Is it Better to Avoid or Confront Headache Triggers?

An interesting study by Paul R. Martin and Colin MacLeod recently refuted the commonly given clinical advice that those suffering from chronic daily headaches should avoid known triggers of their headaches. Instead Martin and MacLeod assert that those with recurrent headaches should learn to cope with headache triggers, combining avoidance with an approach/confront technique which exposes them to triggers. This is a departure from conventional wisdom. Epidemiological studies have shown that at least 85% of headache sufferers are able to personally identify one or more significant identifiable triggers for their headaches, and this number jumps to 95% when they are asked to respond to a given list of triggers. Numerous triggering factors have been identified, ranging from food and drink, emotional and physical stresses, too much or too little sleep, light and sound, to environmental changes. The authors assert that the theory that headache triggers should be avoided has emerged from a theoretical vacuum and that it is not supported by empirically verified research. It is further argued that avoiding headache triggers may actually be detrimental to headache sufferers because this could result in sensitization to triggers which would increase their potential to elicit headaches in the future. It is unlikely that a patient could completely avoid all headache triggers, and attempting to do so would likely lead to a very restricted lifestyle. Furthermore, engaging in avoidance reduces a patients feeling of control over their headaches and could decrease one’s perceived ability to cope with triggers, resulting in worsening of their headache disorder. The authors also cited a study which found that the more a person felt capable of handling stressors effectively, the lower the correlation between headaches and stress was for that person. Ultimately the authors argued that advocating avoidance of headache triggers is too simplistic and that although avoiding headache triggers may result in fewer headaches in the short-term, it could lead to more headaches in the long-term due to sensitization. They conclude that although there are some cases in which avoidance of triggers may be the best option, it is often better for those suffering from headaches to practice an approach/confront technique in which there is moderate exposure to triggers such that sensitization does not occurs and in some cases a tolerance to certain triggers is increased. This was an interesting take on what to do with headache triggers.