How Avoiding Migraine Triggers May Not Be the Right Solution

A Unique Look at the Role of Migraine Triggers

Do flashing lights trigger your migraines?. Nikola Nastastic/E+/Getty Images

Whenever you read about migraines, you will inevitably also read about migraine triggers. In some ways, triggers are good because they can be theoretically avoided. On the other hand, avoiding triggers can be challenging and put a damper on your quality of life.

Let's explore a unique viewpoint on triggers that suggests avoiding them may not be the best solution.

Put Down That Hershey Bar! Or Not...

Food triggers are commonly reported as causing migraine.

In fact, many headache sufferers go to great lengths to minimize dietary triggers. While sometimes beneficial in reducing headaches, a strict dietary adherence can also create unwanted distress and havoc.

But are certain foods really migraine-triggering? We all thought so. But now, let's look at some contrary evidence.

In one double-blind study, the effect of consuming carob was compared to chocolate. Sixty-three women with chronic headache (50% migraine, 37.5% tension-type, 12.5% combined migraine and tension-type) were given samples of chocolate and carob randomly and blindly. Surprisingly, chocolate, a commonly reported migraine trigger, did NOT have a significant triggering effect on migraines, tension-type headaches, or combined headaches.

What About Other Triggers Like Bright Light or Exercise?

In another study in Neurology, 27 patients with migraines with aura (17 women, 10 men) who reported bright or flickering  light or strenuous exercise as migraine triggers, were "experimentally provoked" by different types of photo stimulation (30-40 minute exposure to bright, flashing, or flickering light), strenuous exercise (running or riding a stationary bike for one hour), or a combination of light and exercise exposure.

During and after the provocation, the subjects reported any head pain or other migraine-related symptoms.

Of the 27 provoked patients, only 3 reported attacks of migraine with aura and another 3 reported attacks of migraine without aura.  Exercise alone triggered migraines in 4 of the 12 patients (1 with aura, 3 without).

No patients reported migraines after photo stimulation alone.

A Unique Approach

Dr. Silberstein, Director of the Jefferson Headache Center, and Dr. Goadsby, Director of the University of California San Francisco Headache Center, wrote an editorial of the study that failed to demonstrate bright light as a significant trigger of migraines.

In their editorial, they suggest that migraineurs are not "wrong" about their triggers. Rather, what migraineurs think are triggers for their headaches may actually be symptoms. For instance, maybe chocolate does not trigger your migraines, but rather your migraine causes you to crave chocolate.

In their editorial, Dr. Silberstein and Dr. Goadsby question the usefulness of avoiding triggers, suggesting that avoidance may actually be the wrong advice. Instead, they suggest that maybe migraineurs should "train the brain to habituate," as opposed to avoiding the trigger.

Bottom Line

Certainly this complex topic needs more investigation, but it's something to keep in the back of our minds -- coping with your triggers instead of avoiding them may be more suitable and reasonable advice.

So, should you eliminate those pea pods or that brie cheese that you think is triggering your migraines? Well, do what works for you. If you notice a trend, write it in your headache diary, and follow your gut. There is really no right or wrong answer here.


Goadsby PJ, Silberstein SD. Migraine triggers: harnessing the messages of clinical practice. Neurology. 2013 Jan 29;80(5):424-5.

Hougaard A, Amin F, Hauge AW, Ashina M, Olesen J. Provocation of migraine with aura using natural trigger factors. Neurology 2013;80:428–431.

Marcus DA, Scharff L, Turk D, Gourley LM. A double-blind provocative study of chocolate as a trigger of headache. Cephalalgia 1997;17:855–862.

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

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