The role of avoiding known triggers, embracing protectors, and adhering to healthy lifestyle recommendations in migraine prophylaxis: Insights from a prospective cohort of 1125 people with episodic migraine

Until recently, guidelines for migraine prevention recommended avoiding known migraine headache triggers. Adhering to healthy lifestyle behaviors is also recommended. In a recent cohort study many triggers were found to decrease the probability of migraine attacks in some individuals. The extent to which people with migraine adhere to healthy lifestyle recommendations is unknown. We set out to determine if known migraine trigger factors and daily adherence to healthy lifestyle recommendations are associated with decreased probability of migraine attacks in some individuals.This was an observational longitudinal cohort study of individuals with episodic migraine who registered to track their headache symptoms and daily exposure to trigger factors prospectively using a migraine-headache electronic diary during 90 days. We assessed whether triggers increased or decreased migraine attack risk in each individual. In addition, we calculated the proportion of days in which the individual adhered to lifestyle recommendations.We analyzed a total of 1125 individuals contributing 14,080 migraine attacks. Out of 47 triggers, 24 were more often associated with decreased rather than with increased migraine attack risk. Most pronouncedly this was true for caffeine, alcohol, and chocolate; happiness; relaxedness; sleep factors (longer duration, higher quality, and waking up refreshed); and physical activity. People who were more compliant with healthy behaviors, especially keeping good hydration and regular meals, were significantly older and had been diagnosed with migraine disease for a longer period, compared to those who were less compliant. Overall, exercising ≥3 times a week was the least followed recommendation.Many triggers behaved as protectors in a non-negligible proportion of individuals with episodic migraine, challenging the recommendation of avoiding known triggers. Low adherence to healthy lifestyle recommendations demonstrates an opportunity to increase awareness among people with migraine.