Migraine attacks rarely occur spontaneously in the absence of any possible precipitating factors. A systematic literature review of 25 publications revealed a consistent set of stimuli that have been identified as factors associated with the onset of a migraine attack. The weighted average of the “Top 10” trigger factors was determined. Stress was cited as the overall most common migraine precipitating factor, which was identified as a trigger factor by 58 % of 7187 migraineurs. The incidence of migraine precipitating factors, across various populations globally, demonstrates the clinical consistency of migraine in the human population. Future efforts aimed at mitigating these precipitating factors have the potential to significantly improve migraine management. However, the current healthcare system is unlikely to be able to develop detailed personalized management plans. There is a need to develop a novel approach to the identification and management of multiple trigger factors in individual migraineurs.
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Amery WK, Vandenbergh V. What can precipitating factors teach us about the pathogenesis of migraine? Headache. 1987;27:146–50.
Van den Bergh V, Amery WK, Waelkens J. Trigger factors in migraine: a study conducted by the Belgian Migraine Society. Headache. 1987;27:191–6.
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.
Robbins L. Precipitating factors in migraine: a retrospective review of 494 patients. Headache. 1994;34:214–6.
Scharff L, Turk DC, Marcus DA. Triggers of headache episodes and coping responses of headache diagnostic groups. Headache. 1995;35:397–403.
Turner LC, Molgaard CA, Gardner CH, Rothrock JF, Stang PE. Migraine trigger factors in non-clinical Mexican-American population in San Diego county: implications for etiology. Cephalalgia. 1995;15:523–30.
Chabriat H, Danchot J, Michel P, Joire JE, Henry P. Precipitating factors of headache. A prospective study in a national control-matched survey in migraineurs and nonmigraineurs. Headache. 1999;39:335–8.
Spierings EL, Ranke AH, Honkoop PC. Precipitating and aggravating factors of migraine vs tension-type headache. Headache. 2001;41:554–8.
Henry P, Auray JP, Gaudin AF, Dartigues JF, Duru G, Lantéri-Minet M, et al. Prevalence and clinical characteristics of migraine in France. Neurology. 2002;59:232–7.
Zivadinov R, Willheim K, Sepic-Grahovac D, Jurjevic A, Bucuk M, Brnabic-Razmilic O, et al. Migraine and tension-type headache in Croatia: a population-based survey of precipitating factors. Cephalalgia. 2003;23:336–43.
Kelman L. The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs. Headache. 2004;44:865–72.
Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007;27:394–402.
Al-Shimmery EK. Precipitating and relieving factors of migraine headache in 200 Iraqi Kurdish patients. Oman Med J. 2010;25:212–7. This article demonstrates the similarity of migraine trigger factors between distinct cultures.
Leone M, Vila C, McGown C. Influence of trigger factors on the efficacy of almotriptan as early intervention for the treatment of acute migraine in a primary care setting: the START study. Expert Rev Neurother. 2010;10:1399–408.
Andress-Rothrock D, King W, Rothrock J. An analysis of migraine triggers in a clinic-based population. Headache. 2010;50:1366–70.
Walker CS, Li X, Whiting L, Glyn-Jones S, Zhang S, Hickey AJ, et al. Mice lacking the neuropeptide alpha-calcitonin gene-related peptide are protected against diet-induced obesity. Endocrinology. 2010;151:4257–69.
Yadav RK, Kalita J, Misra UK. A study of triggers of migraine in India. Pain Med. 2010;11:44–7. This article demonstrates the similarity of migraine trigger factors between distinct cultures.
Hauge AW, Kirchmann M, Olesen J. Trigger factors in migraine with aura. Cephalalgia. 2010;30:346–53.
Carod-Artal FJ, Ezpeleta D, Martín-Barriga ML, Guerrero AL. Triggers, symptoms, and treatment in two populations of migraineurs in Brazil and Spain. A cross-cultural study. J Neurol Sci. 2011;304:25–8. This article demonstrates the similarity of migraine trigger factors between distinct cultures.
Haque B, Rahman KM, Hoque A, Hasan ATMH, Chowdhury RN, Khan SU, et al. Precipitating and relieving factors of migraine vs tension type headache. BMC Neurol. 2012;12:82.
Neut D, Fily A, Cuvellier J-C, Vallée L. The prevalence of triggers in paediatric migraine: a questionnaire study in 102 children and adolescents. J Headache Pain. 2012;13:61–5.
Menon B, Kinnera N. Prevalence and characteristics of migraine in medical students and its impact on their daily activities. Ann Indian Acad Neurol. 2013;16:221–5.
Baldacci F, Vedovello M, Ulivi M, Vergallo A, Poletti M, Borelli P, et al. How aware are migraineurs of their triggers? Headache. 2013;53:834–7.
Fraga MDB, Pinho RS, Andreoni S, Vitalle MS, Fisberg M, Peres MFP, et al. Trigger factors mainly from the environmental type are reported by adolescents with migraine. Arq Neuropsiquiatr. 2013;71:290–3.
Wang J, Huang Q, Li N, Tan G, Chen L, Zhou J. Triggers of migraine and tension-type headache in China: a clinic-based survey. Eur J Neurol. 2013;20:689–96. This article demonstrates the similarity of migraine trigger factors between distinct cultures.
Mollaoğlu M. Trigger factors in migraine patients. J Health Psychol. 2013;18:984–94.
Blau JN, Thavapalan M. Preventing migraine: a study of precipitating factors. Headache. 1988;28:481–3.
Graham JR. The natural history of migraine: some observations and a hypothesis. Trans Am Clin Climatol Assoc. 1952;64:61–73. discussion, 73–4.
Henryk-Gutt R, Rees WL. Psychological aspects of migraine. J Psychosom Res. 1973;17:141–53.
Levor RM, Cohen MJ, Naliboff BD, McArthur D, Heuser G. Psychosocial precursors and correlates of migraine headache. J Consult Clin Psychol. 1986;54:347–53.
Holm JE, Bury L, Suda KT. The relationship between stress, headache, and the menstrual cycle in young female migraineurs. Headache. 1996;36:531–7.
Holm JE, Lokken C, Myers TC. Migraine and stress: a daily examination of temporal relationships in women migraineurs. Headache. 1997;37:553–8.
Wacogne C, Lacoste JP, Guillibert E, Hugues FC, Le Jeunne C. Stress, anxiety, depression and migraine. Cephalalgia. 2003;23:451–5.
Martin VT, Behbehani MM. Toward a rational understanding of migraine trigger factors. Med Clin North Am. 2001;85:911–41.
Carrasco GA, Van de Kar LD. Neuroendocrine pharmacology of stress. Eur J Pharmacol. 2003;463:235–72.
Köhler T, Haimerl C. Daily stress as a trigger of migraine attacks: results of thirteen single-subject studies. J Consult Clin Psychol. 1990;58:870–2.
Lipton RB, Buse DC, Hall CB, Tennen H, Defreitas TA, Borkowski TM, et al. Reduction in perceived stress as a migraine trigger: testing the ‘let-down headache’ hypothesis. Neurology. 2014;82:1395–401. A recent article that addresses the issue of the role of stress vs relaxation after stress as a cause of migraine.
Mosek A, Korczyn AD. Yom Kippur headache. Neurology. 1995;45:1953–5.
Kelman L, Rains JC. Headache and sleep: examination of sleep patterns and complaints in a large clinical sample of migraineurs. Headache. 2005;45:904–10.
Cooke LJ, Rose MS, Becker WJ. Chinook winds and migraine headache. Neurology. 2000;54:302–7.
Hay KM, Mortimer MJ, Barker DC, Debney LM, Good PA. 1044 women with migraine: the effect of environmental stimuli. Headache. 1994;34:166–8.
Kelman L. Osmophobia and taste abnormality in migraineurs: a tertiary care study. Headache. 2004;44:1019–23.
Littlewood JT, Gibb C, Glover V, Sandler M, Davies PT, Rose FC. Red wine as a cause of migraine. Lancet. 1988;1:558–9.
The author thanks Mary Ellen Peroutka for editorial assistance.
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Stephen J. Peroutka declares that he has no conflicts of interest.
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This article is part of the Topical Collection on Migraine
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Peroutka, S.J. What Turns on a Migraine? A Systematic Review of Migraine Precipitating Factors. Curr Pain Headache Rep 18, 454 (2014). https://doi.org/10.1007/s11916-014-0454-z