A recent study has confirmed what many headache sufferers have long suspected: More stress leads to more headaches.

German researchers surveyed more than 5,100 people (ages 21 to 71), in the general population, about their stress levels and headaches over a two-year period. Thirty-one percent of the participants had tension-type headache, 14% had migraine, 11% had migraine combined with tension-type headache, and 17% had an unclassified headache type.

For each headache type, an increase in stress was associated with an increase in the number of headaches per month. Individuals with tension-type headache were the most affected by stress. An increase of 10 points on the stress scale was associated with a 6.3% increase in the number of headache days per month. For migraineurs and those with migraine and tension headache, 10 more points on the stress scale was associated with approximately a 4% increase in monthly headache days.

The researchers say the findings illustrate the importance of stress. It can contribute to the onset of headache disorders, accelerate the progression to chronic headache, and provoke and exacerbate headache episodes. Additionally, the authors indicate that headache itself can serve as a stressor.

“These results show that this is a problem for everyone who suffers from headaches and emphasize the importance of stress management approaches for people with migraine and those who treat them,” said study author Sara H. Schramm, MD, of the University Hospital of University Duisburg-Essen in Germany.

This study has not yet been published but will be presented at the American Academy of Neurology’s 66th Annual Meeting in Philadelphia later this spring.