Migraine Aggravating factors/Triggers

Many patients refer to "migraine triggers" but ICDH differentiates between a migraine trigger which is something that causes an attack within 24 hours, like red wine inducing a migraine minutes after it is consumed, 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 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.   I guess it’s an easy thing to consider and look up and avoid, and everybody needs to watch what they eat, but food as a trigger for migraine is not the big issue.  The big issue is stress.  Look at the Kelman's table above which lists various triggers and their frequency. Stress is at the top and food is near the bottom.  All migraine studies of frequency of migraine triggers are like this.

Stress concerns personal insight, work/family relationships, time, travel, eating, exercise, faith, getting along.  It’s a tough series of issues that need to worked out, sometimes requiring counselling, with migraine patients.

 i Chabriat H, Danchot J, MIchel P, Joire JE, Henry P, Precipitating factors of headache.  A prospective study in a nation 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.