Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)




Stress is frequently reported as a major contributing factor in both migraine and muscle-contraction headaches. The general conclusions of studies investigating the stress-headache relations are that headache sufferers experience a significant amount of stress in their lives, that stress can precipitate headache attacks, and that headache subjects tend to overreact to stress. The laboratory method and scales measuring major life-events have typically been used in studying stress but have several limitations, particularly for studying exacerbations and remissions of symptoms. Increasing the comprehensiveness of stress measurement, beyond the traditional life-events approach, by assessing stress and affective states on a daily basis was recommended by the reviewed literature. The present study examined the amount of stress present in the lives of headache sufferers, whether or not headache sufferers overreact to stressful life-events, the relative importance of major and minor stressful life-events for predicting headache activity, and the role that affective states play in different headache disorders. Migraine, mixed, and muscle-contraction headache sufferers and control subjects recorded their headache activity, completed the Daily Stress Inventory, and completed the MAACL on 28 consecutive days. Subjects also completed the Life Experiences Survey. There was no evidence that headache subjects, as compared to controls, experienced a greater amount of life stress or emotionally overreact to stress. Headache subjects, regardless of diagnosis, were more depressed and anxious on headache days as compared to pre-headache days. In addition, the headache groups displayed different patterns of changes in affective states as their headaches approached. Daily stress scores significantly predicted headache activity and improved the predictions made by major life-events scores. The findings advocate using daily measures of stress and affect for studying the stress-headache relations. Implications for stress theories, future research, and treatment, as they pertain to headaches, are discussed.