How Accurate Are Migraine Triggers?

Migraine with aura can be initiated by exercise in a small portion of patients

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) More than half of all patients with migraine with aura can identify at least one thing that initiates their migraine attacks. Yet many of these triggers are simply unavoidable in everyday life.

A recent small study sought to understand the accuracy of self-reported triggers. The study concluded that a small number of those who reported a trigger will actually have a migraine when exposed experimentally to that trigger.

Migraine was more successfully provoked in those who reported strenuous activity as a trigger than those who reported light as a trigger.

"Ask your doctor how you can better manage migraine triggers.           "

Jes Olesen, MD, of the University of Copenhagen in Denmark, and colleagues recruited 27 patients who experienced migraine with aura with a self-reported trigger of exercise or light.

People who experience migraine with aura have intense and painful headaches usually preceded by visual disruptions. The most frequently reported triggers for migraine with aura are stress, bright light, emotional influences and physical effort.

The study participants ranged from age 20 to 69 and experienced a range of one to 144 attacks a year. Among the patients, there was an average of 12 attacks per year.

Thirteen of the study participants had migraine with aura only and 14 had migraine with aura and migraine without aura.

Forty-six percent of the migraine with aura patients reported bright or flickering light as a trigger. Thirty-eight percent reported physical activity as a trigger and 15 percent reported both light and physical exercise as a trigger.

The patients were exposed to either bright light, strenuous exercise or both and asked to report any migraine with aura-related symptoms that happened up to three hours after exposure.

Exercise involved one hour of intense running or stationary bicycle. Those exposed to the light trigger spent 30 to 40 minutes in the presence of bright, flashing or flickering lights.

Eleven percent of all the patients experienced migraine with aura after exposure to their trigger and another 11 percent experienced migraine without aura after exposure to their trigger.

When it came to trigger by exercise alone, one third of those exposed to exercise developed either migraine with aura or migraine alone. When exercise was combined with light, 28.6 percent developed migraine with aura.

The total of 17 percent developed migraine after exposure to strenuous activity, when experienced both alone and accompanied by light. No migraine was experienced after exposure to light alone.

The researchers speculated that exercise in a laboratory setting can provoke migraine in a small subgroup of patients who identify strenuous activity as a trigger.

Dr. Olesen and team suggested avoiding known migraine triggers but to be critical about whether it is actually provoking a migraine. He encouraged migraine sufferers not to be concerned with a suspected trigger if they are exposed to that trigger for three months without developing a migraine.

While some may feel that exercise triggers their migraines, Rusty Gregory, MS, owner of Forte Personal Fitness and dailyRx contributing expert, has seen exercise improve the condition of those living with migraines.

“Although physical activity may be a trigger for migraines with aura, studies also show that regular exercise may prevent migraines,” said Gregory.

“An improvement in circulation and reduction of stress, another known migraine trigger, are thought to be the exercise benefits responsible for this prevention,” added Gregory.

The study was published in Neurology, the online journal of the American Academy of Neurology.

Funding was provided by the University of Copenhagen, the Lundbeck Foundation Center for Neurovascular Signaling, the Danish Council for Independent Research-Medical Sciences, the Novo Nordisk Foundation and the Research Foundation of the Capital Region of Denmark.

The authors collectively reported associations with a dozen various pharmaceutical companies.

Reviewed by: 
Review Date: 
February 1, 2013
Last Updated:
February 3, 2013