Research Spotlight – Migraine Triggers and Healthy Lifestyle Recommendations

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD

A recent observational longitudinal cohort study investigated whether known migraine trigger factors and daily adherence to a healthy lifestyle are related to decreased probability of migraine attacks in some individuals [1]. This study included individuals with episodic migraine, who registered to track their headache symptoms and daily exposure to trigger factors via a headache electronic diary (N1-Headache™ app) across a period of 90 days [1]. Please refer to the end of the article to find the link to the observational study!

The N1-Headache™ app reports that it “enables evidence-based personalized management of migraine” [2]. The app connects patients to their clinicians and allows for individual headache outcomes and therapeutic response to be measured in real-time. In addition, this application has the potential to identify migraine risk factors [2]. The N1-Headache™ app is often utilized in healthcare provider studies investigating perceived stress, and the association between menstruation and migraine days [3,4].

It is also important to differentiate between “triggers” and “premonitory symptoms,” as the article defines all of these symptoms as triggers [1]. The prodrome phase occurs a few days or hours prior to a migraine, and include some of the following symptoms: constipation, mood changes, food cravings, neck stiffness, frequent yawning, fluid retention [5]. This period is also known as the “premonitory phase of migraine,” where there is the presence of non-painful symptoms, and recognition of these signs can ensure early and effective migraine attack management [6]. On the other hand, a “trigger” is a food, drink, or activity that can result in a migraine attack [7]. In the past, the clinical recommendation to patients might have been to avoid triggers. Some of the more well-known triggers include stress, changes to sleep schedule, hormonal changes, caffeine, alcohol, and weather changes [8].

The researchers of the observational study determined whether triggers increased or decreased migraine attack risk in each person. They also measured the proportion of days in which each person adhered to healthy lifestyle recommendations. The researchers found that out of 47 triggers, 24 were more often associated with decreased rather than with increased migraine attack risk, suggesting that there is the presence of a protective relationship [1].  This relationship was present for caffeine, alcohol, chocolate, happiness, relaxedness, sleep factors, and physical activity. In addition, it was reported that exercising 3+ times a week was the least followed lifestyle recommendation [1].

Below are some key takeaways from this observational study!

  • This is an observational longitudinal cohort study of people with episodic migraine registered to track their headache symptoms using a migraine headache electronic diary (N1-Headache™ app).
  • It is important to differentiate between triggers and premonitory symptoms. This article classifies all symptoms as triggers.
  • The findings in this article conflict with our prior recommendations to patients to avoid known triggers. 
    • Prior studies have shown that if too much emphasis is placed on trigger avoidance it can be harmful and results in decreased physical activity and increased disability.
  • The main recommendation these days is for people with migraine to learn to cope with triggers. 
  • Factors that we have classically identified as migraine triggers, actually decreased migraine attack risk in this study. This occurred for known triggers such as caffeine, chocolate, alcohol, long duration/high quality sleep and physical activity. 
  • Symptoms which increased the risk for migraine attacks (like premonitory symptoms) – neck pain, eyestrain, tiredness/fatigue.
  • Adherence to a healthy lifestyle was protective.

Overall, this study discovered that many triggers “behaved as protectors” in a proportion of participants with episodic migraine [1]. This finding contradicts the recommendation of avoiding known triggers. Adherence to a healthy lifestyle was reported as protective, which can be an opportunity to increase awareness among people with migraine  who may not have a healthy lifestyle.

Feel free to read more about the article at the link below! 

Casanova, Amparo, et al. “The Role of Avoiding Known Triggers, Embracing Protectors, and Adhering to Healthy Lifestyle Recommendations in Migraine Prophylaxis: Insights from a Prospective Cohort of 1125 People with Episodic Migraine.” Headache: The Journal of Head and Face Pain, vol. 63, no. 1, Jan. 2023, pp. 51–61. DOI.org (Crossref), https://doi.org/10.1111/head.14451.

 

References:

  1. Casanova, Amparo, et al. “The Role of Avoiding Known Triggers, Embracing Protectors, and Adhering to Healthy Lifestyle Recommendations in Migraine Prophylaxis: Insights from a Prospective Cohort of 1125 People with Episodic Migraine.” Headache: The Journal of Head and Face Pain, vol. 63, no. 1, Jan. 2023, pp. 51–61. DOI.org (Crossref), https://doi.org/10.1111/head.14451.
  2. “N1‑HeadacheTM – Take Back Control®.” Curelator, https://n1-headache.com///. Accessed 6 Mar. 2023.
  3. Vives‐Mestres, Marina, et al. “Perceived Stress and Pain Severity in Individuals with Chronic Migraine: A Longitudinal Cohort Study Using Daily Prospective Diary Data.” Headache: The Journal of Head and Face Pain, vol. 61, no. 8, Sept. 2021, pp. 1245–54. DOI.org (Crossref), https://doi.org/10.1111/head.14199.
  4. McGinley, James S., et al. “Between and Within‐woman Differences in the Association between Menstruation and Migraine Days.” Headache: The Journal of Head and Face Pain, vol. 61, no. 3, Mar. 2021, pp. 430–37. DOI.org (Crossref), https://doi.org/10.1111/head.14058.
  5. “Migraine – Symptoms and Causes.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201. Accessed 6 Mar. 2023.
  6. Karsan, Nazia, et al. “The Migraine Premonitory Phase.” Continuum (Minneapolis, Minn.), vol. 24, no. 4, Headache, Aug. 2018, pp. 996–1008. PubMed, https://doi.org/10.1212/CON.0000000000000624.
  7. “Migraine Attack Triggers.” The Migraine Trust, https://migrainetrust.org/live-with-migraine/self-management/common-triggers/. Accessed 6 Mar. 2023.
  8. “Top 10 Migraine Triggers and How to Deal with Them | AMF.” American Migraine Foundation, https://americanmigrainefoundation.org/resource-library/top-10-migraine-triggers/. Accessed 6 Mar. 2023.

Published On: March 8th, 2023