By Jaimie Dalessio
For the millions of Americans who get migraines, identifying and avoiding migraine triggers is part of everyday life. But what happens when daily life doubles as a migraine trigger? It's a common occurrence for many whose migraines seem to be set off by factors such as bright lights or exercise.
A new study examined the relationship between those assumed triggers and the occurrence of migraine attacks with aura (visions of zig-zag lines or bright lights, for example), which occur in roughly a quarter of people with migraines. The findings are published online in Neurology, the journal 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," study author Jes Olesen, MD, said in a release from the American Academy of Neurology. "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."
Dr. Olesen, with the University of Copenhagen in Denmark, and colleagues recruited 27 people who reported that strenuous exercise or bright or flickering lights triggered their migraines. Then they provoked the participants with their reported triggers. During and following exposure to their triggers, the participants were instructed to report any symptoms.
To the study authors' knowledge, this was the first migraine provocation study designed to confirm natural triggers for migraine with aura, they write in their report.
But what they found was that only 11 percent of the group (three people) reported migraine attacks with aura following exposure to a reported trigger. Additionally, the response of 11 percent to the triggers was migraines without aura. Exercise led to reported migraine in 4 out of 12 patients, but no patients reported migraine following photo-stimulation, or light exposure.
The study suggests that while many people with migraines report certain triggers, they may not back-track and expose themselves to the trigger again to confirm that it is setting off their migraines. In interviewing the participants, researchers noted the problem of "recall bias" for identifying triggers -- that is, recalling something that occurred beforehand and associating it with the migraine. This, they write, is "particularly challenging in the case of factors that are commonly present and not well-defined, such as light, stress, and weather changes."
"Our study shows that, in addition to identification, prospective confirmation of trigger factors is necessary," the authors write, adding that if a person is exposed to a trigger for three months with no migraines, that person no longer has to avoid the suspected trigger.
In an accompanying editorial also published in Neurology, Peter Goadsby, M.D., Ph.D., of the University of California, San Francisco, raises a number of questions regarding migraine triggers.
"It is classic advice to patients to identify and avoid triggers. Perhaps that is wrong advice," Dr. Goadsby writes. "If migraine is a disorder of habituation of the brain to ordinary sensory signals, should one try to train the brain to habituate rather than avoid the trigger? Many questions are unresolved and require continued careful, bedside approaches to studying this common, disabling brain disorder."
"Study Questions the Significance of Common Migraine Triggers" originally appeared in Everyday Health.