Migraine Triggers
A wide range of events and conditions can alter conditions in the brain that bring on nerve excitation and trigger migraines. They include, but are not limited to the following:
- Emotional stress (although the headaches often erupt after the stress has eased).
- One study suggested that some migraine headaches might be precipitated by a sudden drop in blood pressure (hypotension). (Conversely, some cases have suggested that migraine may cause hypotension.)
- Intense physical exertion (such as after lifting, athletic endeavor, and even bowel movements or sexual activity).
- Abrupt weather changes (such as Chinook winds).
- Bright or flickering lights.
- High altitude.
- Travel motion.
- Changes in sleep patterns.
- Low blood sugar has been known to trigger headaches and fasting can often precipitate migraines.
- Chemicals found in certain foods may trigger headaches in some people. More than 100 foods have the capacity to trigger migraine headache.
What are the dietary measures for preventing migraine headaches?
- Avoiding Food Triggers. Avoiding foods that trigger migraine is important in people who are susceptible to these triggers. Keeping a headache diary that includes tracking diet and headache onset can help identify them.
- Healthy Diet. One study indicates that a diet low in fat and high in complex carbohydrates may significantly reduce the frequency, severity, and duration of migraine headaches. Such a diet is healthy in general in any case.
- Eating Regularly. Eating regularly is important to prevent low blood sugar. People with migraines who fast periodically for religious reasons might consider taking preventive medications.
- Fish Oil. Some studies suggest that omega-3 fatty acids, which are found in fish oil, have anti-inflammatory and nerve protecting actions. These fatty acids can be found in oil fish, such as salmon, mackerel, or sardine. They can also be obtained in supplements of specific omega-3 compounds (DHA-EPA).
- Smelling Pleasurable Foods. One interesting study suggested that smelling certain pleasurable foods may reduce migraine pain. (The study used green apples as part of the experiment; patients with headaches who liked the smell of green apples had less pain. The scent had no effect on those who didn't like the fruit.)
Foods That May Trigger Migraines
| Foods and Additives | Responsible Chemical |
|---|---|
| Beers, wines, certain liquors, cheese and cheese-food products, fresh and processed meat (e.g., hotdogs, seafood products, peas, pickles, olives, and sauerkraut). | Tyramine and phenylethylamine. (These chemicals tend to become more potent in foods that are stored improperly.) |
| Apple juice, coffee, red wine, and tea. | Tannin. Caffeine withdrawal (coffee, tea). |
| Preservatives in wines, dried fruits, and other products. | Sulfites. |
| A common seasoning, most notably found in food prepared by Chinese restaurants but also contained in many commercial products. | Monosodium glutamate. |
| Chocolate. | Amines. Of note: some research suggests that chocolate may not trigger headaches. Instead, a craving for sweets often precedes a headache and so each chocolate may be perceived as a trigger. |
| Artificial sweeteners. | Aspartame. |
Headache Diary to Identify Triggers
The patient should try to recall what seems to bring on the headache and anything that relieves it. Keeping a headache diary is a useful way to identify triggers that bring on headaches. Some tips include the following:
- Include all conditions, including any foods eaten, preceding an attack. Often two or more triggers interact to produce a headache. For example, a combination of weather changes and fatigue can make headaches more likely than the presence of just one of these events.
- Keep a migraine record for at least three menstrual cycles. In women this can help to confirm or refute a diagnosis of menstrual migraine.
- Track medications. This is important for identifying possible rebound headache or transformed migraine.
- Attempt to define the intensity of the headache using a number system, such as the following:
- = mild, barely noticeable.
- = noticeable, but does not interfere with work/activities.
- = distracts from work/activities.
- = makes work/activities very difficult.
- = incapacitating.
