Britt Talley Daniel MD

7777 Forest Lane Suite B-220

Dallas, Texas 75230

Migraine Aggravating Factors/Triggers

Many patients refer to “migraine triggers” but ICDH II differentiates between a migraine trigger which is something that causes an attack within 24 hours, like red wine inducing a migraine, and an “aggravating factor” like stress which builds up over weeks to produce migraine.

Chabriat, et al,[i] wrote in 1999 in Headache on “Precipitating factors of headache.  A prospective study in a national control-matched survey in migraineurs and non-migraineurs.”  They screened prospective factors in a migraine and non-migraine group of patients who kept a diary for a 3-month period.  The most frequent precipitating factors in both groups were:

“fatigue and/or sleep, stress, food and/or drinks, menstruation, heat/cold weather, and infections in both groups.”

Kelman[ii] writing in Cephalalgia in 2007 on “The triggers or precipitants of the acute migraine attack” listed stress at a frequency of 79 % and food at 26.9 %.   The table of frequency of individual migraine triggers from his article was:

Trigger                              Frequency

Stress                                             79.7%

Hormones (in women)           65.1%

Not eating                                    57.3%

Weather                                        53.2%

Sleep disturbance                     49.8%

Perfume or odor                       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%

Sexual activity                             5.2%

Kelman is not going by ICDH-II here which refers to stress as an “aggravating factor”, not a “trigger.”  However, his list is interesting and I keep a copy of this article in my office to hand out.

Another observation here is that many patients will focus on the different foods that may aggravate migraine and not recognize stress in their lives which is the most aggravating feature of migraine.

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i Danchot J, Michel P, Joire JE, Henry P.  Precipitating factors of headache.  A prospective study in a national control-matched survey in migraineurs and nonmigraineurs.  Headache.  1999;39(5):335-338.

[ii] Kelman L.  The triggers or precipitants of the acute migraine attack.  Cephalalgia. 2007;27(5):394-402.