Known migraine triggers are not reliable

A new study shows that triggering aura migraine with a patient-speaking trigger in a laboratory setting can only be successful in very few cases. The authors believe that the triggering factor for migraine may not be as important as the patient thinks. The study was published online in the January 23 issue of Neurology 2013 [Neurology 2013Jan23].

The researcher Dr. Anders Hougaard of the Copenhagen Headache Center in Denmark said the results of the new study may influence doctors' recommendations on triggers. “We usually recommend migraine patients to identify triggers and try to avoid contact,” he said. “But our research suggests that this may limit people’s lives, and patients are under unnecessary pressure when trying to avoid exposure to various factors. May not be a trigger."

“Of course, patients need to find triggers, but they need to be clear that these factors are the real trigger before completely avoiding contact, so I would recommend taking several exposures before determining the trigger. Many people avoid touching all possible triggers like Red wine, chocolate, cheese, coffee, sports and sunshine. This makes life very difficult and may not be necessary."

Dr. Hougaard also pointed out that the triggering of migraine is not a simple "yes or no" problem. He said, “It’s actually much more complicated. The threshold for migraine attacks varies with many other factors, including stress, fatigue, hormone levels, etc. At some point patients are more likely to have seizures. The lab’s settings are artificial, Because we can't copy the stress state of everyday life. It's better to test in everyday life, but it's difficult for scientific research."

Dr. Hougaard also raised the possibility that triggers may be confused with certain behaviors (actually the initial part of a migraine attack or aura symptoms). He said, "Before a migraine attack, there is often a feeling, such as fatigue, excitement or depression, or a desire for certain foods. There may be a desire for chocolate, which is misunderstood as a trigger for migraine."

In this study, the researchers recruited 27 patients with aura migraine, who complained of light or flashing light or strenuous exercise could trigger a migraine attack. The patient receives different types of light stimulation, strenuous exercise, or both. Only 3 (11%) patients had a migraine attack. The other 3 patients reported migraine attacks without aura. Exercise is a stronger trigger than light stimulation.

Dr. Hougaard said that light and physical activity are the most common causes of aura migraine, and the other two causes are stress and emotional effects, which are difficult to simulate in a laboratory setting. He said, "Although we are uncertain about deferring the findings to other triggers and migraine without aura, I think the results are likely to apply."

In a review of the study [Neurology2013Jan23], Dr. Peter J. Goadsby of the University of California, San Francisco, and Dr. StePHen D. Silberstein of Thomas Jefferson University in Philadelphia, Pennsylvania, agreed with Dr. Hougaard that the traditional recommendation to avoid exposure to triggers might be Incorrect.

They said, "If migraine is a disease in which the brain is habitualized by ordinary sensory signals, should we try to exercise brain habits instead of avoiding triggers? Many problems are not solved, and detailed and convenient methods are needed to study this common Brain disease."

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