Migraine triggers
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
A migraine trigger is any factor that, on exposure or withdrawal, leads to the development of an acute migraine headache. Triggers may be categorized as behavioral, environmental, infectious, dietary, chemical, or hormonal.In the medical literature, these factors are known as precipitants. Many people report that one or more dietary, physical, hormonal, emotional, or environmental factors precipitate their migraines. The most-often reported triggers include: pesticides (sprayed fruits/vegetables), perfumes or fragrances (30% of sufferers) stress, over-illumination or glare, alcohol, foods, too much or too little sleep, and weather. Some women experience migraines in conjunction with monthly menstrual cycles. Sometimes the migraine occurs with no apparent "cause". The trigger theory supposes that exposure to various environmental factors precipitates, or triggers, individual migraine episodes. Migraine patients have long been advised to try to identify personal headache triggers by looking for associations between their headaches and various suspected trigger factors. Patients are urged to keep a "headache diary" in which to note what they eat and when they get a headache, to look for correlations, and to try to avoid headache by avoiding factors they identify as triggers. Typically this advice is accompanied by a list of trigger factors.
Triggers
Shown below is a list of migraine attacks triggers according to the National Library of Medicine's Medical Encyclopedia:
- Allergic reactions
- Bright lights, loud noises, and certain odors or perfumes
- Physical or emotional stress
- Changes in sleep patterns
- Smoking or exposure to smoke
- Skipping meals
- Alcohol or caffeine
- Menstrual cycle fluctuations, birth control pills
- Exposure to pesticides (sprayed fruits/vegetables)
- Tension headaches Headache
- Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami)
- Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods.[1]
- Drugs like Apremilast, conjugated estrogens, Cidofovir
Cervicogenic Headache
It is very common for patients with migraine to have an associated musculoskeletal component. This portion of the migraine may be perceived as due to tension (which may in fact be a trigger in and of itself), an old neck injury that the afflicted does not realize can cause migraine like headache or degenerative changes in the neck. Less obvious sources of cervicogenic Headache may be postural related. For example in the presence of an old ankle injury center of gravity can be shifted forward. As a result, the neck must be held in extension in order to stand up right. In this instance every step taken aggravates the condition [2].
Food
In 2005, authors who reviewed the medical literature[3] found that the available information about dietary trigger factors relies mostly on the subjective assessments of patients. Some suspected dietary trigger factors appear to genuinely promote or precipitate migraine episodes, but many other suspected dietary triggers have never been demonstrated to trigger migraines. The review authors found that alcohol, caffeine withdrawal, and missing meals are the most important dietary migraine precipitants. The authors say dehydration deserves more attention, and that some patients report sensitivity to red wine. The authors found little or no demonstrated evidence that notorious suspected triggers chocolate, cheese, or that histamine, tyramine, nitrates, or nitrites normally present in foods trigger headaches. The artificial sweetener aspartame (NutraSweet®) has not been shown to trigger headache, but in a large and definitive study monosodium glutamate (MSG) in large doses (2.5 grams) was associated with adverse symptoms including headache more often than was placebo. The review authors also note that while general dietary restriction has not been demonstrated to be an effective migraine therapy, it is beneficial for the individual to avoid what has been a definite cause of the migraine.On the other hand, several headache clinics have had good results with individually tailored dietary restriction as a therapy. Dr. Ian Livingstone, director of the Princeton Headache Clinic, recommends eliminating the following common headache triggers from the diet: aged cheese, monosodium glutamate, processed fish and meats containing nitrates (such as hot dogs), dark chocolate, aspartame, certain alcoholic beverages (including red wine), citrus fruits, and caffeine. After a period of one to two months, these foods can be reintroduced one at a time to determine their trigger potential for that individual. Adding large amounts of the suspected trigger in a short time may generate a response that is easy to observe.Dr. David Buchholz, a neurologist who treats headaches at Johns Hopkins Hospital, has a longer list of suspected migraine triggers. He also recommends eliminating the triggers from the diet altogether, and then reintroducing them slowly after many weeks to measure the effects. His list includes: coffee (including decaf), chocolate, monosodium glutamate, processed meats and fish (aged, canned, preserved, processed with nitrates, and some meats that contain tyramine), cheese and dairy products (the more aged, the worse), nuts, citrus and some other fruits, certain vegetables (especially onions), fresh risen yeast baked goods, dietary sources of tyramine (including the foods listed above), and whatever gives you a headache. The National Headache Foundation has a more specific list of triggers based on the tyramine theory, which differs slightly from David Buchholz's list. For example, it says that decaffeinated coffee is allowed. The list details "Allowed", "Use with caution", and "Avoid" triggers.[4]
Weather
Several studies have found some migraines are triggered by changes in weather. One study[5] noted that 62% of the subjects in the study thought that weather was a factor, in fact 51% were actually sensitive to weather changes. Among those whose migraines did occur during a change in weather, the subjects often picked a weather change other than the actual weather data recorded. Most likely to trigger a migraine were, in order:
- Temperature mixed with humidity. High humidity plus high or low temperature was the biggest cause.
- Significant changes in weather
- Changes in barometric pressure (See Abortive Treatment)
Another study[6]' researched whether chinook winds (warm westerly winds occurring along the Front Ranges of the Rocky Mountains) are a migraine trigger. Many patients had increased incidence of migraines immediately before and/or during the chinook winds. The number of people reporting migrainous episodes during the chinook winds was higher on high-wind chinook days. The probable cause is "through increased air positive ion concentrations." In the 40's the Lancet published the first article on "Barre lieou". This is a weather sensitive headache syndrome associated with blurred vision, ringing in the ears, dizziness and nausea. It is also referred to as The Posterior Cervical Sympathetic Syndrome of Barre-Lieou [2]. Sympathetic galvonic skin response studies utilizing infrared imaging have been reported to be helpful in the diagnosis of this syndrome.
Hair Wash Headache
Another trigger for migraine has been proposed by Dr.K.Ravishankar, a neurologist and headache specialist from India. He reported an unusual trigger for migraine seen among Indian women, Hair Wash Headache. It is described as a migraine headache that originates with a head bath. Most Indian women have long hair and so they wash their hair two or three times a week. Very often they do not use a hair dryer and often plait their hair when wet. This results in a gradual build up of pain which ultimately results in migraine.[7]
Drugs
References
- ↑ http://www.nlm.nih.gov/medlineplus/ency/article/000709.htm
- ↑ "Migraine". Retrieved 2012-08-30.
- ↑ Holzhammer J, Wober C (2006). "[Alimentary trigger factors that provoke migraine and tension-type headache]". Schmerz. 20 (2): 151–9. PMID 15806385.
- ↑ "Low Tyramine Headache Diet" (116 Kb PDF). National Headache Foundation. 2004. p. 2. Retrieved 2006-10-12. Unknown parameter
|month=ignored (help) - ↑ Prince PB, Rapoport AM, Sheftell FD, Tepper SJ, Bigal ME (2004). "The effect of weather on headache". Headache. 44 (6): 596–602. PMID 15186304. Retrieved 2006-05-06.
- ↑ Cooke LJ, Rose MS, Becker WJ (2000). "Chinook winds and migraine headache". Neurology. 54 (2): 302–7. PMID 10668687.
- ↑ Ravishankar, K (2006). "'Hair wash' or 'Head bath' triggering migraine - observations in 94 Indian patients". Cephalagia. 26 (11): 1330–1334. ISSN 0333-1024.