Stress and fasting for inducing migraine attacks: A randomized 2 × 2 factorial crossover trial
Abstract
Objective: The objective of this study was to evaluate the independent and joint effects of acute stress and fasting on the likelihood of headache onset in individuals with migraine.
Background: Stress and fasting are two of the most frequently cited triggers of migraine headache, but experimental evidence regarding their individual and combined effects remains limited.
Methods: This was a partially randomized, 2 × 2 factorial crossover trial conducted in a controlled laboratory setting in Boston, MA, between March 2017 and August 2020. Participants were 18 to 65 years old with episodic migraine. Enrollment was halted early due to recruitment delays. Participants were exposed to two joint experimental manipulations involving stress and fasting: (1) a randomized 12-h fasting or nonfasting condition, and (2) a fixed sequence administration of the Trier Social Stress Test (stress) or a time-matched control task (control), each administered on separate study visits. The primary outcome was an incident headache attack rated ≥4/10 or treated with abortive or analgesic medication within the 6-h laboratory session.
Results: Among 131 analyzable sessions from N = 74 participants, eight (6%) incident headache attacks were observed. Predicted probabilities of a laboratory headache were 3.8% (95% credible intervals [CrI]: 0.3% to 13.9%) for Control/No-Fast, 5.6% (95% CrI: 0.5% to 21.3%) for Control/Fast, 2.7% (95% CrI: 0.2% to 12.5%) for Stress/No-Fast, and 6.8% (95% CrI: 0.6% to 24.3%)…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 74 participants or records.
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