Behavioral Management of Migraine Headache Triggers: Learning to Cope with Triggers
Abstract
The literature on migraine triggers is reviewed, including the most common triggers, interactions between triggers, the research evidence related to the capacity of self-reported triggers to precipitate headaches, and the neurobiologic pathways by which triggers induce migraine attacks. An argument is developed against the standard advice to avoid migraine triggers as the best way of preventing attacks, based on conceptual and practical criticisms, and consideration of cognate literatures on chronic pain, stress, and anxiety. A small number of studies suggest that exposure to headache triggers has the same effect as exposure to anxiety-eliciting stimuli, with short exposure associated with increased pain response and prolonged exposure associated with decreased pain response. On the basis of this literature, "learning to cope with triggers" is advocated, where controlled exposure and approach/confront strategies are used to manage migraine triggers, except in cases where such an approach would probably be inappropriate.
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Behavioral and pharmacological treatments for headache focus on teaching patients to prevent headache mostly via avoidance of external and internal triggers.
“These treatments focus on teaching patients to prevent headache mostly via avoidance of external and internal triggers (things or situations associated with headache emergence: eg, foods, noises, lights, stress).”
From Acceptance and Commitment Therapy for Primary Headache Sufferers: A Randomized Controlled Trial of Efficacy (2021) · cites this paper as [44]
Long-term, excessively applied avoidance of all triggers becomes counterproductive, resulting in more suffering.
“However, long-term, excessively applied avoidance of all triggers (especially internal ones, such as stress, pain, unwanted thoughts, emotions, etc.) irrespective of context, becomes counterproductive, resulting instead in more suffering.44”
From Acceptance and Commitment Therapy for Primary Headache Sufferers: A Randomized Controlled Trial of Efficacy (2021) · cites this paper as [44]
Research and this study's findings do not show differential psychosocial effects between those with migraines and tension-type headache.
“although, research and this studies’ findings do not show differential psychosocial effects between those with migraines and tension-type headache,44”
From Acceptance and Commitment Therapy for Primary Headache Sufferers: A Randomized Controlled Trial of Efficacy (2021) · cites this paper as [44]
Cites
Measuring experiential avoidance: A preliminary test of a working model
Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M. A., Dykstra, T. A., Batten, S. V., Bergan, J., et al. (2004) · The Psychological Record · doi:10.1007/bf03395492 · Cited by 2,140 · see citing works
A new unified treatment approach for emotional disorders based on emotion science
Moses, E. B., & Barlow, D. H. (2006) · Current Directions in Psychological Science · doi:10.1111/j.0963-7214.2006.00425.x · Cited by 197 · see citing works
Behavioral management of headache triggers: Avoidance of triggers is an inadequate strategy
Martin, P. R., & MacLeod, C. (2009) · Clinical Psychology Review · doi:10.1016/j.cpr.2009.05.002 · Cited by 171 · see citing works
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Feuille, M., & Pargament, K. (2015) · Journal of Health Psychology · doi:10.1177/1359105313508459 · Cited by 101 · see citing works
Nonpharmacologic Treatments for Migraine and Tension-Type Headache: How to Choose and When to Use
Nicholson, R. A., Buse, D. C., Andrasik, F., & Lipton, R. B. (2011) · Current Treatment Options in Neurology · doi:10.1007/s11940-010-0102-9 · Cited by 88 · see citing works
Stress and Primary Headache: Review of the Research and Clinical Management
Martin, P. R. (2016) · Current Pain and Headache Reports · doi:10.1007/s11916-016-0576-6 · Cited by 66 · see citing works
Self-citationVasiliou, V. S., Karademas, E. C., Christou, Y., Papacostas, S., & Karekla, M. (2021) · The Journal of Pain · doi:10.1016/j.jpain.2020.06.006 · Cited by 45 · see citing works
Kubik, S. U., & Martin, P. R. (2017) · Headache The Journal of Head and Face Pain · doi:10.1111/head.12940 · Cited by 27 · see citing works
Self-citationKlan, T., Gaul, C., Liesering-Latta, E., Both, B., Held, I., Hennemann, S., & Witthöft, M. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.852616 · Cited by 22 · see citing works
“The different behavioral approaches for the preventive treatment of migraine can be classified into (i) patient education; (ii) relaxation training (RLX); (iii) biofeedback; (iv) cognitive-behavioral therapy (CBT); (v) mindfulness-based interventions, (7–9) and (vi) trigger management for primary headaches by “learnin…”
BackgroundAn Integrative Cognitive Behavioral Therapy Program for Adults With Migraine: A Feasibility Study
Klan, T., Liesering‐Latta, E., Gaul, C., Martin, P. R., & Witthöft, M. (2019) · Headache: The Journal of Head and Face Pain · doi:10.1111/head.13532 · Cited by 21 · see citing works
Self-citationKlan, T., Gaul, C., Liesering-Latta, E., Witthöft, M., & Hennemann, S. (2023) · Cephalalgia · doi:10.1177/03331024231178237 · Cited by 5 · see citing works
“exposure-based approaches (trigger management) (9).”
- Authors
- Martin, P. R.
- Affiliations
- Monash University (AU)
- Corresponding author
- Martin, Paul R.
- ORCID
- Martin, Paul R.
- Venue
- Current Pain and Headache Reports
- Published
- 2010-04-27
- Volume
- 14
- Issue
- 3
- Pages
- 221-227
- ISSN
- 1531-3433 (ISSN-L)
- 1534-3081
- OpenAlex
- W2055409273
- Cited by
- 139
- References
- 3
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 5 · 2023: 6 · 2022: 8 · 2021: 23 · 2020: 12 · 2019: 10 · 2018: 3 · 2017: 6 · 2016: 11 · 2015: 9 · 2014: 7 · 2013: 9 · 2012: 10
- FWCI
- 1.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Current Pain and Headache Reports (publishedVersion)
- PubMed (publishedVersion)
- Griffith Research Online (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- migraine triggers, behavior management, coping strategies, controlled exposure, anxiety, stress, chronic pain, migraine prophylaxis
- MeSH terms
- Humans, Migraine Disorders, Precipitating Factors
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