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.
Although 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.
Although 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:
Particularly fermented liquors: red wine and champagne (histamine, tyramine), coffee, tea, colas, chocolate (caffeine), carob, licorice
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.
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.
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.
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.
Tracking your food intake and symptoms
Testing for food allergies
Minimizing processed foods or the most common food triggers
Limit: tomatoes, onion, oranges, grapefruits, tangerines, lemons, limes, bananas, skim-milk yogurt (1/2 cup per day) and caffeinated drinks (16 ounces per day)
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.
(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.