Relationships between precipitating factors in the pathogenesis of migraine were studied in a sample of 217 migraineurs. The most frequently cited triggers were the menstrual cycle (51.5% of the women), alcoholic beverages (51.6%) and emotional or psychic stress (48.8%). Analysis of 4 subgroups of patients, i.e. those with only one of these 3 triggers or with none of these (controls), showed that alcohol-susceptible patients reported significantly (p<0.001) more alimentary triggers than the controls. A similar phenomenon was found in patients with menstrual-cycle related migraine, but in this group the difference with the controls fell short of reaching statistical significance. A further analysis showed that menstrual migraine attacks are more frequently preceded by depressive symptoms than other migraine attacks.
It is suggested that the gut of certain migraineurs may be unduly permeable, either intrinsically or extrinsically (e.g. under the influence of alcohol). In addition, in some patients with menstrual migraine, a depressive episode, associated with the menstrual period, may facilitate the development of a migraine attack.