title: Analysis of Trigger Factors in Episodic Migraineurs Using a Smartphone Headache Diary Applications.
abstract: BACKGROUND
  Various stimuli can trigger migraines in susceptible individuals. We examined migraine trigger factors by using a smartphone headache diary application.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, the Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Jeong-Wook
authors.initials: JW
authors.lastname: Park
authors.affiliation: Department of Neurology, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Min Kyung
authors.initials: MK
authors.lastname: Chu
authors.affiliation: Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Jae-Moon
authors.initials: JM
authors.lastname: Kim
authors.affiliation: Department of Applied Statistics, Chung-Ang University, Seoul, Korea.
authors.forename: Sang-Gue
authors.initials: SG
authors.lastname: Park
authors.affiliation: Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Cho
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology* / Q000503:physiopathology*; D000068997:Smartphone