Check Your Work: How Much Do You Know About Migraine Triggers?

Before you read further, take the quiz: Quiz: How Much Do You Know About Migraine Triggers?

Each week during Migraine and Headache Awareness Month, Drug Topics will be publishing a weekly quiz focused on a different aspect of migraine and headache management. Our second weekly quiz, published on Thursday, June 20, focused on migraine triggers. Below, we break down the answers.

Question 1

Which of the following is the most common behavioral trigger for migraines?

Answer: Poor sleep hygiene

It’s not uncommon for people with migraine to wake up with a headache, which can be attributed this to a patient’s sleeping habits. There is an association between poor sleep—including poor sleep hygiene and conditions such as insomnia—and migraine frequency and intensity.¹

Question 2

A patient reports experiencing migraines before their menstrual period. This is likely due to fluctuations in which hormone?

Answer: Estrogen

Although both men and women can experience migraine, the condition is more common in women than in men: Approximately 1 in 5 women experience migraine, compared to 1 in 16 men. One potential reason for this disparity is hormones—specifically, estrogen. Changes in estrogen levels, such as those that occur during the menstrual cycle, pregnancy, and menopause, are associated with migraine, including menstrual migraine which impacts between 60% and 70% of women who get migraine.²

Question 3

A young adult with migraines mentions consuming large amounts of processed foods daily. What dietary factor could be a potential trigger?

Answer: Artificial sweeteners (aspartame)

According to the American Migraine Foundation, food triggers “appear to be important in a minority of [people living with migraine].” But like all triggers, they are highly individualized: some migraineurs are triggered by caffeine, while others are triggered by alcohol or chocolate. Foods such as cheese and processed meats contain tyramine and nitrates, respectively, which can also trigger migraine attacks for some. Even additives like aspartame and monosodium glutamate (MSG) may be triggers—but scientific evidence varies.³

Question 4

A patient describes experiencing a migraine after spending a sunny afternoon at the beach. What environmental factor could be a trigger?

Answer: All of the above

Unfortunately for migraineurs who love soaking up the sun, even a sunny afternoon at the beach can trigger a migraine. “The migraine brain hates change,” an article published on the American Migraine Foundation website noted, and changing seasons are no exception.⁴ Before hitting the beach, suggest that patients with migraine prepare to avoid direct sunlight through sufficient shade, sun hats, and sunglasses, limit alcohol consumption, maintain a regular sleep schedule, and—perhaps most importantly—remain hydrated.

Question 5

When counseling a patient about potential migraine triggers, it's important to emphasize that:

Answer: Triggers can be personal and vary greatly from person to person.

Unfortunately for those living with migraine, triggers are highly individual: what bothers one person may not bother another, and what best treats a migraine can also vary from person to person. In order to provide the best care, crucial for pharmacists and other health care providers to understand the highly individualized nature of the disease.⁵

References

1. Sleep, insomnia, and migraine. American Migraine Foundation. October 25, 2023. Accessed June 21, 2024. https://americanmigrainefoundation.org/resource-library/sleep-insomnia-migraine/

2. Pasque LS. Estrogen fluctuations and migraines: The menstrual connection. Mayo Clinic Press. November 16, 2023. Accessed June 21, 2024. https://mcpress.mayoclinic.org/healthy-brain/estrogen-fluctuations-and-migraines-the-menstrual-connection/

3. Diet and headache control. American Migraine Foundation. August 13, 2016. Accessed June 21, 2024. https://americanmigrainefoundation.org/resource-library/diet/

4. How to make the most of summer with migraine. American Migraine Foundation. July 21, 2022. Accessed June 21, 2024. https://americanmigrainefoundation.org/resource-library/how-to-make-the-most-of-summer-with-migraine/

5. Migraine triggers. American Headache Society. August 10, 2018. Accessed June 21, 2024. https://americanheadachesociety.org/news/migraine-triggers/