Article

The Triggers or Precipitants of the Acute Migraine Attack

Authors:
To read the full-text of this research, you can request a copy directly from the author.

Abstract

The aim of this study was to evaluate and define the triggers of the acute migraine attack. Patients rated triggers on a 0-3 scale for the average headache. Demographics, prodrome, aura, headache characteristics, postdrome, medication responsiveness, acute and chronic disability, sleep characteristics and social and personal characteristics were also recorded. One thousand two hundred and seven International Classification of Headache Disorders-2 (1.1-1.2, and 1.5.1) patients were evaluated, of whom 75.9% reported triggers (40.4% infrequently, 26.7% frequently and 8.8% very frequently). The trigger frequencies were stress (79.7%), hormones in women (65.1%), not eating (57.3%), weather (53.2%), sleep disturbance (49.8%), perfume or odour (43.7%), neck pain (38.4%), light(s) (38.1%), alcohol (37.8%), smoke (35.7%), sleeping late (32.0%), heat (30.3%), food (26.9%), exercise (22.1%) and sexual activity (5.2%). Triggers were more likely to be associated with a more florid acute migraine attack. Differences were seen between women and men, aura and no aura, episodic and chronic migraine, and between migraine and probable migraine.

No full-text available

Request Full-text Paper PDF

Request the article directly
from the author on ResearchGate.

... These symptoms occur in about 30 to 90% of patients, as shown by multiple retrospective and a few prospective studies (1)(2)(3)(4)(5)(6)(7). On the other hand, complementary to these typical premonitory symptoms, various migraine triggers have been described, such as changes in weather or sleep regularity, skipping meals or stress in general (7)(8)(9)(10). Some of these so-called triggers can be regarded as part of the premonitory symptoms. ...
... Changes in appetite and food intake such as craving of and binging on certain foods are often reported as premonitory symptoms of migraine (1-3,6,7). Complementary skipping meals, irregular eating and fasting are associated with the development of migraine attacks (7)(8)(9)(10)17). Feeding and fasting are controlled by a complex neuronal network involving the hypothalamus, the nucleus tractus solitarii (NTS), the ventral tegmental area (VTA) and other brainstem nuclei. ...
... In both cases, external stimuli (light or sound) are perceived as unpleasant or abnormally intense. Furthermore, bright light or loud noises are frequently named as migraine triggers (7)(8)(9)(10). Patients with photophobia were more likely to report bright light as a migraine trigger. ...
Article
Aim To describe neuronal networks underlying commonly reported migraine premonitory symptoms and to discuss how these might precipitate migraine pain. Background Migraine headache is frequently preceded by a distinct and well characterized premonitory phase including symptoms like yawning, sleep disturbances, alterations in appetite and food intake and hypersensitivity to certain external stimuli. Recent neuroimaging studies strongly suggest the hypothalamus as the key mediator of the premonitory phase and also suggested alterations in hypothalamic networks as a mechanism of migraine attack generation. When looking at the vast evidence from basic research within the last decades, hypothalamic and thalamic networks are most likely to integrate peripheral influences with central mechanisms, facilitating the precipitation of migraine headaches. These networks include sleep, feeding and stress modulating centers within the hypothalamus, thalamic pathways and brainstem centers closely involved in trigeminal pain processing such as the spinal trigeminal nucleus and the rostral ventromedial medulla, all of which are closely interconnected. Conclusion Taken together, these networks represent the pathophysiological basis for migraine premonitory symptoms as well as a possible integration site of peripheral so-called “triggers” with central attack facilitating processes.
... Migraine is characterized by debilitating symptoms that can be "triggered" by a range of contributors (e.g., diet, environmental factors, sleep, stress) [2,50]. Contributors affect people differently, so people often attempt to identify personal contributors [60]. ...
... Contributors affect people differently, so people often attempt to identify personal contributors [60]. However, multiple contributors often must accumulate before precipitating symptoms [50,84]. Approaches that focus on individual "triggers", rather than considering multiple potential contributors, can therefore be misleading (e.g., identifying spurious correlations due to confounds) and prevent symptom management [4]. ...
Article
Although self-tracking offers potential for a more complete, accurate, and longer-term understanding of personal health, many people struggle with or fail to achieve their goals for health-related self-tracking. This paper investigates how to address challenges that result from current self-tracking tools leaving a person's goals for their data unstated and lacking explicit support. We examine supporting people and health providers in expressing and pursuing their tracking-related goals via goal-directed self-tracking, a novel method to represent relationships between tracking goals and underlying data. Informed by a reanalysis of data from a prior study of migraine tracking goals, we created a paper prototype to explore whether and how goal-directed self-tracking could address current disconnects between the goals people have for data in their chronic condition management and the tools they use to support such goals. We examined this prototype in interviews with 14 people with migraine and 5 health providers. Our findings indicate the potential for scaffolding goal-directed self-tracking to: 1) elicit different types and hierarchies of management and tracking goals; 2) help people prepare for all stages of self-tracking towards a specific goal; and 3) contribute additional expertise in patient-provider collaboration. Based on our findings, we present implications for the design of tools that explicitly represent and support an individual's specific self-tracking goals.
... Understanding the mechanisms involved in the transition from a headache-free to the headache state is crucial in understanding the underlying cause of headaches and the development abortive drugs. In many primary headache disorders, but especially migraine (67,68), several external factors have been reported to trigger this transition; stress, bright light and lack of sleep are probably the most commonly reported (69). The periodicity of migraine attacks strongly indicates involvement of internal clock mechanisms in its pathophysiology (70). ...
... Increased emotionality and concentration difficulties were reported by almost one third (10). Kelman found that tiredness, mood change and gastrointestinal symptoms (nausea) were the most frequent reported symptoms, and that yawning was rarely reported (69). However, there were specific questions about the former categories, but none about the latter symptom. ...
Article
Full-text available
Background: The actions of caffeine as an antagonist of adenosine receptors have been extensively studied, and there is no doubt that both daily and sporadic dietary consumption of caffeine has substantial biological effects on the nervous system. Caffeine influences headaches, the migraine syndrome in particular, but how is unclear. Materials and Methods: This is a narrative review based on selected articles from an extensive literature search. The aim of this study is to elucidate and discuss how caffeine may affect the migraine syndrome and discuss the potential pathophysiological pathways involved. Results: Whether caffeine has any significant analgesic and/or prophylactic effect in migraine remains elusive. Neither is it clear whether caffeine withdrawal is an important trigger for migraine. However, withdrawal after chronic exposure of caffeine may cause migraine-like headache and a syndrome similar to that experienced in the prodromal phase of migraine. Sensory hypersensitivity however, does not seem to be a part of the caffeine withdrawal syndrome. Whether it is among migraineurs is unknown. From a modern viewpoint, the traditional vascular explanation of the withdrawal headache is too simplistic and partly not conceivable. Peripheral mechanisms can hardly explain prodromal symptoms and non-headache withdrawal symptoms. Several lines of evidence point at the hypothalamus as a locus where pivotal actions take place. Conclusion: In general, chronic consumption of caffeine seems to increase the burden of migraine, but a protective effect as an acute treatment or in severely affected patients cannot be excluded. Future clinical trials should explore the relationship between caffeine withdrawal and migraine, and investigate the effects of long-term elimination.
... The genetic basis of migraine is supported by the association of migraine with mutations in a single gene (monogenic migraine) or clusters of genes (polygenic migraine) (reviewed in [56]). Mutations in the three ion channels genes, CACNA1A (calcium voltage-gated channel subunit alpha 1 A), ATP1A2 (ATPase Na + /K + transporting subunit alpha 2), and SCN1A (sodium voltage-gated channel alpha subunit 1) were identified as specifically causal for hemiplegic migraines, a rare variant of MA, and genome-wide association studies have identified 38 loci associated with increased risk of migraines [57]. ...
... The pathogenesis of migraine is largely unknown, but both genetic and environmental factors may be involved. These factors can modulate the threshold for a migraine trigger that precedes and evokes a migraine attack [56]. Many potential migraine triggers have been identified and a substantial fraction of them is associated with food ( Figure 4). ...
Article
Full-text available
Migraines are a common disease with limited treatment options and some dietary factors are recognized to trigger headaches. Although migraine pathogenesis is not completely known, aberrant DNA methylation has been reported to be associated with its occurrence. Folate, an essential micronutrient involved in one-carbon metabolism and DNA methylation, was shown to have beneficial effects on migraines. Moreover, the variability of the methylenetetrahydrofolate reductase gene, important in both folate metabolism and migraine pathogenesis, modulates the beneficial effects of folate for migraines. Therefore, migraine could be targeted by a folate-rich, DNA methylation-directed diet, but there are no data showing that beneficial effects of folate consumption result from its epigenetic action. Furthermore, contrary to epigenetic drugs, epigenetic diets contain many compounds, some yet unidentified, with poorly known or completely unknown potential to interfere with the epigenetic action of the main dietary components. The application of epigenetic diets for migraines and other diseases requires its personalization to the epigenetic profile of a patient, which is largely unknown. Results obtained so far do not warrant the recommendation of any epigenetic diet as effective in migraine prevention and therapy. Further studies including a folate-rich diet fortified with valproic acid, another modifier of epigenetic profile effective in migraine prophylaxis, may help to clarify this issue.
... A migraine is a type of primary headache with recurrent attacks, typically with unilateral, pulsating, severe headaches that last from 4 to 72 h, with accompanying nausea, photophobia, phonophobia, and sometimes even transient neurological symptoms [2]. Individuals with migraines commonly report that certain factors can trigger a migraine attack [3][4][5][6][7]. Trigger factors are defined as measurable endogenous or exogenous exposures which increase the probability of an attack over a short period of time [8]. ...
... However, in the case of exposure, attacks appear usually within 12-24 h after ingestion [3]. Kelman found that migraine patients with triggers have more family members with migraines, but also a longer lifelong duration of migraines, a higher frequency and duration of attacks, a better response to acute medications, more premonitory symptoms, more comorbidity, and more sleep difficulties than individuals without triggers [6]. There are several hypotheses about the causative connections between trigger factors and migraine initiation. ...
Article
Full-text available
Migraine is a chronic disorder with episodic attacks, and patients with a migraine often report that certain factors can trigger their headache, with chocolate being the most popular type of food-based trigger. Many studies have suggested a link between chocolate and headaches; however, the underlying physiological mechanisms are unclear. As premonitory symptoms may herald migraine attacks, a question arises regarding whether eating chocolate before a headache is a consequence of a food craving or indeed a real trigger. Here, we aim to summarize the available evidence on the relationship between chocolate and migraines. All articles concerning this topic published up to January 2020 were retrieved by searching clinical databases, including EMBASE, MEDLINE, PubMed, and Google Scholar. All types of studies have been included. Here, we identify 25 studies investigating the prevalence of chocolate as a trigger factor in migraineurs. Three provocative studies have also evaluated if chocolate can trigger migraine attacks, comparing it to a placebo. Among them, in 23 studies, chocolate was found to be a migraine trigger in a small percentage of participants (ranging from 1.3 to 33), while all provocative studies have failed to find significant differences between migraine attacks induced by eating chocolate and a placebo. Overall, based on our review of the current literature, there is insufficient evidence that chocolate is a migraine trigger; thus, doctors should not make implicit recommendations to migraine patients to avoid it.
... In primary headaches, headache attacks may be triggered by several factors, such as stress, eating habits, sleep deprivation, light stimuli, menstrual changes and odors, especially in migraine patients [1][2][3][4]. In addition, many patients complain of odor intolerance (osmophobia) both during headache attacks and in the pain-free period [5][6][7][8]. ...
... During the refueling of vehicles, they remained close to the gas tank for about 90 s. Several odorant substances can trigger headache attacks in migraine patients, especially perfume, in a frequency ranging from 30 to 75.7% [1,3,4,9,12,18,19], but 2 studies have shown that gasoline can also be a trigger for headache, about from 11 to 28.6% [1,3]. In both groups, workers presented headache after exposure to the odor of gasoline, with a predominance in those diagnosed with migraine, and this difference was statistically significant. ...
Article
Full-text available
Introduction: Headache attacks may be triggered by several factors, among them odors, especially in migraine patients. Objectives: The aim of this study wasto determine the association between gasoline odor and headache attacks in patients with migraine or tension-type headache (TTH). Subjects and methods: The study was prospective, cross-sectional, with comparison of groups, using nonrandom sample and convenience. Fifty-two gas station workers diagnosed with migraine or TTH according to ICHD-3 criteria were interviewed on the relationship between gasoline odor and headache. Results: Of the 52 gas station workers with headaches, there were 39 (75%) with migraine without aura and 13 (25%) with TTH. The age ranged from 19 to 50 years, with a mean of 29.5 ± 7.2 years. Osmophobia during headache attacks predominated in workers with migraine (29/39; 74.4%). The onset of headache due to odor exposure occurred in 23/39 (60%) of the workers with migraine and in 2/13 (15.4%) in TTH. These differences were statistically significant (χ2 = 7.4; p = 0.016). Osmophobia in the absence of pain (period between attacks) predominated in workers with migraine (17/39, 43.6%), but with no statistical value. Conclusions: Gas station workers diagnosed with migraine or TTH may experience osmophobia and headache triggered by the odor of gasoline.
... The most common triggers reported by patients include stress, sleep deprivation, fasting, certain foods, menstruation, to name a few 9 . While physical exercise is also considered a trigger by around 20-40 % of patients 14,15 , many evidences from clinical and epidemiological studies strengthen the recommendation of regular aerobic exercise, and the current understanding is that the protective effect outweighs possible harmful triggered during exercise 1,16 . In fact, exercise imposes a challenge to homeostasis at molecular and physiological levels in several neurobehavioral and physiological processes, it could interact with mechanisms thought to be involved in migraine triggers, such as sleep, stress response, hydration, hypoglycaemia, and so forth to either worse/precipitate the attacks or prevent them 1,17 . ...
... While regular aerobic exercise may reduce migraine frequency 1,3 , between 1/4 and 1/3 of migraine patients report physical exercise as a consistent trigger 14,15 . Surprisingly, there was no reported physical exercisetriggered attack in this study. ...
... Several factors may trigger migraine; stress and lack of sleep are probably the most common [70]. Significant advances have been made in characterising migraine as a brain disorder and in identifying evolutive functional changes in different brain areas during the different phases of a migraine attack (Fig. 1). ...
... A disturbance in homeostatic function is a significant trigger of attacks [70]. Sleep/arousal physiology in particular, deserves greater attention as sleep disturbances can trigger attacks in over 50% of migraine sufferers. ...
Article
Full-text available
Understanding the mechanisms of migraine remains challenging as migraine is not a static disorder, and even in its episodic form migraine remains an "evolutive" chronic condition. Considerable progress has been made in elucidating the pathophysiological mechanisms of migraine, associated genetic factors that may influence susceptibility to the disease, and functional and anatomical changes during the progression of a migraine attack or the transformation of episodic to chronic migraine. Migraine is a life span neurological disorder that follows an evolutive age-dependent change in its prevalence and even clinical presentations. As a disorder, migraine involves recurrent intense head pain and associated unpleasant symptoms. Migraine attacks evolve over different phases with specific neural mechanisms and symptoms being involved during each phase. In some patients, migraine can be transformed into a chronic form with daily or almost daily headaches. The mechanisms behind this evolutive process remain unknown, but genetic and epigenetic factors, inflammatory processes and central sensitization may play an important role.
... Weather is cited as one of many triggers of headache, but the link with air pollution is less established. 28,29 Short-term exposure to ambient air pollutants and PM was associated with increased medical visits for migraine. In Canada, studies have demonstrated a positive association between PM 2.5 and increased ED visits for migraine by 3.3% (95% CI, 0.6-6.0) up to 2 days after exposure. ...
Article
Introduction: Air pollution is a global problem and seasonal haze from forest clearing and peat land burning in Indonesia is an annual phenomenon in Southeast Asia. As neurological disorders comprise 6.3% of the burden of disease globally, we reviewed evidence of the association between common neurological conditions and air pollution exposure, and summarised existing data on the impact of the haze phenomenon in Southeast Asia. Materials and methods: A PubMed search for relevant studies on air pollution, Alzheimer's disease (AD), dementia, epilepsy, haze, headache, migraine, stroke, Parkinson's disease (PD) and neuromuscular conditions was performed. There were 52 articles which were relevant and were reviewed. Results: There were associations between short-term air pollution exposure with AD, epilepsy, ischaemic stroke and migraine. Long-term air pollution exposure was associated with AD, amyotrophic lateral sclerosis, dementia and ischaemic stroke. Evidence on the link between air pollution and PD was inconsistent. Currently, there is no specific data on the effects haze has on neurological conditions in Southeast Asia. Conclusion: Air pollution is associated with increased risk of certain common neurological disorders. More specific studies are needed to investigate the impact of seasonal haze on neurological conditions in Southeast Asia.
... Since March 11th, the imposition of the emergency lockdown related to COVID-19 diffusion disrupted the everyday life of Italian Citizens, including patients affected by migraine. Lifestyle, everyday habits, and stressful conditions influence greatly migraine frequency [1,2]. ...
... In order to better understand the clinical similarities between PTH and migraine, we assessed trigger factors of migraine-like headache exacerbations, with the most common ones being stress ($73%), lack of sleep ($69%), and bright lights ($60%). Interestingly, trigger factors have been reported in individuals with migraine (18,19). In 91 subjects with a migraine-like phenotype, we found that the three most frequently reported associated symptoms were photophobia ($96%), phonophobia ($96%), and nausea ($71%). ...
Article
Objective To investigate clinical characteristics and treatment patterns in persistent post-traumatic headache attributed to mild traumatic brain injury. Methods A total of 100 individuals with persistent post-traumatic headache attributed to mild traumatic brain injury were enrolled between July 2018 and June 2019. Deep phenotyping was performed using a semi-structured interview while allodynia was assessed using the 12-item Allodynia Symptom Checklist. Results In 100 subjects with persistent post-traumatic headache, the mean headache frequency was 25.4 ± 7.1 days per month. The most common headache phenotype was chronic migraine-like headache (n = 61) followed by combined episodic migraine-like and tension-type-like headache (n = 29) while nine subjects reported “pure” chronic tension-type-like headache. The most frequent trigger factors were stress, lack of sleep, and bright lights. A history of preventive medication use was reported by 63 subjects, of which 79% reported failure of at least one preventive drug, while 19% reported failure of at least four preventive drugs. Cutaneous allodynia was absent in 54% of the subjects, mild in 23%, moderate in 17%, and severe in 6%. Conclusions The headache profile of individuals with persistent post-traumatic headache most often resembled a chronic migraine-like phenotype or a combined episodic migraine-like and tension-type-like headache phenotype. Migraine-specific preventive medications were largely reported to be ineffective. Therefore, there is a pressing need for pathophysiological insights and disease-specific therapies.
... In addition, patients with migraine commonly report that certain external factors such as meteorological changes can aggravate migraine attack [32]. But some studies have shown conflicting results [33], which highlight the need to investigate the link between environmental factors and migraine. ...
... [9][10][11][12] Kelman et al indicated stress to be the most prevalent trigger of migraine attacks, as almost 80% of their participants reported a stressful event prior to their episode. 13 Sauro and Becker suggested that stress is a predisposing factor for the development of a new onset migraine, as well as it being a triggering factor of an acute attack. 14 However, few other researchers concluded that stress was not generally related to migraine attacks and increased stress of daily hassles did not have a strong effect on the attack of migraine. ...
Article
Full-text available
Purpose: This study aimed to determine the prevalence of migraine in young female adults and to identify if a relationship exists between psychological stress or poor sleep quality and migraine. Materials and Methods: This case-control study was carried out at Imam Abdulrahman Bin Faisal University (IAU), Dammam, KSA from March 2019 to March 2020 on 1,990 female students (17- to 26-years-old). The study tools were Migraine Screening Questionnaire (MS-Q), International Headache Society (IHS) Criteria for Migraine, K10 Psychological Distress Instrument (K10) and Pittsburgh Sleep Quality Index (PSQI). Results: A total of 103 out of 1,990 (5.17%) participants were identified to have migraine. Migraineurs compared to controls had significantly higher average stress scores; felt more tired, nervous, restless, could not sit still, felt that everything was an effort, and nothing cheered them up (p values; 0.008, 0.001, 0.02, 0.01, 0.004, 0.009, 0.02 respectively). Moreover, presence of migraine was significantly correlated with various stress parameters including “High K10 scores,” “being tired,” “being nervous,” “restlessness,” “inability to sit still,” and “feeling that everything is an effort” (p values: 0.01, 0.002, 0.018, 0.01,0.005, 0.01,0.02). Regarding sleep quality and sleep parameters, no statistically significant difference was found between migraineurs and controls. No correlation was found between presence of migraine and poor sleep quality. Conclusions: The results of this study indicate that 5.17% of young females (17- to 26- years-old) suffer from migraine. It also concludes that poor sleep quality is not correlated with migraine, whereas high stress scores are significantly correlated with migraine in young female adults.
... In the patients with migraine, not only nociceptive pain but also emotional words or emotional negative affect may act as migraine triggers [16]. Emotional stress is one of the most common triggers of acute migraine attack, attributed to about 80% of attacks [17]. In addition, patients with migraine have higher levels of perceived stress than healthy controls [18]. ...
Article
Full-text available
Background: The aim of this study is to investigate the alterations of thalamic nuclei volumes and the intrinsic thalamic network in patients with migraine. Methods: We enrolled 35 patients with migraine without aura and 40 healthy controls. All subjects underwent three-dimensional T1-weighted imaging. The thalamic nuclei were segmented using the FreeSurfer program. We investigated volume changes of individual thalamic nuclei and analyzed the alterations of the intrinsic thalamic network based on volumes in the patients with migraine. Results: Right and left thalamic volumes as a whole were not different between the patients with migraine and healthy controls. However, we found that right anteroventral and right and left medial geniculate nuclei volumes were significantly increased (0.00985% vs. 0.00864%, p = 0.0002; 0.00929% vs. 0.00823%, p = 0.0005; 0.00939% vs. 0.00769%, p < 0.0001; respectively) whereas right and left parafascicular nuclei volumes were decreased in the patients with migraine (0.00359% vs. 0.00435%, p < 0.0001; 0.00360% vs. 0.00438%, p < 0.0001; respectively) compared with healthy controls. The network measures of the intrinsic thalamic network were not different between the groups. Conclusions: We found significant alterations of thalamic nuclei volumes in patients with migraine compared with healthy controls. These findings might contribute to the underlying pathogenesis of the migraine. Trial registration: None.
... 38 Migraine can be associated with symptoms of tiredness, fatigue, and somnolence during premonitory and postdromal phases, and sleep disturbance is one of the most common triggers for migraine. 39,40 Sleepiness or drowsiness can result in cognitive impairment, including reduced vigilance and focus, delayed reaction time, memory impairment, poor coordination, and slowed information processing and decision making. The association between sleepiness and road traffic accidents has been well documented. ...
Article
Full-text available
Objective: To review the published findings relevant to migraine and driving performance, with an intent to encourage discussion on research which may broaden understanding in this area and help educate healthcare providers and their patients. Background: Motor vehicle crashes result in more than 35,000 deaths and more than 2 million injuries annually in the United States. Migraine is one of the most prevalent diseases in the world, and many symptoms associated with migraine attacks have the potential to negatively influence driving ability. Methods: We reviewed the published findings related to migraine and driving performance. Study findings relevant to symptoms of migraine and their potential effect on driving were also reviewed. This required a more expansive exploration of the literature beyond migraine, for example, review of the literature relating to the effect of pain, sleepiness, visual disturbances, or vertigo on driving. Finally, the potential effects of treatment for migraine on driving were reviewed. Results: Literature on the effect of migraine on driving performance is sparse and, in general published studies on the topic have a number of limitations. Based on review of the literature pertaining to other disorders, it seems feasible that some symptoms occurring as part of the migraine attack could impact driving performance, although formal study in this area is lacking. Many of the approved treatments for migraine have the potential to impact driving, yet this has not been specifically studied, and the extent to which these risks are communicated to patients is not clear. Conclusion: The impact of migraine on driving performance has been largely neglected, with few studies specifically designed to address the topic, and relevant studies were generally small with limited control of confounders. This area requires more focus, given a potential for impact on road safety.
... Nevertheless, foods are specifically reported by people as triggers in a low percentage of cases. [26] Our study provides findings to motivate general practitioners and headache specialists to educate people with migraine also on a correct dietary style. ...
Preprint
Full-text available
Background: migraine is a chronic neurological disorder with a high social impact. Several diets have been proposed to help managing migraine, with different outcomes. We aimed at evaluating the effect of education on the Healthy Eating Plate on migraine frequency and disability. Methods: 240 consecutive people with migraine (18 – 72-year old, 84.5% female) were screened for participation in this interventional study. Migraine was diagnosed according to the International Classification of Headache Disorders. At three times of observation (screening = T-12, 12 weeks before the intervention; baseline = T0, time of educational intervention; and follow-up = T12, after 12 weeks from baseline) the enrolled people affected by migraine underwent anthropometric measurement, dietary patterns assessment, and migraine frequency and related disability evaluation (MIDAS, MIDAS A, MIDAS B). At T0 all enrolled people were educated about the Healthy Eating Plate by a nutritionist. The Healthy Eating Plate score was created to assess adherence to the dietary advice. Results; 204 people with migraine were enrolled in the study, of these 119 people were still eligible at T0 while 97 people completed the evaluations at T12. From T0 to T12 we observed a reduction in body mass index and in monthly migraine days in the three months before the last evaluation (MIDAS A). People presenting a reduction of at least 30% in monthly migraine days were classified as responders. Responders significantly presented a reduction in red and processed meats and carb intake compared with non-responders. In addition, the Healthy Eating Plate scores were significantly higher in responders compared to non-responders, while no difference was observed for body mass index. The modification in carb consumption was also related to the variation in perceived disability (MIDAS score, ρ = 0.372 with p <0.0001) and in headache pain intensity (MIDAS B, ρ = 0.220, p=0.033). Binary logistic regression confirmed the main effect of the Healthy Eating Plate score increase and total carb decrease on the responder state. Conclusions This longitudinal study showed that adherence to the healthy eating plate advice, particularly the indication to reduce carb and red and processed meat consumption, is useful in migraine management, reducing monthly migraine days and disability. Trial registration: ISRCTN, ISRCTN14092914. Registered 14 February 2020 - Retrospectively registered, http://www.isrctn.com/ISRCTN14092914
... 28 A hallmark of migraine pathophysiology is altered perception of normal sensory stimuli such as sound, light, smell, and touch. 29,30 Central sensitization is the process by which trigeminal and cervical nociceptors become especially sensitive to normal stimuli leading to allodynia and migraine. 31,32 It is believed that in migraine, like in other chronic pain conditions, a sensitization of peripheral and nociceptive pathways can spread to higher central circuits and compromise auditory modulation mechanisms, leading to hyperacusis. ...
Objectives To evaluate the efficacy of a multi-modal migraine prophylaxis therapy for patients with hyperacusis. Methods In a prospective cohort, patients with hyperacusis were treated with a multi-modal step-wise migraine prophylactic regimen (nortriptyline, verapamil, topiramate, or a combination thereof) as well as lifestyle and dietary modifications. Pre- and post-treatment average loudness discomfort level (LDL), hyperacusis discomfort level measured by a visual analogue scale (VAS), and scores on the modified Khalfa questionnaire for severity of hyperacusis were compared. Results Twenty-two of the 25 patients (88%) reported subjective resolution of their symptoms following treatment. Post-treatment audiograms showed significant improvement in average LDL from 81.3 ± 3.2 dB to 86.4 ± 2.6 dB ( P < .001), indicating increased sound tolerability. The VAS discomfort level also showed significant improvement from a pre-treatment average of 7.7 ± 1.1 to 3.7 ± 1.6 post-treatment ( P < .001). There was also significant improvement in the average total score on modified Khalfa questionnaire (32.2 ± 3.6 vs 22.0 ± 5.7, P < .001). Conclusions The majority of patients with hyperacusis demonstrated symptomatic improvement from migraine prophylaxis therapy, as indicated by self-reported and audiometric measures. Our findings indicate that, for some patients, hyperacusis may share a pathophysiologic basis with migraine disorder and may be successfully managed with multimodal migraine prophylaxis therapy.
... For instance, the DALYs from cardiovascular disorders and the common cancers in Chinese population such as esophageal cancer and stomach cancer decreased significantly in China [8,16]. Prevalence rates in eastern China (the most developed and mostly urban areas) tended to be higher than the western China (the least developed and mostly rural areas), which may be due to poor lifestyle of urban residents such as stress, irregular sleep, irregular intake of meals, physical inactivity and so on [17][18][19]. On the other hand, there may be no clear pattern of decreasing YLDs rate of headache disorders with the socioeconomic level in China. ...
Article
Full-text available
Background: Headache has emerged as a global public health concern. However, little is known about the burden from headache disorders in China. The aim of this work was to quantify the spatial patterns and temporal trends of burden from headache disorders in China. Methods: Following the general analytic strategy used in the 2017 Global Burden of Disease study, we analyzed the prevalence and years lived with disability (YLDs) of headache and its main subcategories, including migraine and tension-type headache (TTH), by age, sex, year and 33 province-level administrative units in China from 1990 to 2017. Results: Almost 112.4 million individuals were estimated to have headache disorders in 1990 in China, which rose to 482.7 million in 2017. The all-age YLDs increased by 36.2% from 1990 to 2017. Migraine caused 5.5 million YLDs, much higher than TTH (1.1 million) in 2017. The age-standardized prevalence and YLDs rate of headache remained stable and high in 2017 compared with 1990, respectively. The proportion of total headache YLDs in all diseases increased from 1990 to 2017 by 5.4%. A female preponderance was observed for YLDs and the YLDs were mainly in people aged 20~54 years. Conclusions: Headache remains a huge health burden in China from 1990 to 2017, with prevalence and YLDs rates higher in eastern provinces than western provinces. The substantial increase in headache cases and YLDs represents an ongoing challenge in Chinese population. Our results can help shape and inform headache research and public policy throughout China, especially for females and middle-aged people.
... [13][14][15] Perhaps the most popular dietary approach to migraine management is avoidance of specific dietary triggers including chocolate, cheese, processed meats, red wine, caffeine, artificial sweeteners and sodium. 11,[14][15][16] Nearly one-third of adults with migraine self-report diet-related triggers, although there is considerable variability across individuals 17 A recent examination of triggers at the individual level showed that individual triggers are unique in up to 85% of patients. 18 Thus, while following an elimination diet is associated with a reduction in migraine attacks, this type of dietary approach has low adherence and limited generalizability given the inter-individual variation in triggers. ...
Article
Full-text available
Background: Migraine and obesity are comorbid particularly in women of reproductive age. Obesity treatment involves reducing energy intake and improving dietary quality but the effect of these changes on migraine is largely unknown. Objective: To determine if adherence to dietary intervention targets (ie, total energy, dietary fat intake, and dietary quality) were associated with improvements in migraine and weight. Methods: Eighty-four women with overweight/obesity and migraine were randomized to and completed either a 16-week behavioral weight loss (BWL) or a migraine education (ME) intervention. For 28 days at baseline and posttreatment, women recorded monthly migraine days, duration, and maximum pain intensity via smartphone-based diary. At each assessment, weight was measured and dietary intake (total energy intake, percent (%) energy from fat, and diet quality, as measured by the Healthy Eating Index, 2010 [HEI-2010]) was assessed using three nonconsecutive 24-hour diet recalls. Results: There were no significant group differences in change mean migraine days per month (BWL: -2.6+4.0, ME: -4.0+4.4; p = 0.1). Participants in BWL significantly reduced their percent fat intake 3.8% (p = 0.004) and improved total diet quality (HEI-2010) by 6.7 points (p = 0.003) relative to baseline and those in ME (%fat: +0.3%; p = 0.821; HEI-2010: +0.7; p = 0.725). After controlling for race/ethnicity and weight change, changes in dietary intake were not related to changes in migraine characteristics or weight loss among BWL participants (p's > 0.05). Conclusions: Changes in dietary intake among participants were small and may have been insufficient to improve migraine in women with overweight/obesity and migraine.
... Mientras que algunos migrañosos señalan de manera convincente al clima como un factor desencadenante exógeno de sus crisis, otros descartan cualquier influencia del clima. Los estudios clínicos apoyan estas observaciones contradictorias (Kelman et al, 2007). ...
... In Taiwan, people have a higher likelihood of opening their windows or going outdoors in the warm season than they do in the cool season, leading to increased exposure; accordingly, monitored air pollutant concentrations could be more closely correlated with personal exposure in the warm season than in the cool season. However, extremely cold or extremely hot weather can be a triggering factor for migraine headache [34][35][36][37][38]. In Taiwan, a subtropical country, summer temperatures are often above 38 °C, and annual average temperatures are often above 25 °C; hence, the effect of high temperatures is significantly higher than that of low temperatures. ...
Preprint
Full-text available
Background Although research has suggested environmental factors to be triggers of headache, the contribution of long-term air pollution exposure to migraine and recurrent headaches (migraine/headaches) is poorly understood. Hence, we executed this nationwide cohort study to investigate the association of levels of ambient air pollution with the incidence and the risk of migraine/headaches in Taiwan children from 2000 to 2012. Methods We collected data from the Taiwan National Health Insurance Research Database and linked them to the Taiwan Air Quality Monitoring Database. Overall 218,008 children aged <18 (0-17) years old were identified from January 1, 2000 and then followed until they were diagnosed by a physician >=3 times with migraine/headaches or until December 31, 2012. We categorized the annual average concentration of each air pollutant (fine particulate matter, total hydrocarbon, methane, sulfur dioxide, and nitrogen dioxide) into quartiles (Q1-Q4). We measured the incidence rate, hazard ratios (HRs), and the corresponding 95% confidence intervals for migraine/headaches stratified by the quartiles. Results A total of 28037 children (12.9%) were identified with migraine/headaches. The incidence rate and adjusted HR for migraine/headaches increased with higher-level exposure of air pollutants, except sulfur dioxide. Conclusions We herein demonstrate that long-term ambient air pollutant exposure might be a risk factor for childhood migraine/headaches.
... This treatment has already shown some ability to alleviate vertigo symptoms in MD and remains effective for approximately 47% of patients [71][72][73]. Interestingly, the percentage of migraine sufferers who report weather as a trigger also falls within the 40-60% range [48,74,75]. Though the mechanism is not completely understood, changes in barometric pressure have been demonstrated to provoke neuropathic pain in rats [76]. ...
Article
Meniere's disease (MD) is a chronic condition affecting the inner ear whose precise etiology is currently unknown. We propose the hypothesis that MD is a migraine-related phenomenon which may have implications for future treatment options for both diseases. The association between MD and migraine is both an epidemiological and a mechanistic one, with up to 51% of individuals with MD experiencing migraine compared to 12% in the general population. The presence of endolymphatic hydrops in those with MD may be the factor that unites the two conditions, as hydropic inner ears have an impaired ability to maintain homeostasis. Migraine headaches are theorized to cause aura and symptoms via spreading cortical depression that ultimately results in substance P release, alterations in blood flow, and neurogenic inflammation. Chronically hydropic inner ears are less able to auto-regulate against the changes induced by active migraine attacks and may ultimately manifest as MD. This same vulnerability to derangements in homeostasis may also explain the common triggering factors of both MD attacks and migraine headaches, including stress, weather, and diet. Similarly, it may explain the efficacy of common treatments for both diseases: current migraine treatments such as anti-hypertensives and anti-convulsants have shown promise in managing MD. Though the etiology of both MD and migraine is likely multifactorial, further exploration of the association between the two conditions may illuminate how to best manage them in the future. MD is likely a manifestation of cochleovestibular migraine, which occurs as a result of migraine related changes in both the cochlea and vestibule.
... 21 Reported premonitory symptoms are numerous and span various categories such as homeostatic alterations, sensory sensitivities, mood, cognitive, and fatigue symptoms, which are regularly mislabelled by patients as triggers. 16,24,25 Frequently reported symptoms include concentration impairment, tiredness/ fatigue, food cravings, irritability, yawning, photophobia, and neck stiffness. 7,27,40 Given the nature and often circadian rhythmicity of premonitory symptoms, the hypothalamus with orexinergic (sleep regulation and feeding) and dopaminergic (yawning and nausea) systems has been suggested to be implicated. ...
Article
Full-text available
Spontaneous and pharmacologically-provoked migraine attacks are frequently preceded by nonheadache symptoms called premonitory symptoms. Here, we systematically evaluated premonitory symptoms in migraine patients and healthy controls following glyceryl trinitrate (GTN) infusion. In women with migraine without aura (n=34) and age-matched female controls (n=24) we conducted systematically a semi-structured interview assessing 21 possible premonitory symptoms every 15 minutes in the 5 hours following GTN infusion (0.5 µg/kg/min over 20 min). Migraine-like headaches occurred in 28/34 (82.4%) migraineurs (GTN responders). After GTN, 26/28 (92.9%) responders, 6/6 (100%) non-responders, and 13/24 (54.2%) controls reported at least one possible premonitory symptom. Concentration difficulties (p=0.011), yawning (p=0.009), nausea (p=0.028), and photophobia (p=0.001) were more frequently reported by those migraineurs who developed a migraine-like attack versus healthy controls. Importantly, concentration difficulties were exclusively reported by those who developed a migraine-like attack. Thus, our findings support the view that GTN is able to provoke the naturally occurring premonitory symptoms, and show that yawning, nausea, photophobia, and concentration difficulties are most specific for an impending GTN-induced migraine-like headache. We suggest that these symptoms may also be helpful as early warning signals in clinical practice with concentration difficulties exclusively reported by those who develop a migraine-like attack.
... For example, sleep changes have been described in ~50% of patients with migraine headaches, although 75% of patients also chose to sleep due to the migraine headache 5 . In addition, a study of 1207 patients with migraine headache identified no less than 16 possible triggers present in at least 5% of migraine sufferers 6 . A similar scale in triggers has also been noted for depression 7 , anxiety 8 , and chronic low back pain flares 9 . ...
Preprint
Management of chronic recurrent medical conditions (CRMC), such as migraine headaches, chronic pain and anxiety/depression, is a major challenge for modern providers. The fact that often the most effective treatments and/or preventative measures for CRMCs vary from patient to patient lends itself to a platform for self-management by patients. However, to develop such an mHealth app requires an understanding of the various applications, and barriers, to real-world use. In this pilot study with internet-based recruitment, we conducted an assessment of user satisfaction of the iMTracker iOS (iPhone) application for CRMC self-management through a self-administered survey of subjects with CRMCs. From May 15, 2019 until March 27, 2020, we recruited 135 subjects to pilot test the iMTracker application for user-selected CRMCs. The most common age group was 31-45 (48.2%), followed by under 30 (22.2%) and 46-55 (20%). There were no subjects over 75 years old completing the survey. 38.8% of subjects were college graduates, followed by 29.6% with a Masters degree, and 25.9% with some college. No subjects had not graduated from high school, and only 2 (1.5%) did not attend college after high school. 80.7% of subjects were self-identified as Caucasian, and 90.4% as not Hispanic or Latino. The most common CRMC was pain (other than headaches) in 40% of subjects, followed by mental health in 17.8% and headaches in 15.6%. 39.3% of subjects experienced the condition multiple times in a day, 40.0% experienced the condition daily, and 14.8% experienced the condition weekly, resulting in a total of 94.1% of subjects experiencing the condition at least weekly. Among the concerns about a self-management app, time demands (54.8%) and ineffectiveness (43.7%) were the most prominent, with privacy (24.4%) and data security (25.2%) also noted. In summary, we found internet-based recruitment identified primarily Caucasian population of relatively young patients with CRMCs of relatively high recurrence rate. Future work is needed to examine the use of this application in older, underrepresented minorities, and lower socioeconomic status populations.
... Lack of awarnes, both in society and among physicians, may also add to the problem. In the frequently cited paper of Kelman about triggers of migraine (29), caffeine withdrawal is not mentioned, perhaps because of the pharing in the questionnaire. In some reviews, however, it is considered as a quite common trigger (30), but solid documentation for this has been lacking. ...
Article
Full-text available
Objective: Assessing the effects of caffeine withdrawal on migraine. Background: The effects of caffeine withdrawal on migraineurs are at large unknown. Methods: This was a randomized, double-blind, crossover study (NCT03022838), designed to enroll 80 adults with episodic migraine and a daily consumption of 300–800 mg caffeine. Participants substituted their estimated dietary caffeine with either placebo capsules or capsulated caffeine tablets for 5 weeks before switching the comparators for 5 more weeks. Results: The study was terminated due to low recruitment. Ten subjects with a mean age of 46.3 ± 9.9 years, BMI of 24.9 ± 3.7, and a mean blood pressure of 134/83 ± 17/12 mmHg were enrolled. The average consumption of caffeine per day was 539 ± 196.3 mg. The average monthly headache days and migraine attack frequency at baseline was 11.5 ± 4.9 and 5.2 ± 1.2, respectively. At baseline Pittsburgh Sleep Quality Index was 5.8 ± 2.5 and HIT-6 was 62.8 ± 3.9. There were no differences in these or in parameters from actigraphy during the caffeine period compared with the placebo period. One subject withdrew just after entering the study. In the remaining nine, withdrawal triggered severe migraine attacks in seven, causing one more drop-out, and a typical caffeine withdrawal syndrome in two. Caffeine continuation did not trigger migraines, but one attack occurred in the wake of caffeine reintroduction. Conclusions: The study failed to answer how caffeine withdrawal affects migraineurs over time, but showed that abrupt withdrawal of caffeine is a potent trigger for migraine attacks.
... Therefore, migraine triggers aggravate migraine headache in a number of diverse ways, including: (i)direct effect on excitatory or inhibitory neuro receptors; (ii) release of internal neuropeptides or neurotransmitters and nitric oxide; and (iii) direct excitation of neurons 40,41 . The most common external triggers for migraine attacks in decreasing frequency are, stress (80%), hormonal fluctuations in women (65%), skipping meals (57%), changes in weather (53%), lack of sleep (50%), perfumes or odors (44%), neck pain (38%), certain foods (27%) and physical activity (22%) 9,42 . Besides this, Cheese, chocolate, red wine and beer and several other food substances contain vasoactive amines, such as tyramine, which constrict arteries, the first step of migraine process. ...
Article
Full-text available
Headaches have afflicted man throughout history, and Migraine is a common, but under diagnosed and under treated type of headache that has a strong social impact, influencing both quality of life and work productivity. Stress, food allergies, neuro endocrine imbalances and nutritional deficiencies all may contribute to migraine attacks. Several mechanisms have been implicated in migraine patho physiology including inflammation, mitochondrial dysfunction, abnormal neuronal excitability and vascular events. Drugs from different pharmacological classes are used for migraine prophylaxis and these agents may normalize neuronal excitability by modulating distinct ionic channels and various neurotransmitter systems. They can also block cortical spreading depression; prevent peripheral and/or central pain sensitization. Over the last two decades, the results from clinical studies have provided evidence of the efficacy of allopathic and herbal drugs which have shown considerable relief in complications of migraine yet a lot of pathological mechanisms and resultant sufferings remain unresolved.
... Trigger avoidance [71] leads to increased trigger potency [21], decreased pain tolerance [18,58,81], restricted lifestyle [40], diminished internal locus of control [42], and exacerbated headaches [6,20]. Therefore, new approaches deemphasizing trigger avoidance may lead to long-term gains in functioning. ...
Article
Prevention of headaches via avoidance of triggers remains the main behavioral treatment suggestion for headache management despite trigger avoidance resulting in increases in potency, lifestyle restrictions, internal locus of control decreases, pain exacerbation and maintenance. New approaches, such as Acceptance and Commitment Therapy (ACT), instead emphasize acceptance and valued living as alternatives to avoidance. Though ACT is an empirically supported treatment for chronic pain, there is limited evidence for headache management whilst preliminary outcome studies are afflicted with methodological limitations. This study compared an ACT-based group headache-specific intervention to wait-list control, in a randomized clinical trial, on disability, distress, medical utilization, functioning and quality of life. 94 individuals with primary headache (84% women; Mage=43 years; 87.35% migraine diagnosis) were randomized into two groups (47 in each). Assessments occurred: before, immediately after, and at 3-months following treatment end. Only the ACT group was additionally assessed at 6- and 12-months follow-up. Results (intent to treat analyses corroborated by linear-mixed-model analyses) showed substantial improvements in favor of ACT compared to control, on disability, quality of life, functional status, and depression at 3-, 6-, and 12-month follow-up. Improvements were maintained in the ACT group at 6- and 12-month follow-up. At 3-month follow-up, clinical improvement occurred in headache-related disability (63%) and 65% in quality of life in ACT vs. 37% & 35% in control. These findings offer new evidence for the utility and efficacy of ACT in localized pain conditions and yields evidence for both statistical and clinical improvements over a years’ period. Perspective: An Acceptance and Commitment Therapy approach focusing on acceptance and values-based activities, was found to improve disability, functioning and quality of life among patients with primary headaches. Trial registration: Clinical trials.gov registry (NCT02734992)
... However, this approach can be viewed critically for several reasons. [4][5][6][7][8][9] Based on the idea that avoiding triggers is not always possible, and in line with the TAMH, researchers now suggest a more effective approach to the management of certain headache triggers may be Learning to Cope with Triggers (LCT). 3 In a randomized clinical trial with patients with migraine and/or tension headache, LCT (which uses a therapeutic approach to promote active handling of triggers and contains elements of exposure treatment) showed better treatment effects compared to traditional treatment methods such as trigger avoidance. ...
Article
Objective: To examine the factor structure of the Headache Triggers Sensitivity and Avoidance Questionnaire (HTSAQ) and its German version (HTSAQ-G), in order to identify potential different types of triggers. Furthermore, a short form of the questionnaire was developed. Background: The HTSAQ includes 24 of the most commonly reported headache triggers (eg, stress, odors, lack of sleep). Both the HTSAQ and HTSAQ-G appeared to be reliable and valid measures of sensitivity to and avoidance of headache triggers. Methods: In a cross-country collaboration, data from 2 cross-sectional studies including N = 391 individuals diagnosed with migraine from Australia (n = 222) and Germany (n = 169) were analyzed. The factor structure of the questionnaire was examined using exploratory and confirmatory factor analysis. Finally, a short form of the HTSAQ was constructed and evaluated regarding psychometric properties. Results: Factor analytic results showed a differentiation between internal and external headache triggers, and different patterns of strategies in coping with triggers. The scales of both the original questionnaire as well as the developed short form showed good reliability (Cronbach's α = 0.76 to 0.96). As expected, negative correlations (r = -0.10 to -0.30, P = .006 to .044) with acceptance of pain were observed. Participants with chronic migraine showed significantly higher triggers sensitivity and avoidance of triggers than those with episodic migraine (t(389) = -9.12, P < .001, Cohens d = 0.93). Conclusions: Both the long and short forms of the questionnaire appear to be reliable and valid measures. The development of the short form of the questionnaire simplifies the use of the HTSAQ in clinical practice. Further research should focus on other primary headache disorders, such as tension-type headache or cluster headache.
... Clinically, sleep deprivation or excessive sleep, as well as other sleep disturbances are among to the most common attack triggers reported by patients with primary headaches (e.g. migraine without aura [25,29], migraine with aura [30], familial hemiplegic migraine [31], tension-type headache [32,33]). Conversely, sleep is associated with the resolution or relief of migraine attacks [34,35]. ...
Article
Full-text available
Background: Migraine is a common headache disorder, with cortical spreading depolarization (CSD) considered as the underlying electrophysiological event. CSD is a slowly propagating wave of neuronal and glial depolarization. Sleep disorders are well known risk factors for migraine chronification, and changes in wake-sleep pattern such as sleep deprivation are common migraine triggers. The underlying mechanisms are unknown. As a step towards developing an animal model to study this, we test whether sleep deprivation, a modifiable migraine trigger, enhances CSD susceptibility in rodent models. Methods: Acute sleep deprivation was achieved using the "gentle handling method", chosen to minimize stress and avoid confounding bias. Sleep deprivation was started with onset of light (diurnal lighting conditions), and assessment of CSD was performed at the end of a 6 h or 12 h sleep deprivation period. The effect of chronic sleep deprivation on CSD was assessed 6 weeks or 12 weeks after lesioning of the hypothalamic ventrolateral preoptic nucleus. All experiments were done in a blinded fashion with respect to sleep status. During 60 min of continuous topical KCl application, we assessed the total number of CSDs, the direct current shift amplitude and duration of the first CSD, the average and cumulative duration of all CSDs, propagation speed, and electrical CSD threshold. Results: Acute sleep deprivation of 6 h (n = 17) or 12 h (n = 11) duration significantly increased CSD frequency compared to controls (17 ± 4 and 18 ± 2, respectively, vs. 14 ± 2 CSDs/hour in controls; p = 0.003 for both), whereas other electrophysiological properties of CSD were unchanged. Acute total sleep deprivation over 12 h but not over 6 h reduced the electrical threshold of CSD compared to controls (p = 0.037 and p = 0.095, respectively). Chronic partial sleep deprivation in contrast did not affect CSD susceptibility in rats. Conclusions: Acute but not chronic sleep deprivation enhances CSD susceptibility in rodents, possibly underlying its negative impact as a migraine trigger and exacerbating factor. Our findings underscore the importance of CSD as a therapeutic target in migraine and suggest that headache management should identify and treat associated sleep disorders.
... Crosssectional evidence has supported this notion, finding that beliefs about trigger potency are positively correlated with migraine-related disability and affective distress [35••]. Avoidance of triggers also prevents individuals from testing whether a particular trigger belief is accurate and thus prevents processing of corrective information (i.e., learning that the avoided stimulus does not in fact reliably trigger headache) [36], which may account for high endorsement rates of multiple triggers [37]. A growing number of studies have called into question the accuracy of patient beliefs about triggers [34,38] and experimental studies have in some cases directly contradicted them [39,40]. ...
Article
Purpose of review: The purpose of this review is to summarize the role of avoidance behavior in headache-related disability and overview relevant clinical implications. Recent findings: Avoidance occupies a central role in contemporary psychological perspectives on headache disorders and other chronic pain conditions. Several cognitive constructs of relevance to headache are influenced and maintained by avoidance behavior. A growing body of literature attests to the notion that avoidance of headache triggers, of stimuli that exacerbate headache, and of broader life domains can negatively affect headache progression, disability/quality of life, and comorbid psychiatric symptoms. Interventions targeting avoidance behavior, such as therapeutic exposure to headache triggers, mindfulness, and acceptance and commitment therapy (ACT), hold promise for headache disorders but need to be tested in larger trials. Researchers and clinicians are encouraged to attend to functional impairment as a critically important treatment outcome. Comprehensive understanding of headache disorders necessitates attention not merely to diagnostic symptoms and their reduction, but to patterns of avoidance behavior that inadvertently exacerbate headache and contribute to functional impairment.
... and in migraine with aura compared to migraine without aura (P = .010). 44 Several cross-sectional studies and questionnaire surveys also reported the association of dietary factors with migraine. In a questionnaire survey assessing the effect of diet-related triggers, the number of people with at least 1 trigger was significantly higher in people with migraine attacks than those with no attacks within the last year (P < .001). ...
Article
Full-text available
Background: Migraine is a disabling primary headache disorder often associated with triggers. Diet-related triggers are a common cause of migraine and certain diets have been reported to decrease the frequency of migraine attacks if dietary triggers or patterns are adjusted. Objective: The systematic literature review was conducted to qualitatively summarize evidence from the published literature regarding the role of diet patterns, diet-related triggers, and diet interventions in people with migraine. Methods: A literature search was carried out on diet patterns, diet-related triggers, and diet interventions used to treat and/or prevent migraine attacks, using an a priori protocol. MEDLINE and EMBASE databases were searched to identify studies assessing the effect of diet, food, and nutrition in people with migraine aged ≥18 years. Only primary literature sources (randomized controlled trials or observational studies) were included and searches were conducted from January 2000 to March 2019. The NICE checklist was used to assess the quality of the included studies of randomized controlled trials and the Downs and Black checklist was used for the assessment of observational studies. Results: A total of 43 studies were included in this review, of which 11 assessed diet patterns, 12 assessed diet interventions, and 20 assessed diet-related triggers. The overall quality of evidence was low, as most of the (68%) studies assessing diet patterns and diet-related triggers were cross-sectional studies or patient surveys. The studies regarding diet interventions assessed a variety of diets, such as ketogenic diet, elimination diets, and low-fat diets. Alcohol and caffeine uses were the most common diet patterns and diet-related triggers associated with increased frequency of migraine attacks. Most of the diet interventions, such as low-fat and elimination diets, were related to a decrease in the frequency of migraine attacks. Conclusions: There is limited high-quality randomized controlled trial data on diet patterns or diet-related triggers. A few small randomized controlled trials have assessed diet interventions in preventing migraine attacks without strong results. Although many patients already reported avoiding personal diet-related triggers in their migraine management, high-quality research is needed to confirm the effect of diet in people with migraine.
Article
Background and purpose: This study investigates the relationship between exposure to hot/cold weather and the characteristic clinical features of headaches in patients with migraine and tension-type headaches. Methods: This cross-sectional study was conducted with the participation of 190 patients with migraine, and 140 patients with tension-type headaches. The patients were evaluated using a form that collected data on their sociodemographic profile, the clinical features of their headaches, any accompanying symptoms and their relationships with changes in the weather (hot/cold). The headaches of all the participants in the study were thought to be triggered by exposure to hot/cold weather. Results: In the patients with migraine, the exposure to hot/cold weather as a trigger was not found to have a significant relationship with age, body mass index or the characteristic clinical features of headaches (p > 0.05). In patients with tension-type headaches, exposure to hot/cold weather as a trigger was found to have a significant relationship with body mass index (p = 0.019), but not with age or the characteristic clinical features of headaches (p > 0.05). Conclusions: In obese patients with tension-type headache, it was found that hot weather triggered headache more than cold weather. In patients with migraine and tension-type headaches, no relationship was found between exposure to hot/cold weather as a trigger and the clinical features of headaches. The accurate identification of the factors precipitating headaches by both clinicians and patients can help lower the frequency of headaches.
Article
Full-text available
Purpose Migraine has consistently been connected with rosacea. Commonalities in epidemiology, trigger factors and associated neuropeptides support shared aetiology and pathophysiological pathways, though underlying mechanisms remain unclear. We established two cohorts of patients diagnosed with either migraine and/or rosacea. All patients were phenotyped in regard to migraine and rosacea. In this article, we describe the baseline parameters of the cohorts. In the future, we expect that these cohorts will help uncover potential disease overlaps and allow for prolonged follow-up through national Danish health registers. Participants COpenhagen ROsacea COhort (COROCO) and COpenhagen MIgraine COhort (COMICO) are prospective cohorts based in the Capital region of Denmark. Participants for COROCO were recruited primarily through two tertiary dermatology clinics in Copenhagen, Denmark and patients for COMICO were recruited through a tertiary neurology clinic in Copenhagen, Denmark. Findings to date COROCO: 67.7% women (median age 51 years (interquartile range (IQR) 43.0–61.0)). Family history of migraine: 44.3%. Family history of rosacea: 45%. There were 13% who currently smoked, and 36.6% were former smokers. Regular intake of alcohol was present in 79.3% (median 4 items/week (IQR 1.0–9.0)). Median body mass index (BMI): 25.7 (IQR 23.1–29.0). Median Dermatology Life Quality Index (DLQI): 2 (IQR 1–5). COMICO: 88.5% women (median age 41 years (IQR 29.5–51.0)). Family history of migraine: 73.4%. Family history of rosacea: 18.4%. There were 17.1% who currently smoked, and 26.0% former smokers. Regular intake of alcohol was present in 62.2% (median intake: 2 item/week (IQR 1.0–3.0)). Median BMI was 24.6 (IQR 21.5–28.2). Median DLQI was 1 (IQR 0–2). Future plans COROCO and COMICO serve as strong data sources that will be used for future studies on rosacea and migraine with focus on risk factors, occurrence, treatment, natural history, complications, comorbidities and prognosis. Trial registration number ClinicalTrials.gov Registry ( NCT03872050 ).
Article
The relationship between affective temperaments and migraine is not well studied to date. It is also uncertain whether some affective temperaments may predispose the migraine patients to major depression (MD). We hypothesized that migraine patients had more affective temperament traits than HCs, and certain affective temperament traits in migraine patients are associated with lifetime MD. The sample included fifty-eight female migraine patients and age-matched 55 healthy women. The migraine was diagnosed according to the third edition of International Classification of Headache Disorders (ICHD-III). Lifetime MD was determined by means of Structured Clinical Interview I for DSM-IV. Migraine Disability Assessment (MIDAS) Questionnaire was applied to participants to determine the impact of migraine on daily life. Affective temperamental traits were assessed through Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire. All affective temperament traits (p < .0001) and the rate of MD (p = .002) were significantly higher in migraine patients compared to HCs. Non-depressive migraine patients (n = 36) had significantly more hyperthymic temperament traits compared to depressive patients (n = 22) (p = .04). Specifically, depressive temperament traits were significantly associated with higher lifetime MD in female migraine patients (B = 0.196, Exp(B) = 1.216, p = .01). Our findings suggest that affective temperaments may predispose some women to migraine, and depressive temperament may have a casual role in the development of lifetime depression in migraine patients.
Article
Full-text available
Migraine headache (MH) is a common disorder affecting millions of people in the United States. MH is substantially more prevalent in women compared to men. An association between migraine with or without aura and risk of cardiovascular disease (CVD) has been extensively reported. There are several proposed theories that may explain the pathophysiologic relationship between MH and CVD. This review will summarize the recent literature on this topic and provide an evidence-based perspective regarding the current knowledge and controversies regarding association of MH and CVD.
Article
Objective: Migraine displays clinical heterogeneity of attack features and attack triggers. The question is whether this heterogeneity is explained by distinct intracellular signaling pathways leading to attacks with distinct clinical features. One well-known migraine-inducing pathway is mediated by cyclic adenosine monophosphate and another by cyclic guanosine monophosphate. Calcitonin gene-related peptide triggers migraine via the cyclic adenosine monophosphate pathway and sildenafil via the cyclic guanosine monophosphate pathway. To date, no studies have examined whether migraine induction mediated via the cyclic adenosine monophosphate and cyclic guanosine monophosphate pathways yields similar attacks within the same patients. Methods: Patients were subjected to migraine induction on two separate days using calcitonin gene-related peptide (1.5 µg/min for 20 minutes) and sildenafil (100 mg) in a double-blind, randomized, double-dummy, cross-over design. Data on headache intensity, characteristics and accompanying symptoms were collected until 24 hours after drug administration. Results: Thirty-four patients were enrolled and 27 completed both study days. Seventeen patients developed migraine after both study drugs (63%; 95% CI: 42-81). Eight patients developed migraine on one day only (seven after sildenafil and one after calcitonin gene-related peptide). Two patients did not develop migraine on either day. Headache laterality, nausea, photophobia and phonophobia were similar between drugs in 77%, 65%, 100%, and 94%, respectively, of the 17 patients who developed attacks on both days. Conclusion: A majority of patients developed migraine after both calcitonin gene-related peptide and sildenafil. This supports the hypothesis that the cyclic adenosine monophosphate and cyclic guanosine monophosphate intracellular signaling pathways in migraine induction converge in a common cellular determinator, which ultimately triggers the same attacks. Trial registration: ClinicalTrials.gov Identifier: NCT03143465.
Article
Full-text available
Migraine is a common and disabling disorder with substantial personal, social, and economic burden that affects 37 million people in the United States. Risk factors for migraine include age, sex, and genetics. The goal of acute treatment of migraine attacks is to stop the pain and associated symptoms of the migraine attack and return the patient to normal function. The acute treatment landscape for migraine has recently expanded beyond the standard nonsteroidal anti-inflammatory drugs, analgesics, triptans, ergotamines, and combination therapies, to include neuromodulation devices, and recently approved calcitonin gene-related peptide receptor antagonists and a serotonin (5-HT1F) receptor agonist. Unmet acute treatment needs still exist due to lack of efficacy, unwanted side effects, or contraindication to treatment. Effective treatment of migraine requires the clinician to assess the patient, make an accurate diagnosis, and then offer appropriate therapy based on the patient’s medical history, comorbidities, and preferences, as well as published clinical evidence. The objective of this narrative review is to familiarize primary care clinicians with the variety of acute treatment options available in the United States today based on clinical trial findings, meta-analyses, evidence-based guidelines, and professional society consensus statements.
Article
Background Migraine treatment may mitigate migraine and associated pain in the perioperative period. Objective The aim of the study was to estimate the effect of perioperative acute and prophylactic migraine treatment on the risk of postoperative 30-day hospital readmission with an admitting diagnosis specifying any pain complaints among migraine patients. Design Electronic health records were analysed for 21,932 adult migraine patients undergoing surgery between 2005 and 2017 at Beth Israel Deaconess Medical Center and Massachusetts General Hospital in Boston, Massachusetts, USA. Methods Perioperative abortive migraine treatment was defined as guideline-recommended medication (triptan, ergotamine, acetaminophen, nonsteroidal anti-inflammatory drug) prescription after surgery, within 30 days after discharge and prior readmission. Perioperatively continued prophylactic migraine treatment was defined as prescription both prior to surgery and perioperatively for recommended medications (beta-blockers, antidepressants, antiepileptics, onabotulinumtoxin A). Results Overall, 10,921 (49.8%) patients received a prescription for abortive migraine drugs. Of these, 1.2% and 1.5% of patients with and without such prescription were readmitted for pain, respectively. Patients with abortive treatment had lower odds of pain-related readmission (adjusted odds ratio 0.63 [95% confidence interval 0.49–0.81]). Prophylactic migraine treatment showed no effect on pain-related readmission independently of acute treatment (adjusted odds ratio 0.97 [95% confidence interval 0.72–1.32]). Conclusions Migraine patients undergoing surgery with a perioperative prescription for abortive migraine drugs were at decreased risk of pain-related hospital readmission.
Article
Purpose of Review Alterations in atmospheric pressure have been long associated with headaches. The purpose of this review article is to investigate the association of barometric pressure with headache, classifying into two broad categories primary headache disorders (barometric pressure triggering migraine or tension-type headache) and secondary headache disorders (barometric pressure triggering high-altitude headache and headache attributed to airplane travel), discussing the pathophysiology and possible treatments. Recent Findings Multiple studies have been performed with inconsistent results regarding the directionality of the association between atmospheric pressure changes and triggering of primary headache disorders, chiefly headaches. Atmospheric pressure is also a trigger of two secondary headache disorders, i.e., high-altitude headache and headache attributed to airplane travel. Hypothesized mechanisms include excitation of neurons in trigeminal nucleus, central and peripheral vasoconstriction, barotrauma, and hypoxia. There are no randomized clinical trials regarding effective acute or preventive treatments. Summary Greater understanding of pathophysiology may enable both acute and preventive treatments for headaches triggered by changes in barometric pressure. Further studies on the subject are needed.
Migraine is a frequent neurological disorder in childhood and adolescence. Its complexity and relevance for everyday life, development and health behavior is regularly underestimated. The prevalence of migraine in childhood and adolescence has been increasing in recent years. The mixed type with overlapping of migraine and tension-type headache is typical for childhood. An early and correct diagnosis is important in order to initiate a rapid and adequate treatment, to support the best possible course of childhood development and to prevent the danger for somatic stress disorder and chronification. The bio-psycho-social understanding of the disease, the association of muscle pain in the neck and shoulder area and migraine (via the so-called trigemino-cervical complex) as well as the structured, interdisciplinary, multiprofessional and multimodal treatment are of special importance. The “moma(modules on migraine activity)-intervention”, an innovation fund project of the Federal Joint Committee (G-BA), provides an example for this approach.
Article
Purpose of Review The purpose of this review is to summarise the current state of knowledge concerning known types of gain, the reasons why patients might seek it, as well as implications for headache disorders. Recent Findings Even though the subject has been studied in the past, it received less attention in recent years. Summary There is no doubt that migraine is a highly disabling disorder. However, attacks sometimes may be beneficial for the migraine brain as a time-out from the daily routine. On the other hand, patients are often stigmatised as trying to satisfy other needs through their disease. These “other needs” may be the exaggerated seeking for attention and affection or an undue official sickness certificate and were named secondary gain. Striving for secondary gain denotes a behaviour that aims at benefiting from a disease in a way that is seen as inappropriate by others. The fact that the term has persisted in doctors’ vocabulary for decades probably indicates that it designates a concept considered relevant by many. However, its usage is complicated by its usually imprecise definition. We found in a literature search that the strive for secondary gain is not limited to neurosis, might both occur consciously and unconsciously, sometimes may aim at financial gain and sometimes at social gain, and can either be potentially expected or readily obtained. This behaviour mainly seems to aim at shaping one’s interactions with the environment. Its causes have not been elucidated completely, though, but “unrequited demands for love, attention and affection” have been postulated. The desire for social gain can be influenced by approaches based upon behavioural psychology. Broaching the issue of secondary gain may be beneficial in the daily clinical routine.
Article
Objective: To investigate plasma glucose changes during the ictal state of migraine compared to the interictal state. Background: Previous studies suggest abnormal glucose metabolism in migraine patients during and outside of attacks. It is not known if plasma glucose levels change during spontaneous migraine attacks. Methods: Plasma glucose levels were measured during and outside of spontaneous migraine attacks with and without aura. Plasma glucose values were corrected for diurnal variation of plasma glucose by subtracting the difference between the moving average (intervals of 2 hours) and overall mean from the plasma glucose values. Results: This was a sub-study of a larger study conducted at Rigshospitalet Glostrup in the Capital Region of Denmark. Thirty-one patients (24 F, 7 M, 13 with aura, 18 without aura) were included in the study. Mean time from attack onset to blood sampling was 7.6 hours. Mean pain at the time of investigation was 6 on a 0-10 verbal rating scale. Plasma glucose was higher ictally compared to the interictal phase (interictal mean: 88.63 mg/dL, SD 11.70 mg/dL; ictal mean: 98.83 mg/dL, SD 13.16 mg/dL, difference 10.20 mg/dL, 95% CI = [4.30; 16.10]), P = .0014). The ictal increase was highest in patients investigated early during attacks and decreased linearly with time from onset of migraine (-1.57 mg/dL/hour from onset of attack, P = .020). The attack-related increase in blood glucose was not affected by pain intensity or presence of aura symptoms. Conclusions: We demonstrated higher plasma glucose values during spontaneous migraine attacks, independent of the presence of aura symptoms and not related to pain intensity, peaking in the early phase of attacks. Additional studies are necessary to confirm our findings and explore the possible underlying mechanisms.
Chapter
Mental health-related symptoms are common following concussion with approximately 30% of athletes reporting symptoms such as anxiety and mood disturbance. There is growing agreement that anxiety/mood issues represent a distinct clinical profile or subtype of concussion. Both anxiety and depressed mood have been associated with poor outcomes and longer recovery time following this injury. Depression and anxiety following concussion typically occur at subclinical levels. However, sometimes these issues may become clinical and evolve into more complex phenomena such as functional neurological and somatic symptom disorders, malingering, or suicide in rare cases. Determining the etiology of these symptoms can be challenging, as concussion often serves as a “door opener” for athletes to discuss or address other mental health conditions under the guise of concussion treatment. Fear and anxiety associated with perceived though not empirically based long-term effects of concussion may also exacerbate anxiety and mood issues for many athletes following their injury. The purpose of this chapter is to review key mental health issues that athletes may face following concussion within the context of a conceptual framework that emphasizes targeted behavioral management and treatment for these issues. The chapter also explores the etiology of mental health issues and analyzes how they often overlap with other concussion profiles or subtypes, and includes a case illustration that demonstrates common mental health issues following concussion.
Chapter
Migraine is one of the most common and disabling neurologic diseases worldwide. An increasing recognition of migraine has led to a growing interest in understanding its pathophysiology and developing new treatments. It is now widely accepted that migraine is not simply a disease related to pain occurring intermittently, but a more complex neurological condition. The migraine attack consists of different phases which, starting from the premonitory phase, give way to the pain phase and terminate in a postdromal phase. An aura phase is also present in around one-third of migraine patients. From the formerly popular vascular theory, which described migraine as a vascular disorder, the field has now moved to the neuronal theories involving either the peripheral or central nervous system, or both. There is ample evidence suggesting that in predisposed migraine patients the activation of different cortical, subcortical, and brainstem regions and the subsequent release of key neuropeptides can contribute to the onset of the attack. A better understanding of migraine biology has paved the way for the development of new migraine-specific and mechanism-based acute and preventive treatments.
Article
Background.: Pain has been qualified under four categories: nociception, perception of pain, suffering, and pain behaviors. Most of the literature on migraine has devoted attention to the first two. The aim of the present cohort study was to investigate patients with migraine enrolled at a tertiary care unit to study suffering and mental pain and identify potential risk factors for migraine. Methods.: An observational cross-sectional study was carried out on patients with chronic migraine (CM) and episodic migraine (EM), and healthy subjects (HS). The three groups were matched for age and sex. A comprehensive assessment of migraine disability, pain, psychiatric disorders, psychosomatic syndromes, depressive and anxious symptoms, euthymia, psychosocial variables, mental pain, and pain-proneness (PP) was performed. Results.: Three hundred subjects were enrolled (100 CM, 100 EM, and 100 HS). Based on the multiple regression analyses, those presenting PP (social impairment: odds ratio [OR] = 3.59, 95% confidence interval [CI] = 1.14-11.29; depressive symptoms: OR = 3.82, 95% CI = 1.74-8.41) were more likely to be CM than HS. Those with higher levels of PP (social impairment: OR = 4.04, 95% CI = 1.60-10.22; depressive symptoms: OR = 2.02, 95% CI = 1.26-3.24) were more likely to be EM than HS. Those presenting higher levels of mental pain were more likely to be CM than EM (OR = 1.45, 95% CI = 1.02-2.07). Conclusion.: Migraine is an unpleasant sensory and emotional experience associated with psychosocial manifestations that might contribute to the level of suffering of the individuals. Mental pain resulted to be the variable that most differentiated patients with CM from EM.
Article
Objective: To test the hypotheses that insufficient duration, high fragmentation, and poor sleep quality are temporally associated with migraine onset on the day immediately following the sleep period (day 0) and the following day (day 1). Methods: In this prospective cohort study of 98 adults with episodic migraine, participants completed twice-daily electronic diaries on sleep, headaches, and other health habits, and wore wrist actigraphs for 6 weeks. We estimated the incidence of migraine following nights with short sleep duration, high fragmentation, or low quality compared to nights with adequate sleep with conditional logistic regression models stratified by participant and adjusted for caffeine intake, alcohol intake, physical activity, stress, and day of week. Results: Participants were a mean age of 35.1 ± 12.1 years. We collected 4,406 days of data, with 870 headaches reported. Sleep duration ≤6.5 hours and poor sleep quality were not associated with migraine on day 0 or day 1. Diary-reported low efficiency was associated with 39% higher odds of headache on day 1 (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.06-1.81). Actigraphic-assessed high fragmentation was associated with lower odds of migraine on day 0 (wake after sleep onset >53 minutes, OR 0.64, 95% CI 0.48-0.86; efficiency ≤88%, OR 0.74, 95% CI 0.56-0.99). Conclusion: Short sleep duration and low sleep quality were not temporally associated with migraine. Sleep fragmentation, defined by low sleep efficiency, was associated with higher odds of migraine on day 1. Further research is needed to understand the clinical and neurobiologic implications of sleep fragmentation and risk of migraine.
Article
In allergic conditions, trigger identification is often inaccurate, and may be influenced by pre-existing beliefs. In this study, we investigated the acquisition and generalization of symptom trigger beliefs in individuals with allergic rhinitis (n = 24) and control participants (n = 24). In a lab-based trigger acquisition task, unique exemplars of two trigger categories were either paired with saline inhalation (CS− category) or citric acid inhalation (CS+ category). The next day, we tested recognition and symptom expectancy for CS category exemplars and exemplars of novel trigger categories. Participants acquired differential symptom expectancies for CS+ compared to CS− exemplars, with faster acquisition in participants with rhinitis. Differential symptom expectancies persisted the next day, and generalized to novel trigger categories, with stronger generalization in rhinitis vs. control participants. These patterns of acquisition and generalization suggest that overgeneralization of trigger beliefs may complicate trigger identification in participants with allergic conditions.
Article
Background : Previous studies of migraine classification have focused on the analysis of brain waves, leading to the development of complex tests that are not accessible to the majority of the population. In the early stages of this pathology, patients tend to go to the emergency services or outpatient department, where timely identification largely depends on the expertise of the physician and continuous monitoring of the patient. However, owing to the lack of time to make a proper diagnosis or the inexperience of the physician, migraines are often misdiagnosed either because they are wrongly classified or because the disease severity is underestimated or disparaged. Both cases can lead to inappropriate, unnecessary, or imprecise therapies, which can result in damage to patients’ health. Methods: This study focuses on designing and testing an early classification system capable of distinguishing between seven types of migraines based on the patient’s symptoms. The methodology proposed comprises four steps: data collection based on symptoms and diagnosis by the treating physician, selection of the most relevant variables, use of artificial neural network models for automatic classification, and selection of the best model based on the accuracy and precision of the diagnosis. Results: The neural network models used provide an excellent classification performance, with accuracy and precision levels >97% and which exceed the classifications made using other model, such as logistic regression, support vector machines, nearest neighbor, and decision trees. Conclusions: The implementation of migraine classification through neural networks is a powerful tool that reduces the time to obtain accurate, reliable, and timely clinical diagnoses.
Article
This research seeks to broaden our understanding of weight stigma and discrimination in healthcare by exploring the influence of social norms on the treatment of higher‐weight individuals. We conducted two experimental studies to investigate: (a) how health professionals' treatment decisions are influenced by patient weight; (b) the effect of norms that endorse weight stigma on health professionals' treatment decisions for patients of different weights; and (c) how these norms may operate differently within healthcare, compared with the general public. Practising health professionals (Study 1; N = 243) and laypeople (Study 2; N = 242) were randomly assigned to view the medical profile of either an average‐weight or higher‐weight patient who was seeking health care for migraines. Study 1 revealed that health professionals tended to treat the higher‐weight patient for both their presenting condition and their weight. Health professionals who perceived weight stigma to be more normative among their colleagues displayed a hyper‐vigilance toward weight, treating weight significantly more among both higher‐weight and average‐weight patients than those who perceived weight stigma to be less normative. Study 2 found that, unlike health professionals, laypeople treated the higher‐weight patient for their weight at the expense of the presenting condition; and such differential treatment was inflated among those who perceived weight stigma to be the norm. The present research found clear evidence of bias in health professionals' treatment decision making—particularly for patients with larger bodies. However, unlike laypeople, this bias did not come at the expense of treating the presenting problem.
Article
Although migraine has been reported to have different inducing factors, changes in weather parameters such as atmospheric pressure, rain, humidity, temperature, wind, and lightning are well known important environmental factors. In recent years, reports of abnormal weather conditions such as heat waves in summer, heavy snow in winter, localized heavy rain, and abnormally light rain, as well as tropical cyclones are increasing. In today’s extreme weather conditions, the worsening, diver­sification, and chronicity of migraine symptoms is concerning, and a higher level of treatment for migraine is required than ever before. Drug therapy is used as the principal treatment for migraine. If the acute treatment alone interferes with daily life, the principle is to combine daily preventive therapies to reduce the frequency, severity, and duration of the migraine attacks. However, there are several cases wherein migraine is poorly controlled only with their combination. Several patients with migraine experience prodromal symptoms, including stiff neck and shoulder as well as sensitivity to light and sound, before migraine attacks. In recent years, it has been reported that sensors for detecting atmospheric pressure exist in the vestibular part of the inner ear, and it has been shown that changes in atmospheric pressure may activate the vestibular nerve activity. We reported that difenidol, a vestibular nerve modulator, was administered to prevent or alleviate migraine attacks during the prodromal phase caused by change in weather. Prevention during the prodromal phase and prevention based on weather prediction are new treatment strategies for migraine. In today’s extreme weather conditions, 3–P therapy that combines the three treatment strategies of prevention, prodrome, and prediction is useful.
23 Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders):8–160. and female migraineurs from the general population
23 Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd Edition. Cephalalgia 2004; 24 (Suppl. 1):8–160. and female migraineurs from the general population. Cephalalgia 1996; 16:239–45.
Article
Full-text available
Com o objetivo de estudar a distribuição de fatores desencadeantes de migrânea em uma população determinada, foram avaliados, através de entrevista pessoal, 100 pacientes que preenchiam os critérios diagnósticos para migrânea sem aura propostos pela Sociedade Internacional de Cefaléia. O estresse foi o desencadeante mais citado, respondendo pelo surgimento de crises de migrânea em 76% dos pacientes. Em seguida, em ordem de frequência decrescente, foram citados: estímulos sensoriais (75%), privação do sono (49%), jejum (48%), fatores ambientais (47%), alimentos (46%), menstruação (39%), fadiga (35%), bebidas alcoólicas (28%), sono prolongado (27%), cafeína (22%), esforço físico (20%), trauma craniano (20%), viagens (4%), atividade sexual (3%), medicamentos (2%), os movimentos do pescoço (2%), tabagismo (1%) e uso de travesseiro baixo (1%). Conclui-se que determinados fatores parecem desempenhar papel importante na precipitação da migrânea.
Article
Full-text available
The typical migraine patient is exposed to a myriad of migraine triggers on a daily basis. These triggers potentially can act at various sites within the cerebral vasculature and the central nervous system to promote the development of migraine headache. The challenge to the physician is in the identification and avoidance of migraine trigger factors within patients suffering from migraine headache. Only through a rational approach to migraine trigger factors can physicians develop an appropriate treatment strategy for migraine patients.
Article
Full-text available
The objective of this study was to study the prevalence, characteristics and predisposing factors of tension-type headache in children. An unselected population-based questionnaire study was carried out in 1409 Finnish schoolchildren aged 12 years. Of them, 1135 (81%) returned an acceptably completed questionnaire. The prevalence of episodic tension-type headache in children was 12% (138 of 1135). Children with episodic tension-type headache also often reported characteristics of pain typical for migraine. Children with frequent and persistent episodic tension-type headache reported stabbing and severe occipital pain, phonophobia and abdominal pain significantly more often than children with infrequent episodic tension-type headache. Neck-shoulder symptoms, symptoms of depression and oromandibular dysfunction were each independently associated with episodic tension-type headache. The father's occupation of a lower-level white-collar worker put the child at a four-fold risk for episodic tension-type headache. We conclude that episodic tension-type headache is as common as migraine in children. It can be associated with depression, oromandibular dysfunction and muscular stress. Especially children with frequent and persistent episodic tension-type headache report characteristics of pain typical for migraine.
Article
Full-text available
Two patients with migraine are described who also suffered from gastric reflux. The reflux triggered headaches that originated from the upper gum/teeth and responded to specific reflux treatment.
Article
Full-text available
To study the distribution of triggers of migraine in a selected population, 100 patients who fulfilled the diagnostic criteria for migraine without aura as proposed by the International Headache Society were evaluated by means of a personal interview. Stress was the most cited trigger, triggering migraine in 76%. Afterwards, in descending order of frequency, were cited sensorial stimuli (75%), sleep deprivation (49%), hunger (48%), environmental factors (47%), food (46%), menses (39%), fatigue (35%), alcohol (28%), sleep excess (27%), caffeine (22%), physical exertion (20%), head trauma (20%), trips (4%), sexual activity (3%), medications (2%), neck movements (2%), smoking (1%) and the use of a low pillow (1%). It is concluded that certain factors seem to play an important role in the triggering of migraine.
Article
Full-text available
Scarcely reported in the literature, crying seems to be an important precipitating factor for both migraine and tension-type headache in daily practice. To evaluate the role of crying as a precipitating factor for migraine and tension-type headache. Prospective evaluation. 163 workers or students from the Universidade Metropolitana de Santos, who presented at least one attack a month, for at least one year, of either migraine or tension-type headache. Interview by means of questionnaires and personal evaluations. Details of precipitating factors for the attacks were assessed. From the total group of 163 individuals, 90 (55.2%) considered crying to be a potential factor for triggering headache attacks. Of this group of 90 persons, 62 presented migraine (6 males, 56 females) and 28 presented tension-type headache (5 males, 23 females). Only stress, anxiety and menstrual periods rated higher or equal to crying as triggering factors for both types of headache. The physiology of crying is not well documented or understood. The act of crying seems to be an important precipitating factor for primary headaches and it should be studied further. The authors welcome comments on the matter and would like to work in collaboration with other groups interested in this subject.
Article
Full-text available
Chronic daily headache (CDH) represents a challenge in clinical practice and the scientific field. CDH with onset in children and adolescents represent a matchless opportunity to understand mechanisms involved in adult CDH. The aim of this study was to evaluate the diagnosis, prognosis and psychiatric co-morbidity of CDH with young onset in the young. Fifty-nine CDH patients has been followed from 1997 to 2001 in our department. Headache and psychiatric diagnoses were made on the basis of the international system of classification (International Headache Society, 1988; DSM-IV). Chi2 test and multinomial logistic regressions were applied to analyse factors predicting outcome. The current diagnostic system allows a diagnosis in 80% of CDH patients, even if age-related characteristics have been evidenced. Psychiatric disorders are notable in CDH (about 64% of patients) and predict (mainly anxiety) a poorer outcome. Surprisingly, analgesic overuse is not involved in the chronicization process. Diagnosis of CDH needs further study. Psychiatric disorders predict a worse outcome and greater account should be taken of them in treatment planning.
Article
INTRODUCTION: Cognitive therapy is a simple, short-term method designed to identify and decrease upset reactions to everyday events. Patients are given new, more rational explanatory "self-talk" interpretations so that similar events do not subsequently generate upset, which can lead to headache. PURPOSE: To review research about, rationale for, and author's approach to cognitive therapy for headache. METHODS: The author reviewed research on Medline and in the psychological literature on cognitive therapy for headache and headache episode antecedents. The author's adaptation of cognitive therapy to headache treatment is described. OUTCOME: Research studies with random assignment to cognitive therapy and control/placebo groups show that cognitive therapy reduces headache index by approximately 50% at 1 to 6 years after treatment. Efficacy is comparable to judicious preventive medication treatment. Emotional upset is the most common headache precipitant; it precedes perhaps half of all headaches in prospective and retrospective studies. The absence of emotional upset is associated with headache-free days. Numerous studies find cognitive therapy effective for both anxiety and depression-the 2 dominant comorbidities of headache. In the author's adaptation of cognitive therapy to headache treatment, patients keep a headache diary to identify upsetting events and the associated irrational, explanatory self-talk. Patients also complete a questionnaire before the first visit to help identify irrational thinking styles-such as perfectionism, excessive goal orientation, time pressure, worry, criticism, and excessive altruism. Simple, rational phrases that refute upsetting irrational thinking styles are offered to the patient to rehearse and overlearn. Common upsetting thinking styles and other precipitant behavior identified with the headache diary are described along with treatment suggestions. CONCLUSION: For selected headache patients for whom stress or depression are key components of headache pathogenesis, cognitive therapy should be helpful in long-term headache prevention. It can decrease reliance on medication and improve self-efficacy.
Article
OBJECTIVE: Headache patients are routinely educated about trigger avoidance to reduce headache frequency. Patients are generally encouraged to avoid changes in scheduling (with sleep and meals and during weekends) and to avoid alcohol, caffeine, and certain foods. This study was designed to evaluate the frequency with which putative headache triggers are endorsed by patients with a variety of chronic headache conditions. METHODS: A total of 289 consecutive patients with chronic headache (69 male and 220 female; average age, 42.5 ± 14.2 years) seeking treatment at a university headache clinic were evaluated by a board-certified neurologist. Patients were asked to report frequent headache triggers and to choose from a list of several possible common trigger factors. Headache diagnoses were migraine (n = 76); tension-type (n = 53); combined migraine and tension-type (n = 69); post-traumatic (n = 45); cluster (n = 9); and secondary to neuralgia, postoperative neuropathy, or intracranial pathology/infection (n = 37). RESULTS: Most patients identified at least 1 headache trigger. Among those with migraine, only 3.9% reported no identifiable trigger. Similarly, no trigger was identified by 7.2% of those with combined migraine and tension-type headache; by 17% with tension-type headache; by 17.8% with post-traumatic headache; by 11.1% with cluster headache; and by 24.3% with secondary headaches. Stress was the most consistently reported trigger for all types of chronic headache (22.2% to 37.7%). A logistical regression analysis identified mood (P < .05), skipping meals (P < .01), odors (P < .01), and caffeine (P = .08) as more commonly endorsed in patients with migrainous headaches. Exercise was more likely to be a trigger for non-migraine headaches (P < .01). Foods (5.4% to 21.7%), alcohol (4.4% to 27.5%), and caffeine (0% to 11.1%) were infrequently identified as usual triggers. CONCLUSIONS: Although most chronic headache sufferers endorse headache exacerbation in relation to triggers, most individual triggers are identified by only a minority of patients. Trigger avoidance should focus on stress management for all types of headache. Migraineurs should maintain regular eating cycles and reduce exposure to odors. Dietary restrictions are unlikely to benefit most patients.
Article
Tested the interactions of migraine headache cycles and sufferers' daily experiences of stressful events, emotional arousal, and physical activity. Hypotheses were that patterns of these variables would be associated with the episodic onset of migraine headache and that frequency of attacks could be predicted by combinations of personality and behavioral variables. 33 23–63 yr old migraine sufferers were interviewed; administered the Minnesota Multiphasic Personality Inventory (MMPI); and given a 4-wk diary for recording daily headache activity, physical activity, stressful events, and emotional states. Repeated-measures analyses found significant elevations of stressful events over the 4 days leading up to and including a migraine day. Physical activity declined over the same period. Emotional arousal tended to significance. Regression analyses identified sets of personality and behavioral predictors accounting for substantial variance in the reported numbers of migraine and headache-free days. Results support a model of migraine characterized by parallel physiological and psychosocial instability during a 4-day cycle and by an interaction of personality and behavioral (self-reported stress) functions. (31 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Objective: We conducted the present study to determine whether there are headache precipitating and aggravating factors that differentiate migraine from tension-type headache and headache precipitating and aggravating factors that differentiate tension-type headache from migraine. Methods: We interviewed 38 patients with migraine and 17 patients with tension-type headache (diagnosed using International Headache Society criteria) by telephone, using a questionnaire. The questionnaire inquired about the following precipitating and aggravating headache factors: (1) physical activity, (2) straining, (3) bending over, (4) stress/tension, (5) coughing/sneezing, (6) fatigue, (7) reading, (8) driving, (9) lack of sleep, (10) specific foods/drinks, (11) alcohol, (12) not eating on time, (13) smoke, (14) smell, (15) light, (16) noise, (17) menstruation, and (18) weather. Results: The most common precipitating factors acknowledged by both groups of patients were stress/tension, not eating on time, fatigue, and lack of sleep. Weather, smell, smoke, and light were the precipitating factors that differentiated migraine from tension-type headache. Excluding those factors that are part of the International Headache Society migraine diagnosis, the aggravating factors were straining, bending over, and smell. We found no precipitating or aggravating factors differentiating tension-type headache from migraine. Conclusion: Apparently there are precipitating and aggravating factors differentiating migraine from tension-type headache but not vice versa. It is interesting that three of the migraine-specific precipitating factors (ie, weather, smell, and smoke) involve the nose/sinus system, suggesting a greater significance of this system in headache than is generally considered.
Article
Prospective studies of precipitating factors in migraine are rare. Mig Access is a national control-matched survey conducted to evaluate the access of migraineurs to health care in France. This study allowed us to screen prospectively some precipitating factors of headache in migraineurs and in nonmigraineurs. Three hundred eighty-five migraineurs (group 1) and 313 nonmigraineurs (group 2) kept a diary for a 3-month period (a total of 35 805 days in group 1 and 29 109 days in group 2). Precipitating factors were reported for each headache period. Headache intensity was self-assessed during each headache period using a visual analog scale of 0 to 100. Headache was reported on 4274 days (12%) in group 1 and on 602 days (2%) in group 2. Headache intensity was greater in group 1 (39 ± 20 versus 32 ± 19, P<.05). The most frequent precipitating factors (reported at least once by more than 10% of subjects [range 18% to 80%] in both groups) were fatigue and/or sleep, stress, food and/or drinks, menstruation, heat/cold/weather, and infections in both groups. All these factors except infections were reported to cause headache more frequently in migraineurs than in nonmigraineurs. Mean intensity of headache related to fatigue and/or sleep, stress, food and/or drinks, hot/cold weather, and menstruation varied from 37 to 43 in migraineurs and from 29 to 35 in nonmigraineurs. Headache with the highest mean intensity was due to infections in the two groups (47 ± 20 in group 1,45 ± 23 in group 2). Our results support that endogenous factors are the most frequent triggers of headache in migraineurs. The most frequent precipitating factors of headache appear identical in migraineurs and in nonmigraineurs. Our results suggest that similar triggers could precipitate headache of different type in these two populations.
Article
The basis of our belief in migraine triggering factors is questioned. To avoid creating migraine-mythology, it is proposed that a trigger for migraine must also cause headache in non-migrainous subjects. This headache-migraine parallelism is examined and if correct, casts doubt on migraine precipitation by cheese, chocolate or allergy. A further weakness of "dietary migraine" is pointed out because the quantity of the trigger consumed, or the time interval between ingestion and the onset of attacks, are rarely mentioned, let alone studied. A difficulty in assessing migraine precipitants is that two factors may act in unison, e.g. stress and not eating. Further an external factor may provoke an attack only if the migraine "milieu intériur" is set appropriately, for example the hormonal state in a woman's menstrual cycle. The value of studying migraine precipitants is two-fold: (1) it provides a means of counselling patients to avoid or reduce these factors, thereby diminishing frequency and severity of attacks; (2) a comprehensive migraine pathogenetic theory must incorporate how and where precipitants act. It is concluded that analysis of triggering mechanisms lends support to the concept that migraine is a primary neurological disturbance with secondary vascular manifestations.
Article
A 6-month longitudinal study examined whether migraine attacks were preceded by or occurred on stressful days. Every evening 13 patients filled out a questionnaire assessing daily stress. Analyses on single-subject level tested whether attacks occurred more often than expected by chance 3, 2, or 1 day after or on day when stress scores were in the upper third of the subject's distribution. Increased stress was generally not found for Days 2 and 3 before an attack, but often for Day 1 and on the migraine day itself. The latter findings were also significant on a group level.
Article
Trigger factors are important for two main reasons. Firstly, they may provide some clues as to the pathogenesis of migraine. Secondly, by avoidance of them, drug therapy may be obviated. There are at least sixty trigger factors in migraine but the mechanism by which they produce migraine attacks varies.
Article
SYNOPSIS Information on trigger factors provoking a migraine attack, was collected in 217 migraineurs (176 women, 41 men). In this selected group of patients, most patients were spontaneously aware of one or more trigger factors; 184 (85%) of the patients reported trigger factors with a median number of 3 different trigger factors. The main trigger factors were menstruation (48%) or ovulation (8.5%) in women, certain food (44.7%), alcoholic beverages (51.6%) and stress 148.8%). After excluding the menstrual cycle as a trigger factor, trigger factors were more frequent in women, in older patients and in patients with a longer duration of disease. Women with a menstrual cycle-related migraine reported more trigger factors, other than the menstrual cycle itself, than women in whom the menstrual cycle had no influence on this migraine: this was especially so for food and beverages. The number and type of trigger factors in the women in whom the migraine was not menstrual cycle-related, were fully comparable with those in men. Patients in whom alcohol acts as a trigger factor had also significantly more other trigger factors, especially food. The same holds true for patients reporting stress as a trigger factor, but the latter difference is not significant when the different subgroups of trigger factors (food, beverages, other)are considered. Certain trigger factors may be mutually related.
Article
Five hundred seventy-seven consecutive patients attending the Princess Margaret Migraine Clinic from 1989 to 1991 have been questioned about dietary precipitants of their headaches. Four hundred twenty-nine patients had migraine, of which 16.5% reported that headaches could be precipitated by cheese or chocolate, and nearly always both. Of the migraine patients, 18.4% reported sensitivity to all alcoholic drinks, while another 11.8% were sensitive to red wine but not to white wine; 28% of the migrainous patients reported that beer would precipitate headaches. There was a definite statistical association between sensitivity to cheese/chocolate and to red wine (P < 0.001) and also to beer (P < 0.001), but none between diet sensitivity and sensitivity to alcoholic drinks in general. None of 40 patients with tension headache (diagnosed by International Headache Society criteria) reported sensitivity to foods, and only one was sensitive to alcoholic drinks. The prevalence of sensitivity among 46 patients with some migrainous features was intermediate between the migraine and tension headache categories. It is concluded that cheese/chocolate and red wine sensitivity, in particular, have closely related mechanisms, in some way related more to migraine than to more chronic tension-type headache, while quite separate mechanisms play a major role in sensitivity to alcoholic drinks in general.
Article
The frequency of common headache instigators or "triggers" and the use of specific behavioral responses to headache episodes were determined using the self-reports of patients with migraine, tension-type, and combined migraine and tension-type headache. Headache diagnostic groups were compared on the nature of headache triggers identified. The diagnostic groups were also compared on the frequency with which they engaged in a set of behavioral responses during headache episodes. No diagnostic group differences were found in triggering stimuli. Emotional, dietary, physical, environmental, and hormonal factors were all reported to be equally likely to precipitate a headache episode regardless of headache diagnosis. There were, however, differences in specific behavioral responses to headache episodes depending upon headache diagnosis. Discriminant analyses were performed to determine the best predictors of headache diagnoses. Migraine patients were significantly more likely to avoid noise, light, social activity, and physical activity compared with tension-type and combined headache patients. When average headache severity was taken into account, the diagnostic group differences in coping responses disappeared. It is concluded from the results of this study that headache severity has a greater impact on coping response than does specific headache diagnosis.
Article
Migraine is an episodic headache disorder associated with various combinations of neurologic, gastrointestinal, and autonomic symptoms. Gastrointestinal disturbances including nausea, vomiting, abdominal cramps, or diarrhea are almost universal. Sensory hyperexcitability manifested by photophobia, phonophobia, and osmophobia are frequently experienced. Other symptoms include blurry vision, nasal stuffiness, tenesmus, polyuria, pallor, and sweating. Our telephone interview survey of 500 self-reported migraine sufferers was performed in 1994. The most common reported symptoms associated with migraine were pain, nausea, problems with vision, and vomiting. Nausea occurred in more than 90% of all migraineurs; nearly one third of these experienced nausea during every attack. Vomiting occurred in almost 70% of all migraineurs; nearly one third of these vomited in the majority of attacks. In those who experienced nausea, 30.5% indicated that it interfered with their ability to take their oral migraine medication; in those with vomiting, 42.2% indicated that it interfered with their ability to take their oral migraine medication. The most important features of a migraine medication were rapid and effective relief of headache pain, decreasing the likelihood of headache recurrence, and not causing nausea. Many migraine patients suffer needlessly because their nausea and vomiting are both unreported to, and unrecognized by physicians. The presence of these symptoms is crucial to diagnose migraine not accompanied by aura.
Article
SYNOPSIS The predominance of certain triggers for migraine was assessed in 494 migraine patients. Stress (62%) was the most frequently cited precipitant. Weather changes (43%), missing a meal (40%), and bright sunlight (38%) were also prominent factors. Sexual activity (5%) was the precipitant cited by the least number of patients. Significant differences were found between men and women in their responses to weather changes, perfumes, cigarette smoke, missing a meal, and sexual activity. Spring was cited by 14% of patients as a time for increased migraine attacks, followed by fall (13%), summer (11%), and winter (7%).
Article
According to recent evoked potential studies, a fundamental, probably protective, feature of cortical information processing, ie, response habituation during stimulus repetition, is abnormal in migraine between attacks. The deficient habituation is found for different sensory modalities and experimental paradigms: pattern-reversal visual evoked potentials (same stimulus at a constant intensity), cortical auditory evoked potentials (same stimulus at increasing intensities) and auditory event-related potentials obtained in a passive "oddball" paradigm (novel stimulus). The abnormal information processing is an interictal cortical dysfunction most likely due to inadequate control by the so-called "state-setting, chemically-addressed pathways" originating in the brain stem, in particular by the serotonergic pathway, leading to a low preactivation level of sensory cortices. We suggest that it may play a pivotal role in migraine pathogenesis in conjunction with the reported decrease of brain mitochondrial energy reserve, by favouring a rupture of metabolic homeostasis and biochemical shifts capable of activating the trigeminovascular system and thus capable of producing a migraine attack. We postulate that both the deficient habituation in information processing and the deranged oxygen metabolism may have behavioral correlates. Which of these abnormalities are inherited, acquired or both remains to be determined.
Article
The clinical characteristics of migraine without aura (MO) and migraine with aura (MA) were compared in 484 migraineurs from the general population. We used the criteria of the International Headache Society. The lifetime prevalence of MO was 14.7% with a M:F ratio of 1:2.2; that of MA was 7.9% with a M:F ratio of 1:1.5. The female preponderance was significant in both MO and MA. The female preponderance was present in all age groups in MA, but was first apparent after menarche in MO, suggesting that female hormones are an initiating factor in MO, but not likely so in MA. The age at onset of MO followed a normal distribution, whereas the age at onset of MA was bimodally distributed, which could be explained by a composition of two normal distributions. The estimated separation between the two groups of MA was at age 26 years among the females and age 31 years among the males. The observed number of persons with co-occurrence of MO and MA was not significantly different from the expected number. The specificity and importance of premonitory symptoms are questioned, but prospective studies are needed. Bright light was a precipitating factor in MA, but not in MO. Menstruation was a precipitating factor in MO, but not likely in MA. Both MO and MA improved during pregnancy. The clinical differences indicate that MO and MA are distinct entities.
Article
We conducted an investigation of migraine headache in a general population of Mexican-Americans living in San Diego county. Specific headache triggers were reported and analyzed, the most frequently reported for females with migraine being missing meals (58.9%), weather changes (54.4%), menstruation (53.6%), post-crisis letdown (52.7%), and fatigue (51.8%). The most frequently reported trigger factors for migraines reported by males were fatigue (58.8%), sleep (as a precipitating factor) (56.3%), post-crisis letdown (41.2%), and weather changes (37.5%). Trigger factors were further evaluated using stratification by presence or absence of Raynaud's phenomenon (RP), menstrual migraine, family history of migraine, and by migraine type. Odds ratios and 95% confidence intervals were calculated. These results suggest that subjects with migraine and RP (perhaps indicative of a systematic vascular tone disorder) and those with menstrual migraine (indicative of sensitivity to hormonal changes) may overall be more sensitive to certain environmental stimuli, particularly those involving change in the internal environment.
Article
Questions about discomfort or pain produced by various stimuli (e.g., light, sound, exercise, neck movements) are currently used to differentiate between various primary headache disorders. In order to evaluate the usefulness of differences in sensitivity to physical stimuli in headache diagnosis, the answers to a questionnaire about sensitivity to various stimuli were compared in 68 patients with migraine, 45 with tension-type headache, 46 with cluster headache, and 23 patients with cervicogenic headache, and in 71 controls. Even among controls, a high proportion reported that many of these stimuli could elicit some degree of discomfort or pain. Without headache, migraineurs differed from the other patients with headache and controls mainly in their increased sensitivity to light. With headache, patients with tension-type headache were the least sensitive and migraineurs were the most sensitive to all stimuli, except for stimuli stemming from neck movements, to which patients with cervicogenic headache were most sensitive. Migraineurs also reported the highest degree of sensitivity regarding aggravation and provocation of headache. However, the most striking finding was that all patient groups, cluster headache in particular, became significantly more sensitive with headache than without headache to almost all stimulus categories. This may indicate that these headaches share important pathogenetic mechanisms. The fact that no headache had a very specific sensitivity profile may point to weaknesses of present headache classification systems.
Article
Prospective studies of precipitating factors in migraine are rare. Mig Access is a national control-matched survey conducted to evaluate the access of migraineurs to health care in France. This study allowed us to screen prospectively some precipitating factors of headache in migraineurs and in nonmigraineurs. Three hundred eighty-five migraineurs (group 1) and 313 nonmigraineurs (group 2) kept a diary for a 3-month period (a total of 35,805 day in group 1 and 29,109 days in group 2). Precipitating factors were reported for each headache period. Headache intensity was self-assessed during each headache period using a visual analog scale of 0 to 100. Headache was reported on 4274 days (12%) in group 1 and on 602 days (2%) in group 2. Headache intensity was greater in group 1 (39 +/- 20 versus 32 +/- 19, P < .05). The most frequent precipitating factors (reported at least once by more than 10% of subjects [range 18% to 80%] in both groups) were fatigue and/or sleep, stress, food and/or drinks, menstruation, heat/cold/weather, and infections in both groups. All these factors except infections were reported to cause headache more frequently in migraineurs than in nonmigraineurs. Mean intensity of headache related to fatigue and/or sleep, stress, food and/or drinks, hot/cold weather, and menstruation varied from 37 to 43 in migraineurs and from 29 to 35 in nonmigraineurs. Headache with the highest mean intensity was due to infections in the two groups (47 +/- 20 in group 1, 45 +/- 23 in group 2). Our results support that endogenous factors are the most frequent triggers of headache in migraineurs. The most frequent precipitating factors of headache appear identical in migraineurs and in nonmigraineurs. Our results suggest that similar triggers could precipitate headache of different type in these two populations.
Article
Eighty-five percent of migraineurs report triggers which include a diverse array of internal and external factors. Crying as a trigger has been reported in two women, without details, in only one prior study. In the present report, the clinical history of two women (aged 38 and 41 years, respectively) with migraines triggered by crying are detailed. In both women, the migraines were triggered by crying associated with sadness or emotional upset. Crying when happy or due to cutting onions was not a trigger. Only in the second patient was crying during a sad movie or theatrical production also a trigger. Crying may be a common underrecognized migraine trigger.
Article
This study tested two contrasting theories of how trigger factors acquire the capacity to precipitate headaches. The sample consisted of 110 participants, of whom 48 suffered from regular headaches. Participants were exposed to a validated headache trigger factor for one of five exposure durations. The trigger used was "visual disturbance" (flicker, glare and eyestrain) induced by a very bright, stroboscopic light. Response to the stimulus was measured by participant ratings of the degree of visual disturbance and head pain caused by the stimulus. As expected, the headache sufferers experienced more visual disturbance and head pain in response to the stimulus than the non-headache individuals. Longer exposure to the stimulus was associated with a subsequent reduction in pain ratings in response to the stimulus. This desensitization effect supported an avoidance model of how trigger factors acquire the capacity to precipitate headaches. The findings of this study have implications for the etiology of headache disorders. Also, the findings imply that the traditional clinical advice that the best way to prevent migraine and headache is to avoid the factors that trigger them, may be counterproductive, as any short-term gains may be more than wiped out by decreased tolerance for the trigger factors.
Article
To investigate the epidemiology of migraine in Sivas, Turkey, including its prevalence, clinical characteristics, and impact according to age, sex, and socioeconomic status. Thirteen hundred twenty subjects were personally interviewed by a neurologist. Each household member with headache was asked questions regarding their headaches including age at onset, frequency, duration, character, location, severity, aggravating and ameliorating factors, and prodromal and associated symptoms. Migraine diagnoses were determined in accordance with the classification criteria of the International Headache Society. Migraine was identified in 173 subjects (45 males and 128 females), and lifetime prevalence of migraine was 7.9% (95% CI, 5.66 to 10.1) in males and 17.1% (95% CI, 14 to 20) in females. Aura was reported by 1.4% of males and 3.3% of females. Migraine prevalence in Turkey is similar to that reported in Europe and the United States.
Article
Electrophysiological methods may help to unravel some of the pathophysiological mechanisms of migraine. Lack of habituation is the principal and most reproducible interictal abnormality in sensory processing in migraineurs. It is found in evoked potential (EP) studies for every stimulation modality including nociceptive stimuli, and it is likely to be responsible for the increased intensity dependence of EP. We have hypothesized that deficient EP habituation in migraine could be due to a reduced preactivation level of sensory cortices because of hypofunctioning subcortico-cortical aminergic pathways. This is not in keeping with simple hyperexcitability of the cortex, which has been suggested by some, but not all, studies of transcranial magnetic stimulation (TMS). A recent study of the effects of repetitive TMS on visual EP strongly supports the hypothesis that migraine is characterized by interictal cortical hypoexcitability. With regard to pain mechanisms in migraine, electrophysiological studies of trigeminal pathways using nociceptive blink and corneal reflexes have confirmed that sensitization of central trigeminal nociceptors occurs during migraine attacks.
Article
To assess headache patients' beliefs about how strongly weather affects their headaches; To objectively investigate the influence of multiple weather variables on headache. Our sample consisted of 77 migraineurs seen in a headache clinic, who provided headache calendars for a period ranging from 2 to 24 months. Our study was divided into two phases. First, each patient was given a questionnaire assessing their beliefs about how strongly (if so) weather affected their headaches. Second, weather data were collected from the National Weather Service, from three reporting stations central to the residences of the study participants. Analysis was performed on 43 variables to generate three meteorological factors. Linear regression was used to assess the relationship between headache and these three factors. Factor 1 represents a function of absolute temperature and humidity. Factor 2 represents a changing weather pattern. Factor 3 represents barometric pressure. Of the 77 subjects in the study, 39 (50.6%), were found to be sensitive to weather, but 48 (62.3%) thought they were sensitive to weather conditions (P < 0.05). Thirty (38.9%) were sensitive to one weather factor and 9 (11.7%) to two factors. Twenty-six (33.7%) were sensitive to factor 1; 11 (14.3%) to factor 2; 10 (12.9%) to factor 3. Our study supports the influence of weather variables on headache. We showed that patients are susceptible to multiple weather variables and that more patients thought weather was a trigger than was the case.
Article
Assignment of a diagnosis of migraine has been formalized in diagnostic criteria proposed by the International Headache Society. The objective of the present study is to determine the reproductibility of the formal diagnosis of migraine in a cohort of headache sufferers over a one-year period. The study was performed in a community cohort taking part in a long-term prospective health survey, the GAZEL study. Two thousand five hundred individuals reporting headache in the GAZEL cohort were sent two postal questionnaires concerning headache symptoms and features at 12-monthly intervals. Replies to the questions allowed a migraine diagnosis to be attributed retrospectively using an algorithm based on the IHS classification scheme. The response rate was 82% for the first questionnaire and 69% for both questionnaires. Of the 1733 subjects providing information at both time-points, the agreement rate for the diagnosis of strict migraine (IHS categories 1.1 or 1.2) was 77.7% (kappa = 0.48), with 62.2% of the patients with this diagnosis (IHS categories 1.1 or 1.2) at Month 0 retaining the same diagnosis at Month 12. When diagnostic criteria were widened to include IHS category 1.7 (migrainous disorder), the agreement rate of the diagnosis was similar at 77.6% (kappa = 0.52), but 82% of the patients with this diagnosis (IHS categories 1.1 or 1.2 or 1.7) at Month 0 now retained the same diagnosis at Month 12. In conclusion, the one-year reproducibility of reporting of migraine headache symptoms is only moderate, varies between symptoms, and leads to instability in the formal assignment of a migraine headache diagnosis and to diagnostic drift between headache types. This finding is compatible with the continuum model of headache, where headache attacks can vary along a severity continuum from episodic tension-type headaches to full-blown migraine attacks.
Article
Theoretical developments and burgeoning research on stress and illness in the mid-20th century yielded the foundations necessary to conceptualize headache as a psychophysiological disorder and eventually to develop and apply contemporary behavioral headache treatments. Over the past three decades, these behavioral headache treatments (relaxation training, biofeedback, cognitive-behavioral therapy, and stress-management training) have amassed a sizeable evidence base. Meta-analytic reviews of the literature consistently have shown behavioral interventions to yield 35% to 55% improvements in migraine and tension-type headache and that these outcomes are significantly superior to control conditions. The strength of the evidence has lead many professional practice organizations to recommend use of behavioral headache treatments alongside pharmacologic treatments for primary headache. The present overview was prepared as a companion article to and intended to provide a background for the Guidelines for Trials of Behavioral Treatments for Recurrent Headache also published within this journal supplement. This article begins with a synopsis of key historical developments leading to our current conceptualization of migraine and tension-type headache as psychophysiological disorders amenable to behavioral intervention. The evolution of the behavioral headache literature is discussed, exemplified by publication trends in the journal Headache. Leading empirically-based behavioral headache interventions are described, and meta-analytic reviews examining the migraine and tension-type headache literatures are summarized, compared, and contrasted. A critique of the methodological quality of the clinical trials literature is presented, highlighting the strengths and weaknesses in relation to recruitment and selection of patients, sample size and statistical power, the use of a credible control, and the reproducibility of the study interventions in clinical practice.