Current pain and headache reports
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Curr Pain Headache Rep · Oct 2014
ReviewWhat turns on a migraine? A systematic review of migraine precipitating factors.
Migraine attacks rarely occur spontaneously in the absence of any possible precipitating factors. A systematic literature review of 25 publications revealed a consistent set of stimuli that have been identified as factors associated with the onset of a migraine attack. The weighted average of the "Top 10" trigger factors was determined. ⋯ Future efforts aimed at mitigating these precipitating factors have the potential to significantly improve migraine management. However, the current healthcare system is unlikely to be able to develop detailed personalized management plans. There is a need to develop a novel approach to the identification and management of multiple trigger factors in individual migraineurs.
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Curr Pain Headache Rep · Oct 2014
ReviewSufficiency and necessity in migraine: how do we figure out if triggers are absolute or partial and, if partial, additive or potentiating?
Migraine is, to a great extent, a genetically determined disorder and once it has manifested itself, it generally continues for years if not for decades. While the migraine is active, headaches can seemingly occur spontaneously but are often reportedly precipitated by events or factors, known as migraine triggers, the interplay of which is the topic of this paper. Among migraine triggers, the menstrual cycle is an important one that probably accounts for much of the excess of migraine in women compared with men. ⋯ Having identified trigger-headache associations, it needs to be determined which triggers are causative in the individual, either singly or in combination with others. This requires running an experiment with the individual that involves behavioral intervention to change exposure to a given trigger and determine whether that improves migraine. The ubiquitous adoption of the smart phone as a personal-data entry device, along with the possibility of bringing the results of sophisticated statistical analysis into the hands of patients and physicians, may well provide us with an important set of tools that will finally allow the unravelling of the age-old migraine-trigger puzzle.