A new theory about triggers

Ask fifteen migraineurs to tell you about their triggers and you will get 15 unique answers. None of us share the same ones. Triggers are so variable that they change from one attack to another even for a single patient.

For example, weather changes are my strongest, most predictable, and least avoidable trigger. Yet sometimes, I am the only one in the house NOT to get an attack during the latest storm. I can safely eat sweet relish in my tuna, but a single sweet pickle will set off an attack within minutes. Chinese food is okay, but canned soups are off limits. One day I skip lunch and dodge that migraine bullet. On another unrelated day just being one hour late for dinner sets off a nasty attack.

It’s a difficult guessing game, isn’t it? 

It would sure be nice to know what’s really going on.

The currently accepted theory regarding triggers is that, alone or in combination, they impact sensitive areas of a migraineur’s brain, setting off a cascading chain of events that leads to a migraine attack. However an explanation as to why triggers are so unique and changeable has thus far eluded researchers.

The January 2016 edition of Headache included a study of a new theory that might explain why triggers are so difficult to pinpoint. In this study, Dr. Johnathan Borkum examined past studies, looking for evidence that common triggers produce oxidative stress. So let’s start by exploring what is meant by “oxidative stress”.

We all know that stress is a commonly-reported migraine trigger. Most of us would define stress as emotional upset, feeling pressured to perform, and/or coping with the daily hassles of life. Oxidative stress is something entirely different and can be measured by physical evidence in the body.

Have you ever heard of free radicals? They are produced in the body in response to all kinds of noxious, toxic, unhealthy exposures – anything from the psychosocial stress with which we are all too familiar to toxic, cancer-causing poisons. Free radical damage has been implicated in the development of cancer, heart disease, diabetes, and even aging. We’ve all heard that antioxidants such as vitamins A, C, and E are protective against this damage (hold that thought).

The basis of this theory is the concept that oxidative stress (also known as free radical damage) is the actual trigger. The stimuli we identify are merely capable of producing oxidative stress. The question that had yet to be answered was whether or not known migraine triggers are even capable of producing such damage in the brain. So Dr. Borkum searched existing studies using the terms “oxidative stress” and “brain” plus these common triggers:

Alcoholdehydrationwater deprivation
monosodium glutamateaspartametyramine
Phenylethylaminedietary nitratesnitrosamines
Noiseweatherair pollutants
Estrogencircadiansleep deprivation
information processingpsychosocial stressnitroglycerin

What he discovered was that each of these triggers does produce oxidative stress within the brain. He goes on to suggest that the brains of migraine patients may either be more vulnerable to oxidative stress or may be more reactive to oxidative stress. He also suggested that migraineurs may be naturally lower in antioxidants in the brain that would normally protect against such damage.

There are still a lot of questions to be answered now that we know triggers and free radical damage are linked in some way. Some of those questions include:

  • Can antioxidant supplements be used as preventive therapies?
  • Can antioxidant supplements be used as acute abortives?
  • Does migraine act as a corrective action to reverse the damage of this oxidative stress?
  • Does trigger exposure cause long-term and/or permanent free radical damage in the brain?
  • Why do migraine attacks decrease with age, but oxidative stress in the brain increase?
  • What is the threshold of oxidative stress required to induce a migraine attack?
  • What amount of trigger exposure is required to induce oxidative stress in the brain?

It’s not a perfectly unifying theory of migraine triggers. A lot of work still needs to be done to determine what, if any, role oxidative stress has on migraine attacks. Still, it’s nice to know that researchers are still brainstorming ideas and testing new theories. One of these days, someone is going to “hit the motherload” and change our lives forever.


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