Identifying Migraine Triggers : Range of migraine triggers, Migraine and the stress response

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Q: What are the triggers for migraine?
A: Many triggers can start a migraine attack. Any situation or substance can act to excite the brain cells of someone with migraine and trigger an attack. These range from stressful events and hormonal changes to drugs and changes in the weather (see Range of migraine triggers, for a detailed list).
Q: How do migraine triggers cause an attack?
A: Migraine triggers cause hyperexcitable brain cells to become more excited by either acting directly on them or by increasing the level of epinephrine (a chemical that excites brain cells). Some scientists believe the triggers do not start the attack but simply intensify the symptoms of an attack already underway. Once the brain cells reach a certain level of excitation, an attack is triggered. Some studies have shown that the electrical reaction of the brain cells is more sensitive to a stimulus not only during an attack but also in between attacks.
Q: What is the most common migraine trigger?
A: The most common trigger for a migraine attack is emotional stress. This is understandable since an emotionally stressful event or situation brings on what is called the “fight-or-flight” response. During such a response, epinephrine is released, which can hyperexcite brain cells and bring on an attack.
Q: Is emotional stress the only thing that causes the “fight-or-flight” response?
A: No, the “fight-or-flight” response is the body’s protective reaction to any thing or situation that threatens harm. “Stress” for the body could be, for example, low blood sugar or oxygen levels, low blood pressure, or any stress related to a medical illness.
Q: Why do some things trigger a migraine attack in some people but not in others?
A: Triggers tend to vary among individuals. Many people with migraine can identify specific triggers while others have no idea. Some people know that they are more susceptible to one trigger than another. In some cases, several triggers work together to increase the likelihood of an attack. Each trigger affects the brain even if it doesn’t lead to an attack; the closer triggers are to one another, the more likely it is that a migraine attack will occur. Often, a trigger is present hours to days before the attack but only when it combines with another trigger does it bring on a migraine attack.
Q: Why do I need to identify and avoid triggers?
A: If you are able to identify and avoid or eliminate some of your triggers, you may be able to reduce the frequency of your attacks. Some studies have shown that trigger identification and avoidance can be as effective as daily preventative medications for migraine. Moreover, medications for migraine can become less effective if attacks occur too frequently.

Range of migraine triggers

Migraine triggers may be internal (coming from inside you) or external (coming from your external environment). The list below gives some of the main triggers.

External triggers:
  • Stressful events

  • Food/drink

  • Food additives

  • Schedule or time changes

  • Sleep disruption

  • Changes in eating habits

  • Weather change

  • Altitude change

  • Intense heat or cold

  • Intense light, sound, or odors

  • Overuse of certain medications

  • Drugs

Internal triggers:
  • Hormonal changes, such as menstruation

  • Missing meals

  • Illness

  • Hypoglycemia (low blood sugar)

  • Dehydration

Migraine and the stress response

An appreciation of the “fight-or-flight” stress response helps you understand why certain situations trigger migraine attacks. During this response, epinephrine excites the hyperexcitable brain cells further, causing a migraine attack. Beta-blockers—drugs that block the effects of epinephrine—are very effective when used to prevent attacks.

Any situation that threatens the delicate balance of the body activates the stress response. This response prepares the body to react to the stressful stimulus, whether this is a physical threat, such as an attack by a wild animal, or an emotional stress, such as taking an exam.

Although the stress response is both vital and valuable, it can also be disruptive and damaging. The response, which evolved to prompt animals to fight or run away from harm, can be misplaced in human society. Humans rarely require the intense physical action generated by this response, yet our biology still provides it. When the stress response is activated repeatedly, it can have a harmful effect on the body. For some people, it can be a frequent trigger for migraine attacks.

The stress response

During stressful situations, messages are carried along nerves from the cerebral cortex (where thought processes occur) to the hypothalamus. The hypothalamus activates autonomic nerves (nerves that carry information about automatic bodily processes) in the brain stem and prompts the release of epinephrine. This causes an increase in heart and breathing rates, blood pressure, and blood sugar levels, a slowing of the gastrointestinal tract, and dilation of the pupils. These changes prepare the body for fight or flight.

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