Provoking migraine with natural triggers: An important topic for researchers and clinicians
Paul RMartin, Professor, Griffith Universitypaul.martin@griffith.edu.au
Paul R Martin, Brisbane, Queensland, Austrlia
Submitted May 07, 2013
It is interesting to see Hougaard and colleagues use a novel provocation technique to investigate migraine triggers [1] because this is a neglected area of scientific inquiry. However, their suggestion that provocation studies of 'natural' triggers have not been carried out previously is misleading. These studies have validated that stress, 'visual disturbance', noise, and hunger are natural triggers. [2] One provocation study manipulated flicker, glare, and eyestrain and found—contrary to Hougaard et al’s contention—that it did induce headaches. [3] Hougaard et al. concluded that it is not enough for patients to identify triggers--- they should challenge themselves with the trigger to confirm its authenticity. I suggested this many years ago and encouraged patients to engage in 'behavioral experiments' to clarify the genuine triggers. [4] The authors suggested that if provocation reveals that the trigger is not a trigger then patients should be advised that they do not need to avoid it. Although this seems sensible, we have argued that 'Learning to Cope with Triggers' (LCT) is a superior approach to advising avoidance of all triggers. [5] LCT involves avoiding triggers that are detrimental to health but use graduated exposure with other triggers to desensitize and increase tolerance.
1. Hougaard A, Amin F, Hauge AW, Ashina M, Olesen J. Provocation of
migraine with aura using natural trigger factors. Neurology 2013;80:428-
431.
2. Martin PR, MacLeod C. Behavioral management of headache triggers:
Avoidance of triggers is an inadequate strategy. Clin Psych Rev
2009:29:483-495.
3. Martin PR, Teoh H-J. Effects of visual stimuli and a stressor on head
pain. Headache 1999;39:705-715.
4. Martin PR. Psychological management of chronic headaches 1993. New
York: Guilford Press.
5. Martin PR. Managing headache triggers: Think 'coping' not 'avoidance'.
Cephalalgia 2010;30:634-637.
For disclosures, please contact the editorial office at journal@neurology.org.
It is interesting to see Hougaard and colleagues use a novel provocation technique to investigate migraine triggers [1] because this is a neglected area of scientific inquiry. However, their suggestion that provocation studies of 'natural' triggers have not been carried out previously is misleading. These studies have validated that stress, 'visual disturbance', noise, and hunger are natural triggers. [2] One provocation study manipulated flicker, glare, and eyestrain and found—contrary to Hougaard et al’s contention—that it did induce headaches. [3] Hougaard et al. concluded that it is not enough for patients to identify triggers--- they should challenge themselves with the trigger to confirm its authenticity. I suggested this many years ago and encouraged patients to engage in 'behavioral experiments' to clarify the genuine triggers. [4] The authors suggested that if provocation reveals that the trigger is not a trigger then patients should be advised that they do not need to avoid it. Although this seems sensible, we have argued that 'Learning to Cope with Triggers' (LCT) is a superior approach to advising avoidance of all triggers. [5] LCT involves avoiding triggers that are detrimental to health but use graduated exposure with other triggers to desensitize and increase tolerance.
1. Hougaard A, Amin F, Hauge AW, Ashina M, Olesen J. Provocation of migraine with aura using natural trigger factors. Neurology 2013;80:428- 431.
2. Martin PR, MacLeod C. Behavioral management of headache triggers: Avoidance of triggers is an inadequate strategy. Clin Psych Rev 2009:29:483-495.
3. Martin PR, Teoh H-J. Effects of visual stimuli and a stressor on head pain. Headache 1999;39:705-715.
4. Martin PR. Psychological management of chronic headaches 1993. New York: Guilford Press.
5. Martin PR. Managing headache triggers: Think 'coping' not 'avoidance'. Cephalalgia 2010;30:634-637.
For disclosures, please contact the editorial office at journal@neurology.org.