Perceived triggers of primary headache disorders: A meta-analysis

Pellegrino, Arine; Davis-Martin, Rachel; Houle, Timothy T.; Turner, Dana P.; Smitherman, Todd A.

doi:10.1177/0333102417727535

Cited by 162 publications

(136 citation statements)

References 26 publications

(27 reference statements)

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“…81 The most commonly endorsed triggers for migraine were sleep and stress. Meta-analysis of headache trigger literature evaluated 40 unique triggers extracted from 85 published papers.…”

Section: Management Of Sleep-related Triggers In Episodicmentioning

confidence: 99%

Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders

Rains

2018

Headache

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The relationship of sleep and migraine is unequivocal and familiarity with the nature and magnitude of these associations may inform clinical practice. Recent prospective, longitudinal, and time-series analysis has begun to unravel the magnitude and temporal patterns of sleep and migraine. Prospective evidence has shown that sleep variables can trigger acute migraine, precede and predict new onset headache by several years, and indeed, sleep disturbance and snoring are risk factors for chronification. The presence of a sleep disorder is associated with more frequent and severe migraine and portends a poorer headache prognosis. Interestingly, the disorders linked to migraine are quite varied, including insomnia, snoring and obstructive sleep apnea, restless legs, circadian rhythm disorders, narcolepsy, and others. Insomnia is by far the most common sleep disorder in headache patients. In fact, the majority of patients with chronic migraine presenting for treatment have insomnia. Despite a rapidly expanding literature, very few controlled treatment studies have been published to guide clinical practice. This paper focuses on clinical assessment and treatment of sleep disorders. An algorithm is presented for sleep disorders management in the migraine patient, which highlights major sleep disorders and psychiatric comorbidity. Diagnostic procedures are recommended that are conducive to clinical practice. Suggested tools include the sleep history, screening mnemonics, prediction equation, and sleep diary. New developments in treatment have produced abbreviated and cost-effective therapies for insomnia and obstructive sleep apnea that may reach a larger population. Revisions in the diagnostic manuals for sleep and headache disorders enhance recognition of sleep-related headache. Recommendations include behavioral sleep regulation, shown in recent controlled trials to decrease migraine frequency, management for sleep apnea headache, cognitive behavioral therapy (CBT) for insomnia abbreviated for the physician practice setting, sleep-related headache trigger, and others. There is no empirical evidence that sleep evaluation should delay or supersede usual headache care. Rather, sleep management is complimentary to standard headache practice.

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“…81 The most commonly endorsed triggers for migraine were sleep and stress. Meta-analysis of headache trigger literature evaluated 40 unique triggers extracted from 85 published papers.…”

Section: Management Of Sleep-related Triggers In Episodicmentioning

confidence: 99%

Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders

Rains

2018

Headache

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“…Since the time of Hippocrates, a vast array of headache trigger candidates has been hypothesized ranging from foods, activities, behaviors, environmental conditions, and many others . Potency beliefs in these diverse factors vary considerably across individuals . Therefore, conceptualizing a common pathway to causing or initiating an attack is difficult.…”

Section: Introductionmentioning

confidence: 99%

Headache Triggers as Surprise

et al. 2019

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Objectives To examine the hypothesis that surprising experiences of headache triggers are associated with daily headache activity. Background Little is known about the specific environmental or behavioral interactions that might trigger a headache attack in a prone individual. We propose that headache trigger exposures can be usefully characterized, not only by their mechanisms of action, but also on the degree of “surprise” they present to the individual. This hypothesis is based on elements of information theory: that unusual events and experiences carry more information than common events and experiences and that headache attacks are associated with reactions to uncommon or unexpected biopsychosocial exposures. Methods A secondary analysis of the Headache Prediction Study, this prospective cohort study followed N = 95 individuals with episodic migraine who contributed 4195 days of diary data. Information was collected on daily levels of several common headache triggers: number of caffeinated beverages, number of alcoholic beverages, stress (Daily Stress Inventory), and mood disturbance (Profile of Mood States). The probability of observing variations in each trigger was used to estimate the “surprisal” of experiencing each trigger, and this information, measured in bits, was used to predict headache attacks. Results Participants experienced a headache attack on 1613 of 4195 days (38.5%). Each of the triggers was modestly related to the probability of experiencing a future headache in a complex manner that involved interactions between current headache status, current levels of the trigger, and lagged (previous) levels of the trigger. However, when expressed as a surprisal, the associations were simplified and strengthened. For example, each of the individual trigger surprisals exhibited a meaningful association with the development of a future headache attack (expressed as a 1 SD change in surprisal), with odds ratios ranging from a low of 1.11 (95%CI: 1.00 to 1.24) for alcohol to a high of 1.30 (95%CI: 1.14 to 1.46) for stress. The individual surprisals could be summed for total trigger surprise and exhibited a reliable association with new onset headache, OR 1.35 (95%CI: 1.17 to 1.49). This score exhibited superior discrimination between headache and non‐headache days from all of the individual triggers (ignoring base rate, AUC: 0.61; AUC: 0.71 with base rate). Conclusions Diverse headache triggers can be uniformly described using their probability distributions. Rare values of headache triggers, or surprising values, were found to have consistent associations with headache activity across a variety of triggers. This finding, if validated in external data using other triggers, has potential to be used to conceptualize the influence of a wide range of headache triggers.

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“…4,10 If a descriptive approach is used, an individual will focus on the direction and strength of the relationship between 2 variables. 11 Because of the large number of headache trigger candidates 11 and the delay between exposure and attack for some triggers like stress, [12][13][14] it is extremely difficult for an individual with headache to conduct covariation assessments using only naturalistic observation. Alternatively, an inferential perspective focuses on identifying the presence or absence of a relationship between 2 variables.…”

Section: Introductionmentioning

confidence: 99%

Appraisal of Headache Trigger Patterns Using Calendars

2019

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Objective.-Using experimental, yet realistic, headache calendars, this laboratory study evaluated the ability of individuals to identify the degree of association between triggers and headaches.Background.-Individuals with headache often record daily diaries or calendars to identify their patterns of triggers.Methods.-This cross-sectional, observational study included adults with migraine, tension-type, or cluster headache who had ever experienced more than 5 attacks. Participants (N = 300) were presented with headache calendars and asked to rate the strength of the relationship (how strongly one causes the other) between 3 experimental triggers (high stress, poor sleep, and cinnamon) and headache using a 0 ("no relationship") to 10 ("perfect relationship") scale for each calendar.Results.-Calendars with a high positive correlation between trigger and headache had higher participant ratings than those with low correlations. The median [25th, 75th] of ratings for each correlation level was low correlation: 1 [0, 4], medium: 4 [2, 5], and high: 5 [4, 8], P < .0001. However, participants appeared to ignore negative associations (ie, trigger present with no headache) and rated calendars with more headache days as having higher associations, regardless of the true relationship. The ratings for 2, 6, and 26 headache days were 1 [0, 3], 4 [1, 6], and 8 [0, 10], respectively (P < .0001). Participants' previous beliefs about the triggers also affected their ratings (average correlation across triggers: r = 0.25, P < .0001).Conclusions.-This laboratory task supports the notion that individuals with headache are able to identify the association between headaches and triggers using headache calendars. However, these judgments can be biased by the individuals' previous beliefs about the trigger and by the degree of headache activity.

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Perceived triggers of primary headache disorders: A meta-analysis

Cited by 162 publications

References 26 publications

Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders

Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders

Headache Triggers as Surprise

Appraisal of Headache Trigger Patterns Using Calendars

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