Vincent Martin, MD, professor of medicine for the University of Cincinnati College of Medicine, director of the headache and facial pain program at the University of Cincinnati and president of the National Headache Foundation, talks about different triggers for Migraines.
Most people have heard of migraines headaches. What is it that someone is experiencing when they have a migraine?
Dr. Martin: Well, migraines are a first of all neurologic disorder. There is a genetic cause for them. And patients experience moderate to severe headaches and usually, the pain is on one side but occasionally it can be two-sided. And they get a variety of different symptoms such as nausea and vomiting and sometimes sensitivity to light and noise as well. And the headaches last a characteristic duration namely four to 72 hours.
How common are migraines?
Dr. Martin: Migraine is extremely common. It’s probably one of the most common conditions that we see in practice. It occurs in about 16 to 18 percent of women and about 5 percent of men. Overall, it’s about 12 percent of the entire population. So, it’s about 1 in 8 people overall.
You said it’s got a genetic causal component to it?
Dr. Martin: It has a genetic component and there’s probably an environmental component as well. There are some genes that probably make the nervous system a bit hyper-responsive to the environment. Hence that’s why a lot of patients with migraines have trigger factors as well. And there are also environmental factors so things like head traumas and probably hormonal changes and in some cases you know big emotional events can sometimes bring on migraines for the first time.
I want to talk about the word trigger. Again, it sounds simple to us but if someone has not heard that term what is a trigger for a migraine?
Dr. Martin: A trigger is any factor that upon exposure or withdrawal of that factor that can actually cause a migraine attack. Some examples of that include hormonal triggers in women particularly like right around the menstrual period. Weather changes are huge particularly here in Cincinnati and the Midwest. We can talk about those later if you like. In addition, stress is a big trigger. So not only when the stress comes on but also when the stress is gone it is called a letdown headache where patients are more likely to get headaches when stress goes away. And then there’s a variety of dietary triggers and as well as smells can trigger headaches.
I want to talk about the weather as a factor. What is it about the fall that can prompt some people to have migraines?
Dr. Martin: Well, they’re probably are a number of different things. There are some unique weather patterns that occur during the fall. So, we see a lot of low-pressure systems in the fall as we transition into winter. And it’s thought that those low-pressure systems where you get both falls in barometric pressure and low barometric pressures can actually trigger headaches in people who are susceptible to them. In addition, lightning seems to be really prominent in the fall and it seems like that can have an effect on some individuals. We actually did a study ourselves where we found that if there was a lightning strike within 25 miles of a person’s home residence that there was about a 26 percent excess risk of migraine attacks on those days as well. And then just sometimes the transitioning from a warmer climate to a colder climate, there’s something about that transition that tends to be very provocative. And then there are other environmental factors that are unique to the fall at least in the Midwest. For example, mold counts are very high at that time which might sensitize this hyperactive nervous system and then even things like ragweed can sometimes be contributors as well.
Can you have a perfect storm? Can you have a couple of things that cause a trigger that can bring on a massive migraine?
Dr. Martin: That’s a great question. So if you have a low-pressure system and it comes in with just a change in barometric pressure say at fall, if you have that along with precipitation, the combination of the three together are much more provocative than just a fall of barometric pressure, low and falling barometric pressure by itself. So there seems to be an additive effect of some of these things. It’s almost like a Build-A-Bear type of thing with the weather. And also, there probably are other environmental factors that occur because of the weather changes that might actually be headache provocative. Like weather can have a huge effect on air pollutants as well. And if that’s the trigger for you then that might trigger headaches in those instances.
You had mentioned going from warm to cold or cold to warm, that extreme. Could that impact someone going on vacation? You’re coming from the northeast, you’re going to somewhere in the South, Florida, that extreme weather change on a vacation, is that a trigger?
Dr. Martin: I mean it could. Particularly if it’s during the winter where you’re going, and you might be in Florida where it could be hot and then go to much colder. But if you’re talking about during the summer when Cincinnati is 90 degrees and Florida is 90 degrees, that’s really not much of a change, but most definitely. There are even some people that will develop headaches when they are out in the heat and they go from the heat into air conditioning. So that temperature change alone can sometimes trigger headaches in susceptible patients.
So, the important part for our viewers, what can you do? First of all, what can you do when you know that certain things are going to trigger these headaches? Obviously, you want to avoid triggers. But when you’re talking about the weather, you can’t really.
Dr. Martin: Well, they’re probably are certain preventatives that can be used. So, you can take a daily preventative. And if it works, then oftentimes it will dampen your sensitivity to certain weather triggers. So, there are certain ones that we commonly use. There’s one called Topiramate which is extremely potent in terms of its effect on preventing migraines, but it also has some side effects as baggage as well. But there are certain preventatives I would use in that situation.
Are there other things that people should think about if they’re susceptible?
Dr. Martin: If you knew for sure what very specific weather pattern that triggered you and you were able to predict it because the weather can actually be predicted for up to seven to 14 days in advance, you could theoretically take a medication called a triptan which is normally used. It’s like sumatriptan or Imitrex-like medication. Normally it’s used to treat an acute headache. But we use some of the ones that stay in the body a little bit longer shortly before a trigger and during the trigger. And it sometimes that can kind of ward it off. There are no studies of that in weather. There are studies of that in something called menstrual migraine which is where women get headaches around their menstrual periods where you can actually stave off these headaches. So, there could be some kind of tailored therapies that you could use to ward off some of these predictable headaches that occur with weather.
Is there anything I didn’t ask you that you think people should know?
Dr. Martin: Bright sunlight is another big trigger too. So, a lot of patients have what we call photic triggers. That means light triggers so real bright lights or lights that glare. So during the summer like if you had – if the sun will shine down like say on the rearview mirror of a car and you’re behind that car and it shines directly in your eye then boom you can develop a headache. So, some people seem to be very sensitive to glare and to bright lights. And that can occur with weather and then sometimes really cold temperatures. So, you can see cold temperatures during the fall too. There are some people that seem to be worse during cold temperatures and some that seem to be worse in warm temperatures. So there seems to be variations in what types of weather patterns a given person might actually be susceptible to.
In your mind what are the top three causes? What do most patients have the biggest problem with especially coming into the fall?
Dr. Martin: Well I’m biased but I think in my opinion the three biggest triggers are gonna be weather, hormones, and then stress.
Do they have a new class of migraine drugs? How has that been tolerated? Have your patients had a success rate with it?
Dr. Martin: Topiramate or Topamax is the other name for it. They’re called monoclonal antibodies. They’re basically shots that are given a onetime per month and they’re very, very effective for migraine. There are some people that are super responders. I would say probably 20 to 35 percent of people have a 75 percent or greater reduction in the frequency of their migraines with these shots. And they can also tame down triggers as well. So that would be another option for weather-induced triggers. Although my experience is that weather is such a potent trigger that oftentimes patients may still breakthrough with real potent weather patterns.
What’s the best way to get them to figure out what their triggers are? Is it seeing a professional? Do they keep a diary of what triggers headaches? How do you start to pinpoint it?
Dr. Martin: Well one thing you can do is you want to start keeping a diary. So even if it’s just something as simple as a calendar where you write either an H for a headache or an M for migraine down and then you can actually record some of the trigger factors on a daily basis like how stressed were you on that day or did you have a menstrual period? And the headaches with menstrual periods usually occur anywhere… Two days before to three days after menstruation so it may not be always the day of onset of the menstrual period. And you can even record some food triggers as well. And you just keep a diary of these things. And if more than about half the time or more than a headache is triggered by or is associated with a given trigger factor, then it probably is a trigger.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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