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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:

Alcohol dehydration water deprivation
monosodium glutamate aspartame tyramine
Phenylethylamine dietary nitrates nitrosamines
Noise weather air pollutants
Hypoglycemia hypoxia infection
Estrogen circadian sleep deprivation
information processing psychosocial stress nitroglycerin

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.

 

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Borkum, Johnathan M. PhD, (January 2016), Migraine Triggers and Oxidative Stress: A Narrative Review and Synthesis, Headache, 2016: 56: 12-35, doi: 10.1111/head12725.

Comments

  • Kristaina
    3 years ago

    I’ve had migraines for as long as I can remember. My best friend even remembers them from when we were little and how I would curl up in a ball from the pain. I am 47 years old now and figure I’ve spent a good percentage of my life down with a migraine. Unfortunately they have not decreased with age.
    My biggest known triggers are stress, weather, alcohol and exercise. I’m finally giving in to admitting that diet plays a big part too (as I’ve been told for years but never wanted to admit it. I’m a little stubborn and love my junk food & sweets).
    I’ve read about the research on migraines & oxidative stress and have decided to start taking an antioxidant blend essential oil daily to see if it helps. I will also start eating better. I’ll post an update if I notice a difference.

  • Joanna Bodner moderator
    3 years ago

    Hi Kristaina,
    Thank you for joining in on the conversation! That’s wonderful you seem to have been able to identify a good number of your triggers…unfortunately sorry to hear so many are at play 🙁 AND you are definitely NOT alone when it comes to admitting diet may play a role. The thought of it for many seems daunting, but there are some simple steps you can begin to incorporate. Baby steps, right? 🙂 Let me share some information with you related to this topic in case there are some things you may not have considered: https://migraine.com/blog/elimination-diet-foods-to-eat-foods-to-avoid/, https://migraine.com/blog/foods-potential-migraine-triggers-understanding-food-chemicals/ and https://migraine.com/blog/tips-for-staying-sane-on-an-elimination-diet/. I hope you find some of these articles helpful. Please do be sure to keep us posted if you notice any results! Take care, Joanna (Migraine.com Team)

  • mstori68
    3 years ago

    Fascinating theory about how the accumulation of oxidative stress (in the form of various known “triggers”) could potentially be the cause of a migraine. I just recently learned a lot about the effects of oxidative stress on our organs and exactly how antioxidants work to combat that oxidative stress. Understanding that process certainly makes it seem more realistic to believe that a simple supplement of some sort could possibly derail the build up of this oxidative stress before the tangible result of a migraine is reached (and potentially, protect from further brain trauma if that is found to be the ultimate end product from all the accumulated oxidative stress). I will be very interested to see where this research tangent goes!

  • zetetic
    3 years ago

    Ever since I’ve been taking 6 mg of melatonin, (a super antioxidant not just a sleep hormone) and lots of regular exercise, meditation my chronic headaches have virtually disappeared. The only thing that all these have in common is the antioxidant qualities of all these activities.

    Who knows if it is all that as it could just be a change in the HA cycle, but definitely interesting that the science keeps toying around with these properties.

  • Bugs
    3 years ago

    I’ve had silent migraines for 45 years, have determined only two verified triggers (iced tea and blinking lights). All others are guess work. I’ve concluded they come when they come and they go when the go (in seasons of a dozen or more and then without any for up to 90 days). Mine haven’t decreased with age, perhaps in severity.

  • Jojiieme
    3 years ago

    It’s a great article and makes for hopeful reading.
    PLoS published an article in January on glutamates in the brain, and how they affect the way pain and other messages are sent around the body. I can’t remember the full citation details now, I’ll try to track it down later.
    Anyway my allergist was telling me this is why, as a migraineur, I need to avoid various food chemical including antioxidants and preservatives. Ingesting or exposure to these substances sets us up to reactive responses; our immune systems respond at peak-threat and maximimum inflammation.
    Control the inflammation (eliminate the irritant) and you control the risk of migraine.

  • Jojiieme
    3 years ago

    Apologies. I typed Jillian. Autocorrect leapt in!

  • Jojiieme
    3 years ago

    Julian, thanks! I’ve already ready those articles. 🙂

  • jns192 moderator
    3 years ago

    JOJ,
    Thanks for sharing!
    Foods can definitely be a huge trigger for those with migraine.
    While some foods are more common triggers such as red wine and deli meats– everyone responds differently. However, I thought you might enjoy this article that discusses foods to try and avoid with migraine.
    https://migraine.com/blog/elimination-diet-foods-to-eat-foods-to-avoid/
    Thanks for being a part of our community.
    Best,
    Jillian (Migraine.com Team)

  • Luna
    3 years ago

    “Why do migraine attacks decrease with age, but oxidative stress in the brain increase?”
    How old do I have to get for this decrease with age? (:)
    Anyway, good article. Thanks Tammy.

  • Luna
    3 years ago

    I am a great-grandmother.

  • Auemerald
    3 years ago

    Thanks I needed a chuckle! Oh, and I am right there with you on that thought.

  • Tammy Rome author
    3 years ago

    LOL 🙂 Good one, Luna. I wondered the same thing, too. I know the statistics say migraine is more prevalent during childbearing years, but I hate to think I have to wait to be a great-grandmother before they stop.

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