April 8, 2013
Multiple Factors Responsible For Triggering Painful Migraines
Brett Smith for redOrbit.com - Your Universe Online
Migraine sufferers are constantly searching for the one thing that triggers their unbearable headaches so they can learn to avoid it at all costs. A team of American researchers that has also been trying to identify these triggers has now found too many confounding factors associated with the condition to place the blame on any single cause.
According to two new reports in the journal Headache, the team tried to determine the source of women´s migraines based on real world conditions.
"But our research shows this is a flawed approach for several reasons," said co author Timothy T. Houle, an associate professor of anesthesia and neurology at Wake Forest Baptist Medical Center. "Correctly identifying triggers allows patients to avoid or manage them in an attempt to prevent future headaches.”
“However, daily fluctuations of variables — such as weather, diet, hormone levels, sleep, physical activity and stress — appear to be enough to prevent the perfect conditions necessary for determining triggers,” he added.
Houle said that many migraine sufferers organize their activities to guard against or around the potential onset of a debilitating headache. He added that his team is striving to understand which behavior modifications are warranted and which are not.
"Many patients live in fear of the unpredictability of headache pain. As a result, they often restrict their daily lives to prepare for the eventuality of the next attack that may leave them bedridden and temporarily disabled," Houle said in a statement. "They may even engage in medication-use strategies that inadvertently worsen their headaches. The goal of this research is to better understand what conditions must be true for an individual headache sufferer to conclude that something causes their headaches."
Based on their research, Houle and his team have published two related papers in Headache: “Causality and Headache Triggers” and “Natural Experimentation Is a Challenging Method for Identifying Headache Triggers.”
For the study, the researchers recruited nine women who were diagnosed with migraines and had typical menstrual cycles, to control for hormonal factors. Participants provided data for three months using a daily diary and a Daily Stress Inventory, a self-administered survey to record the number and impact of common stressors found in everyday life. Researchers recorded the women´s hormone level by testing daily urine samples.
To check for weather-based factors, the team reviewed three years worth of meteorological data from a local weather station.
According to co-author Dana P. Turner, a researcher from Wake Forest, the multitude of factors that could play a role in triggering a migraine makes finding a cause extremely difficult.
Despite their lack of success, the team did formulate three metrics for identifying a potential migraine trigger in their report: “constancy of the sufferer”, “constancy of the trigger effect”, and “constancy of the trigger presentation.”
The study authors also suggested that “formal experimental designs or retrospective diary studies” are the best methods for identifying potential triggers.
Turner said she hopes her team´s efforts will raise awareness surrounding the mystery of migraine triggers.
"People who try to figure out their own triggers probably don't have enough information to truly know what causes their headaches," she said. "They need more formal experiments and should work with their doctors to devise a formal experiment for testing triggers."