Patients usually mistaken about migraine triggers

Most patients with migraines are confused about what triggers their attacks and often take the wrong preventative measures as a result, researchers have found.

The Australian and international team say the disjoint highlights the need to develop patients’ understanding of potential triggers and premonitory symptoms to help them adopt behavioural changes to mitigate attack risk.

The findings are based on inputs to a smartphone app called N1-Headache, which allows patients to record migraines and triggers but also calculates the associations between them, displaying the results for the user to see.

For the observational longitudinal cohort study, the researchers collected data from 328 adult users of the app between October 2014 and June 2017 including symptoms, migraine-related disability, medication use and potential migraine triggers daily.

Users were also given a list commonly-reported triggers such as smoking or caffeine consumption and asked to rate how strongly the trigger contributed to their migraine attacks.

But while each patient self-reported 28 contributing triggers on average, a mean of only 2.2 were actually associated with an individual’s increased risk of attacks, the researchers found.

The most common of these was neck pain, statistically associated with attacks in 39% of participants and eye-strain (21%).

Tiredness/fatigue (20%), exposure to bright lights (18%), allodynia (18%), and loud noise (15%) were other indicators linked with an increased attack risk.

By contrast, the most common self-reported triggers included poor quality sleep (90%), stress (89%), dehydration (86%) and neck pain (79%).

Some 88% of women said menstruation was a trigger, something that was confirmed in just 16%. And while three quarters of drinkers believed alcohol triggered their migraines, an increased risk of migraine attack could not be confirmed in any of them, the researchers said.

“One explanation is that people with migraine are simply wrong about at least some of their triggers, but this begs the question of why they would hold erroneous beliefs,” they wrote in Headache.

“A possible answer to this question is that a person with migraine might conclude after a migraine attack that it was triggered by a certain trigger, and then proceed to avoid that trigger to avoid future attacks.

“Their interpretation might be wrong but, by then avoiding the trigger, there is no opportunity for them to become aware of the error.”

Another reason for people living with migraine disease being  mistaken about their triggers is if they heard – from a source that may or may not be reliable – that something triggered migraine attacks in some people and this led them erroneously to believe that this may be a trigger for them too, the authors added.

They suggested using similar apps as a good first step to improve patients’ understanding of their disorder, specifically why attacks occur when they do.

Nevertheless, there were limitations to that approach given the possibility that things like neck pain or eye strain may not be triggers at all, but rather premonitory symptoms.

Encouraging patients to perform behavioural experiments to explore the causality of common perceived triggers was one solution, particularly in the case of examples like missing meals or eating chocolate.

“The results suggest the need for work on developing even more sophisticated tools for self-monitoring headaches and triggers, for example, including ‘dosage’ variables,” they added.

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