Chronic Stress, Cortisol, and Migraines: How HPA Axis Dysregulation Triggers Headaches

Chronic stress can affect the body in many different ways. One adverse effect of chronic stress is the frequent development of headaches and migraines. Migraines have multiple root causes, but elevated cortisol from chronic stress is a major contributor. The hypothalamic-pituitary-adrenal (HPA) axis remains an ongoing topic of research, as science continues to demonstrate the human body's interconnectedness, particularly regarding the adrenal glands and the potent effects of cortisol.

The adrenal glands are two small glands located on top of each kidney. They secrete essential hormones such as cortisol, adrenaline, and aldosterone, which are responsible for regulating stress, blood pressure, and metabolism. Together with the hypothalamus and pituitary gland, the adrenal glands form the HPA axis. This axis regulates the release of cortisol and other glucocorticoid hormones in response to various forms of stress. Chronic stress is a significant disruptor of this axis, leading to dysregulation that may contribute to chronic headaches and migraines [1].

Cortisol levels in the human body can increase drastically in response to various environmental and psychological stressors [2]. While traumatic events and emotional stress are well-known triggers for cortisol release, cortisol can also be elevated during bouts of intense exercise, infections, and even extreme temperature changes. Therefore, migraine sufferers (migraineurs) need to be mindful of all potential events that can trigger cortisol release. A meta-analysis by Beech et al. (2023) found that migraineurs have significantly higher diurnal (daytime) and nocturnal (nighttime) cortisol levels, as well as heightened cortisol responses upon waking [3]. This indicates an upregulation of the HPA axis and the stress system. A rapid release of cortisol from the adrenal glands can impact vascular blood flow and blood pressure, contributing to headaches and migraines.

It is important to note that chronic stress over time also disrupts and dysregulates the autonomic nervous system (ANS), as cortisol is a potent regulator of physiology [2]. This type of nervous system dysregulation may play a role in the amplification of pain and the body's impaired ability to recover properly from stressful stimuli [1]. Dysregulation of the HPA axis via elevated cortisol can also trigger the activation of mast cells, which may be an additional source of migraine headaches.

It is estimated that nearly 70% of migraineurs attribute stress as the initial trigger of a migraine attack.

Coupled with the unpredictable nature of migraines, this only adds to additional stress, creating a vicious cycle. Therefore, it is essential for those who suffer from migraines to recognize and understand their stress thresholds. A naturopathic approach to managing stress begins with identifying and removing known stressors when possible. When stressors cannot be removed, other supportive measures should be considered, such as ensuring proper nutrition, using adaptogenic herbs, and incorporating homeopathy, among other approaches.

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Author: Dr. Kellyann Tomko, ND

References

1. Sic A, Bogicevic M, Brezic N, Nemr C, Knezevic NN. Chronic Stress and Headaches: The Role of the HPA Axis and Autonomic Nervous System. Biomedicines. 2025 Feb 13;13(2):463. doi: 10.3390/biomedicines13020463. PMID: 40002876; PMCID: PMC11852498.

2. Spencer RL, Deak T. A users guide to HPA axis research. Physiol Behav. 2017 Sep 1;178:43-65. doi: 10.1016/j.physbeh.2016.11.014. Epub 2016 Nov 18. PMID: 27871862; PMCID: PMC5451309.

3. Beech EL, Riddell N, Murphy MJ, Crewther SG. Sex and stress hormone dysregulation as clinical manifestations of hypothalamic function in migraine disorder: A meta-analysis. Eur J Neurosci. 2023 Aug;58(4):3150-3171. doi: 10.1111/ejn.16087. Epub 2023 Jul 15. PMID: 37452646.

Disclaimer:

This information is generalized and intended for educational purposes only. Due to potential individual contraindications, please see your primary care provider before implementing any strategies in these posts.