Migraine triggers Triggers Front page

Migraine may be triggered by one or more external factors. Some patients may get all their attacks from only one trigger, while others may react to several triggers. With a bit of knowledge and understanding it may be possible to avoid some of the triggers, and thus some of the attacks. When it is impossible to avoid the triggers, medicine is a fine way to control the pains. Stress Stress is the trigger that most migraine patients mention when they are asked what they believe is the cause of their attacks. We are all stressed in one way or another, and it is always easy to find some stressful situation at the time the migraine was probably triggered. But there are only a few biochemical analyses that have shown that stress elicits migraine, and even fewer controlled comparisons have been made where migraine patients have been exposed to stress and the effect on their migraine has been recorded. The conclusions seem to indicate that nerve endings may release small amounts of the chemical nitric oxide (NO) under severe stress (like pain or hard work) and NO is a well-known migraine trigger in experiments. Weather and climate Everybody talks about the weather, and nobody does anything about it. Just as we are all exposed to stress, we are all exposed to the weather. The weather changes so much that it is always possible to find some correlation between weather factors and a migraine attack. But when it comes to properly analyzed research results, it is difficult to document a correlation between weather changes, such as changes in air pressure or temperature, and migraine. Cold Cold is often mentioned as a migraine trigger. In particular cold around the head may trigger migraine. Luckily we can handle this one ourselves with a smart hat or a scarf. Food and drink Some food items are often listed as migraine triggers. The most well-documented triggers are chocolate, wine, cheese and alcohol. Monosodium glutamate and caffeine are also mentioned. Many scientific studies have demonstrated that chemical compounds from the group known as monoamines can trigger migraine. Two monoamines are particularly well-documented for this: tyramine and phenylethylamine. Tyramine is present in almost all fermented or matured products. These are cheese, yoghurt, soy sauce, tofu, alcoholic drinks and many more items that may have been left for an extended time in a warm environment where bacteria are present. Phenylethylamine is particularly found in chocolate, wine (more in red than in white) and citrus concentrate. Monosodium glutamate is used in oriental cooking and many prepared dinners etc. Caffeine we meet when we drink coffee, tea and cola. It can be difficult to prove to yourself and to others that your migraine attacks are triggered by one or more food items. We tend to eat a varied diet, and even very small portions of the offending foods may trigger an attack. The simplest way to test whether you have food migraine is to keep a diary of everything you eat and drink. If a clear pattern is not found easily, the best way to progress is to try a diet for a week or so, which includes only foods that are known not to trigger migraine. The diet may be a bit unexciting, in a culinary sense, but the expectation of a life with fewer migraine attacks may make the humdrum less taxing. Always consult your doctor before beginning a diet. Some food items that are considered 'safe' are: milk, oatmeal, sugar, salt, fresh white fish, fresh chicken, flour and pasta (the ordinary yellow type), rice, lentils, butter, oil, onions, carrots, leeks, beetroots, celery, potatoes, peeled apples and pears. As citrus concentrate is widely used as an antioxidant and a pleasant taste in many prepared food items, it is best to avoid all processed and prepared food. Just to make sure, you are also recommended to peel all fruit and vegetables during the period you eliminate all triggers. If it turns out that you have less migraine when keeping such a diet, you can introduce one new item a day. If the introduction is followed by a migraine attack, this food item probably contains 'something' that triggers the migraine. Click here to see lists of foods containing tyramine and phenylethylamine. Menstruational migraine Around 3 out of 4 migraine patients are women. This is because many women have migraine in the time around their menstruation. Migraine coincides with the time when the oestrogen level in their blood suddenly decreases, at just about the beginning of the menstruation. Around 10% of those women who start to take supplementary oestrogen, either as contraception or as a supplement after the menopause, develop migraine after taking the supplementary oestrogen for approximately half a year. As the migraine does not develop right after commencing the treatment, it may be difficult to recognize the connection. All women who are offered treatment with medicine containing oestrogen should be informed about this risk, and should be asked about their migraine at their next visit to the doctor. The doctor may offer alternatives to oestrogens if you develop migraines during the first half year of oestrogen supplements, but it also takes some months to come out of the migraine after termination of the oestrogen supplements. Some women have a natural level of oestrogen that is so high that it can trigger migraine around  the time of menstruation. Since it is the sudden fall in the oestrogen-level in the blood that triggers the attack, some women find that a hormone patch that reduces the rate of fall may alleviate their problem. Light, sound and smells Migraineurs are more sensitive to light, sounds and smells than non-migraineurs, even when we do not have an attack. It is likely that light, sound and smells may trigger migraine attacks in predisposed individuals. Hunger Anecdotal evidence says that we get migraine attacks when we skip a meal. When the blood sugar content falls, the migraine starts. Luckily a bite to eat in time may solve this problem. Regular life Migraine is often most prominent during weekends, just when you have planned a good time, to have a long lie in, to take it easy, or to do something different.  Even though it is a bit of an imposition, you may find it better to live according to the same timetable on days off as during the week , if this reduces the frequency of migraine attacks. We cannot change the weather or eliminate stress completely, but we can organize our weekends in a way that does not call for too many migraine attacks. Treatment of attacks or prophylaxis We are fortunate that the development of new medicine has progressed quickly during the last few years, and new types of migraine medicine keep appearing. Regardless of how eminent the new medicine is, it will always be better to avoid a migraine attack than to treat it. Even the best medicine influences the body and may have long-term effects. Many migraineurs find it difficult to plan because they fear the next attack. The new generation of drugs, the triptans, has provided many migraineurs with the possibility of living a normal life full of activities. Knowledge of the triggers will provide migraineurs with the ability to live an even fuller life. Triggers Front page