many of the patients in the study as possible to understand the details of each individual ’ s condition . Fortunately , we were able to interview several dozen patients in the study .
The following is what we learned .
Car Travel In six patients , car travel was protective for their attacks and in seven it served as a trigger . We interviewed several of the patients in whom car travel was a protector and all of these patients indicated that during car travel they were able to enjoy some solitude . In some cases , the car ride offered an opportunity to listen to their favorite music . Conversely , in those in whom car travel was a trigger , they seemed more aware of the traffic or the journey towards a stressful job . In other words , it didn ’ t seem to be the car , but the person ’ s state of mind in the car that was the determining factor .
Wine and Alcohol Wine and alcohol were less common triggers than expected and much more commonly found as a protector . In several interviews , patients explained that when they drank alcohol it was usually a relaxing occasion – a glass of wine with their spouse or significant other , or a beer with friends . In a contrasting example , in which sparkling wine was a trigger , the patient recognized that she drank sparkling wine at formal occasions such as weddings where the crowds of guests became stressful . Similar to car travel , it was not the factor itself but the occasion associated with the factor that seemed critical .
Tyramine
Fully 18 % of the patients in the Curelator Headache / NHF study associated tyramine with their migraine attacks . More unexpected is the finding that in roughly half of these patients , tyramine served as a protector rather than a trigger . Curiously , the appearance of tyramine as both trigger and protector in different individuals may indicate its potential to function in both capacities , depending on the patient .
Stress The population trigger map reveals that many patients relate an association with stress and their attacks – in our study , 42 %. What stands out , however , is that a small percentage of participants – only about 10 % – described stress as a protector . How could stress lower the risk of a
migraine attack ?
We interviewed one of these patients , who also was puzzled that stress was identified as a protector on his map . The first question we asked this patient was , “ What did you do when you experienced stress ?” The patient advised that he practiced a series of stress management techniques that included deep breathing , meditation , and sitting quietly until he calmed himself . Did this routine reverse the risk of a migraine attack ? It seems the answer is , “ Yes , very effectively .”
Anger Another participant indicated anger and anxiety as protectors . Upon reflection , he thought it was quite possible that he had developed a series of coping mechanisms that were so effective that they protected him from attacks . “ Anger ” on the Population Map demonstrated that four patients reported it as a protector while an additional 20 individuals have “ anger ” as a trigger . It is only through analysis of the individual patient that practical treatments were discovered by the patients themselves .
Earlier we raised the question of whether it might be possible to transform a trigger into a protector . The profiles of more than a few of these interviewees suggest that this had been accomplished . Dr . Paul R . Martin OAM , Professor of Clinical Psychology at Griffith and Monash University in Australia – a leading migraine researcher – shared the following observation with us :
“ Note that at least with some triggers , deviations in either direction have been suggested to cause headaches . For example , headaches allegedly can be precipitated by too little sleep but also too much sleep , and by stress but also relaxation . Perhaps one of the reasons that eating certain foods has been controversial as a headache trigger is because it is complicated to pin down - whether it is a good or bad thing to eat certain foods depends on circumstances . Eating a certain ‘ dose ’ of chocolate is beneficial when blood sugar levels are low , but not when they are high . Certainly , as a clinician , I go down this pathway .”
A different kind of diary approach for managing migraine headaches There is universal consensus that using electronic diaries is the first step in understanding the episodic nature of migraine and how to improve it . However , simple
24 HeadWise ® | Volume 5 , Issue 1 • 2015