Trigger exposure in migraine patients results in migraine with aura only in a small subset of patients

Jan 25^th – Among patients with history of migraine with aura, migraines were triggered in a small subset of patients with exercise alone or exercise with photostimulation.

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Image: PD

1. Among patients with history of migraine with aura, migraines were triggered in a subset of patients with exercise alone or exercise with photostimulation.

2. No patients receiving photostimulation only (in the absence of exercise) had a provoked migraine.

Exercise provoked migraine with aura in 17% of total patients tested. Patients who were only provoked with photostimulation did not develop migraine attacks. This study implies that triggers for migraines are, in fact, less common that previously thought.  Several limitations with the findings exist. The study relies on a relatively small sample size, especially in considering the amount of actual migraines elicited, so the specific values should be considered with caution. In addition, the absence of a placebo group in the study design makes it difficult to interpret findings. Nonetheless, the study indicates that there are a subset of patients that may have migraines with aura provoked with strenuous exercise. It also suggests that patient-reported triggers may not be as reliable as once thought. While future investigation should confirm this finding, much research remains to be done to better delineate trigger factors of migraine aura and their management.

Click to read the study in Neurology

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1. Among patients with history of migraine with aura, migraines were triggered in a subset of patients with exercise alone or exercise with photostimulation.

2. No patients receiving photostimulation only (in the absence of exercise) had a provoked migraine.

This [prospective, observational study]: A total of 27 patients with a history of migraine with aura (MA) were recruited. Subjects were exposed to physical activity, photostimulation, or both. Patients were monitored during and after (up to 3 hours) for migraine-related or aura symptoms.

A total of 32 sessions were performed on 27 patients. Only 3 of 27 (11%) patients reported MA attacks, with 3 additional MO (migraine without aura) attacks. Exercise alone caused 4 migraine attacks out of 12 patients tested. Of the 11 patients exposed to only photostimulation, none developed MA or MO.

Further reading:

1. The triggers or precipitants of the acute migraine attack

2. Characterization of consistent triggers of migraine with aura

In sum: Exercise provoked migraine with aura in 17% of total patients tested. Patients who were only provoked with photostimulation did not develop migraine attacks. This study implies that triggers for migraines are, in fact, less common that previously thought.  Several limitations with the findings exist. The study relies on a relatively small sample size, especially in considering the amount of actual migraines elicited, so the specific values should be considered with caution. In addition, the absence of a placebo group in the study design makes it difficult to interpret findings. Nonetheless, the study indicates that there are a subset of patients that may have migraines with aura provoked with strenuous exercise. It also suggests that patient-reported triggers may not be as reliable as once thought. While future investigation should confirm this finding, much research remains to be done to better delineate trigger factors of migraine aura and their management.

Click to read the study in Neurology

By [EP] and [RR]

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Elizabeth Park: Elizabeth is a 4th year M.D. Candidate at Boston University School of Medicine.

Rif Rahman: Rif is a 4th year M.D. candidate at Harvard Medical School.

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