Migren Tetikleyici Sayısının Migren Karakteristikleri Üzerine Etkileri

Year 2022, Volume: 75 Issue: 4, 556 - 561, 20.01.2023

Hatice Yüksel , Safiye Gül Kenar , Görkem Tutal Gürsoy , Hesna Bektaş

Abstract

Amaç: Migren, genellikle epizodik ve zonklayıcı baş ağrısı ile seyreden kronik bir nörovasküler hastalıktır. Migren ataklarının başlaması birçok içsel
ve dışsal tetikleyicinin varlığı ile ilişkilendirilmiştir. Çalışmamızın amacı ilk olarak en sık bildirilen on tetikleyicinin migren karakteristikleri üzerindeki
etkisini ve ikinci olarak da çok sayıda tetikleyiciye sahip olmanın migren karakteristiklerini değiştirip değiştirmediğini araştırmaktır.

Gereç ve Yöntem: Çalışmaya 315 (%89,5) kadın ve 37 (%10,5) erkek olmak üzere toplam 352 migren hastası dahil edildi. Hastaların migren
karakteristikleri sorgulandı. Hastalar migren ataklarını başlatan tetikçi sayısına bağlı olarak dört ve daha az tetikleyici olanlar (Grup 1), beş veya altı
tetikleyiciye sahip olanlar (Grup 2) ve altıdan fazla tetikleyiciye sahip olanlar (Grup 3) olmak üzere üç gruba ayrıldı.

Bulgular: Grup 3’te migren sıklığı Grup 2 ve Grup 1’den anlamlı olarak yüksekti (p=0,002 ve p=0,001). Atak süresi açısından gruplar arasında anlamlı
farklılık yoktu (p=0,219). Grup 3’te baş ağrısı şiddeti Grup 2 ve Grup 1’den anlamlı olarak yüksekti (p=0,001 ve p=0,001). Grup 3’te çift taraflı baş
ağrısı sıklığı Grup 2 ve Grup 1’den anlamlı derecede yüksekti (p=0,038 ve p=0,018). Stres, yiyecekler, parlak ışık, soğuk, sıcak ve koku tetikleyicileri
tek başlarına tetikleyici olarak baş ağrısı şiddetinde artmaya neden olur iken (p=0,023, p=0,029, p=0,010, p=0,002, p=0,022 ve p=0,001), yüksek sese
maruziyet ise migren sıklığında anlamlı artışa neden oldu (p=0,001).

Sonuç: Biz çalışmamızda migren tetikleyici sayısının artmasının migren sıklığında ve baş ağrısı şiddetinde artmaya neden olduğunu gösterdik.
Çoklu tetikleyici varlığında migrenin etkin tedavisinde sağlığa zararlı tetikleyiciler için kaçınma yöntemi ve diğer tetikleyiciler için ise tetikleyici ile
mücadele etmenin öğrenilmesi yöntemi beraber uygulanmalıdır.

Keywords

Migren , Baş Ağrısı , Tetikleyici

Ethical Statement

Bu retrospektif çalışma Ankara Şehir Hastanesi Yerel Etik Kurulu tarafından onaylandı (karar no: E1- 21-2044, tarih: 22.09.2021).

Supporting Institution

-

Project Number

-

Thanks

-

Effects of Migraine Trigger Number on Migraine Characteristics

Abstract

Objectives: Migraine is a chronic neurovascular disease that usually presents with episodic and throbbing headaches. The onset of migraine attacks
has been associated with the presence of internal and external triggers. The aim of our study was to investigate firstly the effect of the ten most
frequently reported triggers on migraine characteristics, and secondly, the effect of the presence of multiple triggers on the changes in migraine
characteristics.

Materials and Methods: A total of 352 migraine patients, including 315 (89.5%) female and 37 (10.5%) male, were included in the study. Migraine
characteristics of the patients were questioned. Depending on the number of triggers that triggered migraine attacks, the patients were divided into
three groups: those with four or fewer triggers (Group 1), those with five or six triggers (Group 2), and those with more than six triggers (Group 3).

Results: Migraine frequency in Group 3 was significantly higher than in Group 2 and Group 1 (p=0.002 and p=0.001). There was no significant
difference between the groups in terms of attack duration (p=0.219). Headache severity in Group 3 was significantly higher than in Group 2 and
Group 1 (p=0.001 and p=0.001). The frequency of bilateral headache in Group 3 was significantly higher than in Group 2 and Group 1 (p=0.038 and
p=0.018). Stress, food, bright light, cold, heat and odor triggers alone caused an increase in headache severity (p=0.023, p=0.029, p=0.010, p=0.002,
p=0.022 and p=0.001) while exposure to excessive sound caused a significant increase in migraine frequency (p=0.001).

Conclusion: We demonstrated that an increase in the number of migraine triggers caused an increase in migraine frequency and headache severity.
In the effective treatment of migraine in the presence of multiple triggers, avoidance for triggers that are harmful to a healthy life and learning to
cope with triggers for other triggers should be applied together.

Keywords

Migraine , Headache , Trigger

Ethical Statement

-

Supporting Institution

-

Project Number

-

Thanks

-

References

• 1. Goadsby PJ, Holland PR, Martins-Oliveira M, et al. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiol Rev. 2017;97:553-622.
• 2. Noseda R, Burstein R. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain. Pain. 2013 Dec;154 Suppl 1:S44-S553.
• 3. Dodick DW. A Phase-by-Phase Review of Migraine Pathophysiology. Headache. 2018;58 Suppl 1:4-16.
• 4. Goadsby PJ, Lipton RB, Ferrari MD. Migraine--current understanding and treatment. N Engl J Med. 2002;346:257-270.
• 5. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1211-1259.
• 6. Bohm PE, Stancampiano FF, Rozen TD. Migraine Headache: Updates and Future Developments. Mayo Clin Proc. 2018;93:1648-1653.
• 7. Kesserwani H. Migraine Triggers: An Overview of the Pharmacology, Biochemistry, Atmospherics, and Their Effects on Neural Networks. Cureus. 2021;13:e14243.
• 8. Marmura MJ. Triggers, Protectors, and Predictors in Episodic Migraine. Curr Pain Headache Rep. 2018;22:81.
• 9. Buse DC, McGinley JS, Lipton RB. Predicting the Future of Migraine Attack Prediction. Headache. 2020;60:2125-2128.
• 10. Spierings EL, Donoghue S, Mian A, Wöber C. Sufficiency and necessity in migraine: how do we figure out if triggers are absolute or partial and, if partial, additive or potentiating? Curr Pain Headache Rep. 2014;18:455.
• 11. Tekatas A, Mungen B. Migraine headache triggered specifically by sunlight: report of 16 cases. Eur Neurol. 2013;70:263-266.
• 12. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38:1-211.
• 13. Yalin OÖ, Uludüz D, Sungur MA, et al. Identification of Allodynic Migraine Patients with the Turkish Version of the Allodynia Symptom Checklist: Reliability and Consistency Study. Noro Psikiyatr Ars. 2017;54:260-266.
• 14. Lipton RB, Bigal ME, Ashina S, et al. Cutaneous allodynia in the migraine population. Ann Neurol. 2008;63:148-158.
• 15. Rains JC. Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders. Headache. 2018;58:1074-1091.
• 16. Tai MS, Yet SXE, Lim TC, et al. Geographical Differences in Trigger Factors of Tension-Type Headaches and Migraines. Curr Pain Headache Rep. 2019;23:12.
• 17. Turner DP, Lebowitz AD, Chtay I, Houle TT. Forecasting Migraine Attacks and the Utility of Identifying Triggers. Curr Pain Headache Rep. 2018;22:62.
• 18. Hindiyeh NA, Zhang N, Farrar M, et al. The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review. Headache. 2020;60:1300-1316.
• 19. Alstadhaug KB, Ofte HK, Müller KI, et al. Sudden Caffeine Withdrawal Triggers Migraine-A Randomized Controlled Trial. Front Neurol. 2020;11:1002.
• 20. Nowaczewska M, Wiciński M, Kaźmierczak W. The Ambiguous Role of Caffeine in Migraine Headache: From Trigger to Treatment. Nutrients. 2020;12:2259.
• 21. Mostofsky E, Mittleman MA, Buettner C, et al. Prospective Cohort Study of Caffeinated Beverage Intake as a Potential Trigger of Headaches among Migraineurs. Am J Med. 2019;132:984-991.
• 22. Gazerani P. A Bidirectional View of Migraine and Diet Relationship. Neuropsychiatr Dis Treat. 2021;17:435-451.
• 23. Van den Bergh V, Amery WK, Waelkens J. Trigger factors in migraine: a study conducted by the Belgian Migraine Society. Headache. 1987;27:191-196.
• 24. Fukui PT, Gonçalves TR, Strabelli CG, et al. Trigger factors in migraine patients. Arq Neuropsiquiatr. 2008;66:494-499.
• 25. Hoffmann J, Recober A. Migraine and triggers: post hoc ergo propter hoc? Curr Pain Headache Rep. 2013;17:370.
• 26. Caroli A, Klan T, Gaul C, et al. Types of Triggers in Migraine - Factor Structure of the Headache Triggers Sensitivity and Avoidance Questionnaire and Development of a New Short Form (HTSAQ-SF). Headache. 2020;60:1920-1929.
• 27. Martin PR, Reece J, Callan M, et al. Behavioral management of the triggers of recurrent headache: a randomized controlled trial. Behav Res Ther. 201;61:1-411.
• 28. Martin PR, Callan M, Kaur A, et al. Behavioural Management of Headache Triggers: Three Case Examples Illustrating a New Effective Approach (Learning to Cope with Triggers). Behav change. 2015;32:202-208.