From the Guidelines
Common migraine triggers include stress, hormonal changes, certain foods and beverages, sleep disruptions, environmental factors, and sensory stimuli, and identifying personal triggers through a headache diary is essential for migraine management, as triggers vary significantly between individuals 1.
Migraine Triggers
Migraine triggers can be categorized into several groups, including:
- Lifestyle factors: stress, sleep disruptions, and physical factors such as intense exercise, neck tension, and dehydration
- Environmental factors: bright or flickering lights, strong smells, changes in weather or barometric pressure, and high altitude
- Dietary factors: aged cheeses, processed foods with MSG or nitrates, alcohol (particularly red wine), caffeine, and artificial sweeteners
- Hormonal factors: hormonal changes, especially in women during menstruation, pregnancy, or menopause
Importance of Identifying Triggers
Identifying personal triggers is crucial for effective migraine management, as it allows individuals to avoid or manage these triggers, reducing migraine frequency and severity 1.
Comprehensive Treatment Approach
A comprehensive treatment approach should include lifestyle modifications, such as staying well hydrated, maintaining regular meals, securing sufficient and consistent sleep, engaging in regular physical activity, and managing stress with relaxation techniques or mindfulness practices 1.
Key Recommendations
- Advise patients to keep a headache diary to identify personal triggers 1
- Counsel patients on lifestyle modifications and stress management 1
- Consider preventive treatments for frequent or disabling headaches 1
From the Research
Typical Migraine Triggers
There are no research papers provided that directly discuss typical migraine triggers.
Migraine Treatment and Characteristics
- Migraine is a paroxysmal disorder with attacks of headache, nausea, vomiting, photo- and phonophobia and malaise 2
- The triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan) are highly effective in treating migraine attacks 2
- Migraine prophylaxis is recommended, when more than 3 attacks occur per month, if attacks do not respond to acute treatment or if side effects of acute treatment are severe 2
- Substances with proven efficacy for migraine prophylaxis include the beta-blockers metoprolol and propranolol, the calcium channel blocker flunarizine, several 5-HT antagonists and amitriptyline 2
- Novel anti-migraine drugs target CGRP signaling through either stimulation of 5-HT1F receptors on trigeminovascular nerves or direct blockade of CGRP or its receptor 3
- Lasmiditan is a highly selective 5-HT1F receptor agonist and, unlike the triptans, is devoid of vasoconstrictive properties, allowing its use in patients with cardiovascular risk 3
- The CGRP receptor can be targeted by the monoclonal antibody erenumab, or by small-molecule antagonists called gepants 3
- Rimegepant and ubrogepant have been developed for acute migraine treatment, while atogepant is studied for migraine prophylaxis 3
- Combining triptans with NSAID and other agents for the acute treatment of migraine suggests better outcome efficacy measures than the use of single agents 4
- The fixed combination of sumatriptan and naproxen sodium offers improved 2-hour and 24-hour benefits over monotherapy with each one these options 4
- New therapeutic classes of migraine-specific treatment have been developed, including 5-hydroxytryptamine1F receptor agonists (lasmiditan) and calcitonin gene-related peptide antagonists (rimegepant and ubrogepant) 5
- Most triptans were associated with higher ORs for pain freedom at 2 hours compared with lasmiditan, rimegepant, and ubrogepant 5
- Lasmiditan was associated with the highest risk of any adverse events, and certain triptans (rizatriptan, sumatriptan, and zolmitriptan) were also associated with a higher risk of any adverse events than the calcitonin gene-related peptide antagonists 5