Migraine Triggers: it’s about more than food

hlmtii-bodyIt seems that every other week I am introduced to a new website, book, or pamphlet that professes to be able to cure migraine through diet. The research however says otherwise. In fact food triggers are only one cause of migraine, and focusing on the food alone can lead to added stress and focus on migraine, as well as not tracking all the other, and usually more important triggers  including:

  • Stress, as well as coming down from stress
  • A poor sleep schedule
  • Skipping meals
  • Barometric pressure as well as other environmental changes
  • Strong smells, especially certain perfumes and cleaning products
  • Dehydration
  • Bright Light and Computer Screens
  • Hormone Changes (especially for women)

The best evidence suggests that controlling migraine through lifestyle changes means taking everything in moderation1, and having as regulated a schedule as possible. When changes need to occur it is often possible to compensate by paying careful attention to other potential triggers such as dehydration and stress reduction.

The Migraine Threshold Theory

There is also evidence supporting that migraine triggers work on a threshold2. Essentially it is exposure to multiple triggers that lead to migraine attacks. So for example if you’re tired, on your period, having a stressful day, and there’s a thunderstorm you are likely to get a migraine. However, some of these triggers on their own may not cause a migraine.

Also individual migraineurs have different thresholds for different triggers. There are certain foods I cannot have, even if everything else with me is perfect and trigger free, a single sip of wine will cause a roaring migraine headache for me within 30 minutes. Yet, other triggers like caffeine only bother me if other things are added in like being tired, stressed, and dehydrated.

The idea of reducing triggers is to reduce the threshold for migraine. The reason why neurologists emphasize making lifestyle changes as a means of managing chronic migraine is to help the migraineur compensate for triggers that are outside of their control. We can’t control the weather, we can’t control being trapped in an elevator with someone with stinky perfume, and we can’t control our hormones (at least not without medical intervention).

The goal of making lifestyle changes is to find your migraine triggers, not just the food ones, and figure out your own threshold for migraines. For instance: if hormone changes are a trigger taking extra care during key times during the menstrual cycle may be able to reduce those attacks.

Articles on the Cause of Migraine and Migraine Threshold:

The Role Food Actually Plays

We’ve actually known a lot of the foods that can trigger migraines since the early 80s. The actual list of potential food triggers is pretty short, and each migraineur’s individual list of food triggers is usually even shorter. These are some of the biggies:

  • Alcohol, specifically red wine
  • Aspartame sweetener
  • Beans and other tyramine-containing foods
  • Caffeine (often found in foods, beverages, and medicines)
  • Cheeses and yogurt (mainly aged cheeses) (tyramine)
  • MSG
  • Chocolate
  • Processed meats (containing sulfites-eg, bacon, sausages, salami, ham, hotdogs) (tyramine and nitrates)
  • Vitamins and herbal supplements (some contain caffeine or active ingredients that can make headaches worse)

However, even this list is controversial, there is actually little empirical evidence to support most of these foods as being migraine triggers. Even MSG has poor clinical findings6 as a migraine trigger. And there is even a study showing that chocolate7 is not a migraine trigger. Tannins and Tyramine8 also have shaky clinical evidence.

Therefore the best evidence we have is that while there are some common threads that connect food triggers and migraines, what is a food trigger for a migraineur is very individualized. Also, long term restricted diets are actually contraindicated for migraine9.

Caution—do NOT restrict all possible trigger foods from your diet for an extended period of time. This is not likely to be helpful, and too much concern about avoiding foods may be another stress, as well as decrease your enjoyment of mealtime.

Contraversies in Headache Medicine: Migraine Prevention Diets (ACHE.net)9

Instead it is important to take a balanced approach to identifying food triggers, including keeping a comprehensive migraine diary. Often food is misappropriated as being a primary trigger for migraine when stress, hormone cycles, and other factors may have played a bigger role or were actually the only culprit.

Keeping a headache diary and following your lifestyle factors along with diet may help you identify patterns to your headache. Onset of menstrual cycles, work stress, sleep routine changes, and fasting may all be confounding what is thought to be a food trigger for headache. In a systematic and careful way, you can test these triggers one by one to see if any of them are a trigger for you. Soon you will learn that some of the foods you were concerned about are not triggers for you headaches and you can resume your normal diet and start enjoying your foods again. OR you can simply eat wholesome, fresh foods as unprocessed as possible in small amounts throughout the day.

Contraversies in Headache Medicine: Migraine Prevention Diets (ACHE.net)9

References and Resources for Migraine and Diet:

On Caffeine: Prior to the mainstream availability of Triptans as a migraine abortive in the late 1990s, Caffeine was actually a primary ingredient in a lot of migraine abortive treatments. Since there are now newer and better abortive options out there Caffeine is getting demonized a bit.

Caffeine is a complicated migraine trigger, it is believed to trigger migraines more through vasoconstriction and potentially dehydration versus directly triggering a migraine event. Caffeine’s vasoconstrictive properties11 is actually a part of why it was used as an abortive12 for so long. Note: Vasoconstriction is no longer considered to be the cause of migraine, and doesn’t necessarily occur during a migraine.

Caffeine for most is a threshold trigger, overuse of caffeine tends to be what leads to migraine. For those who don’t normally consume caffeine that threshold may be lower. Others still may have a very low migraine threshold with caffeine and need to avoid it all together.

References and Resources on Caffeine:

Stress and Migraine

Stress is both a behavioral and physiological trigger for migraine. When we experience stress it changes the chemical makeup of the body, and all of that starts in the brain. So incorporating relaxation techniques into the daily routine and performing them prior to the body going into a full stress response can potentially prevent migraine.

Stress can also trigger migraine when it is dissipating from the body, as once again the brain is changing and the physiological responses of the body are changing. Migraine brains tend to do very poorly with fast changes, which is why stress management is so important.

There are also indications that abuse and PTSD can lead to the development of migraine. Which on a neurophysiological level makes perfect sense as abuse and PTSD cause long term changes in the brain and lower the threshold for the body’s stress response.

References and Resources for Stress and Migraine:

Mindfulness and Other Stress Reduction Techniques

Mindfulness practices don’t just reduce pain during a migraine attack, but can also help halt the stress response and lower the migraine threshold. Mindfulness helps improve mind and body awareness and also promotes relaxation. The science behind mindfulness, stress and migraine is pretty overwhelming. This is why Mindfulness is such a focus on this site.

References and Resources for Mindfulness, Stress and Migraine:

Sleep, Dehydration, and Skipping Meals

These three things really boil down to one. They are interruptions in daily routines that cause stress on the body. Migraineurs are thought to potentially be more sensitive to changes in the body.

So eating regularly, having a healthy sleep schedule, and staying hydrated can be critical in lowering the migraine threshold. Perfection however, isn’t required. It is all dependent on what other potential triggers are introduced.

References and Resources on Sleep, Dehydration, and Skipping Meals:

The Less Controllable Triggers: Hormones and Weather

On Hormones: There has been fairly conclusive research that changes in hormones, especially in women, can cause migraine. The most common type of hormone triggered migraine is menstrual migraine. There are some prophylactic treatment measures that can be taken if this appears to be a trigger for you.

References and Resources:

On Weather: There is also a fair amount of research suggesting that weather and climate changes (like altitude) can trigger migraine. This includes changes in humidity, barometric pressure changes, storms, dry conditions, and dust.

An important component of any headache diary is what is going on outside. For many the weather is one of the biggest triggers.

References and Resources:

What Does it All Mean?

We have more research back up that poor sleep hygiene, blood sugar changes, hormones, stress, dehydration and weather than we have for food triggers. A proper diet is still important to treating migraine, and food triggers do play a role for a lot of migraineurs, and while there are trends in food triggers in the end they are quite individualized.

A balanced healthy life really is the key to managing migraine naturally. However, what that looks like will vary from person to person. The key to migraine prevention is knowing your migraines and your body. Migraines cannot be healed or cured, but they can be managed once we understand our own headaches, bodies, and triggers.

Hopefully this article provides some keys and resources on developing good self observation and a balanced approach to managing migraine triggers.

An Important Note: Migraine is a complex neurological condition and while lifestyle changes often play an important role in treating migraine, they alone are not always enough. Many people with chronic migraine may require one or more preventative treatments such as medication or Botox. The goal of most neurologists, and what the research suggests, is that a combined approach of lifestyle changes and medication provide the best chance for improving chronic migraine, intractable migraine, and status migraine.

References and Resources:

Managing Migraine Triggers:

Cause of Migraine and Migraine Threshold:

Caffeine and Migraine:

Other Potential Food Triggers:

Stress and Migraine:

Mindfulness, Stress and Migraine:

Sleep, Dehydration, and Skipping Meals:

Hormones and Migraine:

Weather and Migraine:

Links

One Comment

  1. Wendy

    July 25, 2016

    I know I’m very late in commenting on this, but I wanted to tell you that again, you have such great information. Thank you.

    I was thinking. You mentioned PTSD and abuse as being a trigger for migraines, I’m wondering if it can be a trigger that starts a chronic daily headache. (I think they call them New Persistent Daily Headaches now). Often you can remember the exact date that headache starts and it doesn’t go away. I have one. My neurologist believes if we could get that one under control, even a few days without a headache, then we would be able to manage my migraines better.
    But when I read what you said, I’m thinking as I work through things with my therapist if the daily headache might get better. Well that would be an unexpected benefit to therapy. 🙂
    Wendy recently posted…Mindfulness Monday 8My Profile

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