Migraine Triggers May Not Be So Potent After All

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Bright lights and too much exercise are well-known migraine launchers, but the latest study hints that sufferers may not be as sensitive to these triggers as previously thought. Researchers report in the journal Neurology that commonly suspected migraine triggers might not be responsible for a hurting head after all.

Unlike previous studies of migraine triggers, in which sufferers were asked about what conditions or situations preceded a headache, the scientists exposed 27 migraine patients in a lab to flashing lights, intense exercise or a combination of both to provoke a migraine with aura, a type of headache accompanied by often debilitating visual disturbances. Only a handful of subjects experienced any sort of migraine, and those who did had exercised, suggesting that bright lights may not be to blame. The participants ran or used an exercise bike at maximum effort for an hour, while researchers used a combination of lamps, flashes and other visual stimuli to mimic light disturbances for up to 40 minutes in order to study the combined effect of light and exercise. After these sessions, only 11% of the participants — three patients — experienced migraines with auras, and an additional 11% experienced migraines without auras.

“What have generally been reported as sure triggers for migraines are not so sure when you actually expose people to them” says Dr. Jes Olesen, the study’s corresponding author from the University of Copenhagen in Denmark and a fellow of the American Academy of Neurology.

(MORE: Can Brain Freeze Solve the Mystery of Migraines?)

Dr. Stephen D. Silberstein, a professor of neurology at Thomas Jefferson University and the director of the Jefferson Headache Center who co-wrote an accompanying editorial for the study, suggests that some of what people think are triggers may actually be symptoms of migraines instead.

“You eat chocolate and you get a headache. Does that mean chocolate triggers the headache?” Silberstein asks. “What probably happens is the first symptom of your migraine attack is the desire to eat chocolate. Just like when you’re pregnant, you might want pickles or ice cream. That’s one end of the spectrum, where the desire to do something is part of the migraine attack, not the trigger.”

Distinguishing between triggers and symptoms is challenging, not just for those who study migraines but for patients as well. Silberstein says there are some known triggers, such as certain odors, hunger, chemicals in alcohol and hormonal changes linked to menstruation, but that other factors may fall somewhere between an actual trigger and a symptom. How can patients tell? “Everybody with a migraine should try to find out what is triggering their attacks,” Olesen says. “When they have a suspicion, it would be a good idea to try and see if it induces an attack. In most cases, it’s probably not going to be true.”

Both Olesen and Silberstein say there are a number of factors that determine whether these suspected triggers will actually lead to an attack. Patients likely have individual thresholds that vary from day to day and from environment to environment: some days your brain is less vulnerable to certain triggers, while on other days the conditions might be right for a migraine.

(MORE: Migraines May Raise Risk of Depression in Women, Study Says)

Stress, for example, is one of the most commonly reported migraine triggers, and bright lights and exercise may simply be markers for when stress levels are high. The fact that only exercise appeared to trigger migraines came as a surprise to Olesen, considering a majority of the study’s participants believed bright lights induced migraines more than half the time upon exposure. “The patients were almost apologetic to us because they had indicated it would cause an attack, but it didn’t,” Olesen says.

If these suspected triggers aren’t causing migraines, though, why have they been fingered as responsible for the headaches? Most of the evidence linking the triggers to migraines comes from studies in which patients self-reported what they thought were the factors responsible for their headaches; for the most part, these factors weren’t tested in the way that Olesen analyzed the effect of bright lights and exercise on migraines in the lab.

People’s beliefs about migraines may also complicate how researchers explore migraine causes. Similar to the placebo effect, how patients think about migraines will often influence how they experience them. If you’re convinced a certain food will a trigger a migraine, your suspicion might become a reality; if you’re worried you’ll get a migraine, you might just bring about one.

(MORE: Migraines Linked to Brain Lesions in Women)

That’s not to say lights will never cause a migraine. Because the study was conducted in a lab setting, the exposure to triggers may not accurately replicate the conditions that launch a real-life headache. For example, if a migraine strikes after you exit a dark movie theater and walk into bright light, it could be the sudden contrast from the darkness of the theater that made the light problematic. Or, you might have been hungry or sleep-deprived before being exposed to a bright light, which would still make the light a trigger, albeit one of a combination of factors that prime your brain for the headache.

Olesen says researchers have a better understanding of migraines without auras — they have identified certain chemical triggers that have led to the development of a new class of migraine drugs, for example — but migraines with auras continue to be more of a mystery. The findings hint, however, that some long-held truths about avoiding triggers that can induce migraines with aura may be outdated.

“Trigger avoidance is overdone,” Silberstein says. “If you know something is going to cause your headache, whether you believe it as a result of conditioning or reality, avoid it. But people who take away everything in life that they love because it might trigger their headache, that’s useless.” He argues that it’s worth trying to find out what truly triggers your migraines, even if the process is painful. That suffering may be worth it in the long run.

MORE: Botox Treatments Not So Effective for Migraine-Headache Relief

20 comments
mealmy
mealmy

I get the aura's but never headaches.I have recently noticed it occurs on a regular basis if I look at something to close to my eyes,such as small print.I do wear corrective lenses

MigraineD
MigraineD

Hi All,

 It is with great sadness to hear people @SharonT having suffered for 35 years without cure.

I work as an accountant for the Migraine Research institute in South Africa and I know at The Headache Clinic www.headacheclinic.co.za,  Dr Elliot Shevel and his team have been successful treating migraine and headache conditions through surgical procedures. There is hope for sufferers even though I my view, most people are suffering because of lack of proper multidisciplinary diagnosis and effective treatment plans. The pharmaceuticals have also not been of much help to many as financial interest are huge.


I have here a few links you might want to look at.

Dr E Shevel SABC http://www.youtube.com/watch?feature=player_embedded&v=h_nrwvOE5Mo#at=379

Annemarie Jearey from Namibia.http://www.headclin.co.za/uploads/ftp/TESTIMONIALS/A-Jeary.pdf

Omission of scientific data leading to wrong classification of headache  and migrainehttp://youtu.be/YVK2tii8L0g

Pharmaceutical Industry Memo on financed "Patient Groups" leaked http://www.guardian.co.uk/business/2013/jul/21/big-pharma-secret-drugs-trials?CMP=twt_fd … 


Please feel free to contact me for any additional information of how we can help. I will personally make sure Dr Shevel or one of his team members contacts you. 

Regards


M Dube

dube@headacheclinic.co.za

alex.parvulescu
alex.parvulescu

I see nobody here putting forward the idea of keeping a migraine diary. Is that not considered good practice?

Do you guys keep track of how often a migraine occurs? Do you try to figure out triggers on a more consistent basis than just saying "exercise causes migraines"?

"the scientists exposed 27 migraine patients in a lab to flashing lights" it is unfortunate that this is what passes for medical research in 2013.

Guys, start keeping a diary, learn what triggers your migraine, it really helps!

My wife and I are the founders of an online migraine diary www.migrainevibe.com and we'd love to hear how we can help.


krnstr1
krnstr1

My worst migraines are coming from dark into bright sunlight. One day driving out from under an elevated freeway, a migraine hit me like a two-by-four across my face! At least, that's what it felt like. After a few minutes it mellowed to feel like a more normal migraine.

KLInIdaho
KLInIdaho like.author.displayName 1 Like

Something I did not see mentioned here was poor jaw alignment and stress response. If you take your stress out in your jaw, your neck muscles, eye muscles and scalp can get in on the process and effect circulation. I think there can be many triggers for different people and those triggers can vary day to day -- you could have a handful of triggers that interact depending on changing brain chemistry & stress responses through the day and over days.  It's not static direct cause effect, imo. You can wake up with a migraine -- if you clench or grind your teeth while asleep, you may be having a stress response in your sleep.

KLInIdaho
KLInIdaho

I could have used "too much exercise causes migraines" as an excuse not to exercise???!!! OHhhh Damnation!

Lyle
Lyle

Having interviewed thousands of migraine patients during the past decade of doing migraine research, I have found the obvious of what most migraineurs are well aware of; triggers vary from person to person and often vary from day to day for each individual.

What I have discovered is that the reason certain things called triggers cause migraines is based on what chemical reactions they produce in the body.

For example, did you know that being out in the hot sun, strenuous exercise, and eating yogurt all produce a similar reaction in the body that can set into motion the migraine syndrome? Its true, - they all produce and increase the level of nitric oxide (NO) in the body. Nitric oxide is a vasodilator and contributes to the chemical reaction that invokes and sustains a migraine headache.

Avoiding triggers in only part of the solution because the natural internal factors cannot be stopped by avoidance. External triggers increase in power when coupled with internal events.

To read more about triggers and why they cause you to have headaches, see http://tuliv.com/migraine-triggers.aspx

Lyle Henry, Tuliv MD Research

ChrissMarkey
ChrissMarkey

I must praise those who endure these studies as subjects. As a previous classic migraine sufferer (5-12 a week, 3-8 hours each) I cannot imagine engaging in any activity that is known to cause me to suffer even one more migraine that possible.

I got auras, she did not - or was unable to identify them. I saw floating blue dots in my left upper vision field, similar to the old blue dot on the Kodak Film ads, my left pinky finger got exceedingly cold from the big knuckle down, my face took on a noticable ashen color, and my left eye got bloodshot. Often, co-workers would 'see it on me' just before I realized one was coming.

Thankfully, and against every medical provider I used at the time, Chiropratic cured them entirely. I have been migraine free for over 20 years. My wife also was cured of her massively debilitating cluster migraines (all while being a single mom raising three small kids and fighting off an an abusive husband) through Chiropractic and an Osteopath MD.

I am one of six boys. My next youngest brother has early onset Parkenson's, I have pretty bad RLS and PLMD. Other four brothers have no known related health issues.

PeggyPasquinelly
PeggyPasquinelly

A study was needed for this?  Migraines are caused by vasoconstriction in the head.  Exercise affects blood flow.  That's the reason people reported exercise as a trigger, but the vasoconstriction is already there.  When it's been going on for some time, or is becomes more constrictive, migraine occurs.  None of these supposed triggers are triggers.  They only exacerbate a condition that already exists.  Migraine sufferers don't know their blood vessels are constricted until the onset of migraine.

There is no "I should have seen it coming."  There is only healthy lifestyle and treatment options that work for the patient.  Migraine sufferers have no control over vasoconstriction.

MarkL
MarkL

@PeggyPasquinellyMy migraines are actually the reverse and cause by vasodilation. My best relief comes from caffeine due to its vasoconstriction effects. As for knowing if my migraine is coming, I usually have about a 30 minute warning before full blown onset. I can feel the pressure building in the right front temple of my head. As long as I get some medicine (I use the simple migraine relief pills - aspirin, acetaminophen and caffeine combo) or coffee before the onset, I'm usually fine. If I do get a full blown onset, the only relief is a larger does of caffeine along with lying down in the dark with a cold compress to the forehead.

SharonT
SharonT

@PeggyPasquinellyActually, there is "I should have seen it coming." scenarios for some people. My sense of smell is very very strong about 24 hrs in advance of a migraine. Everyone's experiences in migraines are very diverse.

PeggyPasquinelly
PeggyPasquinelly

So, do you always know a migraine is coming before it hits?  I don't know any migraine sufferer who always knows one is coming on before it happens, every time.

ZoogOigg
ZoogOigg

@tiarami Yeah, just keep continuing the circle, you do realise we're the creators, right?  Get in touch, you'll love it.

tiarami
tiarami

Hi peggy, i know you mean well, but I have had migraines for 35 years and I always know its coming, each time there's a signal, excessive yawning, a funny feeling that cant be described, trigemenal nerve pain etc

CatrynaWhite
CatrynaWhite

“Both Olesen and Silberstein say there are a number of factors that determine whether these suspected triggers will actually lead to an attack. Patients likely have individual thresholds that vary from day to day and from environment to environment: Some days your brain is less vulnerable to certain triggers, while on other days the conditions might be right for a migraine.”

This is probably the most important paragraph in the whole article. From day to day we migrainers are subjected to changes in weather. Weather and barometer changes are the biggest unchangeable factor in our lives. If the weather is constant, we can often withstand a number of other triggers without developing a migraine. But, factor in a weather change, be it Santa Anas (evil winds here in SOCAL), hot summer days, exercise, rain, certain foods or additives, humidity or barometer changes and add some stress and you end up with a full blown case. For some, just a change in weather without any other factor can bring a migraine on. Including myself, I have dozens of family members including a couple of children who are migrainers and weather changes are the worst factor. You can change diet, type of exercise, just about anything; but you can’t do anything about the weather.

“The fact that only exercise appeared to trigger migraines came as surprise to Olesen,”

This fact comes as no surprise to most migrainers. Most of us prefer some form of aquatic exercise so that we can keep cool, because our bodies becoming overheated will trigger a migraine. You won’t find most migrainers in a Jazzersize class because they know it’s death!

Certain foods can trigger migraines; hard cheeses, processed meats, etc, GMO foods, additives such as MSG. Also, adding to what has already been listed,  lack of sleep, stress, allergies, cigarettes, alcohol, low blood sugar, high blood sugar, constipation, toxicity. 

 The last paragraph is the second important paragraph. It is essential to find your triggers, that you can control. It can be life changing. I have had migraines since the age of 4 (that I know of), I am now 63. I pretty much know exactly what my triggers are. I have found that a cup of coffee in the morning and in the evening help substantially, as the caffeine levels help. Also, over the years, I have found personally Advil can be my best friend. I am now using a combination of essential oils and am hoping to wean myself off of the coffee.

katedavy13
katedavy13

It took years and a three day fight with what I thought was simple migraine to find out there are several types (something like 86 types) of epilepsy to learn that my migraines were tied to one. Then the pieces began to fall into place. I think people with the most severe types of migraines and strange symptoms and triggers should perhaps investigate this crossover to migraines triggered by epilepsy. The type I have doesn't respond to newer meds. I just monitor myself and what my triggers are. Can I always tell? no. But at least I finally have something to go on that makes sense. The famous Dr. I had in Calgary, Alta. who later published his findings was a Dr Singh. Wonderful person and best in his field at the time (40-45 years ago). His information and research has served me well for all this time. Just wanted to say Thank you to him or to his family if he is no longer with us. We left the area and came to the states a short while after his case study.


Youwho
Youwho

As a person who DOES have light triggered migraines I have many questions about how they did this study.  Did they only use people who knew that light triggered migraines?  Did they expose those people to the kind of light that triggers  their migraines?  What other issues combine and did they replicate them?  Migraine triggers can be very compacted.  For me it is pinpoint light hitting the right spot.  The eye doctor is a nightmare.  Museum exhibits can be challenging.  The new police lights are also an issue.  They will cause a mild migraine if I am very tired or just getting over one. 

Yes light sensitivity is also an effect of my migraines.


bojimbo26
bojimbo26

Potato(s) and potato starch are my triggers , as to which I haven't eaten in 40 years . ( I am now 65 ) .

suzanne.converse
suzanne.converse

I have found that SOY is the biggest trigger for my Migraines.  For years I suffered daily from migraines but after watching EVERYTHING I eat and ready all lables and avoiding SOY as best I can I am doing better.  The biggest problem is that SOY is in everything!!!!  I think one day they will find out how bad it is for us.