Are Triggers the Reason I have my Headaches or Migraines?

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March 14, 2022
May 6, 2021
3
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Are Triggers the Reason I have my Headaches or Migraines?

Trigger avoidance is an important part of anyone’s headache treatment, and for this reason it is essential to better understand your individual triggers.  This can be done by tracking your headaches carefully (which you can do seamlessly with the Neura Health app).  But before trying to figure out your individual triggers, it is important to take a step back and think about the relationship between migraines and triggers in general. 

If I avoid all triggers won’t I completely avoid my migraines?

If you experience migraine, it’s because you have a genetic predisposition for a neurological complex phenomenon to occur. You personally experience migraine more or less frequently based on a number of important factors.  There is a threshold your brain has that has a “point of no return” - this is when your migraine attacks start.  Triggers will elevate or lower that threshold, and eventually lead to that threshold getting crossed and a migraine occurring. 

Aren’t triggers just like allergies? 

Allergies are controlled by the immune system, where certain immune cells think of the allergen as a foreign invader and set off a cascade of reactions.  Migraine triggers can’t be tested in the same way allergens can, because your body isn't producing antibodies or other immune factors in response the same way.  The kinds of things that trigger migraine many times aren’t even in your control the same way most allergens are.  You might be able to avoid peanuts or pet dander if you are allergic to those things, but there really is no way to avoid stress, for example, which is one of the most common migraine triggers. 

How effective is trigger avoidance alone?

Trigger avoidance can be extremely helpful in decreasing migraine frequency, but important studies have shown that they do not “cure” migraine.  One large trial looked at the most common “migraine diets”, and another study exposed people with migraine to their most consistent triggers.  The migraine diets did not significantly impact the overall migraine frequency, and exposure to triggers in a vacuum did not cause a single migraine attack.  The reason why is actually simple: no ONE diet or avoidance plan works for everyone, and while triggers lower the threshold for migraine, that threshold must be low enough for migraine to begin with.  

What is the best approach to dealing with migraine triggers?

Because triggers are very individualized to the person and part of a broader context of many other factors, the approach to triggers has to be individualized - you need to understand how some triggers affect you more broadly.  Not everyone has the same triggers, so you don't want to waste time on a one-size-fits-all diet or an approach that makes you avoid things that are not your triggers. 

More importantly, you have to understand the way many of your triggers lower your migraine threshold.  That is the goal of Neura Health - to give you an individualized perspective on what affects you, and how.  The Neura app lets you to easily track your headaches so you can view trends over time, discover your triggers and useful forms of relief.  Your doctor will review your tracker data ahead of your upcoming appointment, so you can spend the video visit discussing your future treatment plan rather than trying to recount your recent attacks.

With this information about your triggers in hand, you will have a better shot, not at completely avoiding attacks but at lowering the frequency, and keeping that migraine threshold high.  

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Thomas Berk, MD
Thomas Berk is Medical Director at Neura Health and a Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine
About the Author
Dr. Thomas Berk is Medical Director of Neura Health and a neurologist and headache specialist based in New York City. He has over 12 years of clinical experience, having graduated from the NYU Grossman School of Medicine in 2010. He completed his neurology residency at NYU as well and is a board-certified headache specialist, having completed a headache fellowship at the Jefferson Headache Center. He is an emerging leader of the American Headache Society and has been on the Super Doctors list of rising stars for the past five years.

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