Triggers of Primary Headaches: Issues and Pathways Forward

Area of Science:

• Neurology
• Headache Medicine

Background:

• Headache and migraine triggers are significant for understanding and managing primary headaches.
• Historically, triggers have been underrepresented in headache literature, but their importance is increasingly recognized.
• Despite growing attention, the field faces challenges hindering progress in trigger research and management.

Purpose of the Study:

• To elaborate on the issues hindering progress in headache trigger research.
• To propose ways forward for defining, classifying, and managing headache triggers.
• To encourage standardization in trigger research for improved clinical practice and comparative studies.

Main Methods:

• Literature review focusing on issues in headache trigger definition, labeling, and classification.
• Discussion of evidence regarding self-reported triggers and their capacity to precipitate headaches.
• Exploration of clinical trigger management strategies and future research directions.

Main Results:

• Identified issues include lack of standardized definitions, labeling, and classification systems for headache triggers.
• Evidence supports the role of self-reported triggers in precipitating headaches, with potential for acquired or extinguished capacity.
• Clinical trigger management is a vital component of comprehensive headache treatment.

Conclusions:

• Agreement on a definition, list, and classification system for headache triggers is essential.
• Authoritative bodies should establish multidisciplinary committees to standardize trigger-related tasks.
• Incorporating triggers into the International Classification of Headache Disorders would enhance their clinical profile.