Cited by 288Migraine and Headache StudiesTemporomandibular Joint DisordersTraumatic Brain Injury Research

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Perceived triggers of primary headache disorders: A meta-analysis

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Pellegrino, A Brooke Walters, Davis-Martin, Rachel E, Houle, Timothy T, Turner, Dana P, Smitherman, Todd A·2018·Cephalalgia

DOI 10.1177/0333102417727535PMC PMC8544028

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Abstract

Objective: To quantitatively synthesize extant literature on perceived triggers of primary headache disorders. Methods: A meta-analytic review of headache trigger survey studies was conducted. Endorsement rates, assessment method, and headache and sample characteristics were extracted from included articles. Separate random-effects models were used to assess trigger endorsement rates and post-hoc meta-regressions examined potential moderator variables. Results: 85 articles from 1958 to 2015 were included, involving 27,122 participants and querying 420 unique triggers (collapsed into 15 categories). Four-fifths (0.81; 95% CI .75 to .86) of individuals with migraine or tension-type headache endorsed at least one trigger. Rates increased with the number of categories queried (OR: 1.18, 1.08–1.30) and year of publication (OR: 1.04, 1.00–1.08). The triggers most commonly endorsed were stress (.58, .53–.63) and sleep (.41, .36–.47). Conclusions: Extreme heterogeneity characterizes the headache trigger literature. Most individuals with a primary headache disorder perceive their attacks to be triggered by one or more precipitants, the most common of which are stress and sleep. However, trigger endorsement is influenced by method of assessment. Enhancing methodological consistency and prioritizing experimental studies would improve our understanding of headache triggers.

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Additional file 26 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 15 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 8 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 25 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 10 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 23 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 18 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 13 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 3 of Associations of combined lifestyle index with migraine prevalence and headache frequency: a cross-sectional study from the MECH-HK study
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Additional file 1 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 6 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 24 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 19 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 21 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 12 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 20 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 27 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 1 of Poor healthy lifestyle and life’s essential 8 are associated with higher risk of new-onset migraine: a prospective cohort study
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Additional file 9 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 2 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 4 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
Chen, Z.-F., Kong, X.-M., Yang, C.-H., Li, X.-Y., Guo, H., & Wang, Z.-W. (2024) · Figshare · doi:10.6084/m9.figshare.26759360
Additional file 3 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
Chen, Z.-F., Kong, X.-M., Yang, C.-H., Li, X.-Y., Guo, H., & Wang, Z.-W. (2024) · Figshare · doi:10.6084/m9.figshare.26759357
Additional file 2 of Associations of combined lifestyle index with migraine prevalence and headache frequency: a cross-sectional study from the MECH-HK study
Deng, Y., Wang, H. H., Ngai, F. W., Zhang, D., Qin, J., Chen, X., & Xie, Y. J. (2024) · Figshare · doi:10.6084/m9.figshare.25256146
Additional file 14 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
Chen, Z.-F., Kong, X.-M., Yang, C.-H., Li, X.-Y., Guo, H., & Wang, Z.-W. (2024) · Figshare · doi:10.6084/m9.figshare.26759390
Additional file 17 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
Chen, Z.-F., Kong, X.-M., Yang, C.-H., Li, X.-Y., Guo, H., & Wang, Z.-W. (2024) · Figshare · doi:10.6084/m9.figshare.26759399
Additional file 22 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
Chen, Z.-F., Kong, X.-M., Yang, C.-H., Li, X.-Y., Guo, H., & Wang, Z.-W. (2024) · Figshare · doi:10.6084/m9.figshare.26759414
Additional file 5 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
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Additional file 7 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
Chen, Z.-F., Kong, X.-M., Yang, C.-H., Li, X.-Y., Guo, H., & Wang, Z.-W. (2024) · Figshare · doi:10.6084/m9.figshare.26759369
Additional file 29 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
Chen, Z.-F., Kong, X.-M., Yang, C.-H., Li, X.-Y., Guo, H., & Wang, Z.-W. (2024) · Figshare · doi:10.6084/m9.figshare.26759435
Additional file 1 of Associations of combined lifestyle index with migraine prevalence and headache frequency: a cross-sectional study from the MECH-HK study
Deng, Y., Wang, H. H., Ngai, F. W., Zhang, D., Qin, J., Chen, X., & Xie, Y. J. (2024) · Figshare · doi:10.6084/m9.figshare.25255824
Additional file 28 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
Chen, Z.-F., Kong, X.-M., Yang, C.-H., Li, X.-Y., Guo, H., & Wang, Z.-W. (2024) · Figshare · doi:10.6084/m9.figshare.26759432
Additional file 11 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
Chen, Z.-F., Kong, X.-M., Yang, C.-H., Li, X.-Y., Guo, H., & Wang, Z.-W. (2024) · Figshare · doi:10.6084/m9.figshare.26759381
Additional file 16 of Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the global burden of disease study 2021
Chen, Z.-F., Kong, X.-M., Yang, C.-H., Li, X.-Y., Guo, H., & Wang, Z.-W. (2024) · Figshare · doi:10.6084/m9.figshare.26759396
Stress as a migraine trigger: clinical evidence and pathophysiological insights – A narrative review
Sebastianelli, G., Song, M., & Coppola, G. (2026) · Confinia Cephalalgica · doi:10.4081/cc.2026.15917
“(14, 16-19) Indeed, a prospective study using a smartphone headache diary application for 3 months found that stress was the most frequently reported trigger on headache days, as well as the trigger with the highest likelihood of a following migraine attack.”
Meteosensitivity in patients with primary headache
Yarovaya, K., Solodovnikova, Y., Dobrovolsky, V. V., Serbin, І. V., PERKOVA, G. V., & Lebed, O. P. (2025) · Psychiatry Neurology and Medical Psychology · doi:10.26565/2312-5675-2025-32-06
Pathofysiological and clinical correlates of sleep in primary headache disorders: A narrative review
van Liefland, M., Munday, V., van Tilborg, P. J., West, I. M., Holland, P. R., Fronczek, R., & Brandt, R. B. (2026) · Sleep Medicine · doi:10.1016/j.sleep.2026.108844
Rôles et régulations des canaux ioniques ASIC1b dans la douleur
Verkest, C. (2019) · theses.fr (ABES) · doi:10.70675/db17aabazd726z4d22zb273zf58b049ba711
Delta-opioïd receptor : a potential new target for migraine and headache therapies
Dussol, M. (2023) · theses.fr (ABES) · doi:10.70675/b5bbe422z1fabz4af3z9105z1a22963c1217
Individualized Forecasting of Headache Attack Risk Using a Continuously Updating ModelPreprint
Houle, T. T., Lebowitz, A. D., Chtay, I., Patel, T., McGeary, D. D., & Turner, D. P. (2026) · medRxiv · doi:10.64898/2026.04.20.26350119
Self-citation
Stress and fasting for inducing migraine attacks: A randomized 2 × 2 factorial crossover trial
Houle, T. T., Sexton, K., Lebowitz, A. D., Chtay, I., Patel, T., Leffert, L. R., & Turner, D. P. (2026) · Headache The Journal of Head and Face Pain · doi:10.1111/head.70105
“4,5,13,14 The role of stress in headache has been hypothesized for centuries and has been reviewed in several previous works.”
Self-citation
The role of prodromal symptoms in predicting headache onset: A longitudinal electronic momentary assessment study
Lacritz, M., Lipton, R. B., Metts, C. L., & Seng, E. K. (2026) · Headache The Journal of Head and Face Pain · doi:10.1111/head.70146
“10,17,18 These symptoms included stiff neck, sensitivity to light, sensitivity to sound, feeling tired or weary, difficulty thinking or concentrating, irritability, yawning, nausea, thirst, blurred vision, and dizziness.”
Weekend headache in migraine – fact or fiction? An observational study from DMKG-app data
Ruscheweyh, R., Dresler, T., Goßrau, G., Kraya, T., Neeb, L., Raffaelli, B., Ruschil, V., & Scheidt, J. (2026) · Cephalalgia · doi:10.1177/03331024261444664
“19 Interestingly, while sleep disturbances and alcohol consumption are among the most frequent trigger factors for migraine indicated by patients, 20 diary studies have shown a limited in ﬂ uence, 21,22 maybe due to migraine triggers being individually very different and/or susceptible persons…”
Greater Mediterranean Diet Adherence Is Associated with Lower Odds of Chronic Migraine: A Retrospective Observational Study
Aliş, C., Uludüz, E., Eyüpoglu, S., İskender, M., Öztornacı, O., Özge, A., & Uludüz, D. (2026) · Nutrients · doi:10.3390/nu18152563
Lifetime Probability of Developing Migraine: A Novel Epidemiological Perspective Based on Global Burden of Disease Data
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Sleep and Migraine Interactions in Episodic and Chronic Migraine: A Hospital-Based Cross-Sectional Study
Mathur, S., Seshagiri, D. V., Mythirayee, S., Mailankody, P., Raja, P., Ahmed, S., Nair, B. V. S., Kamble, N., Kulkarni, G. B., Ravi, Y., et al. (2026) · Annals of Indian Academy of Neurology · doi:10.4103/aian.aian_433_26
The association between sleep duration and migraine frequency, disability, and perceived stress in the Headache Assessment via a Digital Platform in United States ( HeAD ‐ US ) study
Vgontzas, A., Fanning, K. M., Bostic, R. C., Urani, A., Cadiou, F., Lipton, R. B., & Ezzati, A. (2026) · Headache The Journal of Head and Face Pain · doi:10.1111/head.70215
Headache with cognitive and behavioral impairment
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Authors: Pellegrino, A. B. W., Davis-Martin, R. E., Houle, T. T., Turner, D. P., & Smitherman, T. A.
Affiliations: Hartford HealthCare Headache Center, West Hartford, CT, USA
University of Massachusetts Chan Medical School (US)
Massachusetts General Hospital (US)
University of Mississippi (US)
Corresponding author: Smitherman, Todd A
ORCID: Pellegrino, A Brooke Walters
Davis-Martin, Rachel E
Houle, Timothy T
Turner, Dana P
Smitherman, Todd A
Venue: Cephalalgia
Publisher: SAGE Publications
Published: 2017-08-20
Volume: 38
Issue: 6
Pages: 1188-1198
ISSN: 0333-1024 (ISSN-L)
1468-2982
DOI: 10.1177/0333102417727535
PMC: PMC8544028
OpenAlex: W2746815301
Cited by: 288
References: 24
Citations by year: 2026: 16 · 2025: 37 · 2024: 75 · 2023: 29 · 2022: 25 · 2021: 34 · 2020: 25 · 2019: 24 · 2018: 16 · 2017: 5
FWCI: 2.91
Type: journal article
Language: en
Open access: green
europepmc.org
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Cephalalgia (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Neurological Disorders and Stroke (R01NS065257)
Topics: Health Sciences › Medicine › Clinical Neurology › Migraine and Headache Studies
Health Sciences › Dentistry › Oral Surgery › Temporomandibular Joint Disorders
Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
Keywords: headache triggers, primary headache, migraine, tension-type headache, stress, sleep
MeSH terms: Humans, Headache Disorders, Primary

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Perceived triggers of primary headache disorders: A meta-analysis

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