The DOI matches its Crossref record; 24 of the 24 references it cites were found in a registry or an index.
Perceived triggers of primary headache disorders: A meta-analysis
Open accessAbstract
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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In the citing paper
“since emotional distress is regarded as the most important trigger in migraine attacks (6).”
From Efficacy of Cognitive-Behavioral Therapy for the Prophylaxis of Migraine in Adults: A Three-Armed Randomized Controlled Trial (2022) · cites this paper as [6]
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In the citing paper
“Interoceptive awareness localizes to the insula,39 an area of the brain considered a “hub of activity” in migraine, playing a key role in integrating many of the dynamic processes of migraine (sensory, autonomic, cognitive, and emotional).40”
From Mechanisms of mindfulness in patients with migraine: Results of a qualitative study. (2023) · cites this paper as [40]
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Citations
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Measuring inconsistency in meta-analyses
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“methods of assessment, sample characteristics, diagnostic criteria used) (15).”
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The global burden of headache: A documentation of headache prevalence and disability worldwide
Stovner, L., Hagen, K., Jensen, R., Katsarava, Z., Lipton, R., Scher, A., Steiner, T., & Zwart, J.-A. (2007) · Cephalalgia · doi:10.1111/j.1468-2982.2007.01288.x · Cited by 2,444 · cited 8×
“) (5), all alcohol (1), all alcohol (red wine, white wine, clear spirits) (1), beer (5), beer spirits (1), hard liquor (1), red wine (6), red wine (but not white wine or clear spirits) (1), red wine/cheese (1), sparkling wine (1), spirits (4), tequila only (of”
InfluentialMigraine prevalence, disease burden, and the need for preventive therapy
Lipton, R. B., Bigal, M. E., Diamond, M., Freitag, F., Reed, M. L., & Stewart, W. F. (2007) · Neurology · doi:10.1212/01.wnl.0000252808.97649.21 · Cited by 2,337 · cited 7×
“(1), feeling sad (1), intense emotional influences (3), irritation (1), low mood (1), negative affect (anxiety, anger, depression) (3), thinking about negative events (1), worries (1) 26”
InfluentialEpidemiology of Tension-Type Headache
Schwartz, B. S. (1998) · JAMA · doi:10.1001/jama.279.5.381 · Cited by 762 · cited 9×
“glare (4), hours in front PC/TV/video games (2), intense light (2), light/sun (1), lights (9), orange colors (1), other visual stimuli (3), prolonged computer use (1), road stripes or cones (1), sun clarity (1), sun exposure (1), sunlight (11), sunlight/bright light (2), too many hours reading (1), VDU screens/compute…”
InfluentialBurch, R. C., Loder, S., Loder, E., & Smitherman, T. A. (2015) · Headache The Journal of Head and Face Pain · doi:10.1111/head.12482 · Cited by 497
Self-citationDiamond, S., BIGAL, M. E., Silberstein, S. D., Loder, E., Reed, M. L., & Lipton, R. B. (2006) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2006.00631.x · Cited by 413 · cited 6×
“Despite their prevalence and burden, headache disorders remain undiagnosed or inadequately treated among most who suffer from them (7,8).”
InfluentialGoadsby, P. J., Charbit, A. R., Andreou, A. P., Akerman, S., & Holland, P. R. (2009) · Neuroscience · doi:10.1016/j.neuroscience.2009.03.019 · Cited by 380
Borsook, D., Maleki, N., Becerra, L. R., & McEwen, B. S. (2012) · Neuron · doi:10.1016/j.neuron.2012.01.001 · Cited by 370 · cited 2×
“Stress produces direct effects on the autonomic nervous and neuroendocrine systems that over time may sensitize nociceptors (16), and chronic stress in combination with experiencing recurrent headache attacks impairs the brain’s ability to maintain allostasis (17).”
Barriers to the Diagnosis and Treatment of Migraine: Effects of Sex, Income, and Headache Features
Lipton, R. B., Serrano, D., Holland, S., Fanning, K. M., Reed, M. L., & Buse, D. C. (2012) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2012.02265.x · Cited by 205 · cited 3×
“product) (2), smell (fat) (2), smell (food) (2), smell (odour) (3), smoke (5), smoke (auto emission) (1), smoke (smoking cigarettes) (3), smoking or smell of smoking (8), strong odours (2) 41”
TOWARD A RATIONAL UNDERSTANDING OF MIGRAINE TRIGGER FACTORS
Martin, V. T., & Behbehani, M. M. (2001) · Medical Clinics of North America · doi:10.1016/s0025-7125(05)70351-5 · Cited by 172 · cited 4×
“glare (4), hours in front PC/TV/video games (2), intense light (2), light/sun (1), lights (9), orange colors (1), other visual stimuli (3), prolonged computer use (1), road stripes or cones (1), sun clarity (1), sun exposure (1), sunlight (11), sunlight/bright light (2), too many hours reading (1), VDU screens/compute…”
InfluentialBehavioral 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 · cited 1×
“Indeed, accumulating evidence suggests that the clinical lore of advising headache patients to avoid triggers may inadvertently increase sensitization to some triggers (23), and that training patients in other means of coping with triggers may be a viable management strategy (24), particularly for those that cannot be…”
What Turns on a Migraine? A Systematic Review of Migraine Precipitating Factors
Peroutka, S. J. (2014) · Current Pain and Headache Reports · doi:10.1007/s11916-014-0454-z · Cited by 170 · cited 2×
“insufficient sleep (1), lack of sleep (11), napping (2), nocturnal sleeping (1), oversleep (5), poor sleep (1), prolonged sleep (1), sleep (5), sleep (weekends) (2), sleep deprivation (9), sleep disturbance (10), sleep pattern change (1), sleep problems (1), sleeping”
Trigger Factors and Premonitory Features of Migraine Attacks: Summary of Studies
Pavlovic, J. M., Buse, D. C., Sollars, C. M., Haut, S. R., & Lipton, R. B. (2014) · Headache The Journal of Head and Face Pain · doi:10.1111/head.12468 · Cited by 155 · cited 1×
“An initial step is to test and compare these trigger perceptions using experimental designs that satisfy the numerous conditions required to demonstrate causality and to establish mechanisms of action (13,20,21).”
Reduction in perceived stress as a migraine trigger
Lipton, R. B., Buse, D. C., Hall, C. B., Tennen, H. A., DeFreitas, T. A., Borkowski, T. M., Grosberg, B. M., & Haut, S. R. (2014) · Neurology · doi:10.1212/wnl.0000000000000332 · Cited by 151
RED WINE AS A CAUSE OF MIGRAINE
Littlewood, J. T., Glover, V. A. S., Davies, P. T. G., Gibb, C., Sandler, M., & Rose, F. C. (1988) · The Lancet · doi:10.1016/s0140-6736(88)91353-0 · Cited by 143 · cited 3×
“habits (1), eggs (1), fasting (5), fatty food (1), fish (1), food (17), food additives (2), food seasonings (1), fried foods (2), fruits and vegetables (1), full meals (1), honey mead (1), hot dogs (1), hunger (18), hunger (missing a meal) (1), ice cream (3), khat (Ethiopian”
A Double-Blind Provocative Study Chocolate as A Trigger of Headache
Marcus, D., Scharff, L., Turk, D., & Gourley, L. (1997) · Cephalalgia · doi:10.1046/j.1468-2982.1997.1708855.x · Cited by 121 · cited 2×
“Though few in number, experimental studies have not always confirmed perceptions reported in survey studies, as was shown in an elegant double-blind study of chocolate versus carob (22).”
Behavioral management of the triggers of recurrent headache: A randomized controlled trial
Martin, P. R., Reece, J., Callan, M., MacLeod, C., Kaur, A., Gregg, K., & Goadsby, P. J. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.07.002 · Cited by 116 · cited 1×
“Indeed, accumulating evidence suggests that the clinical lore of advising headache patients to avoid triggers may inadvertently increase sensitization to some triggers (23), and that training patients in other means of coping with triggers may be a viable management strategy (24), particularly for those that cannot be…”
Methodological Issues in Studying Trigger Factors and Premonitory Features of Migraine
Lipton, R. B., Pavlovic, J. M., Haut, S. R., Grosberg, B. M., & Buse, D. C. (2014) · Headache The Journal of Head and Face Pain · doi:10.1111/head.12464 · Cited by 112 · cited 2×
“In some cases, stimuli presumed to be causal triggers may be revealed to instead reflect effects of premonitory changes (20).”
Stress and Headache Chronification
Houle, T. T., & Nash, J. M. (2007) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2007.00973.x · Cited by 69 · cited 1×
“Stress produces direct effects on the autonomic nervous and neuroendocrine systems that over time may sensitize nociceptors (16), and chronic stress in combination with experiencing recurrent headache attacks impairs the brain’s ability to maintain allostasis (17).”
Self-citationCausality and Headache Triggers
Turner, D. P., Smitherman, T. A., Martin, V. T., Penzien, D. B., & Houle, T. T. (2013) · Headache The Journal of Head and Face Pain · doi:10.1111/head.12076 · Cited by 53 · cited 2×
“Although study designs involving experimental manipulation of triggers are ideal, satisfying the numerous assumptions required for establishing causality of headache triggers is both rare and often unfeasible (13).”
Self-citationRothrock, J. F. (2008) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2007.01050.x · Cited by 19 · cited 2×
“activity (12), sexual intercourse (1), singing (1), squatting (1), straining (2), strenuous physical activity (1), tension in neck muscles (1), yoga (1) 46”
Cited by
Sorted by citations
Salvagioni, D. A. J., Melanda, F. N., Mesas, A. E., González, A. D., Gabani, F. L., & Andrade, S. M. D. (2017) · PLOS ONE · doi:10.1371/journal.pone.0185781 · Cited by 1,508
Burch, R. C., Buse, D. C., & Lipton, R. B. (2019) · Neurologic Clinics · doi:10.1016/j.ncl.2019.06.001 · Cited by 741
Ong, J. J. Y., Chandra, B., Goh, Y., Tang, J. Z. Y., Sooi, K. W. X., Tan, Y. L., Tan, B. Y., Teoh, H., Ong, S. T., Allen, D. M., et al. (2020) · Headache The Journal of Head and Face Pain · doi:10.1111/head.13811 · Cited by 475
Ashina, S., Mitsikostas, D. D., Lee, M. J., Yamani, N., Wang, S., Messina, R., Ashina, H., Buse, D. C., Pozo‐Rosich, P., Jensen, R., et al. (2021) · Nature Reviews Disease Primers · doi:10.1038/s41572-021-00257-2 · Cited by 290
Dresler, T., Caratozzolo, S., Guldolf, K., Huhn, J.-I., Loiacono, C., Niiberg-Pikksööt, T., Puma, M., Sforza, G., Tobia, A., Ornello, R., et al. (2019) · The Journal of Headache and Pain · doi:10.1186/s10194-019-0988-x · Cited by 253
“Moreover, specific manifestations of eating disorders, such as dieting, fasting or skipping meals, are often reported as migraine triggers [35, 155].”
Background
Metadata
- 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
- Venue
- Cephalalgia
- Publisher
- SAGE Publications
- Published
- 2017-08-20
- Volume
- 38
- Issue
- 6
- Pages
- 1188-1198
- ISSN
- 0333-1024 (ISSN-L)
- 1468-2982
- 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
- 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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