tiny details that doctors tend to leave out (like occipital neuralgia headaches... only one doctor told me what I actually had). So thank you for the kind compliment!! :D

Mel Flagg COA OSC (author) from Rural Central Florida on December 02, 2012:

@kitty I'm so glad you stopped by! I haven't had a chance to read your stuff lately either, but I've bookmarked all of your recent work in my "to read" list. We're hanging in there, since hubby was injured on the job, things have spiraled out of control it seems. I've been posting updates on my blog (too much to list here). Needless to say, I've been writing almost 24/7 just to keep the lights on. Although I hope to get the yule tree up soon, especially since this Yule is extremely special with the whole 12/21/2012 thing :D

How about you? Brightest blessings!

Mel Flagg COA OSC (author) from Rural Central Florida on December 02, 2012:

@tillsontitan Trigeminal neuralgia is horrible. I've had so many patients come to the office with it, and you can just see how painful it is in their eyes. So sorry you have to deal with it. But like you said once you find the right combination of medication, you can almost forget it's there.

Suzie from Carson City on November 30, 2012:

DoM.....At one time, I actually had all of this info stored in my head (no pun intended) due to the fact that I did some massive research on "headaches." It is always good to read a refresher, especially as well-written and educational as this one.

Headaches are soooo common anymore. I think 8 in 10 people I know, suffer from some form of headache, at least monthly. It's very important for all to know and understand what you have presented here.

Thank so much, DoM... Your health hubs, rock!...UP+++

Kitty Fields from Summerland on November 28, 2012:

Wow, great lay-out and article. Haven't visited your page in awhile, but was happy to see all of your hubs on medical ailments, etc. How's everything going? Preparing for the holidays? Blessings, love.

Mary Craig from New York on November 28, 2012:

This is very comprehensive Maat! Lots of good information and phsyiology. I know first hand about Trigeminal neuralgia and can attest to it being very painful. Once managed with medication you almost forget you have it, almost.

Stress is definitely a one way or another! Years ago they called it "nerves" but by whatever name, it can really get you down.

Voted up, useful, and interesting.

Mel Flagg COA OSC (author) from Rural Central Florida on November 28, 2012:

@seeker, cold compresses on the back of the neck work really well for several reasons. The coldness decreases the inflammation in the muscles and relaxes them which releases the compression, and it also cools the blood entering the brain causing the blood vessels to constrict and raise serotonin levels. :D

Mel Flagg COA OSC (author) from Rural Central Florida on November 28, 2012:

@denise, I know exactly how you feel. I've found it's a relief to know there really is a reason for the headaches.

Helen Murphy Howell from Fife, Scotland on November 28, 2012:

This is an excellent hub and I didn't realise there were so many different forms of headache.

I suffer from tension headaches on occasion and they can be very painful. Sometimes I've found putting a cold compress on the back of my neck has actually stopped the headache immediately. At other times it doesn't work so well. It's then a case of taking the pain killers and putting up with it until it passes.

An excellent and very informative hub. Voted up + shared!!

Denise W Anderson from Bismarck, North Dakota on November 28, 2012:

I never really understood the anatomy of my headaches, but this information definitely makes sense. When I am stressed, my shoulders tense, and the pain in my neck and head follows like clockwork. Relaxing my shoulders usually makes the pain go down, and keeps the headache at bay.

Mel Flagg COA OSC (author) from Rural Central Florida on November 28, 2012:

@Billybuc, Sure go ahead and rub it in that you don't have any stress lol just kidding! I had seen Rajan's hub on the feed, but I haven't had a chance to read it yet. But, I definitely need to

Mel Flagg COA OSC (author) from Rural Central Florida on November 28, 2012:

@lovedoctor26 Thank you, yes those hot patches are wonderful for relaxing my neck muscles. They have helped prevent quite a few headaches!

Bill Holland from Olympia, WA on November 27, 2012:

Very useful information my friend! I am lucky in that I rarely get headaches; of course, I rarely have stress, so there you go.

Rajan had a great hub today about pressure points used for headaches, in case you haven't seen it.

lovedoctor926 on November 27, 2012:

Thank you for this useful information. This is a great presentation with good visuals. I get migraines on one side of my forehead and around the eye area. Sometimes I get headaches for an entire week. There are icy hot patches or cream that you can put on the back of your neck and forehead. they provide relief.

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