Associations between stress and migraine and tension-type headache: Results from a school-based study in adolescents from grammar schools in Germany

Introduction: Stress is considered the major contributor to
migraine and tension-type headache in adolescents. Previous studies
have focused on general stressors, whereas the aim of the present
study was to investigate associations between individuals’
stressful experiences and different types of headache. Methods:
Adolescents from 10th and 11th grades of grammar schools filled in
questionnaires. Stressful experiences were measured with the Trier
Inventory of Chronic Stress. Type of headache was classified
according to the International Classification of Headache
Disorders. Linear regressions, adjusted for sex and grade, were
calculated to estimate differences in stress scores that can be
attributed to migraine, tension-type headache or miscellaneous
headache. Results: A total of 1260 questionnaires were analysed.
Tension-type headache, migraine and co-existing migraine plus
tension-type headache were found in 48.7%, 10.2% and 19.8% of the
participants. In subjects with migraine or co-existing migraine
plus tension-type headache, high increases in stress scores were
found in all investigated dimensions, whereas much weaker and
inconsistent associations were found in subjects with tension-type
headache only. Conclusions: The characteristic of migraine is more
associated with stressful experiences than this is the case for
tensiontype headache. This suggests that adolescent migraine
patients might specially benefit from behavioural interventions
regarding stress.