PHILADELPHIA—Three quarters of migraineurs experience triggers for the acute attack. Stress, hormones (in women), not eating, weather, and sleep disturbance are the most common triggers, according to the results of a recent study conducted by Leslie Kelman, MD, Medical Director at the Headache Center of Atlanta. Dr. Kelman’s research, presented at the American Headache Society’s 47th Annual Scientific Meeting, also revealed that these migraine triggers are more likely to be associated with a more florid acute migraine attack.

“The high incidence of triggers in migraineurs offers an opportunity to avoid or modify acute migraine attacks by reducing exposure to triggers. Thus addressing the commonest triggers with behavioral modification for stress, hormonal manipulation in women, eating meals regularly, and improving sleep offer opportunities to reduce or avoid the acute migraine attack,” commented Dr. Kelman in an interview with Neurology Reviews.

RATING GENERAL AND SPECIFIC TRIGGERS

Dr. Kelman’s study sought to evaluate and define specific acute migraine triggers. During routine first visits to his headache clinic, he asked patients to rate triggers in general and specifically on a scale of 0 (none) to 3 (very frequent) for the average headache. Specific triggers included alcohol, food, hormone changes, lights, not eating, perfume or odors, stress, weather, sexual activity, physical activity, heat, smoke, sleep disturbance, sleeping late, and neck pain. Information on demographics, headache characteristics, acute and chronic disability, sleep characteristics, and social and personal characteristics was also obtained at the patient’s first office visit.

The study cohort comprised 1,746 patients who met International Classification of Headache Disorders, Second Edition (ICHD-2) criteria for migraine. Of these, 85.6% were females, the mean age was 38.2, and the mean body metabolic index was 25.2. Mean lifetime duration of headaches was 14.9 years; mean headache frequency was 12.7 headaches per month, Dr. Kelman reported.

HIGH FREQUENCY, HIGH STRESS

According to the study results, 74.9% of migraineurs reported having triggers (40.1% infrequently, 26.7% frequently, and 8.8% very frequently). The mean number of triggers per patient was 6.7, with all 15 triggers studied occurring in only four patients, Dr. Kelman noted. The frequency of individual triggers ranged from 79.7% for stress to 5.2% for sexual activity (see Table).

Migraineurs with triggers as a whole (rather than individual triggers) were more likely to have a higher number of family members with migraine and to experience a longer duration of headache in years than migraineurs without triggers. They were also more likely to experience a prodrome, a postdrome, throbbing, pressure, stabbing, nausea, photophobia, running of nose/tearing of eyes, osmophobia, taste abnormality, and headache waking from sleep, Dr. Kelman reported.

Additionally, these migraineurs were more likely to choose to sleep or rest with a headache and showed greater response to acute medication. They also had a higher percentage of headache recurrence; more trouble staying asleep; more anxiety, depression, and mood swings; and more aches and pain in general. Additionally, they were less likely to rate their sleep as normal.

NR

—Christine DeFranco

Suggested Reading
Martin VT, Behbehani MM. Toward a rational understanding of migraine trigger factors. Med Clin North Am. 2001;85:911-941.

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