Emotional
Chronic high-level stress
Abrupt change in the stress level
Anxiety
Depression
Sex hormones
Puberty
Menstruation/ovulation
Oral contraceptives and hormone replacement therapy
Pregnancy
Perimenopausal period
Environmental
Bright lights, sun glare
Loud sounds
Smoking
Scents such as perfume or paint thinner
Exposure to heat or cold (hot weather, hot baths)
Traveling
Jet lag
Atmospheric weather
Change of weather conditions (low barometric pressure, warm winds, high temperature, precipitation, lightning)
High altitudes (hiking, skiing)
Food
Citrus fruits
Fermented foods and beverages
Chocolate, nuts
Aged cheese, dairy products
Foods containing nitrates (bacon, hot dogs, salami, cured meats)
Foods containing monosodium glutamate, aspartame
Processed, marinated, or pickled foods
Beverages
Alcoholic beverages (i.e., beer, red wine)
High caffeine consumption (coffee, tea, energy drinks)
Limited water consumption
Drugs
Abuse of over-the-counter pain medication
Overuse of painkillers containing caffeine, butalbital, codeine
Nitroglycerin, nifedipine
Hormone replacement therapy, OCP
Daily living habits
Changes in wake-sleep pattern, not enough or too much sleep, frequent wake-ups
Skipping meals, insufficient meal, fasting
Abnormal head and neck position while working (computer, screen viewing, etc)
Others
Colds, flu, or a sinus infection
Intense physical exertion, sexual activity
Head injury
This patient’s attacks are also triggered by stress, skipping meals, excessive sleep, daytime sleep, and loss of sleep. Such triggers may provoke both migraine and tension-type headache. Mood changes may trigger both migraine and tension-type headache. However, while stress is the most frequent trigger for both migraine and tension-type headache, joyfulness may only trigger migraine, as in this patient. Although skipping meals and sleep disturbances may commonly trigger migraine attacks, occasionally they may also trigger tension-type headaches.
Changes in the weather and warm winds have long been known to affect individuals with migraine, and are correlated with the emergence of headache. Major atmospheric weather variables such as atmospheric pressure, temperature, humidity, and wind or thunderstorm activity are all implicated as potential triggers for headache. It is noteworthy that weather change is usually accompanied by alteration of more than one atmospheric variable. For instance, low atmospheric pressure stimulates movement of air from surrounding areas, and is generally associated with winds, increased temperature, and humidity, facilitating the development of clouds, precipitation, and thunderstorms. Dust-laden weather originating in the African desert has been implicated as a possible trigger by providing molecules and nanoparticles to induce migraine headaches. Outbreaks of Saharan dust are seasonal and very frequent in transitional seasons, and are associated with warm winds and low pressure. Lightning and associated meteorological changes were recently associated with a 28 % increase in the frequency of migraine headaches. Other environmental factors such as high altitude, loud noises, and exposure to glare or flickering lights are also documented as triggers. Atmospheric changes such as windy weather, barometric changes, and bright sunlight are much more frequently reported by migraineurs than by patients with tension-type headaches. Odors such as perfumes, smoke, and strong smells trigger migraine specifically, and are nearly never reported by patients with pure tension-type headache.
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