title: The association between stress and headache: A longitudinal population-based study.
abstract: BACKGROUND
  We studied the association between stress intensity and headache frequency for tension-type headache (TTH), migraine and migraine with coexisting TTH (MigTTH).
  
  
  METHODS
  We studied a population-based sample of 5159 participants (21-71 years) who were asked quarterly 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 (modified visual analog scale (VAS) from 0 to 100) and headache frequency (days/month) stratified by headache subtypes and age groups and adjusted for sex, age, frequent intake of acute pain drugs, drinking, smoking, BMI and education.
  
  
  RESULTS
  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 ± 5.2 days/month, 62.4 ± 23.3), MigTTH in 10.6% (43.5 ± 11.5 years, 61.0%, 3.6 ± 4.8 days/month, 58.6 ± 24.1), 23.6% were unclassifiable, and 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% (adjusted). Higher effects were observed in younger age groups (21-30/31-40/41-50/51-60/61-71 years: 9.8/10.2/7.0/6.5/3.5%). Slightly lower effects 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%).
  
  
  CONCLUSIONS
  Our study provides evidence for an association between stress intensity and headache frequency.
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of University Duisburg-Essen, Germany sara.schramm@uk-essen.de.
authors.forename: Sara H
authors.initials: SH
authors.lastname: Schramm
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of University Duisburg-Essen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of University Duisburg-Essen, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Lehmann
authors.affiliation: Department of Psychology, Center for Psychotherapy, University of Zurich, Switzerland.
authors.forename: Ursula
authors.initials: U
authors.lastname: Galli
authors.affiliation: Department of Neurology, University Hospital of University Duisburg-Essen, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Obermann
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of University Duisburg-Essen, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Bock
authors.affiliation: Department of Neurology, St. Joseph Hospital, Ruhr-University of Bochum, Germany.
authors.forename: Min-Suk
authors.initials: MS
authors.lastname: Yoon
authors.affiliation: Department of Neurology, University Hospital of University Duisburg-Essen, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.affiliation: Department of Neurology, Evangelisches Krankenhaus Unna, Germany.
authors.forename: Zaza
authors.initials: Z
authors.lastname: Katsarava
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D013315:Stress, Psychological / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Stress; epidemiology; headache; longitudinal; migraine; tension-type headache