Trigger factors of migraine and tension-type headache

Abstract

tating factors for both migraine and tension-type headache attacks has identified several potential triggers with percentages differing widely among studies [1–5]. They include menstrual cycle, particularly in women affected by migraine; environmental factors, especially changes in weather conditions and temperature; afferent stimulation, physical activity and psychological factors, mainly stress or relaxation from stress; sleep disturbances; frequent travelling; oral contraceptives; and finally eating habits, and some food items. According to some authors, lifetime migraineurs experienced headache attacks preceded by triggering factors more frequently than tension-type headache sufferers [5]. Moreover, certain endogenous and exogenous factors seem to differentiate migraine from tension-type headache and it is of interest to note in this regard that three of the precipitating factors considered more migraine-specific (i.e., weather, smell and smoke) involve the nose/sinus system, suggesting a greater significance of this system in migraine than is generally believed [4]. The aim of the Wober et al. [6] study was to investigate the consistency of the recurrence of precipitating factors in migraineurs and tension-type headache patients enrolled from a clinical outpatient setting and from a sample, although not conspicuous, of the general population. The authors found that the majority of trigger factors precipitate migraine and tension-type headache only occasionally and not consistently in almost the majority of cases. In contrast to previous experiences, no differences emerged in this study in the percentages of factors referred as attack precipitants between the two patient groups. The occasional occurrence of some precipitating factors in some but not all migraine and tension-type headache attacks supports the view that they can surely play a role, although not exclusively, in influencing the pathophysiological substrate underlying the threshold for attacks in both headache forms. This predisposed substrate can be, from time to time, influenced by different inner and outer stimuli. Mechanisms involved in the potentiality of different factors in precipitating attacks by activating strategic brain areas involved in the generation and abnormal processing of painful information from the head remain to be established. New imaging techniques and particular experimental settings could be helpful in clarifying this important issue, at least for some attack precipitants, as recent experiences have found [7]. J Headache Pain (2006) 7:172–173 DOI 10.1007/s10194-006-0304-4