Relation of Trigger Factors to Migraine with Aura

J. Millichap

doi:10.15844/pedneurbriefs-27-3-1

Author:

J. Gordon Millichap

Northwestern University Feinberg School of Medicine, US

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Abstract

How to Cite: Millichap, J.G., 2013. Relation of Trigger Factors to Migraine with Aura. Pediatric Neurology Briefs, 27(3), pp.17–18. DOI: http://doi.org/10.15844/pedneurbriefs-27-3-1

Researchers from the University of Copenhagen, Denmark studied the relation between natural trigger factors and migraine with aura (MA) in 27 patients who reported that bright or flickering light or strenuous exercise would trigger their attacks. Patients were provoked by photic stimulation, strenuous exercise, or a combination of these two factors. Three patients (11%) reported attacks of MA following provocation. An additional 3 patients reported migraine without aura (MO) attacks. Following exercise, 17% developed an aura, 4 out of 12 patients reported migraine (1 MA, 3 MO) headaches, while no patients developed attacks following photic stimulation alone. Patients were exhausted after the exercise and 5 developed nausea, 2 vomited, and 6 complained of dizziness. Light stimulation, especially low frequency of 1-5 Hz, was considered unpleasant but was well tolerated. [1]

COMMENT. In an editorial [2], the trigger effect of exercise demonstrated in the present study is considered small (10%) compared to that of nitroglycerin infusion that induces migraine and premonitory symptoms in 75% of patients [3]. Food triggers or sensitivities, frequently discussed in the migraine literature [4, 5], have variable effects or mechanisms. As an example, ingredients in chocolate implicated in the mechanism of dietary-triggered migraine include phenylethylamine, theobromine, caffeine, and catechin. These chemicals may initiate a headache by alteration of cerebral blood flow and release of norepinephrine from sympathetic nerve cells [6]. Alternatively, a chocolate trigger may be explained by a premonitory food craving; and chocolate is consumed because of a response to a migraine attack and not a cause. Also, an urge to exercise may represent a premonitory symptom of migraine. The classic advice to avoid suspect triggers may be incorrect, and the migraineur should instead, be advised to become habituated to the provocative factor [7]. Indeed, some adult patients advised to avoid chocolate and red wine would rather suffer an occasional migraine.

References

Houguard, A, Amin, F, Hauge, AW, Ashina, M and Oleson, J (2013). Provocation of migraine with aura using natural trigger factors. Neurology Jan 29 201380(5): 428–31, DOI: https://doi.org/10.1212/WNL.0b013e31827f0f10 [PubMed]

Goadsby, PJ and Silberstein, SD (2013). Migraine triggers: harnessing the messages of clinical practice. Neurology Jan 29 201380(5): 424–5, DOI: https://doi.org/10.1212/WNL.0b013e31827f100c [PubMed]

Iversen, H (2001). Human migraine models. Cephalalgia Sep 200121(7): 781–5. [PubMed]

Egger, J, Carter, CM, Wilson, J, Turner, MW and Soothill, JF (1983). Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment. Lancet Oct 15 19832(8355): 865–9, DOI: https://doi.org/10.1016/S0140-6736(83)90866-8 [PubMed]

Millichap, JG and Yee, MM (2003). The diet factor in pediatric and adolescent migraine. Pediatr Neurol Jan 200328(1): 9–15, DOI: https://doi.org/10.1016/S0887-8994(02)00466-6 [PubMed]

Martin, VT and Behbehani, MM (2001). Toward a rational understanding of migraine trigger factors. Med Clin North Am Jul 200185(4): 911–41, DOI: https://doi.org/10.1016/S0025-7125(05)70351-5 [PubMed]

Martin, PR (2010). Managing headache triggers: think ‘coping’ not ‘avoidance.’. Cephalalgia May 201030(5): 634–7, DOI: https://doi.org/10.1111/j.1468-2982.2009.01989.x [PubMed]

[CIT0001] Houguard, A, Amin, F, Hauge, AW, Ashina, M and Oleson, J (2013). Provocation of migraine with aura using natural trigger factors. Neurology Jan 29 201380(5): 428–31, DOI: https://doi.org/10.1212/WNL.0b013e31827f0f10 [PubMed]

[CIT0002] Goadsby, PJ and Silberstein, SD (2013). Migraine triggers: harnessing the messages of clinical practice. Neurology Jan 29 201380(5): 424–5, DOI: https://doi.org/10.1212/WNL.0b013e31827f100c [PubMed]

[CIT0003] Iversen, H (2001). Human migraine models. Cephalalgia Sep 200121(7): 781–5. [PubMed]

[CIT0004] Egger, J, Carter, CM, Wilson, J, Turner, MW and Soothill, JF (1983). Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment. Lancet Oct 15 19832(8355): 865–9, DOI: https://doi.org/10.1016/S0140-6736(83)90866-8 [PubMed]

[CIT0005] Millichap, JG and Yee, MM (2003). The diet factor in pediatric and adolescent migraine. Pediatr Neurol Jan 200328(1): 9–15, DOI: https://doi.org/10.1016/S0887-8994(02)00466-6 [PubMed]

[CIT0006] Martin, VT and Behbehani, MM (2001). Toward a rational understanding of migraine trigger factors. Med Clin North Am Jul 200185(4): 911–41, DOI: https://doi.org/10.1016/S0025-7125(05)70351-5 [PubMed]

[CIT0007] Martin, PR (2010). Managing headache triggers: think ‘coping’ not ‘avoidance.’. Cephalalgia May 201030(5): 634–7, DOI: https://doi.org/10.1111/j.1468-2982.2009.01989.x [PubMed]

Reading: Relation of Trigger Factors to Migraine with Aura

Headache Disorders

Relation of Trigger Factors to Migraine with Aura

Author:

J. Gordon Millichap

Northwestern University Feinberg School of Medicine, US

X close

Abstract

References