Do we know all the triggers of migraine?
Conhecemos todos os gatilhos da enxaqueca?
Raimundo Pereira Silva-Néto (1)
1 - Scientific Editor, Headache Medicine
Raimundo Pereira Silva-Néto
Universidade Federal do Delta do Parnaíba,
Avenida São Sebastião, 2819, Fátima, Parnaíba, PI, 64001-020, Brasil.
Tel. + 55 3237-2104.
Migraine trigger is understood as any factor that is temporally associated with the development of migraine attacks. These triggers can be single or multiple for the same patient. In order to study these triggers, a recent meta-analysis analyzed 85 published articles and found 420 unique triggers that triggered headache attacks in only 86% of migraine patients1.
Some of these triggers are noteworthy, such as odors. In an experimental study, Silva-Néto et al2 exposed two groups of patients, one with migraine; and another with other primary headaches. Headache attacks were triggered by odor only in patients with migraine, corresponding to 34.7% of the sample, but in none with other primary headaches.
When studying the triggers, we must look at some of their particularities. First, the frequency with which they are found, for example, stress, odor, prolonged fasting or sleep deprivation are cited by most migraine patients. Second, the potency of causing pain, that is, the likelihood of the patient having a headache attack after exposure. Investigating triggers and clarifying the patient is critical. When he/she identifies any trigger of his pain, there will be a change in behavior in response to that factor3.
What is the percentage of migraine attacks that occur without any triggers? This is a frequent question from neurologists and patients. According to the meta-analysis shown, 14% of patients did not identify any triggers1. We do not yet know if there are migraine attacks in the absence of any triggering factors or if these factors are unknown.
Is the patient able to identify all triggering factors of their migraine attacks? Would neuronal hyperexcitability make the patient more vulnerable to external and internal factors? There are many unanswered questions. Therefore, future studies need to be conducted to clarify these doubts.
- Pellegrino ABW, Davis-Martin RE, Houle TT, Turner DP, Smitherman TA (2018). Perceived triggers of primary headache disorders: A meta-analysis. Cephalalgia, 38(6):1188-1198.
- Silva-Néto RP, Rodrigues ÂB, Cavalcante DC, Ferreira PH, Nasi EP, Sousa KM, et al (2017). May headache triggered by odors be regarded as a differentiating factor between migraine and other primary headaches? Cephalalgia, 37(1):20-28.
- Turner DP, Jchtay I, Lebowitz AD, Leffert LR, Houle TT (2018). Perceived migraine triggers: Understanding trigger perception can improve Practical Neurology, 37-41.