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Comment by jlebrech | Hacker News Reader

you could also just avoid your migraine trigger, I have and get around 3 migraines a year max rather than having one every month or 2 or 3 a week as a teen.

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> you could also just avoid your migraine trigger

Jerry Weinberg, who died yesterday, used to say that every time you hear the j-word ("just") you should replace it with "have trouble", i.e. "you could also have trouble avoiding your migraine trigger". He was talking about software projects, but the rule is general. The j-word usually indicates that difficulty is being glossed over.

Anecdotally, over the years I've tried identifying my triggers by keeping logs of food, drink, sleep, stress, travel, etc, and correlating the data. After all that, I've identified a few specific foods, but even those were unreliable triggers, and avoiding them didn't cause a significant decrease overall. Medication gave me my life back.

You state that as if it's simple and anyone can do it.

What if something common like changes in atmospheric pressure trigger it? What if you have multiple common triggers? What if you don't know all your triggers?

Just keep a food log, mood log, sleep log, stress log, barometric pressure log, air quality log, oxygen level log, altitude log, brightness log, screen-time log, eye strain log, face-shoulder-neck tension log, spine pain log, head trauma log, and a blood pressure log.

Then you can hook up all the data into a recurrent neural network that finds the patterns in the data and lets you know what combination of conditions will give you migraines.

It's really easy to find all your migraine triggers if you follow these very basic steps.

Should also probably log stool weight/color, mineral/vitamin intake across all foods, etc etc - just to make it even more clear that a person has no time to “just log everything” that could possibly play a role. And at the end, it would probably not explain a majority of the headaches - at least in my experience.

> it would probably not explain a majority of the headaches - at least in my experience

This is my experience too. I know a good number of my migraine triggers, but some days I do everything right: I eat good food (regularly), plenty of sleep, no over-exertion, lots of water, breaks from screen time, no eye strain, etc etc...still get a fucking migraine!

Sometimes there's just not a reason for it.

Yep and that list of things you did correct could go on for pages. It’s similar for how I treat my headaches. I don’t just take a triptan. I do the yoga stretch, maybe a cup of tea (full cup of coffee if I’m in 9/10 zone), some Gatorade, ginger powder, tumeric powder, heat on the traps, TENS unit on the traps/neck/temples, ice, etc and nothing. I’ve even fallen asleep while doing half of those in the crocodile position before. It worked that time, too.

You should also do weekly MRI's just to see if there's anything neurologically you might be able to notice/track.

Also, might be helpful to just download your consciousness into a synthetic brain

I was under the impression that identifying the trigger can be quite difficult, to the point where some folks who suffer from Chronic migraines can spend years trying to figure out the combination of factors that act as the trigger?

With the variety of triggers that are possible and the possibility of there being multiple triggers with complex interactions, that is much easier said than done for many. After keeping meticulous logs of anything that might be a trigger, I've managed to reduce my migraines to 1 a month from 3-4 per weeks over a period of about 4 years, eventually identifying 7 or 8 causes. Even then, when I do get one, which combination of pain drugs to take is a huge gamble. CBD oil seems to be the only thing that always works, but that's unfeasible for me. So I'm not going to complain about a new drug for it.

Well, most migraine triggers are basically oxidative stress (https://onlinelibrary.wiley.com/doi/abs/10.1111/head.12725), and it is impossible to avoid oxidative stress since even simply burning glucose contributes to it.

Interesting. Perhaps this explains why people on ketosis with very low sugar report fewer migraines.

I found high-sugar foods to be one of my many triggers. Never really understood why...

There may be two effects going in parallel, but: for chronic migraine sufferers reducing blood pressure can be effective in reducing attack frequency, and ketogenic (and other very low carb diets), can reduce blood pressure frequently. Blood pressure being a big factor in the effects of vasodilation.

Honestly, I've long dismissed the claimed benefits of ketogenic diets like 'reduced inflamation' as... minor and uninteresting. A few weeks into a low-carb diet for my migraines and my sedentary butt is suddenly running and with my untrained knees never having felt better. I would not be shocked if there were other beneficial effects of ketosis on migraines.

Not all migraines have triggers. This drug in particular is for chronic migraines, and while the definition of chronic is 15 days or more, the people who will qualify for this drug (and who it was really designed for) are the people who have them 24 hours a day, 7 days a week non-stop. So living is their trigger. Nice advice.

Hard to do when sometimes migraine triggers can be changes in the weather.

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