Sex differences in prevalence of migraine trigger factors: A cross-sectional study

Casteren, Daphne S van; Verhagen, Iris E; Onderwater, Gerrit L.J.; MaassenVanDenBrink, Antoinette; Terwindt, Gisela M.

doi:10.1177/0333102420974362

Cited by 34 publications

(31 citation statements)

References 21 publications

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“…Inclusion: women with migraine who were not using combined oral contraceptives and with at least three registered menstrual cycles. DRSP= Daily Record of Severity of Problems; total symptom score (range 21-126), total functional impairment score (ranges [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The following criteria needed to be met for PMS: (1) 30% higher mean total symptom score in late luteal phase compared to mid-follicular phase;…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 Menstruation is the most reported migraine trigger factor in women. 3 The exact underlying pathophysiologic mechanism is suggested to be the drop in estrogen level prior to the menstruation leading to increased brain excitability and triggering the trigeminovascular system. 4 - 6 The rate of estrogen decline seems important in attack provocation.…”

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Comparing Perimenstrual and Nonperimenstrual Migraine Attacks Using an e-Diary

et al. 2021

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BackgroundEndogenous and exogenous female sex hormones are considered important contributors to migraine pathophysiology. Previous studies have cautiously suggested that perimenstrual migraine attacks have a longer duration and are associated with higher disability compared to non-perimenstrual attacks, but they showed conflicting results on acute therapy efficacy, pain intensity, and associated symptoms.ObjectivesTo compare perimenstrual and non-perimenstrual migraine attack characteristics and assess premenstrual syndrome (PMS) in women with migraine.MethodsWomen with migraine were invited to complete a headache E-diary. Characteristics of perimenstrual attacks and non-perimenstrual attacks were compared. The primary outcome was attack duration. Secondary outcomes were headache intensity, accompanying symptoms, acute medication intake and pain coping. Mixed effects models were used to account for multiple attacks within patients. PMS was assessed in those without hormonal contraceptives. Subgroup analyses were performed for women with menstrually related migraine (MRM) and non-menstrually related migraine (non-MRM), and women with a natural menstrual cycle and women using hormonal contraceptives.ResultsA representative group of n=500 participants completed the E-diary for at least one month. Perimenstrual migraine attacks (n=998) compared with non-perimenstrual attacks (n=4097) were associated with longer duration (20.0 vs 16.1 hours, 95%CI [0.2-0.4]), higher recurrence risk (OR 2.4 [2.0-2.9]), increased triptan intake (OR 1.2 [1.1-1.4]), higher headache intensity (OR 1.4 [1.2-1.7]), less pain coping (mean difference -0.2 [-0.3- -0.1]), more pronounced photophobia (OR 1.3 [1.2-1.4]) and phonophobia (OR 1.2 [1.1-1.4]) and less aura (OR 0.8 [0.6-1.0]). In total 396/500 women completed the diary for ≥3 consecutive menstrual cycles, of whom 56% (221/396) fulfilled MRM criteria. Differences in attack characteristics became more pronounced when focusing on women with MRM and women using hormonal contraceptives. Prevalence of PMS was not different for women with MRM compared to non-MRM (11% vs. 15%).DiscussionThe longer duration of perimenstrual migraine attacks in women (with MRM) is associated with higher recurrence risk and increased triptan use. This may increase the risk of medication overuse and emphasizes the need to develop female-specific prophylactic treatment.

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Section: Discussionmentioning

confidence: 99%

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Comparing Perimenstrual and Nonperimenstrual Migraine Attacks Using an e-Diary

et al. 2021

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“…In mixed populations of individuals with migraine without aura and with aura, up to 69% of patients report light as a trigger factor 6,10–13 . When examining specific subgroups, the number is lower for migraine without aura, 35% of individuals, whereas migraine with aura has a higher occurrence of light as a trigger, 75% 6,12–14 . Interestingly, the proportion of patients affected may be higher for those individuals who report a seasonal pattern of their attacks.…”

Section: Light As a Trigger Factormentioning

confidence: 99%

Migraine and light: A narrative review

et al. 2022

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Objective In this narrative review, we summarize clinical and experimental data on the effect of light in migraine and discuss future prospects. Background Effective nonpharmacological treatment of hypersensitivity to light in migraine is an unmet clinical need. Current management strategies primarily consist of seeking a dark room and avoiding light exposure. Advances in the past 2 decades have improved our understanding of the underlying pathophysiology of how migraine is influenced by light. This may provide promising avenues for novel approaches in clinical management. Methods We searched MEDLINE for articles published from database inception up to September 1, 2021. We used the search term “migraine” with the search terms “light,” “photophobia,” “treatment,” “trigger,” “circadian rhythm,” “environment,” and/or “pathophysiology.” Results Light is commonly reported as a trigger factor of migraine attacks, however, early manifestation of photophobia and false attribution is likely the actual cause based on data deriving from retrospective, prospective, and experimental studies. The most common photophobia symptoms in migraine are exacerbation of headache by light and abnormal sensitivity to light with the underlying neural pathways likely being dependent on ongoing activity in the trigeminovascular system. Clinical studies and experimental models have identified mediators of photophobia and uncovered narrow wavebands of the light spectrum that may reduce pain intensity during a migraine attack. Consequently, novel devices have undergone exploratory clinical trials with promising results. Conclusion False attribution is likely the reason why light is commonly reported as a trigger factor of migraine attacks, and a prospective confirmation is required to prevent unnecessary avoidance. The observation that individuals with migraine are not equally photophobic to all wavebands of the light spectrum opens the potential for innovative pain management strategies. In this context, using human‐centric lighting (also called integrative lighting) to mimic the natural daylight cycle and avoid harmful wavebands through modern technology may prove beneficial. Future research should identify direct and indirect consequences of light and other environmental factors in migraine to fill out knowledge gaps and enable evidence‐based care strategies within institutions, work environments, and other settings.

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“…Furthermore, many trigger factors for migraine attacks are associated with limbic circuits, e.g. psycho-physical distress and emotions, homeostatic changes or circadian rhythms 28,29 .…”

Section: Limbic Networkmentioning

confidence: 99%

Intrinsic Network Connectivity Reflects the Cyclic Trajectory of Migraine Attacks

Stankewitz

Schulz

2021

Preprint

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BackgroundEpisodic migraine is considered to be cyclic in nature, triggered by the hypothalamus. To assess the natural trajectory of intrinsic networks over an entire migraine cycle, we designed a longitudinal intra-individual study using functional magnetic resonance imaging (fMRI).MethodsIntrinsic network connectivity was assessed for 12 migraineurs in 82 sessions including spontaneous, untriggered headache attacks and follow-up recordings towards the next attack.ResultsWe found cyclic changes in the visual, auditory, and somatosensory networks, in limbic networks (e.g. thalamo-insular, parahippocampal), and in the salience network (anterior insula and dorsal anterior cingulate cortex). Connectivity changes also extended to further cortical networks, such as the central executive network, the default mode network, as well as subcortical networks.Almost all of these network connectivity changes followed the trajectory of a linear increase over the pain-free interval that peaked immediately prior to the headache, and “dropped” to the baseline level during the headache. These network alterations are associated with a number of cortical functions that may explain the variety of ictal and pre-ictal physiological and psychological migraine symptoms.ConclusionOur results suggest that migraine disease is associated with widespread cyclic alterations of intrinsic networks that develop before the headache is initiated, i.e. during the interictal and premonitory phase. The increasing magnitude of connectivity within these networks towards the next attack may reflect an increasing effort to maintain network integrity.

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Sex differences in prevalence of migraine trigger factors: A cross-sectional study

Cited by 34 publications

References 21 publications

Comparing Perimenstrual and Nonperimenstrual Migraine Attacks Using an e-Diary

Comparing Perimenstrual and Nonperimenstrual Migraine Attacks Using an e-Diary

Migraine and light: A narrative review

Intrinsic Network Connectivity Reflects the Cyclic Trajectory of Migraine Attacks

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