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www.aeirc-edu.com                                                                                                                                                                               Volume 1- 2014  

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©Advance Education Institute & Research Centre-2014                                                                                             

EXAGGERATING AND RETRAINING FACTORS LEADING TO MIGRAINE 

INCIDENCE IN PAKISTAN 

Sadaf Ahmed, 1 Shamoon Noushad, 1, Rida Nasir,1 Huma Khalid,1  & Shaikh Mohammad Tahir 1 

1. Psychophysiology Research Division, Advance Educational Institute & Research Centre 

2. Neurovascular Physiology & Biophysics Unit, Department of Physiology, University of Karachi 

Corresponding author: sadaf@aeirc-edu.com 

ABSTRACT Migraine is a neurological disorder with primary episodes of headache pain affecting populations worldwide. Almost people of all 

ages and family history are able to develop this pattern of throbbing and unilateral pain with visual disturbance to physical sensations. The key 

triggers that are most likely to initiate this headache includes psychosocial, economical, environmental or physical stress, hormonal disturbances, 

dietary variations, high sensitivity to light, smell and sounds.185 subjects both male and females of different ages from 16-60 years were 

interviewed to investigate the key triggering reasons for migraine attacks. Meanwhile they were also inquired by any restraining factors that help 

them to get instant or long-lasting relief. Evaluation was done on the basis of ICHD-II criteria. Moreover the family history, socio-economic 

status and demographic data were also noted.  Our results gave a clear view that emotional and mental stress was the key trigger that can 

exaggerate the feeling of headache with physical strain as the other main burden. Secondly exposure to immense sunlight and bright lights was 

frequently reported. Other minor initiators observed were lack of sleep, dietary changes, skipped meals, menstruation, and particular smells like 

fragrance or unpleasant odors. While excessive sleep and medications were noted as chief controls this can restrain headache pain incidence. In 

this study, emotional stresses were significant in female. Psychological stress is reported to be a major contributor to headaches. The attacks may 

be relief by proper medication and sleep. Stress and sunlight trigger migraine head pain in majority that can be cure by proper medicine and sleep. 

KEYWORDS Migraine, triggers, exaggerating, stress, headache  

 

INTRODUCTION:  

Migraine is the primary episodes of headache/neurological pain. It 

is followed by unilateral pain and throbbing and in many cases it 

may be severe. It can occur in the normal functioning brain, 

causing it to act abnormally (Goadsby, 2002; May, 1999; Ayata, 

2006). Recent studies throughout the world (Africa, Asia, 

Australia, Europe, North America, Central and South America) 

showed an average rate prevalence of migraine while western 

world showed higher than the Japanese population. 4 According to 

world health organization’s estimation, 303 million people suffered 

migraines worldwide and every day at least 20 million attacks of 

migraine happen (WHO, 2006). Headache is ranked at fifth 

position in most disabling condition for women globally (Samaan, 

2010). Rate of migraine is more prevalent in females than in males 

(Goadsby, 2002; Hauser, 2012 & Martelletti, 2005). In adulthood, 

the likelihood of women suffering from migraine is three times 

more than men. In childhood, boys are affected more than girls, but 

after adolescence, when estrogen influence begins in young girls, 

the risk of migraine and its severity rises in females. Some scientist 

have suggested that gonadal steroid may be the reason for 

headache or migraine as changes occur in estrogen levels at 

menarche, menstrual period, pregnancy, and menopause (Goadsby, 

2002; Dzugan, 2004). Female sex hormones can control majority 

mediators and receptor systems; these actions may be preserving at 

the central nervous system and peripheral, neurovascular level. For 

illustration, women sex hormone have been revealed to enhance:  

(i) neuronal excitability by increased Ca2+ and decreasing Mg2+ 

concentrations, an action that may occur with other mechanisms 

triggering migraine; Researchers have demonstrated that increase 

in estrogen leads a decrease in ionized magnesium but when 

progesterone levels rise, ionized magnesium levels also rise.  

(ii) The synthesis and release of nitric oxide (NO) and 

neuropeptides, such as calcitonin gene-related peptide CGRP, a 

mechanism that reinforces vasodilatation and activates trigeminal 

sensory afferents with stimulation of pain centers.  

 

 

 

(iii) The function of receptors mediating vasodilatation, while the 

responses of receptors inducing vasoconstriction are weakened 

(Gupta, 2007 & Dzugan, 2006).  

The migraine attacks may start at any age; the effect increases 

more in early to mid-adolescence (Goadsby, 2002). Unfortunately 

it is also very common in children although there are various 

theories as to the potential cause(s) of migraine, one of them is the 

genetic factors (Lin, 2005; Anjum, 2012; Haan, 1997). Diverse 

numbers of factors were reported that can initiate headache in 

particular individuals while they are not universal as they vary 

from person to person. The major triggering factors include food, 

missed meals, alcohol, menstrual periods, environmental condition, 

stress and hormonal factors (WHO, 2006; Zagami, 2006; Sauro, 

2009 ;Bokhari,2009 & Sauro, 2009). Psychological and emotional 

stressors include moods like depression, anger; anxiety, reported a 

common initiative factor in migraine patients (Anjum, 2012). The 

aim of this study was to evaluate the most common factors in our 

population that trigger migraine we also targeted the factors that 

can contribute to the cure and reduction of migraine in our people. 

 

METHOD: 

185 subjects, including both male and females, ages ranging 

between 16-60 years were interviewed in order to investigate the 

major triggering factors that stimulates migraine attacks and 

restraining factors that help them to get rid of headache and 

provide long-lasting relief. The inclusion and exclusion criteria 

was based on sensation of pain in the head, people who reported 

the pain sensation were studied on the basis of the intensity of pain 

and other factors like duration, causes, feeling, impact, side of head 

where pain feels the most, family history etc. socio-economic 

status and demographic data were also collected. The data was 

collected before and during examination while evaluation was 

done on the basis of ICHD-II criteria. 

 

 

 



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©Advance Education Institute & Research Centre-2014                                                                                             

RESULTS: 

Table 1: Most common exaggerating factors for both headache 

and migraine 

RELIEVING  FACTORS PERCENTAGE OF 

RESPONDENTS 

Sleeping 38.38 

Rest 28.64 

Eating 14.59 

Spinal Adjustment 2.16 

Improving posture 5.40 

Dark quiet room 29.73 

Medication 36.76 

Nothing Helps 10.27 

Drinking coffee 27.57 

Muscle Massage 12.43 

Cold Pack 3.24 

Other 2.2 

Table 2: Most common relieving factors for both headache and 

migraine. 

The most common exaggerating factors were emotional stress, 

bright light, and period after emotional stress. The most common 
factors that relieve migraine were: sleeping, medication, dark 

room, rest and drinking coffee. 

DISCUSSION: 

Diverse number of precipitating factors that initiate headache and 

migraine included in this study were also examined by different 

authors (WHO, 2006; Anjum, 2012; Sauro, 2009). The current 

study focused on finding the most common migraine exaggerating 
factors and relieving factors among headache and migraine 

sufferers. The major triggers of headache pain in both categories 

are shown in Table 1, emotional stress, evening time, bright light 
and hunger are the most common triggers. Stress and bright light 

are the most common triggers. Studies indicate that stress is the 

major factor in migraine (Fakhsheena, 2012; Sauro, 2009 & 
Bokhari, 2008). Rasmussen and Robbins L et al. reported in their 

studies that most recurrent factor of migraine and headache was 

stress and mental tension. Stress/anxiety as activated the central 
mechanism of the ascending reticular pathway (1994; Spierings, 

1997). Here we have seen that evening time was also a major 

factor that plays a role in initiating migraine. It was mentioned in 
previous study that finds out the time onset of migraine and 

indicates a same factor trigger head pain with a low rate (Sauro, 

2009). While on another study showed Hassles in the afternoon led 
to migraine headache that similar to evening or during the night. 

(Friedman,2009 & Soleimanpour, 2012). Martins and Prarreira 

identified six exercises tried by the people, most commonly the 

migraineurs to improve the head pain during and attack. It is a 

common observation, by clinicians involved in the headache field 

that many patients use some natural exercises, of their own that 
improve their pain. In one of the study that recognize the relieving 

factors they also observed that sleeping, rest were very useful 

practice attempt by both groups. 

 

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INITIATING FACTORS PERCENTAGE OF 

RESPONDENTS 

Morning 7.56 

Evening 37.30 

Afternoon 15.13 

During Sleep 14.59 

Beginning of week 4.32 

Middle of week 8.65 

End of week 8.65 

Bright light 33.51 

During or After having sex 0.54 

Period after emotional stress 37.84 

After emotional stress 23.24 

During physical exertion 10.81 

After not eating several hours 27.57 

After napping or over sleep 17.84 

After drinking alcohol 0.54 

Before Menstrual cycle 7.57 

During Menstrual cycle 5.40 

After Menstrual cycle 1.08 

After bending your head 

downwards 

17.84 

No Pattern 11.35 



ORIGINAL ARTICLE  
www.aeirc-edu.com                                                                                                                                                                               Volume 1- 2014  

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©Advance Education Institute & Research Centre-2014                                                                                             

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