Migraine Trigger Factors Research Articles

Various Trigger Factors of Migraine: A Review of Pathophysiology and Mechanism

Migraine is a high prevalence primary headache. Global epidemiological data from 132 countries in 2016 shows an estimated 1.04 billion people have migraine. Epidemiological data in Bali based on research by Adnyana in 2012 showed 23.7% nursing students had migraines. Although migraine can occur spontaneously, many migraine attacks are triggered by certain trigger factors. The trigger factors for migraine are various, ranging from foods, hormonal disorders, stress, sleep disorders, and environmental factors. Each of these factors has its own mechanism that contributes to the pathophysiology of migraine. Based on scientific data, some factors have strong supporting evidence regarding their correlation with migraine, but some others are only suggestive and not supported by scientific evidence. Factors that have obvious involvement with migraine are hormonal factors, stress, and sleep. Some types of foods such as chocolate and caffeine have a migraine trigger effect, but they can also treat migraine. It is recommended for patients to be able to identify factors that may trigger headache attacks, so that they can reduce the frequency of attacks in chronic migraine patients. Keywords: Migraine, Trigger, Mechanism

Trigger Factors of Migraine in Patients Attending Headache and Neurology Outpatient Clinics at Ain Shams University Hospitals

Abstract Background Migraine is the second most common cause of headache, affecting approximately 15% of women and 6% of men. Also, it is one of the most ten disabling diseases in the world. Objectives To determine the triggers of migraine headache in migraine patients attending Headache clinic at Ain Shams university hospitals. Methods A descriptive study was carried out among 292 migraine subjects from different parts of Cairo governorate from December 2019 to March 2020. Case definition of migraine was based on the International Headache Society (IHS) criteria. Results Females constituted 85.6% of the study sample. The majority of the sample (71.3%) aged 18-39 years. Psychological problems as: stress and family problems were the commonest triggers (89%), followed by fatigue (86.3%), too little sleep (staying up late) (82.2%), loud noises (77.7%), hunger, fasting and missing meals (75.3%), bright lights or and sun exposure (75%), and in relation to females menstruation (61.9%), hot weather (61.3%), too much sleep (46.9%), odors (46.2%). The least triggers were physical exercise, caffeinated drinks, smoking, chocolate and dairy products, and ice-cream were 28.8%, 26%, 24.7%, 23.3%, 16.1% respectively. Forty percent of the study population had positive family history of migraine, 30.1% of them reported major stresses (moving of residence, marriage, or death of a close relative) in the last year. Conclusion Stress, anxiety, family problems, fatigue, too little sleep, and loud noises were the commonest triggers of migraine headache. Family history was present in 41.1% of migraine patients.

Effectiveness of Tai Chi on Blood Pressure, Stress, Fatigue, and Sleep Quality among Chinese Women with Episodic Migraine: A Randomised Controlled Trial.

The beneficial effects of Tai Chi on the cardiovascular risk profile and the migraine trigger factors among female migraineurs remain unknown. This study aimed to evaluate the effectiveness of a 12-week Tai Chi training on blood pressure (BP) and migraine-related trigger factors, including stress, fatigue, and sleep quality among Chinese women with episodic migraine. In this study, eligible Hong Kong Chinese women aged 18–65 years were randomly assigned to the Tai Chi group adopting a modified 33-short form of Yang style Tai Chi training for 12 weeks, followed by additional 12 weeks of self-practice or the waiting list control group that maintained the usual lifestyle for 24 weeks. The primary outcome was the changes in BP from the baseline to 12 and 24 weeks. The secondary outcomes included the stress level, fatigue, and sleep quality measured by the perceived stress scale (PSS), the numeric rating scale-fatigue (NRS-fatigue), and the Pittsburgh sleep quality index (PSQI), respectively. Significant between-group differences were found in systolic BP (−6.8 mmHg at 24 weeks, P=0.02), and a decreasing trend was significant across baseline, 12 weeks, and 24 weeks between groups (P < 0.05). The 12-week Tai Chi training significantly reduced the BP level and moderately improved stress level, fatigue status, and sleep quality among Chinese women with episodic migraine. Therefore, Tai Chi could be considered a promising mind-body exercise with good feasibility for migraineurs in the future. This trial is registered with registration number NCT03015753.

Migraine Attacks and Relevant Trigger Factors in Undergraduate Nursing Students in Hong Kong: A Cross-Sectional Study.

ObjectiveThis study aimed to examine the prevalence and features of migraine and explore the possible migraine triggers in a sample of university nursing students in Hong Kong.MethodsA cross-sectional study using self-administered questionnaires was conducted in the Hong Kong Polytechnic University in 2016. The questionnaire included ID Migraine™ for migraine screening and items measuring the frequency, duration, severity, associated symptoms, and trigger factors of migraine. Years 2–5 undergraduate nursing students from the university completed the questionnaires. Binary logistic regression was conducted to examine the migraine-associated factors.ResultsA total of 702 nursing students, including 168 males and 534 females, were successfully screened. Their mean age was 20.8 ± 1.4 years. The overall prevalence of migraine reached 11.8%. Over half (67.5%) of the students with migraine experienced attacks at least once per month. Each attack had a median duration of 3 h (interquartile range: 1–4 h) and the mean pain intensity score of 6.4 ± 1.6. Students with a family history of migraine (adjusted odds ratio [OR]: 1.89; 95% confidence interval [CI]: 1.10, 3.25; p < 0.05) and poor general health status (Adjusted OR: 3.41, 95% CI: 1.05, 11.09; p < 0.05) were more likely to suffer from migraine than those without. The three most common migraine triggers were the lack of sleep (94.0%), change in sleep schedule (83.1%), and noise (81.9%). Female students were more likely to experience fatigue-triggered migraine than male students (85.9% vs 63.2%, p < 0.05).ConclusionMigraine prevalence was relatively high among undergraduate nursing students in Hong Kong. Sleep problem was the most frequent trigger factor. The students’ awareness of migraine attacks should be increased, and migraine management must be improved by avoiding common trigger factors in this population.

Sex differences in prevalence of migraine trigger factors: A cross-sectional study.

AimTo examine the effect of sex on migraine trigger factors.MethodsPrevalence of 11 frequently reported trigger factors was determined in a cross-sectional study among migraine patients from a validated migraine database (n = 5725 females and n = 1061 males). Female-to-male odds ratios were calculated for each trigger, using a logistic regression model with attack frequency and migraine subtype (with or without aura) as covariates. Additionally, the effect of sex on total number of triggers per individual was determined.ResultsThe top three most reported triggers in women were menstruation (78%), stress (77%), and bright light (69%). Men reported stress (69%), bright light (63%), and sleep deprivation (60%) most frequently as provoking factors. The following triggers were more often reported by women than men: Bright light (odds ratio 1.29 [95% CI 1.12–1.48]; p = 0.003), stress (1.47 [1.27–1.69]; p < 0.001), skipping a meal (1.24 [1.09–1.42]; p = 0.015), sleep deprivation (1.37 [1.20–1.57]; p < 0.001), high altitudes (1.70 [1.40–2.09]; p < 0.001), and weather changes (1.35 [1.18–1.55]; p < 0.001). Women reported more triggers than men, even when menstruation was disregarded (mean ± SD: 4.6 ± 2.3 and 4.3 ± 2.3; p < 0.001).Conclusion: Women report migraine trigger factors to be provocative of their attacks more frequently than men, which may be related to a lower migraine threshold due to sex hormonal changes.

Impact of Puberty in Pediatric Migraine: A Pilot Prospective Study.

Background and PurposeThe short-term evolution of pediatric migraine remains unclear. We aimed to describe the evolution of migraine before and after puberty and its relationship with lifestyle habits.MethodsWe prospectively selected prepuberal patients from a neuropediatric unit who had a migraine diagnosis. Their medical history, migraine characteristics and impact, and lifestyle habits were recorded at the baseline visit. After 2 years we performed a telephone follow-up assessment.ResultsNineteen patients were recruited (age 10.2±2.9 years, mean±SD; 57.9% female), of whom 27.5% had migraine with aura. The accompanying symptoms had changed at the follow-up, with significantly higher prevalence rates of dizziness (44.4% vs. 88.9%), vertigo (11.1% vs. 66.7%), mood changes (38.9% vs 83.3%), confusion (5.6% vs. 77.8%), and allodynia (27.8% vs. 61.1%). Sleep disturbances (5.6% vs. 38.9%) and schedule changes (0% vs. 38.9%) increased significantly as triggers. Prodromal symptoms became more prevalent (16.7% vs. 50%), with a higher proportion of sleep disturbances reported (50.0% vs. 87.5%).ConclusionsProdromal symptoms increase in pediatric migraine after 2 years, and some trigger factors for migraine become more prevalent, including sleep disturbances. New accompanying symptoms are also identified. These changes provide information about how migraine changes during puberty along with physical and lifestyle changes, and represent a dynamic physiopathological process that deserves more research.

Prevalence of trigger factors in migraine

Background: Migraine is one of the most common types of headache. Many patients with migraine have precipitating factors known as trigger factors, recognition of which may lead to a better diagnostic, preventive and therapeutic approach. Objective: To study the prevalence of various trigger factors in patients with migraine, and to analyse various socio-demographic factors with respect to trigger factors. Materials and Methods: A total number of 500 patients of either sex fulfilling the ICHD3 diagnostic criteria for migraine aged more than 15 years attending Neurology Department of SMS Medical College, Jaipur, between January 2018 and February 2019 were studied. Patient enrolled in the study underwent a detailed structured interview and the information regarding the characteristics of headache including the time of onset, duration, frequency, character, site and associated features with due stress on the trigger or precipitating factors. Chi-square and t-test were performed to determine the statistical significance of the results. Results: As per the analysis, 91% of the patients reported more than one trigger factor for headache. Bright sunlight (43%), physical activity (43%), noise (42%), stressful events (41%), tea/coffee deprivation (38%), travelling (34%), hunger (33%), sleep (31%), and fatigue (29%) were some of the major trigger factors reported by the sample. People living in urban areas reported a higher number of trigger factor as compared to rural areas, which includes factors such as stress and fatigue. Sleep deprivation and physical stress were higher among rural areas. Conclusion: The present study presents a general idea about trigger factors related to headache in the North-western part of India. Bright sunlight, physical activity, noise, stressful events, tea/coffee deprivation, travelling, hunger, sleep, and fatigue parameters were some of the major trigger factors reported by the sample. Moreover, people living in urban areas reported a higher

The Effectiveness of Diet Restriction in Elderly with Migraine.

Introduction:Migraine type headache is a type of pain with a high socioeconomic burden that limits the activities of daily life of individuals of all ages. The pathogenesis is not fully understood. There are a lot of migraine’s trigger factors and foods are one of them. The purpose of this study was to specify the effect of migraine triggering on the migraine attacks prevention in the elderly population.Method:The study consisted of patients over the age of 65 with a diagnose of migraine without aura according to International Headache classification. Thirty-one migraine patients with migraine attacks were included in the study. Triggering foods were expelled from the diets of migraine patients. This diet and pre-diet 2 months after the application, the frequency of attack within a month, attack duration and visual analog scale (VAS) pain intensity, the number of analgesics and triptans used were recorded.Results:A total of 31 patients (8 male and 23 female) were evaluated. In the second month after dieting, the frequency of attack, attack duration, pain severity, and analgesic and triptan counts were statistically significantly lower than the pre-treatment level (p<0.05).Conclusion:Results of the study; In migraine-aged elderly patients, it can be concluded that migraine attacks may be an effective and reliable treatment in reducing the number of analgesics and triptans used in migraine attacks.

Dietary trigger factors of migraine and tension-type headache in a South East Asian country.

BackgroundThe literature on the dietary trigger factors of headache among the South East Asians is limited.ObjectiveThe objective of the study was to examine the dietary trigger factors of migraine and tension-type headache (TTH) in Malaysian patients, consisting of Malays, Chinese and Indians.MethodsIn this prospective cross-sectional study, patients presenting with migraine and TTH to a neurology clinic between April 2010 and June 2017 were recruited. The patients were given a comprehensive dietary list consisting of 25 specified types of food and drink items as well as other unspecified types of food and drink items which were possible dietary triggers. The data on these dietary triggers and missing meals were collected.ResultsA total of 684 patients with headache (319 migraine and 365 TTH patients) were recruited. One hundred and fifty-eight (23.1%) patients had missing meals as trigger. Two hundred and fifty-five (37.3%) patients had dietary triggers; 141 (44.2%) patients with migraine and 114 (31.2%) patients with TTH had dietary triggers. Eighty-four (52.8%) Malay, 28 (41.8%) Chinese, 25 (32.5%) Indian migraine patients and five (38.5%) migraine patients from other ethnic groups, had dietary triggers. Some 58 (40.0%) Malay, 27 (25.2%) Chinese, 22 (23.9%) Indian patients and 7 (29.2%) patients from other ethnic groups with TTH had dietary triggers. The most common dietary trigger factors were coffee (19.9%), chocolate (7.5%) and food rich in monosodium glutamate (5.6%). Logistic regression showed that chocolate (OR 2.16, 95% CI 1.06–4.41, p = 0.035) and coffee (OR 1.73, 95% CI 1.12–2.68, p = 0.014) were significantly associated with migraine compared to TTH.ConclusionChocolate and coffee significantly triggered migraine compared to TTH. Inter-ethnic differences were observed for dietary trigger factors.

Migraine attacks among medical students in Soochow University, Southeast China: a cross-sectional study.

PurposeMigraine is one of the most common primary headache disorders and is burdensome to both the individual and society, influencing the academic performance and quality of daily lives of medical students worldwide. This study aimed to investigate the migraine prevalence in a sample of university medical students in China and to examine the features and typical trigger factors of migraine among these students.Patients and methodsFrom May 2016 to August 2016, a total of 1,060 medical students who were enrolled in Soochow University in Jiangsu Province in China were chosen through stratified random sampling. A self-administered questionnaire that included the ID Migraine™ for screening of migraine cases was used to collect data. The frequency, severity, duration of migraine attacks, and relevant trigger factors were measured for migraine cases. In total, 986 students completed the questionnaire.ResultsThe overall migraine prevalence among students was 7.91%, with 4.64% in male and 9.84% in female students. Junior-grade students had a higher migraine prevalence than senior students (prevalence of migraine of year 1 to year 5 undergraduates: 10.83%, 8.9% vs. 6.25%, 4.42%, 5.33%, P<0.05; prevalence of migraine of year 1 to year 3 graduates: 9.68%, 9.71% vs. 6.38%, P<0.05). Students with a positive family history were more likely to suffer migraine than those without (OR=8.48, 95% CI: 4.33–16.59). Stress (n=73, 93.59%), lack of sleep (n=72, 92.31%), and change of sleeping time (n=68, 87.18%) were the top three trigger factors among the students.ConclusionMigraine was common among medical students from a university in China, and especially higher in female and junior-grade students, and those with a family history of migraine. Reducing stress and improving sleep quality might be effective to reduce migraine attacks in this population.

Trigger Factors in Childhood Migraine: A Prospective Clinic-Based Study From North of France.

The objective was to study the prevalence and characterization of pediatric migraine triggers and to compare results to this retrospective study. A total of 101 pediatric patients with ICHD-II migraine with and/or without aura were instructed to prospectively complete a diary dealing with attacks triggers for a 3-month period. Each subject reported at least 1 trigger (range: 1-14) with a total number of 532 attacks and a median per subject of 3. Lack of sleep (51.4%), stress (44.6%), warm climate (41.9%), noise (32.4%), and excitation (29.7%) were the most frequently reported. The delay between trigger exposure and attack onset was between 0 and 3 hours in 67.6% of attacks. This prospective study confirmed the findings of the authors' previous study, with the exception that number of triggers was smaller, probably due to recall bias. The 4 most frequent triggers (lack of sleep, stress, hot weather, and noise) were identical in both studies.

Mobile health (mHealth) for headache disorders: A review of the evidence base

The aim of this review was to explore and summarise the evidence base for using mobile apps for the management of headache disorders. PubMed, Web of Science, Embase and Scopus were searched for studies reporting the use of mobile health applications (apps) for managing headache disorders. Different combinations of keywords for mobile health, smartphone and headache were used for electronic search. Six studies (two journal papers and four conference papers) met the inclusion criteria and were reviewed. All of the reviewed studies were categorised as the lowest level (level IV) of evidence according to the National Health and Medical Research Council (NHMRC) hierarchy of evidence. The results of the studies demonstrated the feasibility and acceptability of a few mobile apps for headache in very limited settings, and indicated that these apps can be effective tools for identifying trigger factors of migraine, improving self-management of headache disorders, and mediating the interactions between headache sufferers and their treating doctors. The role of participatory research and involvement of patients and clinicians in the development of such apps was also highlighted. Despite the availability of numerous mobile apps for headache disorders, the evidence base to support their effectiveness and clinical safety is very weak. The current literature indicates that mobile apps have the potential for improving the care of headache sufferers, but this is yet to be proven by adequately designed studies.

Trigger factors of migraine in patients presenting to a neurology unit in North Central Sri Lanka

Trigger factors of migraine in patients presenting to a neurology unit in North Central Sri Lanka

The Prevalence and Awareness of Migraine Among University Students in Harbin, China.

To determine the prevalence and the awareness of migraine among university students in Harbin, China. A cross-sectional study of students was conducted in Harbin Medical University from April 1 to June 30, 2012. The Chinese version of the Identification of Migraine Screener (ID-Migraine) was used as the screening tool, and the awareness of migraine was evaluated by a structured questionnaire. A subgroup of the students was randomly selected to fill out the questionnaire again to evaluate its test-retest reliability. The internal consistency reliability and structured validity were tested using Cronbach's alpha coefficient and exploratory factor analyses. Of the 5,129 registered students, 4,406 students (85.9%) signed a consent form and completed the questionnaire. Three hundred ninety-five students were screened positive for migraine, with a prevalence of 9.0%, and the migraine prevalence increased with age (z=-2.82, P<.01). Gender (χ²=0.12, P=.73) and body mass index (χ²=0.51, P=.78) did not significantly influence migraine prevalence, and the prevalence showed no significant difference between medical and nonmedical students (χ²=2.10, P=.15). The awareness of fundamental details (definition, classification, symptoms), treatment, and trigger factors of migraine were 40.4%, 42.4%, and 68.6%, respectively. The test-retest reliability of these parts of the questionnaire was 0.61 (95% confidence interval [CI]: 0.48-0.75), 0.77 (95% CI: 0.66-0.88), and 0.80 (95% CI: 0.69-0.91), respectively. Three components accumulatively explained 52.1% of the total variance of the scale, and the rotated factor loadings (the correlation coefficient between the items and the common factor) in each part were all higher than 0.50 excluding item C11. The prevalence of migraine in university students was 9.0%, which is comparable to the prevalence found in Chinese adults from the general population in two previous studies. University students have limited awareness of migraine.

Photo-, osmo- and phonophobia in the premonitory phase of migraine: mistaking symptoms for triggers?

BackgroundCertain environmental stimuli are frequently reported as typical triggers of migraine pain. Whether these so-called triggers are independent precipitators of migraine pain or mere symptoms of the premonitory phase of migraine remains to be elucidated.MethodsIn this retrospective cohort study of 1010 migraine patients of a tertiary headache center we assessed the frequency of common trigger factors, premonitory symptoms and accompanying symptoms as well as basic headache characteristics and demographic data.ResultsPremonitory symptoms with an onset of 2 or more hours prior to the headache were present in 38.9% of migraine patients, the most frequent being a tense neck, phonophobia and difficulty concentrating. There was a clear overlap of certain trigger factors and the presence of corresponding premonitory symptoms: flickering or bright light as a trigger was associated with higher frequency of photophobia in the premonitory phase. The same applied to the presence of food craving and osmophobia in the premonitory phase and certain foods or odours as trigger factors.ConclusionsOur data thus support the view that commonly reported trigger factors of migraine are not so much independent precipitators of migraine pain, but that they are most likely just misinterpreted results of enhanced attention to certain stimuli mediated by typical premonitory symptoms of migraine pain.

Dietary patterns according to headache and migraine status: a cross-sectional study.

Several potential dietary trigger factors for migraine have been proposed. However, few studies have examined the intake pattern of these dietary items compared to adequate control populations and whether intake levels may vary by migraine aura status or attack frequency. We conducted a cross-sectional study among participants in the Women's Health Study. We used logistic regression to evaluate the association between migraine and headache status and low intake of foods commonly reported to affect migraine. A total of 25,755 women reported no history of migraine or headache, 5573 reported non-migraine headache and 7042 reported any migraine. Those with non-migraine headache or any migraine were more likely to have low intake of total alcohol (OR = 1.22, 95% CI:1.14-1.29 and OR = 1.17, 95% CI:1.11-1.24, respectively). Migraineurs with aura were more likely to have low intake of chocolate, ice cream, hot dogs, and processed meats. Those who experience migraine at least once per week were more likely to have low intake of skim/low-fat milk and white and red wine. Intake of most suggested migraine dietary triggers differs by migraine aura status and attack frequency, a pattern not found for non-migraine headache.

Trigger factors mainly from the environmental type are reported by adolescents with migraine

Migraine can be triggered by many factors such as stress, sleep, fasting and environmental causes. There are few studies that evaluated migraine trigger factors in the adolescent population. A total of 100 participants from 10 to 19 years were subjected to a detailed headache questionnaire, with demographic and clinical data, and a headache diary including trigger factors during a two-month period was asked. Fifty of the participants exhibited chronic migraine and the other 50 participants demonstrated episodic migraine. The most common group of trigger factors reported was the environmental one, mainly sun/clarity, followed by hot weather and the smell of perfume. Ninety-one percent of children and adolescents with migraine reported a trigger factor precipitating the migraine attack.

Provocation of migraine with aura using natural trigger factors

It is well-known that migraine attacks can be precipitated by various stimuli. More than 50% of patients with migraine with aura (MA) know of at least one stimulus that always or often triggers their MA attacks. The objective of this study was to expose patients with MA to their self-reported trigger factors in order to assess the causal relation between trigger factors and attacks. We recruited 27 patients with MA who reported that bright or flickering light or strenuous exercise would trigger their migraine attacks. The patients were experimentally provoked by different types of photo stimulation, strenuous exercise, or a combination of these 2 factors. During and following provocation, the patients would report any aura symptoms or other migraine-related symptoms. Of 27 provoked patients with MA, 3 (11%) reported attacks of MA following provocation. An additional 3 patients reported migraine without aura attacks. Following exercise, 4 out of 12 patients reported migraine, while no patients developed attacks following photo stimulation. Experimental provocation using self-reported natural trigger factors causes MA only in a small subgroup of patients with MA. Prospective confirmation is important for future studies of migraine trigger factors and in the clinical management of patients with migraine.

Trigger factors in migraine patients

The objective of this study was to examine potential trigger factors in migraine patients. A total of 126 migraine patients were interviewed about possible trigger factors for migraine. The most common trigger factors were emotional stress (79%), sleep disturbance (64%) and dietary factors (44%). Sleep and stress were significant trigger factors in patients with migraine with aura, whereas environmental factors were important trigger factors in patients with migraine without aura. Stress, sleep and environmental factors were important trigger factors in women and differed significantly from men. Trigger factors are frequent in migraine patients, and avoidance of such factors may result in a better control of the disorder.

Dietary aspects of migraine trigger factors

The significance of dietary factors as triggers for migraines is controversial, and the assessment of this topic is complex and inconclusive. In order to evaluate the published evidence on dietary triggers, a critical review of the literature was performed by conducting a search for food item descriptors linked to migraines in the PubMed and SciELO databases. Reviews and relevant references cited within the articles that resulted from the search were also included. Of the 45 studies reviewed, 16 were population studies that involved the association between migraines and eating habits or the prevalence of related dietary factors; 12 involved interventions or analyzed observational prospective cohorts; and 17 were retrospective studies. Approximately 30 dietary triggers were explored in total, although only seven of these were addressed experimentally. In the prospective studies, patients were instructed to keep a diary; two of these studies involved dietary interventions. Conclusions that are based on nonpharmacological prophylactic strategies with a scientific basis and that show an association between certain dietary factors and the triggering of migraines are limited by the lack of prospective studies with clear experimental designs. Nevertheless, the high frequency of possible specific dietary triggers validates efforts to elucidate the involvement of food-related factors in precipitating migraines.