What is the Migraine Bucket Theory?

Migraine is one of the most prevalent neurological disorders worldwide, affecting more than 1 billion people globally.  Migraine is commonly thought of as only a severe headache, but it goes well beyond that. 

Migraine can produce a diverse range of symptoms, from visual auras, to numbness and tingling in the face and body, to vertigo, to difficulty with word retrieval and memory.  If one experiences the whole cycle of a migraine, symptoms can fluctuate over the course of 6-7 days.  And for those with chronic migraine, in which symptoms are present 15 days per month for 3 or more months, the long migraine cycle can overlap with a new symptom onset, making it seem continuous. 

Because migraine can be present without head pain (that’s right, you do not need a headache to have migraine), they are often difficult to diagnose.  Once you have been diagnosed, learning about migraine triggers and thresholds can help improve the frequency, intensity and duration of your symptoms.  

The most common migraine triggers include:

• Irregular sleep schedules
• Stress
• MSG, Nitrates & Aspartame
• Alcohol
• Caffeine
• Hormones
• Changes in weather (barometric pressure)
• Foods (chocolate, cheese, nuts)
• Dehydration
• Bright/flashing/natural lights
• Smells
• Overuse of medication

We used to think there was a direct cause and effect relationship between migraine triggers and onset of symptoms.  For instance, if chocolate was a known trigger for you, it was thought that every time you ate chocolate, you would develop migraine.  That theory has evolved as we learn more about migraine.  Now, there is the Threshold (or “Bucket”) Theory.

What is the Threshold Theory?  The Threshold Theory says:

• Each person with migraine has a variety of triggers that cause symptoms
• Depending on the day, each trigger can affect you more or less than on previous days
• The triggers accumulate throughout hours, days or weeks
• The triggers add up, and eventually reach the person’s threshold, where their nervous system becomes triggered for migraine and a migraine cycle begins

What does the Threshold Theory mean for you in managing your migraine?

• There is likely not one thing that causes your migraine
• Some of the triggers are things that you can help control, others are outside of your control
• Learn strategies to minimize the effects of known triggers such as:
  • Sleep hygiene
  • Deep breathing
  • Dietary changes
  • Vestibular & neck exercises
• Even though some triggers are outside of your control (like the weather), knowing that it affects you can help you prepare more effectively for the days ahead
• Taking action to lessen exposure to known triggers within your control can help keep the accumulation of triggers below your threshold, minimizing migraine frequency

If you are living with migraine, work to find a good team of healthcare professionals that can help support you and your health.  If dysfunction with your neck or dizziness are part of your migraine symptoms and/or triggers, our Balance & Concussion Team is ready to help you.  Organizations such as the American Migraine Foundation can also help keep you up to date with the newest research and updates on migraine.