A vital piece of a good Migraine management plan is being able to identify and manage triggers. Research has shown that more than 50% of people who have Migraine with aura (MA) are typically able identify one trigger that will consistently or near consistently bring on a Migraine attack. A small study, MigraineTriggers May Not Be as Strong as You Think, published in the online issue of Neurology, today, January 23, 2013, explores the relationship between Migraine triggers and attacks. This new research hints that triggers for people who have MA may not be as firm as some believe.
Migraine is typically triggered by certain stimuli including fluctuating hormones, changes in the barometric pressure, skipping meals, dehydration, too much, too little or poor quality of sleep, certain foods and more. Stress always brings up a bit of controversy - some firmly believe it's a Migraine trigger, while others believe stress an exacerbating factor. According to an author of the study Dr. Jes Olsen of the University of Copenhagen in Denmark and a Fellow of the American Academy of Neurology:
"People with Migraine with aura are told to avoid possible triggers, which may lead them to avoid a wide range of suspected factors. Yet the most commonly reported triggers are stress, bright light, emotional influences and physical effort, which can be difficult to avoid and potentially detrimental, if people avoid all physical activity."¹
Many people with Migraine know life can be very limiting if we attempt to avoid all our triggers. And sometimes trigger avoidance is just not possible. Dr. Peter Goadsby from the University of California, San Francisco, member of the American Academy of Neurology, and President of the International Headache Society, brings up an interesting question in regards to triggers and the study:
"Perhaps rather than triggers, these behaviors are a brain-driven response to the early phases of the migraine itself. Maybe people are driven to exercise as an early symptom and the association with light is simply the sensitivity to light that occurs with the attack itself?"¹
- Twenty seven - 13 had Migraine with aura (MA); 14 had Migraine without aura (MO).
- 46% of subjects self-reported their Migraines were triggered by "bright or flickering light."
- 38% of subjects self-reported their Migraines were triggered by "physical activity."
- 15% of subjects self-reported their Migraines were triggered by both stimuli.
- Subject experienced Migraine attacks approximately 12 times year.
- Subjects ranged in age from 20-years-old to 69-years-old.
The subjects took part in physical exertion or photo stimulation (see below) or both. When physical exertion was used, it consisted of either a strenuous run for an hour or use of an exercise bike (for an hour) while they increased their heart rate to 80% of maximum performance.
The photo stimulation portion of the study included exposure to vibrant, sporadic, or flickering lights for a period of 30 to 40 minutes. Throughout all the exposure and then right afterwards, subjects documented any symptoms of aura and/or migraine, and they could be exposed more than once if they so desired. Subjects were observed for three hours after exposure.
- 11% (3) of subjects stated they had Migraine with aura.
- 11% (3) of subjects stated they had Migraine without aura.
- After the exposure, 4 out of 12 subjects stated they had Migraine.
- NO subjects were triggered solely by photo stimulation.
Researchers concluded that exposing people who had MA may only trigger MA in a small subsetof these subjects. The study findings intimate that if a subject is exposed to their trigger for a total of three months without experiencing a Migraine attack, they don't necessarily have to be concerned with avoiding that trigger. Further study needs to be done to confirm the impact of Migraine triggers and how they can be better managed.
Comments and Concerns
As interesting as this study is, it is a very small and only explores two Migraine triggers; physical exertion and photo sensitivity. Not everyone who has Migraine is triggered by those. The list of possible triggers is extensive and while a small subset of Migraineurs in the study may not have triggered a Migraine during exposure to their triggers for three months, I'm not sure that's enough time for us to disregard current trigger managment. However, I do think this may be a small step forward in trigger identification and management research.
¹ American Academy of Neurology Press Release. "Migraine Triggers May Not Be As Strong As You Think."
EurekAlert. January 23, 2013.
² Hougaard, Anders, M.D.; Faisal, Amin, M.D.; Anne, Werner Hauge. M.D., PhD.; Messoud Ashina, M.D.PhD, DMSc; Jes Olesen, M.D, DMsc. "Provocation of migraine with aura using natural trigger factors." American Academy of Neurology. 80. January 23, 2013.
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© HealthCentral Network, 2013.
Last updated January 23, 2013.
Published On: January 23, 2013