Understanding migraine triggers

Posted on: 14 November 2014 by 50connect editorial

Migraine episodes can be hugely debilitating but identifying them is not always easy as there are so many potential factors. Read our guide about understanding migraine triggers.

migraine causes

What are migraines?

According to the UK charity, Migraine Action, migraine is a condition of recurring headaches that may be linked with other symptoms such as sensitivity to light and noise, nausea, vomiting, dizziness and eyesight changes. The World Health association (WHO) classifies severe attacks as amongst the most debilitating illnesses, comparable to dementia, quadriplegia and active psychosis (2).

Who is more susceptible?

Research suggests that women are more likely to have a migraine attack than men, 18% of women and 8% of men (1) and are most common in people aged 25yrs to 35yrs, although some experience migraines in childhood, normally when in early to mid teens (3). Depression is also although thought to affect migraine sufferers; three times more common in headache and migraine sufferers compared with healthy individuals (4). How they are caused is not fully understood although temporary changes in chemicals and blood vessels in the brain are thought to play a key role.  As about half of all migraine sufferers have a close relative with the condition it is thought that genes may play a role.

What are the symptoms?

Sufferers usually experience one-sided, severe, throbbing or pulsating headache along with other symptoms and these can last from a few hours to several days. Migraine can occur in several ways, which include:

Migraine with aura: Around 10% of sufferers will experience a warning aura before the headache begins which may be a visual disturbance (partial loss of sight, complete loss of sight, flashing lights and colours), tingling on the side of the face or body or changes in sense of smell. Even if they do not get an aura, some sufferers will get a warning signal before a migraine develops that can include feeling the cold, food craving (many associated certain sweet foods as triggers when in fact the sweet craving is a warning signal of the migraine), mood changes, frequent yawning or a sudden burst of energy.

Migraine without aura: Here a migraine occurs without any warning signs.

Migraine aura without headache: This is often referred to as a silent migraine where the sufferer will experience aura or other warning signals but does not develop a headache.

Know your triggers

A trigger is defined as any event, change, external stimulus or physical act, which seems to result in a migraine. Triggers precede attacks by as much as 6-8 hours and identifying them is not always easy as there are so many potential factors. It is thought that certain triggers cause blood vessels in the brain to constrict and then relax which results in nerve endings to send out pain signals. These triggers can be classed in to several categories depending on the origin. 

Environmental

This includes bright lights, loud noises, strong odours, cigarette smoke, temperature changes, weather and altitudes.

Hormonal

Related to the menstrual cycle, this is experienced by women and is linked to changes in oestrogen. Oral contraceptives and oestrogen supplements can also have the same effect.  

Activity

A lack of exercise or no exercise whatsoever, motion sickness, too much or too little sleep and eyestrain can result in a migraine.

Emotional

Negative emotions such as anger, resentment, depression and fatigue can result in anxiety and stress, which can trigger a migraine. 

dietary triggers

Dietary

Of all the triggers these may be the simplest to try and control. Many foods, additives and other dietary components can result in migraines, however, these triggers can vary greatly between individuals 

Robert Hobson, Head of Healthspan Nutrition says, “You should first make sure that you remain properly hydrated (2 litres of fluid each day) and avoid skipping meals, as hunger and low blood sugar are common dietary causes of migraines. Try including plenty of complex carbohydrate foods to maintain steady blood glucose levels and keep you feeling centred.”

Trigger foods often include those that are rich in the amino acid tyramine as well as those that contain other chemicals and preservatives including monosodium glutamate (MSG), sulphates, nitrates and artificial sweeteners such as aspartame. Common foods include:

  • Aged cheeses such as brie, camembert and Swiss cheeses (opt instead for ricotta or cottage cheese)
  • Fermented foods such as pickles, soy sauce and miso
  • Chocolate and cocoa
  • Nuts, seeds, peanut butter and muesli bars are high tyramine
  • Drinks including those containing caffeine as well as certain beers and red wine
  • Offal or meats that have been processed or cured (often contain nitrates), bacon and sausages may also act as triggers as they contain low levels of tyramine (opt for fresh meat instead of processed).
  • Preserved foods that contain sulphates (look out for canned pulses) as well as wine and dried fruit
  • Take-away foods especially Chinese cuisine (MSG)
  • Seasonings and flavour enhancers including stock cubes, sweeteners and fish sauce
  • Canned fish including anchovies and sardines
  • Many fruits including avocados, bananas, citrus fruits, figs, grapes, passion fruits, pineapples, plums and raspberries

 

Preventative steps

Try to remove the common foods listed above; many of these foods will be eliminated by cooking from fresh and following a healthy balanced diet free of processed foods.  Other triggers can be identified by keeping a detailed symptom and trigger diary, which will help you to identify any foods and other factors that result in the onset of a migraine.

You will need to keep the diary for at least a month and include your daily routine and factors such as what you ate, your mood, weather, migraine symptoms and severity, menstrual cycle and medication. You may begin to see patterns emerge around the different factors.  If a specific food is suspected then try removing it to see if the frequency of attacks decreases.  If this is not the case then reintroduce the food and remove another suspect.

This may be simple if only one trigger is to blame but often it is a multitude of triggers that work together to encourage the onset of a migraine, which can make identification tricky.  Don’t feel deflated if you can’t identify any triggers as not everyone can. You can find more information and an online migraine diary at http://www.migraine.org.uk/information/factsheets/migraine-diary/ 

Make dietary changes - drink plenty of water, two liters a day and cut out sugary foods, limit or avoid caffeine and alcohol Stress is a key factor in trigging migraines and researchers from the Cleveland Clinic in the US found that between 8am and 10am on a Monday is a a key time when they strike.  Learn relaxation techniques, improve your posture and try and try and maintain a regular sleep pattern.

Adjust your working environment - avoid large reflective surfaces e.g. plain white walls and ensure your computer screen is properly adjusted with anti-glare filters and avoid any flashing lights.  Do also make sure where you work has good ventilation and ensure your working environment is as ergonomic as possible.

Regular exercise such as yoga and deep breathing could help release tension. 

vitamins & supplements

Vitamin and mineral supplementation

There has been some promising research into magnesium, Vitamin B12, and CoQ10.

Traditional herbal medicines such as FeverFew have been used for centuries and Healthspan's Feverfew Migraine Relief (THR) contains 100mg of Feverfew dry herb has been found to help.  A study by the Department of Medicine, University Hospital, Nottingham, assessed 72 migraine sufferers who received a daily capsule of the traditional herbal medicine feverfew  or a placebo over four months. Results found decreased incidences and severity of migraines, fewer vomiting attacks and visual disturbances in those participants taking feverfew.

For further information, advice and health try http://www.migraine.org.uk/

1. TJ Steiner, AI Scher , WF Stewart, K Kolodner, J Liberman, RB Lipton (2003). The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity. Cephalagia. September, vol 23 (7), 519-527

2. RE Shapiro and PJ Goadsby (2007). The long drought: The dearth of punlic health fundng for headache research. Cephalalgia. September.  Vol 27 (9), 991-994

3. PJ Goadsby, RB Lipton and MD Ferrari (2002). Migraine – current understanding and treatment. New England Journal of Medicine. January. Vol 346 (4), 257-270

4. WHO, Factsheet 277, March 2004 (http://www.who.int/mediacentre/factsheets/fs277/en/)

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