Compiling any list of triggers as it relates to migraine disease can be a challenging undertaking; one the one hand, they all start to look very similar after a while, but triggering factors also vary for each person and often by attack—which means no list can fully capture an individual’s unique experience. Still, it is important to highlight what research shows to be the most common of triggers for the various types of migraine, including the rare hemiplegic migraine.
While hemiplegic migraine represents a form of migraine with aura, there are some key differences in triggers. Here are the leading instigators of hemiplegic migraine attacks, according to clinical research.
Acute and emotional stress
A recurring theme among various medical studies center on the role of stress in migraine, with it topping countless “trigger” lists. For hemiplegic migraine, stress comes in many forms—acute stress during or after a stressful event as well as emotional tension. Evidence suggests that at least one-third of those with hemiplegic migraine cite various stressors as principal factors in the onset of attacks.1,2
Bright and artificial light
Light sensitivity is known to affect patients with this rare form of migraine during an attack, but how frequently does it function as a trigger? Quite often, apparently. In fact, it is the second most common triggering factor for hemiplegic migraine, perhaps even more so than other subtypes of the headache disorder.1 Screen use and flashing lights (from video games, for example) in particular might be a notable precursor for children with hemiplegic episodes, although more research is needed to understand which light sources are most problematic.3
It probably comes as no surprise that any injury or trauma to the head can bring on a migraine attack, and there is repeated evidence that a pre-existing headache diagnosis only worsens these symptoms after a concussion or traumatic brain injury. Curiously however, trauma to the head seems to more prominently impact those with hemiplegic migraine, for both adults and children, even if it does not rise to the severity of a concussion. Estimates vary, but approximately 25% of people have reported precipitating head injuries before an episode.2,3
Disrupted sleep patterns
Whether you get too much sleep or not enough, inconsistencies in rest repeatedly and negatively impact people with migraine, including the hemiplegic type. With over 30% of hemiplegic patients acknowledging this trigger, any disruption in nightly routine can lead to pain and other symptoms the following day for so many.1 And of course this uptick in attacks can further lead to poor sleep quality, thus creating a cruel cycle. However, there remains so much more to learn around this topic on account of conflicting research findings.4,5
Putting added stress and strain on the physical body, through exercise or other means, can unfortunately instigate a hemiplegic migraine attack for one out of every five individuals with the headache condition.1,3 This includes children as well, and generally it requires intense physical effort; running is a frequent example provided in clinical research, but the definition still remains unclear, and there are plenty of patients who find at least moderate exercise helpful. As with other triggers, it is critical to understand your own limitations.
While migraine is not a “woman’s disease” by any stretch, we cannot overlook the fact that it is predominantly diagnosed in adult women, particularly after the beginning of their first menstrual cycle. Falling hormone levels, particularly estrogen, have been implicated in the brain inflammation associated with migraine attacks, which may partially explain why a quarter of people with hemiplegic migraine report menstruation or taking a break from their birth control pill as a trigger.1,6
The power of a strong odor, even if not unpleasant to most noses, can set off a chain of neurological responses in the migraine brain. Although fewer than 20% of those with hemiplegic migraine are triggered by smell, it still ranks in the top ten among other triggers and—alongside light and sound sensitivity—rounds out the sensory disturbances commonly associated with all forms of migraine.1
Consumption of alcoholic beverages is another trigger factor that comes with its own controversy among patients and researchers. While many with migraine (any type) describe it as a common catalyst for attacks and even discontinue drinking it on account of this concern, some studies have suggested it is inconsistent at best.7 Still, it may act as a known trigger for 15% of people with hemiplegic migraine.1 In particular, red wine is the most common of alcohol-based triggers, although beer and other liquor can bring about the same outcomes.
Read more about migraine triggers:
1Hansen JM, Hauge AW, Ashina M, Olesen J. Trigger factors for familial hemiplegic migraine. Cephalalgia. 2011;31(12):1274-1281. doi:10.1177/0333102411415878
2Ducros A, Denier C, Joutel A, et al. The Clinical Spectrum of Familial Hemiplegic Migraine Associated with Mutations in a Neuronal Calcium Channel. New England Journal of Medicine. 2001;345(1):17-24. doi:10.1056/nejm200107053450103.
3Toldo I, Brunello F, Morao V, et al. First Attack and Clinical Presentation of Hemiplegic Migraine in Pediatric Age: A Multicenter Retrospective Study and Literature Review. Frontiers in Neurology. 2019;10. doi:10.3389/fneur.2019.01079.
4Bertisch SM, Li W, Buettner C, et al. Nightly sleep duration, fragmentation, and quality and daily risk of migraine. Neurology. 2019;94(5). doi:10.1212/wnl.0000000000008740.
5Lin Y-K, Lin G-Y, Lee J-T, et al. Associations Between Sleep Quality and Migraine Frequency. Medicine. 2016;95(17). doi:10.1097/md.0000000000003554.
6Cupini LM, Corbelli I, Sarchelli P. Menstrual migraine: what it is and does it matter? [published online ahead of print, 2020 Jan 28]. J Neurol. 2020;10.1007/s00415-020-09726-2. doi:10.1007/s00415-020-09726-2
7Onderwater GLJ, van Oosterhout WPJ, Schoonman GG, Ferrari MD, Terwindt GM. Alcoholic beverages as trigger factor and the effect on alcohol consumption behavior in patients with migraine. Eur J Neurol. 2019;26(4):588-595. doi:10.1111/ene.13861