Two experts not connected to the study agreed that the relationship between "triggers" and migraine attack is a complicated one.
"These results are not a surprise," said Dr. Mark Green, director of the Center for Headache and Pain Medicine at Mount Sinai Hospital in New York City. For example, he said, "although occasionally dietary management can be helpful, routine use of strict anti-migraine diets has not been recommended by me for years and was very burdensome to patients."
Green believes that "some 'triggers,' like chocolate, are probably not triggers at all but rather a neurobiological craving that is associated with the migraine attack, rather than causing the attack."
And Dr. Randall Berliner, a neurologist specializing in headaches at Lenox Hill Hospital in New York City, said that "triggers" might only be relevant under certain conditions.
"Perhaps the triggers only exert their effect when the brain is already susceptible to a migraine," he said. "We do know that there are cycles of vulnerability that the brain may undergo that can increase the likelihood that a migraine may occur. It may be that provocation of a migraine requires a vulnerable brain and the right combination or threshold of triggers."
He said that headache specialists typically encourage people to keep track of potential triggers. "This study helps us further understand the impact of migraine triggers but also allows us to appreciate just how complicated the relationship between migraine triggers and migraine attacks may be," Berliner said.
For his part, Green also believes that "triggers are likely to be additive and are a 'perfect storm' when they trigger an attack. For example, in a woman who is premenstrual, triggers may become relevant, whereas other times of the month they are innocuous."
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