Talk About a Let-Down: Why Migraine Sometimes Happens After Reducing Stress

Changes in hormone levels, muscle tension, and disrupted sleep are some of the possible reasons for let-down migraine attacks, and reducing these triggers are among the ways to avoid them.

We still don’t know what causes migraine. However, people may have specific triggers, like food, light and sound sensitivity, and stress. The last one, stress, is the most commonly reported trigger. A 2021 review suggested that 80% of people who reported having known migraine triggers reported stress as one.

Unsurprisingly, reducing stress is an oft-given piece of advice for avoiding a migraine episode. Yet, sometimes there is stress we can’t avoid. Perhaps you worked hard to create an important work presentation (and nailed it!). Or maybe you hosted a large dinner party for friends.

And then? Once you’ve accomplished your goal and had a chance to relax you feel a migraine coming on.

What? Why? How? Let’s start with what.

“Migraine often occurs not only during stress but also in the relaxation phase afterward, known as a let-down migraine,” says Emad Noor, MD, a neurologist.

Science is still trying to catch up with the “why” and “how” behind stress let-down migraine episodes — along with whether they even occur at all. However, it’s possible to reduce your odds of experiencing a migraine after a tense period, and lowering and managing your response to stressful events is one of the important ways to do that.

These are the theories on why stress let-down migraine might happen and ways to prevent one.

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Stress let-down migraine: What it is and why it happens

“A let-down headache is a type of headache that occurs after a period of stress or heightened activity has subsided,” Noor says. “These headaches often emerge when the body transitions from a state of high stress to relaxation.”

Sometimes, these attacks are referred to as “weekend” or “honeymoon” migraine because they happen after stressful events (a work or school week or wedding planning/jitters). 

A small, older study of 22 people from 2014 suggested that a drop in stress from one day to the next was linked to a higher chance of a migraine attack. However, the aforementioned 2021 review indicated that the limited research is mixed.

Noor says characteristics of migraine that might be linked with stress let-down include:

• Timing: These episodes happen after a stressful period, like exams, work deadlines, or intense physical exercise.
• Symptoms: Dull, throbbing, and pressure-like pain with potential light and sound sensitivity — much like a migraine with another trigger.
• Trigger: “The relaxation or let-down period itself seems to be the trigger, as the body’s stress management system adjusts,” Noor says.

There isn’t a definitive answer to why relaxation can trigger the migraine — or if it does — but there are several theories.

Hormones

Stress can prompt a person to enter “fight or flight” mode as the body releases cortisol. The increase in cortisol could trigger a migraine.

“During periods of heightened stress, the body releases stress hormones like cortisol and adrenaline, which can influence blood vessel activity, pain sensitivity, and inflammation, potentially triggering a migraine,” Noor says.

Reducing these stress levels is essential and may help lower the odds of experiencing a migraine. Yet, sometimes, you might wind up with one anyway.

“Interestingly, in let-down headaches, it may be changes in cortisol and other stress hormones that can trigger the headache,” says Alex Dimitriu, MD, a psychiatrist and sleep medicine specialist.

Noor says the changes in hormone levels cause the body to recalibrate and may trigger the episode.

Migraine triggers and management

Self-care can fall by the wayside during high-stress periods, whether you’re trying to meet a deadline at work or grappling with grief after losing a loved one. With your mind on other stressors, you may forget to practice migraine hygiene.

“Stress can cause muscle tension, increased reactivity, and impaired sleep, all of which can be triggers for headaches,” Dimitriu says.

A person may also skip meals, become dehydrated, and forget to take preventive migraine medications when they’re stressed, says Dharti Dua, MD, a neurology and headache specialist. 

Missed signals

The post-stress relaxation (or let-down) may not have triggered the migraine at all. Instead, it’s possible the migraine was already developing because of the stress.

“It is also possible that stress led to an increased incidence of migraine, and the person was experiencing a migraine prodrome [the first stage of a migraine that can happen days or hours before an episode] all along,” Dua says.

Understandably, you may not have noticed the symptoms because you were so busy and stressed.

Avoiding stress let-down migraine

It’s unclear whether the relaxation period after a stressful event actually triggers a migraine, but it might. And Noor says that the steps to lowering your odds of developing one can, more generally, make it less likely that you have a migraine attack period — regardless of the trigger — and build stress resilience in the process.

The neurologists shared their top tips to reduce the roller coaster of high stress to relaxation.

Exercise

Dua says exercising for 30 minutes daily, multiple times weekly, might lower migraine frequency and severity.

Noor emphasizes that the movement doesn’t have to be strenuous.

“Gentle daily routines like yoga and tai chi can smooth the shift from stress to relaxation,” Noor says. It’s important to do what you can to stick with those routines, even during higher stress periods.

Sleep

Poor sleep is associated with higher levels of stress and migraine, so consistently logging enough Zzz’s can lower your risk of both (and any potential “let-down” headaches).

“Prioritize regular, restorative sleep,” Noor says. “Aim for 7 to 9 hours of quality sleep per night with consistent bedtimes and wake times, even on weekends. Poor sleep or drastic changes in your schedule can increase headache susceptibility.”

Nourish your body

It can be hard to remember to eat or even sip water when you’re grinding at the office, grieving, or otherwise busy and stressed. But not doing so ups your odds of developing a migraine.

“Drink 80 to 100 ounces of water per day, as we know that dehydration can trigger migraine,” Dua says. “Eat regular meals and snacks because skipping meals can trigger a migraine.”

Make sure that you’re keeping water and easy snacks nearby when you’re focused on other tasks so that you are more likely to maintain good habits.

Proactively manage stress

Life isn’t a high intensity interval workout, but if you’re riding a rollercoaster of stress, it can sure feel like it to your body. While you cannot entirely avoid stress, proactively managing it can help you handle the curveballs life throws.

“Instead of allowing yourself to get maximally stressed out, and then trying hard to slow down, ideally, it’s best to implement relaxation techniques along the way to not get too wound up in the first place,” Dimitriu says.

Noor says mindfulness, meditation, and journaling can help keep stress from building to levels that trigger a migraine (or a migraine during relaxation).

Dua adds that time management can also help prevent rushing (and stressing). For instance, you might prioritize deadline-driven tasks, so you’re not scrambling to complete them on time. 

Therapies

Noor says professionals can perform or teach you techniques to reduce physical and psychological stressors that might contribute to a migraine. These include:

• biofeedback to control physiological processes, like muscle tension and heart rate increases
• cognitive behavioral therapy (CBT) for stress reduction and coping
• progressive muscle relaxation (PMR) to learn gradual tension-release exercises that might ease transitions between stress and relaxation
• physical therapy to address muscle tension or postural issues

Additionally, Noor says that remembering to take preventive medications as directed can help you avoid a let-down migraine. Setting reminders on your phone or writing them on a to-do list can help you remember to take this vital step when stressed.

Coping with a stress let-down migraine

If you’re in the midst of a migraine, whether you believe it’s caused by a stress let-down, stress, or something else, it’s important to lean into the care practices that soothe symptoms. 

Dimitriu recommends:

• gentle movement
• resting in a quiet, dark room
• resting or napping
• hydration
• meditation
• cold compresses

Dua says biofeedback and deep breathing can also help.

Noor adds that acute medications can also help, including pain relievers, triptans, CGRP inhibitors, and muscle relaxants (if the muscle tension contributed to the attack)

Takeaway

A let-down migraine is a migraine episode that develops in the relaxation period following a stressful event or period. You may also see it referred to as a weekend or honeymoon migraine.

It’s unclear if this period does trigger a migraine, and it’s possible that the attack began developing during the stressful event itself. However, it’s theorized that hormonal fluctuations, specifically the stress hormone cortisol, may contribute to this type of migraine.

Also, people may put migraine hygiene on the back burner during tense periods and sleep less (or poorly), skip meals, experience dehydration, and not notice symptoms in time to take medications.

Getting enough physical activity, eating and drinking nourishing foods and beverages, and consistent sleep can lower your risk of a let-down migraine.

Stress management, like breathing and therapies, including CBT, can help you manage anxiety-provoking events so that you won’t experience such heightened feelings of stress — or such a dramatic drop in stress when the event is over. These strategies can also soothe symptoms if you develop a migraine after a stressful time.