Trigger factors in migraine patients


of 6
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
BACKGROUND: Migraine is a chronic neurological disease with several trigger factors, including dietary, hormonal and environmental factors. PURPOSE: To analyse precipitating factors in a sample of migraine patients. METHOD: Two hundred consecutive
  Arq Neuropsiquiatr 2008;66(3-A):494-499494 Trigger facTors in Migraine PaTienTs Patrícia Timy Fukui 1  , Tessa Rachel Tranquillini Gonçalves 1  , Cintia Giunchetti Strabelli 1  , Natalia Maria Fernandes Lucchino 1  , Fernanda Cunha Matos 1  , Juliana Pinto Moreira dos Santos 1  , Eliova Zukerman  2  , Vera Zukerman-Guendler   2  , Juliane Prieto Mercante  2,4  , Marcelo Rodrigues Masruha  2,3  , Domingos Sávio Vieira  2,3  , Mario Fernando Prieto Peres 1,2,3 Abstract – Background: Migraine is a hroni neuroogia disease with seera trigger fators, inuding dietary, hormona and enironmenta fators. Purpose: To anayse preipitating fators in a sampe of migraine patients. Method: Two hundred onseutie migraine patients were interiewed about possibe trigger fators for migraine attaks. Results: Most patients showed at east one dietary trigger, fasting was the most frequent one, foowed by aoho and hooate. Hormona fators appeared in 53% , being the pre-menstrua period the most frequent trigger. Physia atiities aused migraine in 13%, sexua atiities in 2.5% and 64% reported emotiona stress a trigger fator. 81% reated some seep probem as a trigger fator. Regarding enironmenta fators, smes were reported by 36.5%. Conclusion: Trigger fators are frequent in migraine patients, its aoidane may derease headahe frequeny and aso improe patients’ quaity of ife.KEY WORDS: migraine, trigger fators. fatores desencadeantes de enxaqueca Resumo – Introdução: A enxaquea é uma doença neuroógia rônia que apresenta diersos desenadeantes omo fatores aimentares, hormonais e ambientais. Objetivo: Anaisar os fatores desenadeantes em uma amostra de paientes om enxaquea. Método: Duzentos paientes om diagnóstio de enxaquea foram questionados sobre fatores que pudessem desenadear suas rises. Resultados: 83,5% apresentaram agum fator aimentar, jejum foi o fator mais freqüente, seguido de áoo e hooate. Dos fatores hormonais, o período pré-menstrua foi o mais freqüente. Atiidade físia ausou enxaqueas em 13%, atiidade sexua em 2,5%, estresse em 64% e 81% reataram o sono omo fator desenadeante. Em reação aos fatores ambientais, odores foram desenadeantes em 36,5%. Conclusão: Os fatores desenadeantes são freqüentes em enxaquea e a sua deteção dee ser pormenorizada para que se reduza a freqüênia de rises e mehore a quaidade de ida do paiente.PAlAvRAS-cHAvE: enxaquea, fatores desenadeantes. 1 liga de cefaéia da Faudade de Mediina do ABc, São Bernardo SP, Brazi; 2 Instituto Israeita de Ensino e Pesquisa Abert Einstein, São Pauo SP, Brazi; 3 Neuroiênias, Uniersidade Federa de São Pauo, São Pauo SP, Brazi; 4 AMBAN, Instituto de Psiquiatria da FMUSP, São Pauo SP, Brazi.Reeied 4 Otober 2007, reeied in na form 6 June 2008. Aepted 23 June 2008. Dr. Mário F. Prieto Peres – Rua Joaquim Eugênio de Lima 881 / 708 - 01403-001 São Paulo SP - Brasil. E-mail: Migraine is a hroni debiitating neuroogia ondi-tion with seera trigger fators. It usuay begins in hid-hood or adoesene and an remain with the patient for the whoe ife. It is more ommon in women than men, its preaene is 12% of the genera popuation, affeting 18% to 20% of women, ourring mainy during their produ-tie and reprodutie phases (20 to 50 years od). There-fore, migraine has a signiant soioeonomi impat and in patients quaity of ife 1 . Migraine is a ompex disor-der with seera pathopsysioogia mehanisms inoed, suh as hypothaami dysfuntion shown by a hronobi-oogi dysreguation, and a possibe hyperdopaminergi state 2 . A ariety of externa and interna fators hae been demonstrated to preipitate migraine attaks. Trigger fators are important in migraine management sine their aoidane may resut in a better ontro of the disorder. Seera studies are onsistent with stress, ak of seep, and fasting being the most ommon trig-ger fators 3,4 , but some other fators suh as inuding a-oho intake, exessie affeine onsumption, and hor-mona fators in women are aso reognized. In spite of its importane, itte is known about migraine trigger fa-tors in our soiety. The aim of this study was to make an anaysis of the pre-ipitating fators in a sampe of Braziian migraine patients. MeThod We studied 200 migraine patients diagnosed aording to  Arq Neuropsiquiatr 2008;66(3-A) 495 Migraine: trigger fatorsFukui et a. the Internationa cassiation of Headahe Disorders 5 . One hundred and sixty two women and thirty eight men were spe-iay asked about presene or absene of possibe trigger fa-tors for their migraine attaks. A pre-determined ist of trigger fators inuding: dietary (hooate, sausage, saami, monosodium gutamate, heese, mik, aspartame, aoho, red wine, white wine, offee, soft drink, itri fruits, ieream and nuts), fasting, hormona fa-tors (menstruation, pre menstrua period, after menstrua pe-riod, pregnany, menopause, ouation and hormona repae-ment), seep (oerseep, ak of seep, hanges in time of seep, weekend), stress (at work, at home and famiy, rying, onit, argument and aggressieness), exertiona atiities (physia, sex-ua, oughing, sneezing, to ift weight, eauation) and eniron-menta (aergy, poution, wind, rain, height, sun/arity, od weather, hot weather, hanges in the weather, igarette, air on-ditioning in the ar, home or work, odors of perfumes, food, fat, eanness produt and gasoine). The study was performed by media students at the liga de cefaeia of ABc Media Shoo under the superision of the senior author (MFPP) .It was approed by the Eti commit-ted in Researh of FMABc and registered under the number of 028/2007. resulTs Two hundred patients were anayzed, 162 women (81%) and 38 men (19%). The mean age of femae patients was 37.0 ± 11.14 and 40.7 ± 14.20 for mae, the tota aerage was 37.7. The most ommon group of trigger fators was di-etary triggers, in both women and men. In Tabe 1, it is de-sribed the main group of trigger fators and its distribu-tion aording to gender. Table 1. Trigger factors in migraine patients according to gender.  Femae%Mae%Tota%FatorsaarageFasting65.4355.2663.50Dietary64.8160.5364.004.70Hormona53.700.0043.500.95Seep75.9073.6075.502.30Atiities12.9026.3015.500.23Stress65.4063.1065.001.64Enironmenta74.0044.7068.503.18Minimum of 1 fator100100Minimum of 2 fators96.3092.10 Table 2. Number and percentage distribution of dietary trigger factors in migraine patients according to gender. Dietary fatorTotaFemaeMaen%n%n%chooate4120.503722.84410.53Sausage126.0095.5537.89Saami94.5074.3225.26Monosodium gutamate52.5053.0900cheese178.50159.2625.26Mik52.5053.0900Aspartame178.50148.6437.89Aoho6834.005332.721539.47Red wine*3919.503622.2237.89White wine2110.501811.1137.89Others4020.003119.13923.68coffee2914.502112.96821.05Soft drink31.5010.6225.26citri fruits84.0084.9400Ieream63.0042.4725.26Nuts31.5021.2312.63Minimun of 1 fator1286410564.812360.52Minimun of 2 fators7939.506540.121436.84Minimun of 3 fators4623.003726.84923.68Minimun 4 fators2814.002414.81410.53Minimun 4 fators168.00148.6425.265 Or more fators84.0063.7025.26 A the eements hae no signiant distribution with the exeption of red wine, that has the signiane of p < 0.05  Arq Neuropsiquiatr 2008;66(3-A)496 Migraine: trigger fatorsFukui et a. In Tabe 2, the dietary triggers are isted in detai. Fast-ing was the most frequent one, foowed by aoho, ho-oate, red wine and offee. Aoho intake in genera, ho-oate, red wine and offee were aso signiant. The resut of hi-square test showed that women had signianty more migraines trigger by red wine than men. In Tabe 3, stress is desribed. Work is the main ause of stress in pa-tients with migraine, being the rst for the women and men. Moreoer, other situations regarding daiy routine as famiy and home, suh as arguments between peope were aso seen as preipitating fators of migraine. Further-more, seep behaiour (oerseep or ak of seep) seems to hae an inuene in the migraine ourrene (Tabe 4).A the enironmenta fators are desribed in Tabe 5. The most frequent were sun/arity and igarette smok-ing. Regarding odors, pefume sme was the most frequent one, foowed by gasoine and onsidering air onditioning as a fator, the most important was ar air onditioning.Exertiona atiities were aso asked, being physia atiity the most frequent one.The minority (15.5%) pre-sented at east one exertiona trigger fator, 2.0% report-ed at east 2 fators and just 1.0% presented 3 or more fa-tors, being the aerage 0.23 fators. Athough ow in per-entages, exertiona triggers may be important due to its ominous srcin in seeted ases (Fig 1).One spei part of the study was dediated to hor-mona reated issues in women, menstruation, pregnany, menopause, ouation and hormona responses as a pre-ipitating fator in migraine. The eement pregnany was reported by one patient and menopause by none. Further-more, ouation and hormona repaement were ited by three patients eah. Therefore, the majority (54.32%) presented at east one hormona trigger fator, 19.14% re-ported at east 2 fators and just 0.62 % presented 3 or more fators (Fig 2).The e main trigger fators reported by the patients were fasting, foowed by stress and ak of seep (Fig 3). Then, other fators as sme and pre menstrua period were aso ited. discussion Trigger fators are ery important for migraine pa- Table 3. Number and percentage distribution of stress as trigger factors in migraine patients according to gender. StressTotaFemaeMaen%n%n%Stress at12361.5010061.72360.50 Work10351.5081.0050.002257.89 Home7236.0062.0038.271026.31 Famiy199.5016.009.8837.89crying94.507.004.3225.26conit52.503.001.8525.26Argument94.507.004.3225.26Aggressieness10.500.00012.63Minimun of 1 fator12864.00104.0064.102463.10Minimun of 2 fators7035.0058.0035.801231.503 or more fators199.5017.0010.5025.26 Table 4. Number and percentage distribution of sleep as trigger factors in migraine patients according to gender. SeepTotaFemaeMaen%n%n%Oerseep8844.007143.831744.74lak of seep12361.509961.112463.16changes in time of seep6532.505634.5795.55Weekends73.5074.3200.00Minimun of 1 fator15175.5012375.922873.68Minimun of 2 fators8643.007143.831539.47 3 or more fators4422.003722.84718.42  Arq Neuropsiquiatr 2008;66(3-A) 497 Migraine: trigger fatorsFukui et a. Table 5. Number and percentage distribution of environmental as trigger factors in migraine patients according to  gender. EnironmentaTotaFemaeMaen%n%n%Aergy115.50116.7900Poution147116.7937.89Wind52.5042.4712.63Rain31.5010.6225.26Height4242.4700Sun / carity28142314.20513.16cod weather189159.2637.89Hot weather199.50138.02615.79changes in the weather73.5053.0925.26cigarette smoking22111911.7337.89Air onditioning of52264326.54923.68 ar2311.502012.3437.89 home136.50116.7925.26 work168127.41410.53Sme7135.506338.90821.10 perfume60305332.72718.42 food157.50138.0225.26 fat63.0053.0912.63 eanness produt2110.501811.1137.89 gasoine2211.002012.3425.26Minimun of 1 fator11658.0010061.731642.10Minimun of 2 fators7638.006540.121128.95Minimun of 3 fators4422.003823.45615.79Minimun of 4 fators2512.502213.5837.89Minimun of 5 fators168.00148.6425.265 or more fators115.595.5625.26 Fig 1. Number and percentage distribution of exertional activities as trigger factors in migraine pa-tients according to gender.  Arq Neuropsiquiatr 2008;66(3-A)498 Migraine: trigger fatorsFukui et a. tients, we oud obsere that a patients had at east one trigger fator and around of 95. 5% had at east 2 trigger fators. Therefore, studying its distribution and harater-istis in a Braziian popuation euidates what iniians wi fae in daiy pratie. Athough reeant to migraine management trigger fators hae neer been studied in a arge sampe of Braziian migraineurs. This study is to our knowedge the rst of a kind to assess this issue in our popuation.Anayzing as a group, our study indiated the most fre-quent preipitating fators reported by patients were di-etary (84.5%), seep (75. 5%), enironmenta (68. 5%), stress (65%), hormona fators (43.5%) and exertiona atiities (15. 5%). Eah group researhed was subdiided into se-era eements and the most ited trigger fators was fast-ing (63. 5%), stress (61. 5%), and ak of seep (61. 5%). A-ording to Spierings et a. 4 , stress/ tension was the most frequent trigger fator (84%), foowed by fasting (82%) and seepessness (74%). In different studies 6-8 , stress was reported as the most signiant fator (72.4 % by Sharff    et a. 8 and 62% by Robbins 7 ). These resuts, in addition to the ndings in our study, suggest that psyhoogia man-agement, dietary orientation and seep hygiene reom-mendations shoud be important for migraine patients.Fasting was the most ited aspet oera, foowed by aoho intake, hooate and affeine onsumption, whih is in aordane to the iterature onsuted 4,6,7 . In-terestingy, wine was signianty more ommon as a trig-ger in women than men, showing that women are more sensitie to red wine than men. Many reasons may be re-ated to this nding, suh as different drinking habits in women ompared to men, genetiay and/or hormona mediated suseptibiity.Hormona and geneti fators may expain this nd-ing. Dietary triggers may be oerrepresented in this study beause it was the rst to be asked in the ist of triggers, when we anayze the fators isoated, not grouped, we an see stress and seep probems as emerging aspets, with simiar perentages, and magnitude. Hormona fators are ery important as triggers in women, mainy the pre menstrua period (26%) and the Fig 2. Number and percentage distribution of hormonal factors in migraine.Fig 3. Number and percentage distribution of the more frequents trigger factors in migraine patients according to gender.
Related Search
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks