Migraine Myth of the Month: Elimination of migraine triggers is highly effective in reducing migraine burden
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Well, yes…but also no. Often helpful, definitely. But “highly effective”, not so much.
The majority of migraineurs (over 90% in many studies) report that their migraine episodes may be precipitated by “triggers”. The triggers most commonly cited by migraine patients are physical or emotional stress, menses, exposure to bright or flickering light, certain odors and, more and more, prolonged computer screen time. Sleep deprivation or “oversleeping”, fasting or skipping meals, weather changes and ingestion of alcohol (especially red wine or other aromatic alcohol-containing beverages) also are frequently reported as triggers.
No matter the country, specific region of a country, culture, gender, race or ethnicity, migraineurs invariably rank “stress” as their most common trigger. In a previous issue we focused on the importance of assessing and reducing one’s level of stress so as to minimize migraine burden, but with the curveballs life continually throws our way the reduction of stress - let alone its elimination - can be a tough slog. Chucking it all to live and play on a beautiful beach well may reduce both stress and associated migraine, but reality intrudes. No harm in fantasizing, but some regular aerobic exercise and time spent using an app devoted to relaxation techniques/meditation may have to substitute for that golden beach.
And menses is a tough one as well. Almost 75% of actively cycling female migraineurs report aggravation of their migraine by menses. In some cases this can be at least partially alleviated by eliminating menses via a hormone-secreting IUD, active use of an oral contraceptive throughout the month or other techniques. Scheduled use of magnesium or certain migraine medications more commonly used for acute headache treatment during the high risk portion of one’s menstrual cycle also may help. All well and good, but relatively few female have “pure” menstrual migraine. Most have headaches at other times of the monthly cycle as well.
Attempting to reduce computer screen time is no easy task in a working world that often seems dedicated to promoting just the opposite. Filtering shades for the screen or certain lenses for the user sometimes offer relief, but for many that just isn’t enough. Not surprising. Bad luck for migraineurs, the occipital lobes, the portion of the brain whose function is to receive and process visual information received via the retinas and optic nerves, are inherently hypersensitive in those with migraine. Short of living in the dark, this can be a tough trigger to eliminate or even reduce significantly.
Without question, stress reduction, regular aerobic exercise, good sleep hygiene, and taking regular breaks from the computer screen can help reduce migraine burden…but don’t consider yourself unusual or deficient if you are doing all of these things and more but still suffer from frequent migraine episodes. Just as no single migraine medication is universally effective for all migraineurs, an exhaustive search for and elimination of triggers is rarely “the answer” for reaching the Promised Land of “headache-free or nearly so”. Holistic may be an overused adjective, but for migraine that is not well-controlled it makes good sense to work with your healthcare provider to develop a holistic management strategy that is both realistic and likely to be effective.
In closing, let’s harken back to some general caveats from an article about migraine triggers published in a previous issue:
No single entity, however “classic”, (e.g., red wine) acts as a trigger in all migraineurs.
In the individual migraineur, rarely does an identified trigger always provoke an attack.
Simultaneous exposure to two or more triggers may be required to provoke an attack (e.g., red wine ingested during menses).
In a given migraineur, what serves as a trigger may also serve as a treatment (e.g., caffeine).
