Sex differences in prevalence of migraine trigger factors: A cross-sectional study.

Aim: To examine the effect of sex on migraine trigger factors.

Methods: Prevalence of 11 frequently reported trigger factors was determined in a cross-sectional study among migraine patients from a validated migraine database (n = 5725 females and n = 1061 males). Female-to-male odds ratios were calculated for each trigger, using a logistic regression model with attack frequency and migraine subtype (with or without aura) as covariates. Additionally, the effect of sex on total number of triggers per individual was determined.

Results: The top three most reported triggers in women were menstruation (78%), stress (77%), and bright light (69%). Men reported stress (69%), bright light (63%), and sleep deprivation (60%) most frequently as provoking factors. The following triggers were more often reported by women than men: Bright light (odds ratio 1.29 [95% CI 1.12-1.48];  = 0.003), stress (1.47 [1.27-1.69];  < 0.001), skipping a meal (1.24 [1.09-1.42];  = 0.015), sleep deprivation (1.37 [1.20-1.57];  < 0.001), high altitudes (1.70 [1.40-2.09];  < 0.001), and weather changes (1.35 [1.18-1.55];  < 0.001). Women reported more triggers than men, even when menstruation was disregarded (mean ± SD: 4.6 ± 2.3 and 4.3 ± 2.3;  < 0.001). Women report migraine trigger factors to be provocative of their attacks more frequently than men, which may be related to a lower migraine threshold due to sex hormonal changes.