DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20203135

Impact of trigger factors on clinical profile of migraine patients

Muddasir Sharief Banday, Maqbool Wani, Bilal Ahmad Para, Sabia Qureshi

Abstract


Background: Migraine is a primary headache disorder. The study was designed to provide a better understanding of the potential role of triggers in the cause of migraine and their impact on its clinical profile and treatment protocol.

Methods: A prospective study was conducted between June 2018 to May 2020 in 323 patients suffering from migraine in out-patient department of neurology. Patients were labelled as migraine on the basis of simplified diagnostic criteria for migraine. A structured questionnaire was used to interview patients about triggers and correlated with various clinical variables.

Results: All patients had migraine without aura with males 30 (9.3%) and females 293 (90.7%). Episodic migraine found more than chronic daily headache. Trigger factors were present in 234 (72.4%) and absent in 89 (27.6%) patients. Common triggers were hot climate, emotional stress, lack of sleep and fasting. Common foods to precipitate an attack are tomatoes, cheese and collard greens. Mean duration of headache in patients with trigger factors is 5.67±4.99 years with a significant p value (p<0.02). Mean frequency of headache in trigger positive patients is 15.22±8.28 (days/month). Clinical symptoms significant in trigger positive patients are nausea (p<0.0001) (OR=3.94;95% CI=2.02-7.68),vomiting (p=0.0001) (OR=2.62;95% CI=1.50-4.59), photophobia (p<0.0001) (OR=2.69;95% CI=1.56-4.64), phonophobia (p<0.0001) (OR=5.16; 95% CI=2.54-47), pulsating headache (p=0.006) (OR=2.09; 95% CI=1.22-3.56), unilateral location (p<0.0001) (OR=2.88; 95% CI=1.74-4.77).

Conclusions: Triggers are not easily modifiable, and avoiding triggers may not be realistic. Healthy life style like exercise, adequate sleep, stress management and eating regularly may prevent triggers and transformation to chronification over time.


Keywords


Migraine, Headache, Trigger factors

Full Text:

PDF

References


Peter JG, Neil HR. Migraine and other Primary Headache Disorders In: Dennis LK, Anthony SF, Stephen LH, Dan LL, Larry J, Joseph L, eds Harrison’s Principles of Internal Medicine. Mc Graw Hill; 2016:2586-98.

Steiner TJ, Stovner LJ, Birbeck GL. Migraine: the seventh disabler. J Headache Pain. 2013;14:1.

Steiner TJ, Stovner LJ, Vos T. GBD 2015: migraine is the third cause of disability in under 50s. J Headache Pain. 2016;17(1):104.

Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68:343-9.

Hawkins K, Wang S, Rupnow M. Direct cost burden among insured US employees with migraine. Headache. 2008;48:553-63.

Vos T, Flaxman AD, Naghavi M. Years lived with disability (YLD) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163-96.

Blumenfeld AM, Varon SF, Wilcox TK. Disability, HR QoL and resource use among chronic and episodic migraineures: results from the International Burden of Migraine Study (IBMS). Cephalalgia. 2011;31:301-15.

Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C. Prevalence of migraine in patients with a history of self-reported or physician diagnosed “sinus” headache. Arch Intern Med. 2004;44(9):856-64.

Headache Classification Committee of the International Headache society (IHS); the international Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629-808.

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

Zagami AS, Bahra A. Symptomatology of migraines without aura. In J P Olesen J. N. Goadsby M. Ramadan P. T felt-Hansen, and K. M. A. Welch (Eds.), The headaches (pp. 399-405)., (3rd. ed.). Philadelphia: Lippincott Williams and Wilkins; 2006.

Rama KY, Jayantee K, Usha KM. A study of triggers of migraine in India. Pain Med. 2010;11:44-7.

Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and Burden of Migraine in US: Data From the American Migraine study II. Headache. 2001;41:646-57.

Martin PR, Milech D, Nathan PR. Towards a functional model of chronic headaches. Headache. 1993;33:461-70.

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

Bergh VD, Amery WK, Waelkens J. Trigger factors in migraine: a study conducted by the Belgian migraine society. Headache. 1987;27:191-6.

Yadav RK, Kalita J, Misra UK. A Study of Triggers of Migraine in India. Pain Med. 2010;11:44-7.

Millichap JG, Yee MM. The diet factor in pediatric and adolescent migraine. Pediatr Neurol. 2003;28:9-15.

Blau JN. Water deprivation: a new migraine precipitant. Headache. 2005;45:757-9.

Migraine HE. In: Lessof MH, ed. Clinical reactions to food. Chichester: John Wiley; 1983: 155-180.

Spierings ELH, Ranke AH, Honkoop PC. Precipitating and Aggravating Factors of Migraine versus Tension type Headache. Headache. 2001;41:554-8.