A new study1 has identified the top 10 migraine triggers and the frequency at which they occur. The study’s author* culled this list by examining a collection of existing migraine studies in a meta-analysis of 25 previously published studies of a wide range of migraineurs throughout the world. They found the top 10 triggers to be:
1. Stress, 58% (of 7,187 patients)
The researcher defined stress as “a specific adaptive and defensive physiological reaction by the nervous system in response to a wide variety of physiological and/or psychological stimuli.” In most studies, the increased stress coincided with increased migraine frequency, though one found that the migraine attacks occurred after the stress lifted.
2. Auditory, 56% (of 397 patients)
While noise and sounds are ranked second, they were mentioned in far fewer studies than the other triggers. The percentage may or may not scale if a larger number of patients were assessed.
3. Fatigue, 45% (of 2,577)
The article noted that fatigue and stress could be interrelated. I wonder if fatigue is the trigger or if patients notice feeling fatigued before a migraine and assume it is a trigger when it is actually a very early migraine symptom.
4. Fasting, 44% (of 3,374)
Whether intentionally fasting or unintentionally skipping a meal, doing so was a trigger in almost half of migraineurs.
5. Hormonal, 44% (of 4,461)
This applies only to women. The article noted that the “association of a migraine with specific phases of the menstrual cycle is perhaps the most commonly known and accepted migraine precipitating factor.”
6. Sleep, 43% (of 5,347)
The studies examined a variety of sleep pattern disturbances, though “sleep deprivation” and “lack of sleep” were frequently mentioned.
7. Weather, 39% (of 5,527)
Weather changes were the most commonly cited weather-related trigger, though strong winds were also mentioned. The article also notes that strong winds are indicative of a weather change.
8. Visual, 38% (of 5,176)
Lights and glare were mentioned the most, though flickering lights or contrasting patterns (like road stripes) were also cited.
9. Olfactory, 38% (of 5,251)
The odors were typically “generated by organic compounds such as perfumes, nail polish, paint, gasoline, and cleaning products,” according the study.
10. Alcohol, 27% (of 3,695)
The association between alcohol and migraine was lower than the author believed to be expected. He questioned whether alcohol in general is the trigger or if it only certain types of alcohol.
Other frequently mentioned triggers that didn’t make the top 10 include physical activity (exercise, exertion, and/or straining) for 25% of migraineurs and foods for 20%. The paper mentioned that there were many more, but none occurred in more than 20% of patients on average. Many of the triggers affected only subgroups of migraineurs.
What ties all the triggers together, according to the article, “appears to be an intrinsic difficulty in adapting to internal and external environmental changes.” They noted that this was particular apparent with a decrease in many stimuli, including barometric pressure, estrogen, and sleep. Why and how do these factors trigger migraine attacks? Those are questions for future research.
Findings were published in the August issue of the journal Current Pain and Headache Reports.
*Stephen J. Peroutka, MD, PhD, is the chief medical officer at Semnur Pharmaceuticals, a start-up known for work on non-opioid drugs for back pain. I have to admit immense curiosity about why the company’s CMO is writing about migraine triggers.