Similar Triggers Reported for Migraine Subtypes - HM trigger same as common and classic M

By: DAMIAN MCNAMARA, Internal Medicine News Digital Network

BERLIN – The factors that patients report to be triggers of familial hemiplegic migraine appear to coincide in many instances with the same triggers reported by migraine patients with and without aura, according to findings from a questionnaire-based study.

Mailed questionnaires completed by 75 patients with familial hemiplegic migraine (FHM) indicated that 63% experience between 1 and 12 triggers, whereas the remaining 37% said no environmental triggers precede their attacks, Dr. Jakob Hansen said at the International Headache Congress, which was sponsored by the International Headache Society and the American Headache Society.

At least half of the respondents reported that most commonly acute stress (following a stressful event) triggered FHM, followed in frequency by sunlight and other bright lights; acute stress (during a stressful episode); intense emotional influences; and sleep disturbances (too little or too much sleep).

"If you can identify and avoid these trigger factors, that actually might be helpful in your clinical practice, so talk to your patients about this," said Dr. Hansen, a research fellow at the Danish Headache Center at the University of Copenhagen.

The pattern of trigger factors for FHM and those previously reported for migraine with aura and migraine without aura "seem to match pretty well," he said. For example, acute stress (following a stressful event) topped the list for both FHM and migraine without aura patients.

"Now we have some data that [FHM] does not seem to be so different from the more common types of migraine," Dr. Hansen said. He added that although neurologists consider FHM a distinct headache type, the alignment of triggers suggests some shared etiology or physiology.

The researchers asked the patients to rate 16 possible environmental factors that trigger headaches on the questionnaire using a scale of 0 (never) to 4 (always).

Although patients report some of these same triggers in face-to-face consultations with physicians, "what our patients tell us triggers their headaches [can differ]," Dr. Hansen said. Patients often said these factors include hormones; foods such as cheese, red wine, or chocolate; weather changes; and medication. "Some will say, ‘I get this from my mother,’ which in part could be true, especially if they suffer from familial hemiplegic migraine."

Among the patients who selected at least one trigger for FHM on the questionnaire, 36% reported at least one trigger factor that often or always (questionnaire response of 3 or 4, respectively) precipitated a FHM attack, he said.

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