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Triggers of Migraine

If triggers can be identified, control of migraine is possible

Stimuli Can Provoke A Headache

Specific internal or external stimuli sometimes provoke a headache. They are called triggers and, if they can be identified, avoidance is a valuable control of migraine.

There are six general categories of these triggers, explained below:

Avoiding certain foods can be the best treatment for some people with migraine. Unfortunately, fewer than 30% of people with migraine have their symptoms triggered by food. To be considered a migraine trigger, the food must trigger your migraine-related symptom(s) within 24 hours of the time it’s consumed, and it must do that more than half the time that the food is eaten.

Keeping a symptom diary that includes what you are eating, menstrual cycle, activities and changes in environment or weather is a valuable tool for identifying food triggers. Spotting a pattern and then sidestepping triggers can help keep the pain at bay.

Intense or sudden exercise can initiate a headache in certain people with migraine, but, in general, routine, moderate exercise reduces the frequency of headaches. Blows to the head can also initiate a migraine headache, as well as post-concussion syndromes.

 

 

 

Hormone affects on migraineAlthough the hormone levels of an irregular menstrual cycle, pregnancy, ovarian cyst or hysterectomy cannot be controlled, Menses, ovulation (increased estrogen), pregnancy, hysterectomy, birth control pills and hormone replacement (progesterone) can sometimes suppress migraine symptoms. Unfortunately, some birth control pills with higher levels of estrogen and hormone replacement therapy can make migraines worse. Consequently an experience medical professional should be overseeing hormone therapy for the treatment of migraine.

Migraines may increase in the first trimester of pregnancy, but improve in the later trimesters. Treatment is usually limited to analgesics.

weather affects on migraineAlthough not well understood, weather conditions such as barometric pressure changes, seasonal changes and lightning have been associated with the onset of migraine attacks.

 

 

 

Bright or flickering lights, excessive or repetitive noises, odors, fragrances, tobacco smoke, high altitudes, and medications: decongestants, pain remedies containing caffeine.

Illness, intense or strenuous activity or exercise, jet lag, fasting, missing meals or abnormal sleep habits can generate stress. Any activities to reduce stress may be helpful.

 

 

 

 

Dietary Strategy Tips

Common Food Triggers

The following foods may trigger migraine headaches:

Alcohol –

Particularly fermented liquors: red wine and champagne (histamine, tyramine), coffee, tea, colas, chocolate (caffeine), carob, licorice

Tyramine –

An amino acid, found in red wine, aged cheese, smoked fish, chicken livers, figs, and some beans. Strong or aged cheese, especially cheddar (but not American, ricotta, cottage, Velveeta or cream cheese). Broad beans in pods: lima, fava, string, garbanzos, lentils, snow peas.

Nitrated –

Cured meats, including hot dogs, bacon, ham, salami, sausage, bologna, pepperoni. Fermented, smoked or pickled foods: pickles, pickled herring and other fish, olives, chicken liver and pate.

Monosodium Glutamate (MSG) –

A flavor enhancer found often in food from Chinese restaurants – Chinese food, soy sauce, meat tenderizers, seasoned salt, Accent.

Caffeine –

Coffee, chocolate, tea, cola drinks, carob and licorice. This is a controversial trigger.  Caffeine that can be a trigger in some migraineurs and a relief for others. See additional information on caffeine below.

Phenylalanine –

Containing foods and beverages. Nuts, including peanut butter, All seeds, Some fruits, like avocado, red plums, papayas and citrus, Dried fruits, such as raisin, dates, apricots, canned figs, Onions, Dairy products, eggs, Wheat, freshly baked yeast products, sourdough bread, All artificial sweeteners, including diet sodas (aspartame– NutraSweet), Mustard, ketchup, chili peppers and mayonnaise.

To remove all of these foods from your diet is not realistic. Instead, there are dietary approaches to consider.

Elimination Diet

If you think that any of these foods cause your migraines, try eliminating one or more of the items on this list from your diet for two weeks and then reintroducing them one at a time.

Tracking your food intake and symptoms

Keep a diary and when the number of symptoms increases after eating certain foods, you can assume that this food is a migraine trigger. This food item can then be avoided.

Testing for food allergies

Although one does not have to have an allergic reaction (a reaction from your immune system) to a food, a food allergy is another possible trigger. You may also want to consider food allergy testing to determine your specific sensitivities or triggers.

Minimizing processed foods or the most common food triggers

Shop primarily in the aisles on the perimeter of the grocery store. It is often the chemicals used to cure or preserve food that irritates the nervous system. Those aisles contain the fresh, less processed foods (fresh fruits, vegetables, meats, fish and breads).
Limit: tomatoes, onion, oranges, grapefruits, tangerines, lemons, limes, bananas, skim-milk yogurt (1/2 cup per day) and caffeinated drinks (16 ounces per day)

Caffeine

Caffeine is a commonly used drug that increases alertness, decreases fatigue, and improves muscle coordination. Caffeine also can act like a pain-reliever, comparable to acetaminophen. Caffeine helps the body absorb headache drugs more quickly, bringing faster relief. And it makes painkillers work better and lower doses of painkillers reduce the risk of their side effects and drug addiction. Migraineurs often report that a strong cup of coffee can stop some attacks.

While occasional caffeine use has beneficial effects, too much caffeine can be overly stimulating and cause anxiety, sleep problems, muscle twitching, or abdominal pain. Also frequent use reduces its positive effects. As drug tolerance develops, people tend to want to consume more caffeine. And, with time, our brains become dependent on this drug. When it is not delivered, a nasty withdrawal headache (“rebound headache”), fatigue, loss of concentration and nausea occur. Caffeine dependency can occur after as little as 7 days of exposure. 100 mg per day can avoid withdrawal symptoms.

The effect of caffeine varies between people because of genetics. Scientists do not know whether the inherited tendency to experience caffeine withdrawal syndrome relates to the genetic factors that cause migraine. However, chronic daily headache patients are much more likely to use daily dietary caffeine and/or prefer caffeine-containing headache medications. Moreover, people who occasionally experience migraine attacks are at a higher risk of developing chronic daily headaches when they also consume caffeine daily too. This association is particularly notable for young women – a group already at greater risk for migraine.

Caffeine is naturally found in coffee, tea and chocolate and added to soft drinks. A standard 8-ounce cup of coffee contains between 125-250 mg of caffeine. A 12-ounce can of Coca Cola contains 34 mg. According to a US Department of Agriculture rule, 97.5 % of caffeine must be removed from coffee in order for it to be called decaffeinated. Caffeine is also a common ingredient in many prescription and over-the-counter headache medications, such as Excedrin Migraine, Anacin, Midol, Darvon Compound, Fioricet, and Migranal. Unfortunately, caffeine tolerance can develop.

Recommend that caffeine should not be used to control your headache more than 2 days a week. The elimination or reduction of caffeine from one’s diet must be performed gradually over days, even weeks. Other overused painkillers must also be removed and this is a good time to add a less harmful preventive measure.

Gluten-free diet

Migraine sufferers have a higher risk of having celiac disease that the general population. Some migraineurs on a gluten-free diet have experienced a significant reduction in symptoms, but this approach does not work for all sufferers.

Weight loss

There has been a 2011 study involved 24 participants who were severely obese and migraines (88% middle-aged women) underwent laparoscopic gastric banding surgery or Roux-en-Y gastric bypass. On average they dropped their BMI from 46.6 to 34.6 (26% of body weight). After surgery 50% experienced 50% fewer bouts of migraine, but also less severe and disabling ones when they did come. Before surgery 50% of participants reported that they required medical treatment but this dropped to 12.5% six months after surgery.

(Bond DS, Vithiananthan S, Nash JM, et al. Improvement of migraine headaches in severely obese patients after bariatric surgery. Neurology. 2011;76 (13): 1135-1138.)

It is not yet confirmed if other methods of weight loss would have the same effect.

The Sensitive Brain and Migraine Triggers

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