Migraine Trigger Points
Although environmental factors are common triggers for migraine sufferers, there is a separate category of “migraine triggers” that are anatomical: nerve triggers. These are nerves of sensation around the face and neck that can send faulty signals to the brain, causing a domino effect that ends in a migraine.
Dr. Jonathan Cabin of The Migraine Institute helps patients achieve long-lasting migraine relief by finding and treating migraine triggers. As a board-certified head and neck surgeon with dual-subspecialty training in facial plastic and reconstructive surgery, Dr. Cabin takes a comprehensive and personalized approach to migraines. Dr. Cabin helps patients determine the best course of action to reduce or eliminate migraines via nerve trigger treatments.
What Triggers a Migraine?
A migraine takes place inside the brain, but it actually begins outside the brain. During a migraine attack, an anatomical trigger delivers a faulty signal to the brain. This ultimately results in migraine pain inside the brain.
There are four anatomical triggers for a migraine. These are:
- Forehead: Causes an individual to experience migraine pain from above the eye or on the forehead, either on one or both sides. Forehead migraines occur when the supratrochlear or supraorbital nerves are irritated by bone, blood vessels, muscle or fascia (lining of muscles).
- Temples: Causes an individual to experience migraine pain from the temples area, either on one or both sides. Temples migraines occur due to irritation of the zygomaticotemporal or auriculotemporal nerves; this irritation may be caused by blood vessels, muscle or fascia.
- Nose: Causes an individual to experience migraine pain from behind the eye and affects one or both sides of the nose. Additionally, nose migraines may cause congestion, a runny nose and other cold symptoms. Many nerve branches may be involved in nose migraines, and these nerves can be irritated by bone or cartilage or the mucosa (lining) of the nose.
- Neck: Causes an individual to experience migraine pain from the back of the neck that impacts one or both sides of the neck. Neck migraines occur due to irritation of the greater occipital nerve, lesser occipital nerve or third occipital nerve by blood vessels, muscle or fascia.
Common Migraine Triggers
Some of the most common migraine triggers include:
- Changes in a daily or weekend routine
- Lack of sleep or too much sleep
- Physical conditions such as muscle tension or repeated coughing
Sleep, Stress & Migraines
Migraine sufferers may be more susceptible than others to sleep disorders. Common sleep disorders associated with migraines include:
- Obstructive Sleep Apnea: Intermittent breathing stoppage while sleeping. Obstructive sleep apnea causes the throat muscles to relax and block the airway, resulting in snoring.
- Insomnia: Lack of restful sleep that may lead to fatigue, irritability and anxiety. Insomnia generally affects individuals who have trouble falling or staying asleep, and those who experience insomnia usually get less than six hours of restful sleep per night.
- Restless Legs Syndrome (RLS): An uncontrollable urge to move the legs or unpleasant sensation in the legs. RLS symptoms often increase in severity overnight and can make it difficult for a person to enjoy restful sleep.
There is a direct correlation between sleep and stress, too. Insufficient sleep typically affects a person’s mood, memory and judgment, along with his or her stress levels. Additionally, restless nights sometimes cause people to feel stressed about getting sufficient sleep – something that may lead to an ongoing cycle of poor sleep.There are many things that a migraine sufferer can do to develop a healthy sleep routine, such as:
- Follow consistent bed and wake-up times. Go to bed and wake up at the same time consistently.
- Create a comfortable sleep environment. Ensure a bedroom is quiet and free of bright lights, loud noises and other potential sleep distractions
- Relax, then go to sleep. Turn off electronic devices and read a book, meditate or practice relaxing activities before going to sleep.
For migraine sufferers, it is important to understand the relationship between sleep, stress and migraines. With the right treatment plan, a migraine sufferer can develop a healthy sleep routine. As a result, this individual may be better equipped than ever before to combat his or her migraine pain, along with any sleep- and stress-related issues.
Is It Possible to Treat Migraine Triggers?
There is no one-size-fits-all treatment to address the anatomical triggers of migraines. Following an initial migraine diagnosis from a doctor, individuals often receive preventative and pain-relieving medications to treat migraine pain. Preventative medications are designed to help individuals alleviate migraine pain over an extended period of time, while pain-relieving medications act quickly to treat migraine pain as it occurs.
Although migraine medications may be prescribed, these treatments sometimes fail to help patients achieve long-term migraine pain relief. In some instances, migraine medications are ineffective and do not help patients minimize migraine pain. Or, in other cases, migraine medications cause intolerable side effects like nausea, vomiting, dizziness and fatigue.
Dr. Cabin of The Migraine Institute treats the four anatomical triggers of migraines. He is happy to help individuals who have received a chronic migraine diagnosis and find that their current migraine medications are ineffective or cause unwanted side effects.
To treat the anatomical triggers of migraines, Dr. Cabin may recommend Botox® injections or minimally invasive surgery. Botox® is an FDA-approved treatment that can be administered across a migraine patient’s head and neck. It can be administered every two to four months and has been shown to help migraine patients prevent an average of eight to nine migraine days per month. Comparatively, migraine surgery is available to permanently remove the faulty nerve signals that causes migraines. Dr. Cabin uses advanced migraine decompression surgery techniques to address a patient’s migraine triggers. He also customizes each surgical procedure to help a patient achieve the best-possible results.
Dr. Cabin uses a comprehensive migraine consultation process to help a patient determine if Botox® or minimally invasive surgery is a viable option. He allocates significant time and resources to perform a patient assessment. That way, Dr. Cabin can help a patient find the best way to alleviate migraine pain both now and in the future.
How Are Anatomical Migraine Trigger Sites Diagnosed?
Dr. Cabin will perform comprehensive testing to determine whether a patient is a candidate for migraine decompression surgery, and which anatomical trigger sites to treat. However, he will complete a patient assessment only after an individual has received a chronic migraine diagnosis from a neurologist and finds that current medications are not working and/or cause intolerable side effects.
It may take several weeks or months to determine a patient’s anatomical migraine trigger sites. During this time, Dr. Cabin mayA may perform or prescribe one or more of the following tests to verify an anatomical migraine trigger site:
- Nerve block injection(s)
- Botox injection(s)
- Doppler ultrasound
- CT scan
- Nasal spray
- Examination by other specialists
What Are The Treatment Options For Anatomical Migraine Triggers?
Botox has been shown to help treat three of the anatomical migraine triggers. It works by relaxing the muscle around the nerves, and potentially acts on the nerves themselves. Botox is long-lasting but temporary, requiring repeat injections every two to four months. Unlike Botox injections elsewhere, Dr. Cabin uses the smallest needles available and, combined with his unique injection protocol, are nearly pain free.
Depending on the cause of nerve irritation, migraine surgery can be an excellent option in patients who may or may not have previously received Botox injections. Migraine surgery is a minimally invasive procedure that helps eliminate the faulty signals from the trigger nerves that can cause migraines. Migraine surgery is an outpatient procedure that typically lasts between one and five hours, depending on the number of trigger nerves requiring treatment. A patient can often return home the same day as surgery.
Prior to migraine surgery, Dr. Cabin will use an in-depth patient evaluation and anatomical migraine trigger point confirmation techniques to determine if an individual is an appropriate candidate for the procedure. He will then develop a customized surgical plan for the patient, which may include up to four trigger sites. After surgery, over 90% of patients notice a significant reduction in the frequency, duration and/or intensity of migraines, and nearly 50% find themselves migraine-free within a few months of treatment.
Migraine Triggers FAQs
What is a migraine trigger point?
A migraine trigger point is a place on a patient’s face, neck or scalp that is linked to the onset of migraine pain. Typically, a patient refers to a migraine trigger point as the “starting from” area associated with a migraine. A migraine trigger point sometimes causes tenderness when an individual puts pressure on it, too.
Does each migraine patient have a single migraine trigger point?
The answer to this question depends on the patient. Sometimes, patients have multiple trigger points. In these scenarios, different migraines occur at various migraine trigger points.
What are migraine trigger point injections?
A migraine trigger point injection involves the use of an injectable treatment to alleviate migraine pain. The injection may contain a local anesthetic or steroid medication and is intended to provide immediate migraine pain relief.
Typically, a migraine trigger point injection is performed at a doctor’s office. It does not usually require sedation and may be performed while a patient is sitting or lying down.
During a migraine trigger point injection procedure, a small needle is inserted into a patient’s skin. A doctor may use one or more injections during a single treatment session. He or she may also perform peripheral nerve blocks in conjunction with trigger point injections.
Is a migraine trigger point injection safe?
A migraine trigger point injection often blocks pain receptors around the nerves surrounding a migraine trigger point. As a result, it helps reduce pain signals sent to the brain.
However, there are side effects associated with migraine trigger point injections. Some patients experience numbness or bleeding at the injection site. Patients may also be susceptible to infection.
Can certain foods trigger migraines?
Certain foods have been shown to trigger migraines in some patients. These foods include:
- Aged Cheese: Cheddar, feta and other aged cheeses contain tyramine, a substance that has been linked to headaches.
- Alcohol: Beer, red wine and other alcoholic beverages increase blood flow to the brain. Some alcoholic beverages also contain sulfites that cause headaches.
- Food Additives: Hot dogs, ham and other foods may contain preservatives (additives) that dilate the blood vessels.
- Cold Foods: Consuming ice cream or drinking cold beverages too quickly may lead to headaches. In fact, recent research indicates approximately 90% of migraine sufferers are more sensitive than others to ice cream.
- Caffeine: Drinking excessive amounts of coffee, tea and other caffeinated beverages may cause headaches. Also, caffeine withdrawal has been linked to headaches.
Can the weather affect migraines?
Weather is not a migraine trigger for all migraine patients. But in some cases, migraine patients are prone to migraine attacks due to hot, humid conditions or changes in barometric pressure.
How does Dr. Cabin treat a patient’s migraine trigger points?
If an individual has received a chronic migraine diagnosis but finds his or her migraine medications are causing intolerable side effects or fail to deliver the ideal results, Dr. Cabin requests a consultation. At this time, Dr. Cabin performs a full assessment to help a patient identify his or her migraine trigger points.
What should I expect during a consultation with Dr. Cabin?
Prior to a consultation, Dr. Cabin requests information about a patient’s medical history, as well as a migraine log. He then conducts a physical assessment, learns about a patient and analyzes his or her migraine symptoms. Dr. Cabin may also request specialized tests as part of his patient evaluation.
After a patient evaluation, Dr. Cabin shares his findings with a patient. He allocates the necessary time and resources to provide a treatment recommendation and respond to any patient concerns or questions.
Dr. Cabin’s goal is to help a patient overcome his or her migraine symptoms both now and in the future. He works with each patient, and by doing so, ensures each patient receives a personalized migraine treatment plan. Plus, if a patient requires additional support during a migraine treatment, Dr. Cabin is available to provide support.
How can I find out if migraine surgery is right for me?
Dr. Cabin wants to provide each patient with a safe, effective migraine treatment. As such, he won’t recommend surgery for all migraine patients. To determine if a patient is a good candidate for migraine surgery, Dr. Cabin conducts an in-depth patient evaluation. Dr. Cabin may require several weeks or months to determine if a patient is a viable candidate for migraine surgery. With his extensive approach to patient evaluations, Dr. Cabin can help a patient determine if surgery or another treatment option is the best course of action to treat his or her migraine symptoms.
Is migraine surgery an effective way to treat migraine triggers?
Migraine surgery often helps patients reduce the severity, duration and frequency of migraine attacks. It may provide a viable alternative to migraine patients who failed to relieve their migraine pain with medications or Botox injections, too.
For chronic migraine patients who are considering surgery, meeting with Dr. Cabin offers a great starting point. Dr. Cabin learns about a migraine patient and performs a full evaluation. He then crafts a custom treatment plan based on a patient’s migraine triggers. If Dr. Cabin believes surgery provides a safe, effective way to address migraine pain, he will recommend surgery. Or, if a patient does not qualify for migraine surgery, Dr. Cabin is happy to provide alternative treatment options.
Schedule a Migraine Treatment Consultation with Dr. Cabin Today
Dr. Cabin is happy to help patients manage their migraine triggers, and ultimately, achieve long-term migraine pain relief. To schedule a consultation with Dr. Cabin, please contact us at 310.461.0303 or fill out our online form.