What is the relationship between crying and triggering migraines?

The Relationship Between Crying and Migraine Triggers

Crying, especially when associated with sadness or emotional upset, can trigger migraine attacks in susceptible individuals. 1, 2

Physiological Mechanism

• Crying is an important but underrecognized precipitating factor for both migraine and tension-type headaches, with studies showing that 55.2% of headache sufferers identify crying as a potential trigger 2
• The stress response associated with emotional crying releases stress hormones including glucocorticoids, which have been shown in preclinical models to mediate stress-induced migraine-like behaviors 3
• Emotional dysregulation appears to be more pronounced in chronic migraine patients compared to those with episodic migraine, suggesting a potential role in migraine chronification 4

Clinical Significance

• Crying ranks among the top triggers for migraine attacks, alongside stress, anxiety, and menstrual periods 2
• Not all types of crying trigger migraines equally - crying associated with sadness or emotional upset is more likely to trigger migraines than crying from happiness or from cutting onions 1
• Stress is the factor most often listed by migraine sufferers as a trigger for their attacks, and crying represents a physiological manifestation of emotional stress 5

Management Strategies

• Educating patients about crying as a potential migraine trigger is essential for effective migraine management 6
• Stress management techniques should be recommended to help patients reduce their emotional responses to stressors, potentially decreasing crying-triggered migraines 5
• For acute management of migraines triggered by crying:
  • First-line: NSAIDs (acetylsalicylic acid, ibuprofen, diclofenac potassium) for mild to moderate attacks 6, 7
  • Second-line: Triptans for moderate to severe attacks that don't respond to NSAIDs 6, 7
  • Early intervention during the headache phase is critical for maximum effectiveness 6

Prevention Approaches

• For patients experiencing frequent crying-triggered migraines, preventive therapy should be considered if attacks occur ≥2 days per month despite optimized acute treatment 7
• First-line preventive options include beta-blockers (propranolol, metoprolol) and topiramate 7
• Identifying and addressing comorbid conditions like anxiety and depression is crucial, as these may increase emotional crying episodes 7
• Cognitive behavioral therapy and stress management techniques may help reduce emotional responses that lead to crying 5

Clinical Pearls and Pitfalls

• Crying-triggered migraines appear to be more common in women than men, consistent with the higher prevalence of migraine in females 1, 2
• Patients may not spontaneously report crying as a trigger unless specifically asked, making it important to inquire about this potential trigger during clinical assessment 1
• Crying may create a vicious cycle where migraine pain causes emotional distress, leading to crying, which then worsens or triggers additional migraine attacks 5
• Avoid dismissing emotional triggers as less important than other migraine triggers; they represent a significant and potentially modifiable risk factor 4