Dr. Christine Lay
Neurologist & Founder, The Headache Program at the University of Toronto
For those living with migraine, understanding triggers can be an important step in successful management of their attacks, particularly during busy times of the year.
Most Canadains are familiar with the pain typical of a headache. Often, a screen break or fresh air will relieve even the most persistent symptoms. For 4.5 million Canadians living with migraine, however, the debilitating headaches are on ongoing struggle, impacting their ability to complete even the simplest tasks.
“Much more than a headache, migraine is a complex neurobiological disease with general influence, that involves many parts of the central nervous system network,” explains Dr. Christine Lay, neurologist, and founder of The Headache Program at the University of Toronto. The WHO classifies migraine as one of the most disabling health events a person can experience.
For people living with migraine, understanding and recognizing early warning signs and or potential triggers is important to help better manage an attack, but individual variation between attacks or between people, means trying to control triggers is an impossible task for many.
The Science Behind Migraine
“One of the clinical components of migraine attack is a disabling headache, often along with light and sound sensitivity as well as nausea and sometimes ‘brain fog’,” says Dr. Lay. “Because migraine is so potentially disabling, it is important to treat migraine attacks early and effectively, to prevent ongoing disability or next-day recurrence.”
Being aware of potential migraine triggers and identifying the very first sign that an attack is underway – the prodrome – is one-way to improve well-being and reduce disability.
“Cause and triggers are two different things,” says Valerie Lawler, a nurse practitioner who works closely with Dr. Lay. “Triggers are not the cause of migraine, but they might make a person more vulnerable to a migraine attack.”
A trigger, such as a bright light may not be a ‘trigger’ for a migraine attack but rather the sensitivity to light could mean an attack is underway.
There is no one-size-fits-all approach when it comes to addressing a true migraine trigger. What works for one person may not work for another. It’s therefore important to monitor each migraine experience, identify commonalities, and make small changes that may eventually lead to big rewards.
The change of seasons is a common time to experience more migraine attacks. With winter approaching, now is an ideal time for Canadians to pay extra attention to migraine management.
External environmental or weather-related migraine triggers can include anything from temperature changes, increasing or decreasing sunlight, changes in barometric pressure, through to extreme heat/cold, humidity and altitude – many of which arrive alongside winter’s hallmark snowstorms.
“Weather is a common trigger for a migraine attack. The migraine brain is hypersensitive and thus people with migraine may be more aware of subtle changes in barometric pressure, sun glare or temperature,” says Dr. Lay. “While frustrating, this heightened awareness can benefit patients, allowing them time to better prepare for a potential migraine attack and treat early.”
International triggers can be just as difficult to control. Hormone changes, especially those associated with puberty, a menstrual period, pregnancy and menopause can increase vulnerability to a migraine attack. Sleep also has a complex relationship to migraine and, as Valerie notes, “not enough sleep can trigger a migraine, oversleeping can trigger a migraine, yet sleep can also alleviate symptoms of an attack.”
The holidays can lead to increased stress, longer work hours with more screen time, less sleep/late nights and consuming foods or beverages with additives or preservatives that you are not used to. Being mindful to keep a routine, avoid colours/additives as best you can, limiting alcohol, avoiding too much caffeine, and staying well hydrated can help. Practicing mindfulness or breathing techniques can help manage stress.
Migraine: A Balancing Act
Marta Mrozek experienced her first migraine attack at just five years old and has lived with chronic migraine since the age of 30. Now in her 40s, Marta has better identified her personal triggers, which has been critical to helping her manage her disease. “For people living with migraine, it’s a constant balancing act. It’s not that you need to be oversensitive or think about your condition at all times, but you have to be mindful.”
While it may feel daunting, understanding more about migraine and your prodrome and identifying individual triggers is important to better manage migraine. Support organizations like Migraine Canada offer effective resources aimed at helping Canadians and their providers better manage migraine.
Keeping a migraine calendar can also help you and your provider identify potential patterns or triggers such as a hormonal change or shift work for example. Dr Lay and Valerie recommend recording your days like a traffic light – GREEN for an I can GO day, YELLOW for an I have to SLOW down day and RED for an I have to STOP day, depending on your migraine-associated disability.
Educating yourself, your loved ones and coworkers about migraine and the debilitating nature of this common brain disease can help you feel supported and take charge to help reduce your migraine-associated disability.
To learn more about migraine treatment and to better understand triggers and migraine management visit https://migrainecanada.org/
This article was made possible with support from Pfizer Canada.