Skip to main content

Advertisement

Log in

Migraine and Triggers: Post Hoc Ergo Propter Hoc?

  • Migraine (R Cowan, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

The influence of environmental factors on the clinical manifestation of migraine has been a matter of extensive debate over the past decades. Migraineurs commonly report foods, alcohol, meteorologic or atmospheric changes, exposure to light, sounds, or odors, as factors that trigger or aggravate their migraine attacks. In the same way, physicians frequently follow this belief in their recommendations in how migraineurs may reduce their attack frequency, especially with regard to the consumption of certain food components. Interestingly, despite being such a common belief, most of the clinical studies have shown conflicting results. The aim of the review is to critically analyze clinical and pathophysiological facts that support or refute a correlation between certain environmental stimuli and the occurrence of migraine attacks. Given the substantial discrepancy between patients' reports and objective clinical data, the methodological difficulties of investigating the link between environmental factors and migraine are highlighted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of outstanding importance

  1. Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007;27:394–402.

    Article  PubMed  CAS  Google Scholar 

  2. Spierings EL, Ranke AH, Honkoop PC. Precipitating and aggravating factors of migraine vs tension-type headache. Headache. 2001;41:554–8.

    Article  PubMed  CAS  Google Scholar 

  3. Turner L, Molgaard C, Gardner C, Rothrock J, Stang P. Migraine trigger factors in a non-clinical mexican-american population in San Diego county: Implications for etiology. Cephalalgia. 1995;15:523–30.

    PubMed  CAS  Google Scholar 

  4. von Mackensen S, Hoeppe P, Maarouf A, Tourigny P, Nowak D. Prevalence of weather sensitivity in Germany and Canada. Int J Biometeorol. 2005;49:156–66.

    Article  Google Scholar 

  5. Wöber C, Holzhammer J, Zeitlhofer J, Wessely P, Wöber-Bingöl Ç. Trigger factors of migraine and tension-type headache: Experience and knowledge of the patients. J Headache Pain. 2006;7:188–95.

    Article  PubMed  Google Scholar 

  6. Wöber C, Wöber-Bingöl Ç. Chapter 12 - Triggers of migraine and tension-type headache. In: Michael J. Aminoff FB, Dick FS, Eds. Handbook of Clinical Neurology: Elsevier. 2010;pp 161–72.

  7. •• Houle TT, Turner DP. Natural experimentation is a challenging method for identifying headache triggers. Headache. 2013;53:636–43. This study challenges the feasibility of identifying migraine triggers in clinical practice by using natural experimentation.

    Article  PubMed  Google Scholar 

  8. Turner DP, Smitherman TA, Martin VT, Penzien DB, Houle TT. Causality and headache triggers. Headache. 2013;53:628–35.

    Article  PubMed  Google Scholar 

  9. Schurks M, Buring JE, Kurth T. Migraine features, associated symptoms and triggers: A principal component analysis in the Women's health study. Cephalalgia. 2011;31:861–9.

    Article  PubMed  Google Scholar 

  10. Goadsby PJ, Silberstein SD. Migraine triggers: Harnessing the messages of clinical practice. Neurology. 2013;80:424–5.

    Article  PubMed  Google Scholar 

  11. Charles A. The evolution of a migraine attack - a review of recent evidence. Headache. 2013;53:413–9.

    Article  PubMed  Google Scholar 

  12. Finocchi C, Sivori G. Food as trigger and aggravating factor of migraine. Neurological Sciences. 2012;33:77–80.

    Article  Google Scholar 

  13. Selby G, Lance JW. Observations on 500 cases of migraine and allied vascular headache. J Neurol Neurosurg Psychiatry. 1960;23:23–32.

    Article  PubMed  CAS  Google Scholar 

  14. Camboim Rockett F, Castro K, Rossoni de Oliveira V, Da Silveira Perla A, Fagundes Chaves ML, Schweigert Perry ID. Perceived migraine triggers: Do dietary factors play a role? Nutr Hosp. 2012;27:483–9.

    PubMed  CAS  Google Scholar 

  15. Pascual J, Oterino A. IgG-mediated allergy: A new mechanism for migraine attacks? Cephalalgia. 2010;30:777–9.

    Article  PubMed  Google Scholar 

  16. Arroyave Hernandez CM, Echavarria Pinto M, Hernandez Montiel HL. Food allergy mediated by IgG antibodies associated with migraine in adults. Rev Alerg Mex. 2007;54:162–8.

    PubMed  Google Scholar 

  17. • Alpay K, Ertas M, Orhan EK, Ustay DK, Lieners C, Baykan B. Diet restriction in migraine, based on IgG against foods: A clinical double-blind, randomised, cross-over trial. Cephalalgia. 2010;30:829–37. This study suggests that individualized elimination diet may be useful and feasible to prevent migraine.

    Article  PubMed  Google Scholar 

  18. Aydinlar EI, Dikmen PY, Tiftikci A, Saruc M, Aksu M, Gunsoy HG, et al. IgG-based elimination diet in migraine plus irritable bowel syndrome. Headache. 2013;53:514–25.

    Article  PubMed  Google Scholar 

  19. Mitchell N, Hewitt CE, Jayakody S, Islam M, Adamson J, Watt I, et al. Randomised controlled trial of food elimination diet based on IgG antibodies for the prevention of migraine like headaches. Nutr J. 2011;10:85.

    Article  PubMed  Google Scholar 

  20. Panconesi A, Bartolozzi M, Guidi L. Alcohol and migraine: What should we tell patients? Curr Pain Headache Rep. 2011;15:177–84.

    Article  PubMed  Google Scholar 

  21. Panconesi A, Bartolozzi ML, Mugnai S, Guidi L. Alcohol as a dietary trigger of primary headaches: What triggering site could be compatible? Neurol Sci. 2012;33 Suppl 1:S203–5.

    Article  PubMed  Google Scholar 

  22. Littlewood JT, Gibb C, Glover V, Sandler M, Davies PT, Rose FC. Red wine as a cause of migraine. Lancet. 1988;1:558–9.

    Article  PubMed  CAS  Google Scholar 

  23. Panconesi A, Franchini M, Bartolozzi ML, Mugnai S, Guidi L. Alcoholic drinks as triggers in primary headaches. Pain Medicine. 2013

  24. Nicoletti P, Trevisani M, Manconi M, Gatti R, De Siena G, Zagli G, et al. Ethanol causes neurogenic vasodilation by TRPV1 activation and CGRP release in the trigeminovascular system of the guinea pig. Cephalalgia. 2008;28:9–17.

    Article  PubMed  CAS  Google Scholar 

  25. Schulman J, Leviton A, Slack W, Porter D, Graham JR. The relationship of headache occurrence to barometric pressure. Int J Biometeorol. 1980;24:263–9.

    Article  PubMed  CAS  Google Scholar 

  26. Barrie MA, Fox WR, Weatherall M, Wilkinson MIP. Analysis of symptoms of patients with headaches and their response to treatment with ergot derivatives. QJM. 1968;37:319–36.

    PubMed  CAS  Google Scholar 

  27. Wilkinson M, Woodrow J. Migraine and weather. Headache. 1979;19:375–8.

    Article  PubMed  CAS  Google Scholar 

  28. Osterman PO, Lövstrand KG, Lundberg PO, Lundquist S, Muhr C. Weekly headache periodicity and the effect of weather changes on headache. Int J Biometeorol. 1981;25:39–45.

    Article  PubMed  CAS  Google Scholar 

  29. Cull RE. Barometric pressure and other factors in migraine. Headache. 1981;21:102–3.

    Article  PubMed  CAS  Google Scholar 

  30. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.

    Article  Google Scholar 

  31. Rasmussen BK. Migraine and tension-type headache in a general population: Precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain. 1993;53:65–72.

    Article  PubMed  CAS  Google Scholar 

  32. Robbins L. Precipitating factors in migraine: A retrospective review of 494 patients. Headache. 1994;34:214–6.

    Article  PubMed  CAS  Google Scholar 

  33. Larmande P, Hubert B, Sorabella A, Montigny E, Belin C, Gourdon D. Influence of changes in climate and the calendar on the onset of a migraine crisis. Rev Neurol (Paris). 1996;152:38–43.

    PubMed  CAS  Google Scholar 

  34. Zebenholzer K, Rudel E, Frantal S, Brannath W, Schmidt K, Wober-Bingol C, et al. Migraine and weather: A prospective diary-based analysis. Cephalalgia. 2011;31:391–400.

    Article  PubMed  Google Scholar 

  35. Villeneuve PJ, Szyszkowicz M, Stieb D, Bourque DA. Weather and emergency room visits for migraine headaches in Ottawa. Canada Headache. 2006;46:64–72.

    Article  CAS  Google Scholar 

  36. Hoffmann J, Lo H, Neeb L, Martus P, Reuter U. Weather sensitivity in migraineurs. J Neurol. 2010:1–7.

  37. Kimoto K, Aiba S, Takashima R, Suzuki K, Takekawa H, Watanabe Y, et al. Influence of barometric pressure in patients with migraine headache. Intern Med. 2011;50:1923–8.

    Article  PubMed  Google Scholar 

  38. Prince PB, Rapoport AM, Sheftell FD, Tepper SJ, Bigal ME. The effect of weather on headache. Headache. 2004;44:596–602.

    Article  PubMed  Google Scholar 

  39. Messlinger K, Funakubo M, Sato J, Mizumura K. Increases in neuronal activity in rat spinal trigeminal nucleus following changes in barometric pressure—relevance for weather-associated headaches? Headache. 2010;50:1449–63.

    Article  PubMed  Google Scholar 

  40. Walach H, Betz HD, Schweickhardt A. Sferics and headache: A prospective study. Cephalalgia. 2001;21:685–90.

    Article  PubMed  CAS  Google Scholar 

  41. Vaitl D, Propson N, Stark R, Walter B, Schienle A. Headache and sferics. Headache. 2001;41:845–53.

    PubMed  CAS  Google Scholar 

  42. Vaitl D, Propson N, Stark R, Schienle A. Natural very-low-frequency sferics and headache. Int J Biometeorol. 2001;45:115–23.

    Article  PubMed  CAS  Google Scholar 

  43. Martin GV, Houle T, Nicholson R, Peterlin A, Martin VT. Lightning and its association with the frequency of headache in migraineurs: an observational cohort study. Cephalalgia. 2013.

  44. Kato Y, Johansson O. Reported functional impairments of electrohypersensitive japanese: A questionnaire survey. Pathophysiology. 2012;19:95–100.

    Article  PubMed  Google Scholar 

  45. Preece AW, Georgiou AG, Dunn EJ, Farrow SC. Health response of two communities to military antennae in Cyprus. Occup Environ Med. 2007;64:402–8.

    Article  PubMed  CAS  Google Scholar 

  46. Baliatsas C, Van Kamp I, Bolte J, Schipper M, Yzermans J, Lebret E. Non-specific physical symptoms and electromagnetic field exposure in the general population: can we get more specific? A systematic review. Environ Int. 2012;41:15–28.

    Article  PubMed  Google Scholar 

  47. Kowacs PA, Piovesan EJ, Werneck LC, Tatsui CE, Lange MC, Ribas LC, et al. Influence of intense light stimulation on trigeminal and cervical pain perception thresholds. Cephalalgia. 2001;21:184–8.

    Article  PubMed  CAS  Google Scholar 

  48. Chu MK, Im HJ, Chung CS, Oh K. Interictal pattern-induced visual discomfort and ictal photophobia in episodic migraineurs: An association of interictal and ictal photophobia. Headache. 2011;51:1461–7.

    Article  PubMed  Google Scholar 

  49. Hay KM, Mortimer MJ, Barker DC, Debney LM, Good PA. 1044 Women with migraine: The effect of environmental stimuli. Headache. 1994;34:166–8.

    Article  PubMed  CAS  Google Scholar 

  50. Chronicle EP, Mulleners WM. Visual system dysfunction in migraine: A review of clinical and psychophysical findings. Cephalalgia. 1996;16:525–35. discussion 3.

    Article  PubMed  CAS  Google Scholar 

  51. Wray SH, Mijovic-Prelec D, Kosslyn SM. Visual processing in migraineurs. Brain. 1995;118(Pt 1):25–35.

    Article  PubMed  Google Scholar 

  52. Hauge AW, Kirchmann M, Olesen J. Trigger factors in migraine with aura. Cephalalgia. 2010;30:346–53.

    Article  PubMed  CAS  Google Scholar 

  53. Vijayan N, Gould S, Watson C. Exposure to sun and precipitation of migraine. Headache. 1980;20:42–3.

    Article  PubMed  CAS  Google Scholar 

  54. •• Hougaard A, Amin FM, Hauge AW, Ashina M, Olesen J. Provocation of migraine with aura using natural trigger factors. Neurology. 2013;80:428–31. This study demonstrates that bright lights do not trigger migraine with aura in an experimental setting..

    Article  PubMed  Google Scholar 

  55. Hauge AW, Kirchmann M, Olesen J. Characterization of consistent triggers of migraine with aura. Cephalalgia. 2011;31:416–38.

    Article  PubMed  Google Scholar 

  56. Vingen JV, Sand T, Stovner LJ. Sensitivity to various stimuli in primary headaches: A questionnaire study. Headache. 1999;39:552–8.

    Article  PubMed  CAS  Google Scholar 

  57. Salvesen R, Bekkelund SI. Migraine, compared to other headaches, is worse during midnight-sun summer than during polar night. A questionnaire study in an Arctic population. Headache. 2000;40:824–9.

    Article  PubMed  CAS  Google Scholar 

  58. Bekkelund SI, Hindberg K, Bashari H, Godtliebsen F, Alstadhaug KB. Sun-induced migraine attacks in an Arctic population. Cephalalgia. 2011;31:992–8.

    Article  PubMed  Google Scholar 

  59. Alstadhaug KB, Bekkelund S, Salvesen R. Circannual periodicity of migraine? Eur J Neurol. 2007;14:983–8.

    Article  PubMed  CAS  Google Scholar 

  60. Lilleng H, Bekkelund SI. Arctic environment triggers migraine attacks. Can Fam Physician. 2010;56:549–51.

    PubMed  Google Scholar 

  61. Alstadhaug KB, Salvesen R, Bekkelund SI. Seasonal variation in migraine. Cephalalgia. 2005;25:811–6.

    Article  PubMed  CAS  Google Scholar 

  62. Bekkelund SI, Alstadhaug KB, Salvesen R. Lack of seasonal variation in menstrually-related migraine. Cephalalgia. 2008;28:1277–81.

    Article  PubMed  CAS  Google Scholar 

  63. Sjostrand C, Savic I, Laudon-Meyer E, Hillert L, Lodin K, Waldenlind E. Migraine and olfactory stimuli. Curr Pain Headache Rep. 2010;14:244–51.

    Article  PubMed  Google Scholar 

  64. Lima AM, Sapienza GB, Giraud Vde O, Fragoso YD. Odors as triggering and worsening factors for migraine in men. Arq Neuropsiquiatr. 2011;69:324–7.

    Article  PubMed  Google Scholar 

  65. Silva-Neto R, Peres M, Valenca M. Odorant substances that trigger headaches in migraine patients. Cephalalgia. 2013

  66. Saisu A, Tatsumoto M, Hoshiyama E, Aiba S, Hirata K. Evaluation of olfaction in patients with migraine using an odour stick identification test. Cephalalgia. 2011;31:1023–8.

    Article  PubMed  Google Scholar 

  67. Demarquay G, Royet JP, Mick G, Ryvlin P. Olfactory hypersensitivity in migraineurs: A H(2)(15)O-PET study. Cephalalgia. 2008;28:1069–80.

    Article  PubMed  CAS  Google Scholar 

  68. Stankewitz A, May A. Increased limbic and brainstem activity during migraine attacks following olfactory stimulation. Neurology. 2011;77:476–82.

    Article  PubMed  Google Scholar 

  69. • Martin PR. Managing headache triggers: Think 'coping' not 'avoidance'. Cephalalgia. 2010;30:634–7. This perspective article challenges the common practice of trigger avoidance and suggests flexibility when adivising patients regarding triggers..

    PubMed  CAS  Google Scholar 

  70. Martin PR, MacLeod C. Behavioral management of headache triggers: Avoidance of triggers is an inadequate strategy. Clin Psychol Rev. 2009;29:483–95.

    Article  PubMed  Google Scholar 

  71. Martin PR, Reece J, Forsyth M. Noise as a trigger for headaches: Relationship between exposure and sensitivity. Headache. 2006;46:962–72.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the National Institutes of Health (National Institute of Neurological Disorders and Stroke) [K08 –NS066087].

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Jan Hoffmann received a grant from Deutsche Forschungsgemeinschaft-DFG and payment for manuscript preparation from the Journal Watch Neurology. Dr. Hoffmann had travel/accommodations expenses covered or reimbursed by Allergan, International Headache Society, and American Headache Society.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ana Recober.

Additional information

This article is part of the Topical Collection on Migraine

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoffmann, J., Recober, A. Migraine and Triggers: Post Hoc Ergo Propter Hoc?. Curr Pain Headache Rep 17, 370 (2013). https://doi.org/10.1007/s11916-013-0370-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-013-0370-7

Keywords

Navigation