Attack-Based Care: Triggers

Written by Lizzie Propati and Shoshana Lipson | March 29, 2022

Migraine triggers are that all elusive aspect of life with migraine. They’re something we have all heard of, and something we tend to talk a lot about. However, did you know that some triggers can result in more treatment resistant, faster escalating, or more debilitating attacks, while others seem to result in less severe attacks? So, how can we approach treating a migraine attack based on what triggered it? Knowing your triggers can help you come up with an attack-based plan where you can quickly decide how to treat. For example, you will have a better idea of whether to start with an FDA-cleared medical device, rest and OTC medication, or jump straight into your full-strength rescue medication, a dark room, and the need to cancel all appointments or work.

Let’s look at three different situations here: when triggers result in treatment resistant attacks, when they result in more severe or faster escalating attacks, and what might happen when triggers stack!

Triggers of Treatment-Resistant Attacks

Many patients find that some triggers result in longer lasting and/or more treatment resistant attacks. A great example of this for some would be hormonally triggered migraine—whether menstrual or for women going through peri-menopause. Many headache specialists even prescribe specific abortive medications as a form of preventive to try and head menstrual migraine attacks off at the pass, because they are known to often last longer.

However, there may be other triggers for you that impact your migraine the same way. It could be barometric pressure, humidity, or any other trigger that happens to be problematic in your specific situation. Knowing if any of your migraine triggers result in this type of attack could modify the way you and your doctor determine treatment. This could range from proactively using specific abortive medications for attacks you know will be coming, to using a different combination of treatments, or just being more aggressive in making sure that you get rest during those times!

Triggers of More Severe/Faster Escalating Attacks

One of the reasons it is important to know your own body is because different triggers can result in different levels of pain and other symptoms, or even faster escalating attacks. This can result in a multitude of possibilities for your attack-based plan.

The N1-headache app is unique in that it not only helps patients understand what their triggers may be, but also where those triggers lie on an “impact scale” – e.g. which of your triggers are high impact, medium impact, or low impact. A high impact trigger might result in an attack within minutes without any other triggers needing to be present. It might also cause that attack to escalate faster, and/or result in more severe symptoms such as vomiting instead of nausea. On the other end of the scale, low-impact triggers may take longer to have effect, may need more than one trigger present to result in an attack, or could result in a less severe migraine overall.

What Happens When Triggers Stack

If you have been disabled by triggers stacking on top of each other, then you know how that can impact your migraine attacks and how quickly pain and other symptoms can build up. Sometimes even causing a total disruption to your life where everything has to come to a complete halt.

So what can we do? Aside from knowing your body, your triggers and your pain tolerance, the key question here is how to treat those “perfect storms” where multiple triggers coincide at once. Do you have a way to keep the pain from going from a green light (where you can function) to a red light (totally down and out)? You can read more about the “Stop Light Theory” here!

For example, if you have a hormonal migraine at the same time as being exposed to triggers such as scents, bright lights, and weather changes, would you expect that attack to be any different than an attack where you were only exposed to one of your more minor triggers? It’s important to know whether attacks caused by “stacked triggers” are harder for you to treat, escalate faster, or have worse symptoms. And if so, how might you treat them differently? Having a plan together for situations like this is crucial.

In conclusion, knowledge is power! It’s important to keep track of your migraine attacks as well as anything that might be a trigger. As time goes on you will start to have a better understanding of what your triggers are and how each one, or combination of them, might impact you. Yes, this takes time and patience, but it will be well worth it because the result will help you deal better with your pain levels and bring your symptoms down to a more tolerable and functional level more quickly. It is key to take that knowledge about your own situation, speak with your doctor, and come up with a plan in advance, so that your attack-based care is ready to go and you can make decisions quickly and easily!

Let us know what your experience is like. Do you find that different triggers result in different types of migraine attacks? What happens to your migraine attacks when triggers stack? We would love to hear from you so that we can work together to help lessen the burden and pain of migraine.

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