Analysis of Trigger Factors in Episodic Migraineurs Using a Smartphone Headache Diary Applications

Background
Various stimuli can trigger migraines in susceptible individuals. We examined migraine trigger factors by using a smartphone headache diary application.
Method
Episodic migraineurs who agreed to participate in our study downloaded smartphone headache diary application, which was designed to capture the details regarding headache trigger factors and characteristics for 3 months. The participants were asked to access the smartphone headache diary application daily and to confirm the presence of a headache and input the types of trigger factors.
Results
Sixty-two participants kept diary entries until the end of the study. The diary data for 4,579 days were analyzed. In this data set, 1,099 headache days (336 migraines, 763 non-migraine headaches) were recorded; of these, 772 headache events had with trigger factors, and 327 events did not have trigger factors. The common trigger factors that were present on headache days included stress, fatigue, sleep deprivation, hormonal changes, and weather changes. The likelihood of a headache trigger was 57.7% for stress, 55.1% for sleep deprivation, 48.5% for fatigue, and 46.5% for any trigger. The headaches with trigger factors were associated with greater pain intensity (p<0.001), headache-related disability (p<0.001), abortive medication use (p = 0.02), and the proportion of migraine (p < 0.001), relative to those without trigger factors. Traveling (odd ratios [OR]: 6.4), hormonal changes (OR: 3.5), noise (OR: 2.8), alcohol (OR: 2.5), overeating (OR: 2.4), and stress (OR:1.8) were significantly associated with migraines compared to non-migraine headaches. The headaches that were associated with hormonal changes or noise were more often migraines, regardless of the preventive medication. The headaches due to stress, overeating, alcohol, and traveling were more often migraines without preventive medication, but it was not evident with preventive medication.
Conclusion
Smartphone headache diary application is an effective tool to assess migraine trigger factors. The headaches with trigger factors had greater severity or migraine features. The type of triggers and the presence of preventive medication influenced the headache characteristics; hence, an investigation of trigger factors would be helpful in understanding migraine occurrences.

背景
多种刺激因素可诱发易感人群罹患偏头痛。本研究借助智能手机头痛日记应用程序，对偏头痛诱发因素开展了系统性考察。

方法
本研究招募的发作性偏头痛患者在知情同意后，下载了本研究开发的智能手机头痛日记应用程序，该程序用于采集为期3个月的头痛诱发因素及头痛特征相关详细数据。研究要求受试者每日登录该应用程序，确认当日是否出现头痛，并记录头痛诱发因素类型。

结果
共有62名受试者完整完成了整个研究的日记记录。本研究最终纳入分析的日记数据共计4579个有效观测日。本数据集中共记录头痛日1099天，其中偏头痛发作336次，非偏头痛性头痛763次；在上述头痛事件中，772次存在明确诱发因素，327次无明确诱发因素。头痛日常见诱发因素包括压力、疲劳、睡眠剥夺、激素水平变化及天气变化。各类诱发因素对应的头痛触发概率分别为：压力57.7%、睡眠剥夺55.1%、疲劳48.5%，任意一种诱发因素的触发总概率为46.5%。与无诱发因素的头痛相比，存在诱发因素的头痛伴随更高的疼痛强度（p<0.001）、更显著的头痛相关功能障碍（p<0.001）、更高的急性期用药使用率（p=0.02）以及更高的偏头痛占比（p<0.001）。与非偏头痛性头痛相比，旅行（比值比[OR]: 6.4）、激素水平变化（OR: 3.5）、噪音（OR: 2.8）、饮酒（OR: 2.5）、过量进食（OR: 2.4）及压力（OR:1.8）与偏头痛发作存在显著关联。无论受试者是否使用预防性用药，与激素水平变化或噪音相关的头痛更易表现为偏头痛发作；而在未使用预防性用药的受试者中，与压力、过量进食、饮酒及旅行相关的头痛更易表现为偏头痛，但该关联在使用预防性用药的受试者中并不显著。

结论
智能手机头痛日记应用程序是评估偏头痛诱发因素的有效工具。存在诱发因素的头痛往往具有更高的严重程度或更典型的偏头痛特征。诱发因素类型及预防性用药的使用情况均会影响头痛特征，因此对诱发因素的考察有助于深入理解偏头痛的发作规律。