Stress is often blamed for triggering migraines, and not without reason. Most people who live with migraine headaches have been told at some point that stress is part of the problem. It shows up in questionnaires, doctor’s offices, and nearly every online list of common triggers. But the reality is more complicated. Stress alone doesn’t always explain what’s happening.
In many cases, stress acts as the spark that ignites a deeper issue—one that’s physical, not just emotional. When people experience stress, the muscles in the neck, shoulders, and upper back naturally tense. This tightening may seem harmless at first, but in patients who already have tight anatomical spaces around certain sensory nerves, it can cause those nerves to become compressed.
That compression can lead to nerve irritation and pain. In someone prone to migraines, this sets off a cascade of symptoms—throbbing pain, nausea, sensitivity to light—that feel identical to a migraine triggered by hormones or weather. What’s different is the starting point: here, the pain begins with the nerve
And once that pain starts, it adds more stress. The person becomes anxious, muscles tense further, and the nerve remains under pressure. This creates a self-sustaining cycle—a “pain loop”—where stress tightens muscles, muscle tension compresses nerves, nerve compression causes pain, and the pain increases stress.¹²
How Stress Triggers the Pain Loop
The body’s natural response to stress includes muscle contraction—especially in the shoulders, neck, and upper back. These muscle groups play a direct role in supporting the head and are intimately involved with several peripheral sensory nerves. When these muscles contract repeatedly or remain in a state of sustained tension, the underlying nerves can become compressed.³
This nerve irritation activates the trigeminovascular system, a key player in migraine physiology. While traditionally thought of as a central neurological event, this cascade can just as easily be initiated by a peripheral trigger. The result is a headache that presents like a classic migraine—throbbing pain, nausea, light sensitivity—but began with tension and nerve inflammation.⁴
Which Nerves Are Affected?
The most common nerves involved in stress-aggravated migraines include:
– Greater occipital nerve – travels through tight muscle and fascial planes at the back of the head
– Lesser occipital nerve – located along the posterior and lateral scalp
– Supraorbital and supratrochlear nerves – pass through muscle and fascia near the brow
Compression of these nerves has been shown to produce migraine-like symptoms. Importantly, the location of pain often corresponds to the nerve’s anatomical path, providing a physical explanation for what is often assumed to be a purely neurological issue.⁵
Diagnosing the Stress–Compression Link
A key feature in patients with stress-triggered migraines is the predictability and localization of symptoms. Pain may always begin in the same place—such as the occiput, temple, or brow—and may worsen with posture or tension. Pressing on these trigger points often reproduces the headache.
Diagnostic nerve blocks—where a small dose of local anesthetic is injected around the nerve—can provide temporary but powerful relief. A positive block response supports the idea that the pain is being driven by nerve irritation rather than brain chemistry alone.⁶
Similarly, a positive response to Botox in the neck or brow muscles may reduce pressure on the compressed nerves, further supporting the compressive model. Botox’s benefit in these cases likely stems not only from its effect on neurotransmitters but from its ability to reduce muscular tension around vulnerable nerves.⁷
These insights are further supported in Headache Surgery – Understanding a Path Forward, which details how chronic muscular tension and stress can directly worsen nerve compression and explains how identifying anatomical trigger sites is critical for breaking this cycle.⁸.
Breaking the Cycle
When stress sets the pain loop into motion, treating the emotional or psychological side of stress may help—but it doesn’t address the mechanical source of pain. For patients with nerve compression, traditional stress-reduction strategies like meditation or exercise may fall short.
In these cases, peripheral nerve decompression offers a more direct solution. By surgically releasing the structures that are compressing the nerve, the anatomical root of the pain can be removed. This doesn’t mean patients won’t still feel stress—but it does mean that stress is far less likely to result in headache pain.
Once the nerve is no longer chronically irritated, the loop is broken: stress no longer causes tension that provokes nerve pain, and the patient is no longer trapped in a cycle of worsening symptoms.
Why This Connection Is Often Missed
Despite the clear interplay between stress, muscle tension, and nerve compression, this model remains underutilized in conventional migraine care. Most neurologists are trained to approach migraines as central disorders and may not routinely assess for anatomical compression.
Imaging is often unhelpful, as these compressive issues are soft-tissue related and don’t appear on scans. Instead, diagnosis relies on physical examination and a deep understanding of nerve anatomy.
So—Can Stress Cause Migraines?
The answer is yes—but often not in isolation. For many patients, stress is the spark that ignites an already unstable system. And in those cases, the instability stems from nerve compression.
Understanding this relationship can reshape not just how migraines are managed, but how they’re treated. Patients who have been told their pain is “all in their head” may, in fact, be experiencing a very real, mechanical issue—one that can be addressed.
For those trapped in a pain loop where stress leads to muscle tension, which compresses a nerve, which causes migraine pain, which adds more stress—the solution may not be another medication. It may be decompression. And with that, the cycle can finally stop.
For individuals who have spent years cycling through medications and stress management without lasting relief, visiting a specialized migraine clinic can offer new answers. Clinics that focus on the anatomical causes of migraine, including nerve compression, can provide access to diagnostic nerve blocks, surgical evaluation, and truly individualized care—opening the door to solutions beyond symptom management.
References
- Guyuron B, Kriegler JS, Davis J, Amini SB. Comprehensive surgical treatment of migraine headaches. Plast Reconstr Surg. 2005;115(1):1–9.↩︎
- Lowenstein A. Headache Surgery – Understanding a Path Forward. Santa Barbara, CA: Self-published; 2024.↩︎
- Janis JE, Dhanik A, Howard JH. Validation of the peripheral trigger point theory of migraine headaches. Plast Reconstr Surg. 2011;128(4):882–887.↩︎
- Gfrerer L, Austen WG Jr. Migraine surgery: a plastic surgery solution for migraine headaches. Curr Pain Headache Rep. 2017;21(2):8.↩︎
- Totonchi A, Guyuron B. Identifying and treating the great auricular nerve as a migraine trigger site. Plast Reconstr Surg. 2007;119(6):1707–1711.↩︎
- Dash KS, Janis JE, Guyuron B. The lesser and third occipital nerves and migraine headaches. Plast Reconstr Surg. 2005;115(6):1752–1758.↩︎
- Blumenfeld A. Botox and the mechanistic rationale for migraine. Headache. 2012;52(Suppl 2):54–58.↩︎
- Lowenstein A. Headache Surgery – Understanding a Path Forward. Santa Barbara, CA: Self-published; 2024.↩︎
