Too quick to pull the migraine trigger?

If you suffer from migraines, you may think chocolate or bright lights trigger your headaches. So you avoid these triggers at all costs. But that cause-and-effect relationship may not be as strong as you think.

In fact, Dutch scientists recently took a close look at two classic migraine triggers: exercise and bright light. The scientists wanted to know if exposure to classic triggers always results in migraine attacks. And are migraine “triggers” as strong as patients believe?

For the study, a team of researchers led by Anders Hougaard, M.D. recruited 27 migraine sufferers. Each of the patients said that bright or flickering lights or strenuous activity triggered their migraines. So, the researchers tried to provoke migraines in the patients using these reported triggers.

They exposed the patients to bright lights, strenuous activity, or a combination of both triggers. Only three patients (11 percent) actually had migraine attacks with aura following these provocative tests. Three other patients reported migraines but without aura. The researchers discovered that exercise proved a stronger trigger than light exposure.

Dr. Hougaard suggested that these results could benefit migraine patients. “Migraine patients are usually advised to identify triggers and try and avoid them,” he told Medscape Medical News. “But our research suggests that this may be limiting people’s lives and causing unnecessary stress in trying to avoid a wide range of factors which may turn out not to be triggers after all.”

In fact, Dr. Hougaard warns migraine patients to carefully evaluate whether or not something is an actual trigger. He said, “Patients need to try to identify triggers but they need to establish that they are true triggers before cutting them out of their lives. So I would advise that they allow several exposures before defining a trigger.”

So if you suffer from migraines, be very careful before you blindly cut out all “classic” triggers. Especially since many purported triggers–such as sunlight, exercise, wine, coffee, chocolate, and cheese–are actually good for you in moderation!

Plus, many other factors affect your threshold for a migraine attack. In fact, your fatigue, your hormone levels, and even the time of day can make you more vulnerable to an attack. For instance, how tired were you when you drank that glass of wine? Or were certain hormones high when you went for that three-mile run in the bright morning light?

In addition…

You may confuse migraine “triggers” with cravings or certain behaviors. We know that feelings of tiredness, excitement, and depression, or food cravings often precede migraines. So, you may think eating chocolate triggers the migraine. But it’s really a warning signal. Doctors call it a “premonitory symptom.” 

For example, you may crave chocolate one afternoon, so you eat a small piece of a candy bar. By dinnertime, you have a migraine. You kick yourself and think the chocolate triggered the migraine. But chocolate wasn’t really the trigger. The craving was actually part of the onset of the migraine itself.

My former colleague, Stephen D. Silberstein, M.D., is a Professor of Neurology and Director of the headache center at Thomas Jefferson University. He agrees that avoiding triggers may be flawed advice. He says, “If migraine is a disorder of habituation of the brain to ordinary sensory signals, should one try to train the brain to habituate rather than avoid the trigger?”

That may explain why biofeedback helps so many migraine sufferers. With biofeedback, you learn to control your body’s functions. You watch or listen to a monitor. And you learn by trial and error to control your heart rate, temperature, even your brain wave patterns. With biofeedback, can you even train your brain to handle exposure to so-called triggers, as my colleague suggests?

If you suffer from migraines, I recommend investigating biofeedback along with other “mind-body” therapies. You should choose these therapies based on your emotional “type.”  I explain all about this in my book Your Emotional Type. 

Also, the American Academy of Neurology now recognizes butterbur as an effective non-drug migraine treatment. Feverfew is another good option. As I described in another Daily Dispatch, both herbs have long histories as alternative treatments for migraine headaches.


1. Neurology. 2013;80:428-431, 424-425