Migraine and Triggers: Post Hoc Ergo Propter Hoc?

Abstract

The influence of environmental factors on the clinical manifestation of migraine has been a matter of extensive debate over the past decades. Migraineurs commonly report foods, alcohol, meteorologic or atmospheric changes, exposure to light, sounds, or odors, as factors that trigger or aggravate their migraine attacks. In the same way, physicians frequently follow this belief in their recommendations in how migraineurs may reduce their attack frequency, especially with regard to the consumption of certain food components. Interestingly, despite being such a common belief, most of the clinical studies have shown conflicting results. The aim of the review is to critically analyze clinical and pathophysiological facts that support or refute a correlation between certain environmental stimuli and the occurrence of migraine attacks. Given the substantial discrepancy between patients' reports and objective clinical data, the methodological difficulties of investigating the link between environmental factors and migraine are highlighted.

Headache and Alcohol

“…The notion that environmental factors have the ability to trigger headaches and in particular migraine is not always based on controlled clinical studies or data . In the case of alcohol and headache, there are still unanswered questions.…”

Trigger Factors and Premonitory Features of Migraine Attacks: Summary of Studies

“…This article does not focus on studies of individual headache triggers or their pathophysiological underpinnings. This topic has been examined in several excellent reviews …”

“…This topic has been examined in several excellent reviews. 3,4 Our goal is not to provide a comprehensive review but to exemplify the methodological issues and opportunities for better understanding of trigger factors and premonitory features. We consider retrospective surveys, diary studies, and clinical trials and close with a discussion of the prospects for preemptive therapy.…”

Cortisol and migraine. A systematic literature review

“…[2,3] Regardless of the presence of an aura (i.e., visual and/or sensory and/or speech disturbances occurring before the headache pain), the role of biological, psychological and environmental factors on triggering or aggravating migraine attacks has been now clearly acknowledged. [4] Among these, stress seems to play a very prominent role.…”