It’s all in your head? Yes – but the struggle is real!

People with headaches and migraines often feel that their suffering is not taken seriously. Because their pain is not visible to those around them, it’s easy for others to dismiss it as minor or even imaginary. However, the impact of the condition on sufferers’ lives is very real.

Medical research is trying to make the effects of headaches visible. Researchers around the world are studying how headaches affect the quality of life of those affected. The hope is that this will help others better understand the challenges faced by sufferers and lead to more empathy.

Living with migraines

According to a study by the American organization AMPP ("American Migraine Prevalence and Prevention"), half of all migraine sufferers are noticeably impaired by their condition, and one in five face severe challenges. More than half of those surveyed stated that they sometimes have to stay in bed during an attack. Another study in 1,000 people aged 21 to 30 with and without migraines found that people with migraines are twice as likely to miss work due to acute symptoms compared to those without migraines.

Headaches affect daily life and social interactions

Migraines don’t just affect education and work. In a recent study, almost 70% of migraine sufferers and over 55% of those with tension headaches stated that they were unable to fully perform their work, studies or household duties during an attack. Migraines were particularly disruptive, causing significant absences from work, university and school. They also led to canceled plans, avoiding social gatherings, and staying home. In other words, migraines made it hard to maintain social contacts.

Avoiding exercise: an unfortunate effect

An American study from 2019 focusing on the exercise habits of women with migraines revealed that many cut back on physical activity due to a fear of triggering an attack. That is unfortunate, because moderate exercise such as light cardio has been shown to positively impact headache frequency. The real message is: for a physically active person who is prone to migraines, it is especially important to stay fueled and hydrated. However, intense exercise is best avoided because it could trigger attacks.

Stress and strain promote attacks

Frederick G. Freitag, an American neurologist, reviewed multiple studies to identify the areas of life most affected in people with migraines. Studies since the 1990s show that having a migraine disorder creates emotional stress and has a negative impact on energy levels and satisfaction with life. The additional burden of poor sleep quality, which is common in people with migraine, is particularly relevant as it plays a significant role in triggering new attacks.

Restful sleep is crucial

A 2005 study with more than 2500 participants established a clear link between poor sleep and migraines. Issues like difficulty falling asleep and frequent nighttime awakenings lead to fatigue, reduced performance, and anxiety, which can, in turn, trigger migraines. (Read more about headaches and sleep here.)

Stress from migraines, migraines from stress

On the complex topic of individual stress perception, which increases in response to the burden of migraine attacks and can be a potent migraine trigger in its own right, French research showed that migraine sufferers experience significantly higher stress levels between attacks compared to control groups. Further studies went on to reveal that people with migraine respond more intensely to emotional stressors and spend considerable energy on internal defense and coping strategies, as well as being significantly more likely to report impatience, irritability and feeling under pressure.

A large-scale international study with over 12,000 participants using a dedicated "Migraine-Specific Quality-of-Life Questionnaire” showed a correlation between the number of headache days and quality-of-life responses, confirming that patient-reported quality of life declines with increasing migraine burden. Additional major deterioration in subjective quality of life was linked to episodes of depression, heightened sensitivity to pain, and – to a lesser extent – associated worry and anxiety. The authors conclude that treatment should not only aim to reduce attack frequency but also address these accompanying factors, especially depression.

All these studies on the migraine cycle provide hard evidence that people with migraine are burdened not only by the significant discomfort experienced during actual attacks, but also struggle with additional challenges in the periods between attacks.

The very real impact of tension headaches

A Swedish study demonstrates that tension-type headaches also have a major impact on daily life and well-being. This research also demonstrated a link between mental health issues and headaches. Tension headache sufferers reported anxiety, stress, mood swings and feeling constantly under pressure, resulting in a lower subjective quality of life compared to the headache-free control group.

Headaches and university life

A comprehensive survey by ZIES gGmbH at several German universities found that over 65% of students with migraines reported being significantly impaired in their academic performance one day per month, on average. For those with tension headaches, the figure was over 45%. Over 50% of migraine sufferers and more than 25% of tension headache sufferers reported being unable to do housework or study at home on an average of one day per month.

A 2023 Irish review of more than 100 studies highlights the massive impact of migraines and tension headaches on the everyday life of students. The known trigger factors for the two most common types of headache are omnipresent in the everyday lives of students. Some studies even suggest that migraine prevalence among students has increased over the past two decades.

Students consistently report significantly impaired quality of life from both headache types, migraines in particular. Female students report a greater impact from migraines than their male peers, including more intense pain and longer-lasting attacks. The studies available so far also show a higher tendency among the student population to use medication to manage pain, possibly to avoid the risk of absences and academic performance issues. At the same time, students are far less likely to seek medical advice than other sectors of the population.

Even among students, migraine sufferers often restrict their physical activities to avoid triggering migraines, which – as seen earlier – can be counterproductive for prevention. There is also an increased tendency among students to keep their condition private, possibly due to the potential stigma associated with migraines. The authors say that it is up to university institutions to tackle this issue. Dealing openly with the associated impairments is crucial to give those affected the help and support they need to accommodate their disadvantages and reassure them that their challenges are taken seriously.

Prevention is key

Despite how it may feel, headaches are not an inevitable part of life. By becoming an expert in managing your condition, you can take charge of your pain. The mainstays of headache prevention are a balanced, regular diet, staying hydrated, getting sufficient restful sleep, taking regular breaks, and healthy physical activity to reduce stress. Relaxation techniques such as Jacobson’s progressive muscle relaxation are a proven way to reduce tension and lower your attack risk. The Headache Hurts app offers a concise version of these exercises that is easily incorporated into daily life, along with other helpful features for headache prevention. The app explains the key factors and helps you keep track of habits that may be linked to your headaches. A reminder feature assists with making the changes that will help prevent headaches. Many people find that implementing little lifestyle modifications can make a big difference to their headache burden.