What role do trigger play for migraines?

The word trigger means trigger. It's like a gun. When you press the trigger, the shot goes off. A small event triggers a complex process. The bullet “waits” in the gun, but the kinetic energy is only released when the trigger is triggered. The word is derived from the earlier idea that something causes migraines. But that's not how it is. A trigger is not causal, it just triggers something, as the word suggests. Triggers work at some times and not at others. I can be stressed today, and next week too, but it's only the week after next that stress triggers a migraine attack. So it's not primarily about the trigger, but about the willingness and the situation in which a trigger can actually have an effect. Triggers in and of themselves are not crucial for triggering a migraine attack.

Do you tend to overestimate the topic?

Many patients panic about certain triggers. We know those affected who can no longer go to a restaurant because they are afraid of certain food components. For decades it was thought that cheese, coffee, citrus fruits or chocolate promoted migraine attacks - that's not the case. On the contrary: cravings for certain foods are already a symptom of migraines. Just as hunger for Rollmops and raspberry ice cream is not the cause of pregnancy, but rather a symptom of the particular situation, hunger for chocolate is not the cause of migraines, but also a symptom. Unfortunately, this is still little known and old myths persist. Many people still believe this, but these earlier attempts to explain it are long outdated.

Why do you react sensitively to certain triggers?

Certain risk genes in our genetic makeup are responsible for a high susceptibility to migraines. In the largest migraine study ever with over 375,000 test subjects, which was carried out at the world's leading migraine centers, 38 risk genes and 44 gene variants were discovered. These are responsible for two essential control mechanisms in our body: On the one hand, they affect the cardiovascular system. This also means that the risk of developing high blood pressure, heart attacks or strokes is almost twice as high in migraine sufferers as in non-affected people. The second major topic, on the other hand, is psychological and sensory mechanisms for which our nervous system is responsible, i.e. perception, thinking, cognition and feelings. Migraine sufferers perceive and react more quickly to stimuli. They continually absorb recurring stimuli and find it difficult to block them out. Anything that comes too quickly, too suddenly or constantly can trigger migraine attacks. That's what many triggers have in common. The nervous system, which already works very quickly due to its special genetic makeup, reaches its upper limit and an energy deficit arises in the nerve cells. Now the brain tries to compensate for the energy deficit through a protective mechanism by craving for high-calorie foods. That's why many people report that unrestrained cravings arise in the run-up to the migraine. You then eat the chocolate or the cheese bread, for example. And the next day you think: Aha, I ate this or that and that triggered the whole thing. Cravings are a protective mechanism. You should give in to your cravings for carbohydrates and regularly refuel your nervous system in unison. The brain essentially needs three things: carbohydrates, water and oxygen. If one of these resources is insufficient or is used too much, for example in times of stress, overactivity, skipping meals, drinking too little or staying in poorly ventilated rooms, a deficit occurs with the result that migraine attacks are caused by one A lack of energy supply to the nerve cells can occur.

How can it be explained that sometimes something throws me off track and sometimes it doesn't?

What matters is not the individual factor, but the sum of things in the past few days. So it doesn't matter what happened today, but what condition my body is in in general. If I have had five days of stress, the problem is not the first day when the stress was the worst, but the fifth or sixth day of stress because that is when the nervous system is exhausted. By the way, the most common day for migraines is Saturday followed by Sunday. The reason can be derived directly from this knowledge.

So when triggers add up, that's not good. You shouldn't overvalue them, but you should pay a little attention to them, right? What triggers do migraine sufferers report the most?

The common denominator in all of these factors is change. Anything that changes too quickly, too impulsively, too suddenly puts a strain on the nervous system. We have developed a checklist of trigger factors for migraines. Stress is at the top. However, stress is experienced very individually. Overactivation of the nervous system, for example when something is troubling, is a typical trigger and a condition for an energy deficit in the nervous system. Second on the hit list is fear. Many patients suffer more from the fear of the next attack than from the pain itself. They perceive more things as threatening - for example the fear of the next migraine attack and then not being able to go to work, not being there for the children or the partner to be able to have to take medication. The constant fear means that the body is constantly on alert and ready to flee. This in turn creates stress and anxiety. This creates the opportunity to change these conditions using certain psychological and behavioral medicine techniques. You can be angry about anything, but you are not obligated to be. Other important triggers are negative or positive emotions such as worries, sadness or emotion.

What about physical triggers?

This includes, for example, physical overexertion. The body uses energy that is no longer available for the nervous system. Anything irregular like going to bed too late, rushing off on vacation, traveling, jogging before breakfast, skipping meals, etc. can trigger attacks. Physical factors such as the famous change in the weather also play a role. The problem is not the weather itself, but rather the body's adjustment to a new weather situation, which in turn requires energy. If all other factors are stable, the weather doesn't bother you. You can't change the weather, but you can change yourself. By generally not risking an energy deficit. This includes, for example, eating evenly, relaxing or planning balance. After the night, a carbohydrate-rich breakfast is particularly important so that the nerve cells quickly regain energy and the ability to work.

Can you do something else and reduce what is too much for the brain?

It's like a bank account. You shouldn't withdraw more than you deposit so as not to end up in the red. If I know that anxiety and stress trigger migraines, I can make a difference through relaxation, distraction, stress management training, or behavioral therapy. I am often asked by patients: What else should I do? My answer: It's not a question of doing anything more or even anything complicated. The most effective thing is what migraine sufferers find particularly difficult: just doing nothing, pausing, feeling bored. To relax, sit on a bench, watch the clouds and listen to the birds. Not to let the nervous system work and prevent the energy deficit.

How do you find the right balance between a regular daily routine and fun?

Some migraine sufferers would like the following solution: a magic cure that will eliminate the migraine and then they can live the way they want. Unfortunately that does not work. Due to the special hereditary characteristics, active health behavior must be adhered to. You also have to brush your teeth so that they don't get cavities. Anyone who has high blood pressure doesn't enjoy eating a low-salt diet, taking their medication and avoiding stress. But he has to do it. Even those who have diabetes have to follow a strict diet, measure their blood sugar and perhaps inject insulin, and change and adapt their lives. If a migraine sufferer says, I don't feel like it and wants a magic method, then he doesn't understand that he has a serious and complex illness. These patients should keep in mind that the risk of high blood pressure, stroke, heart attack, anxiety, depression and personality changes is significantly increased due to not properly treated migraines. Personal responsibility, knowledge and behavioral adjustment are essential for effective stabilization of the disease.

Shouldn't you be careful not to worry too much again?

There is still a myth that migraine is something for alternative treatment using methods without sufficient evidence of effectiveness. And if you don't eat cheese, take globules and do acupuncture, everything will be fine. The belief comes from the past, when there was hardly any scientifically proven knowledge about migraines. That's why those affected were often disappointed with medicine and looked for alternatives because they had the feeling that medicine didn't care. But over the last 30 years we have experienced an enormous explosion of knowledge. We know the processes in the nervous system, know specific genetic makeup, know connections to other diseases, and know effective acute therapies and preventive treatments.

Maybe that's why you don't take it so seriously because migraines are an invisible disease and others smile at you?

You think: everyone has headache. But migraines are a severe and complex neurological disease. She is often confused with everyday head pain that almost everyone knows. Those affected suffer from the fact that a lot is thrown into a pot, there are 367 different shapes of headache that have to be treated very specifically.

Is it even more important to accept the migraine?

The willingness to suffer from migraines is anchored in the genetic makeup. You can't just magic away migraines or outrun them. You have to adapt to it and adapt your life to it. Just understanding that is essential. It doesn't work to find supposed triggers and then expect to no longer have migraines. The willingness remains, you can't shake it. With this knowledge, you can develop active health habits, effectively control your migraine propensity and avoid complications.


“I have a migraine - And what is your superpower?: Your companion through good and bad days” which will be published by Complete Media Verlag on September 9th, 2019.

Bianca Leppert publishes a regular podcast on the subject of migraines: “I have a migraine – and what is your superpower?” ( https://www.biancaleppert.de/links )