The EASE approach
Learning to cope with headache/migraine triggers: The EASE approach
Headache triggers refer to anything that can lead to or aggravate a headache/migraine, and include stress, anxiety, flicker, glare, noise, certain foods, hunger, weather conditions, too little sleep, and for females the menstrual cycle. Most headache sufferers can identify 4 to 9 triggers with 6 or 7 the most common numbers. The traditional advice given by medical practitioners and on the internet has been that the best way of preventing headaches is to avoid these triggers. Although this advice sounds logical, it has been criticised in recent years on the grounds that there is no evidence it works, it is virtually impossible to follow given how common triggers are, and attempts to avoid triggers or escape from triggers may lead to reduced tolerance for triggers or increased sensitivity (sensitisation). Evidence is now emerging that a better strategy may be a philosophy of ‘learning to cope with triggers’, whereby different triggers are managed in different ways. In some cases, avoidance may be the best approach but for other triggers the goal should be to desensitise or increase tolerance for the triggers which can be achieved by appropriate exposure strategies. Below are some general suggestions about trigger management followed by four specific strategies.
First, do not think that headache triggers are out there and hence headaches are inevitable for you. You should not approach life by trying to avoid all potential headache triggers which would result in a very restricted lifestyle. Headaches have a genetic component but are also a function of how you live your life (family relationships, work environment, recreational activities, etc). It is not easy to overcome a headache disorder but with effort it is possible for anyone to reduce her/his headaches to the occasional mild/moderate headache.
Second, a good starting point is to keep a record of your headaches and what you think may have triggered/aggravated them as this will help you to accurately identify the triggers. Remember that there are many different potential triggers and headaches may sometimes occur as a result of several triggers occurring at low levels of intensity (i.e., barely noticeable) around the same time so that the effect is additive. Time of the month rarely causes headaches on its own, but can increase vulnerability such that if any other trigger occurs even in a mild form a headache will eventuate.
Four strategies for managing headache triggers (EASE)
1. Experiment – some factors that you think are headache triggers may not be. If there is any doubt whether a trigger really can lead to headaches test whether it can by exposing yourself to a mild version of the trigger to see what happens. Foods are the best examples of factors that are often believed to trigger headaches when this is not the case. Do not ‘experiment’ in a way that sets you up for a severe headache.
2. Avoid – there are some triggers that are best avoided. These tend to be the triggers that not only precipitate headaches but are bad for your health/well-being. Good examples here would be toxic fumes, lack of sleep, extreme hunger, and dehydration. Avoidance may be the best strategy for triggers that are relatively rare and extreme.
3. Stress – stress is the most common trigger of headaches and generally avoiding ‘stressors’ is not the best way to manage stress mainly because it is impossible to avoid all stressors. The approach here should be to learn to cope with stress (stress management). There are a range of skills that can be learnt to help with stress such as relaxation and ‘positive thinking’. A good strategy can be inducing mild stress by imagining being in a stressful situation and then practising the coping skills.
4. Exposure – it is possible to reduce the capacity of some triggers to precipitate headaches by ‘graduated exposure’. That is, exposing yourself to a trigger whereby the intensity of the trigger and duration of exposure to the trigger are challenging but fall short of a level where it would precipitate a significant headache. This enables desensitisation to take place and the build-up of tolerance for the trigger. As tolerance develops you can expose yourself to more intense versions of the trigger or for longer periods. This approach can work well for emotional triggers such as stress, anxiety and anger, and environmental triggers such as flicker, glare, eyestrain, noise and high temperature.
Warning. If headache sufferers have any concerns about whether this approach is right for them they should consult their GP. If they want help implementing this approach they should ask their GP for a referral to a psychologist as this profession specialises in behavioural management.
Professor Paul R Martin
Head, School of Applied Psychology
Mt Gravatt Campus, Griffith University
176 Messines Ridge Road
Mt Gravatt, Queensland 4122, Australia
Adjunct Professor, School of Psychology and Psychiatry, Monash University
Head, CONQUER HEADACHES – The Headache and Migraine Program