Department of Brain and Behavioral Sciences, University of Pavia, Pavia.
Headache Science and Rehabilitation Center, IRCCS C. Mondino Foundation, Italy.
Curr Opin Neurol. 2022 Jun 1;35(3):360-366. doi: 10.1097/WCO.0000000000001065.
In this review, we illustrate and discuss the recent findings regarding the epidemiology and pathophysiology of migraine triggers and their implications in clinical practice.
Data from the literature suggest that individual triggers fail to provoke migraine attack in experimental settings. It is therefore possible that more triggers acting in combination are needed to induce an attack by promoting some degree of brain dysfunction and thus increasing the vulnerability to migraine. Caution is however needed, because some of the factors rated as triggers by the patients may actually be a component of the clinical picture of migraine attacks.
Trigger factors of migraine are endogenous or exogenous elements associated with an increased likelihood of an attack in a short period of time and are reported by up to 75.9% of patients. Triggers must be differentiated from premonitory symptoms that precede the headache phase but do not have a causative role in attack provocation, being rather the very first manifestations of the attack. Identification of real triggers is an important step in the management of migraine. Vice versa, promoting an active avoiding behaviour toward factors whose role as triggers is not certain would be ineffective and even frustrating for patients.
本文旨在阐述和讨论偏头痛触发因素的流行病学和病理生理学的最新发现，及其在临床实践中的意义。
文献中的数据表明，在实验环境中，单一的触发因素无法引发偏头痛发作。因此，可能需要更多的触发因素协同作用，通过促进一定程度的大脑功能障碍，从而增加偏头痛的易感性，来引发攻击。然而需要注意的是，患者认为的一些触发因素实际上可能是偏头痛发作临床特征的一部分。
偏头痛的触发因素是指在短时间内增加发作可能性的内源性或外源性因素，高达 75.9%的患者报告有触发因素。触发因素必须与先兆症状区分开来，先兆症状先于头痛阶段出现，但在引发攻击方面没有因果关系，而是攻击的最初表现。确定真正的触发因素是偏头痛管理的重要步骤。相反，促进对其作为触发因素作用不明确的因素的积极回避行为对患者来说是无效的，甚至是令人沮丧的。
