Migraine and Migraine Triggers
Migraine is a throbbing headache (one- or both-sided) with nausea and sensitivity to lights and sounds, lasting from 4 to 72 hours. Migraine is considered as an inherited sensitivity of the nervous system resulting in dilation (expanding) of the arteries on the brain surface when triggered by certain stimuli (1).
Migraine triggers are stimuli that may increase a risk of having a migraine attack in a sensitive person. A certain migraine trigger does not necessary provoke migraine in all migraine sufferers, and not even always in the same person.
Migraine triggers include (2):
- Hormonal changes in women
- Foods and drinks
- Psychological stress
- Sensory stimuli
- Sleep disturbance
- Physical stress
- Weather and environmental effect
- Health conditions
1. HORMONAL CHANGES IN WOMEN
Fluctuations (usually a drop) of estrogen level may trigger migraine attack during puberty, menstruation, ovulation, pregnancy, menopause, or during taking birth control pills or receiving hormone replacement therapy. Pregnany can trigger migraine in a woman who has never had migraines, or just the opposite – chronic migraines may cease completely during pregnancy.
2. FOODS AND DRINKS
Cheese, chocolate, alcohol, bananas, and citrus fruit are commonly reported migraine triggers. No of these or below foods, food ingredients or additives were proven as migraine triggers by any study, though (7).
Cold foods, like ice cream can trigger a migraine attack.
- Red wine
- Dark alcohols, like whiskey, sherry, vermouth, liquors
- Cocoa, chocolate milk
- Coffee and other drinks containing caffeine, like cola, energy drinks, black tea
- Soups: canned or pre-prepared soups, soups made from bouillon, stock or meat extracts
- Avocados and bananas, if overripe
- Citrus fruits
- Dried fruits, like figs and raisins
- Kiwi fruit
- Red plums
- Beans: broad, fava, garbanzo, Italian, lima, pinto, string beans
- Chili pepper
- Garlic (raw)
- Onions (not, if only for flavoring)
- Peas, like snow peas
Grains and Nuts
- Freshly baked yeast bread, doughnuts, sourdough bread
- Wheat – individuals with celiac disease who are sensitive to gluten (in wheat, barley and rye) may suffer from migraines (3)
- Nuts: peanuts, peanut butter, other nuts
- Seeds: pumpkin, sunflower and other seeds
- Cultured milk: buttermilk, sour cream, yogurt
- Cheese: blue, Brie, brick (natural), Camembert, cheddar, Gouda, Gruyere, mozzarella, Parmesan, provolone, romano, Roquefort, Stilton, Swiss (emmentaler)
Meat and Fish
- Aged, caned, cured, marinated, pickled, processed, smoked meat or fish: bacon, bologna, caned anchovies and sardines, caviar, corned beef, frankfurter, ham, hot dog, game, jerky, liverwurst, paté, pastrami, pepperoni, pickled herrings, salted dried fish, salami, sausage and any meet preserved by using nitrites
- Animal intestines: chicken liver
- Meat prepared with meat tenderizer: Accent, bromealin, papain, actinidin, ficin
- Candies and chewing gum
- Fatty foods in general
- Flavourings (like vanilla) that can contain alcohol
- Imitation crab
- Pre-prepared sauces: soy sauce, mustard, ketchup, mayonnaise, Worcestershire or teriyaki sauce
- Salty foods
- Seasoned salt
- Tea that contains theophylline, caffeine and tannins
- Vinegar: red and balsamic; (white vinegar should be fine)
Food Ingredients and Additives That Can Trigger Migraine
- Aspartame (Nutrasweet, Equal) is an artificial sweetener added to many foods and drinks.
- Benzoic acid is used as a preservative in certain foods and drugs.
- Caffeine, if consumped in large amounts, or withdrawal after long-term drinking of large amounts of coffee may trigger migraine. Caffeine may be also in chocolate, soda, energy drinks. Small doses of caffeine may help to relive migraine, though.
- Carrageenan, an extract from algae or seaweed, is used as a thickener.
- Casein and sodium or calcium caseinate in dairy and other products.
- Glutamic acid
- Gluten in wheat, barley and rye (possibly in oats). Other foods that may contain gluten
- Histamine is in bananas, beef, beer, cheese, chicken liver, chocolate, citrus fruits, egg plant, fish, miso, pineapple, processed meat (salami), sauerkraut, spinach, strawberries, tamari, tempeh, tomato, tofu, pork, wine, foods containing yeasts.
- Hydrogenated oil may be in margarine and other foods containing plant fat.
- Malt extract, maltodextrin
- Monosodium glutamate (MSG) (synonyms: sodium caseinate, hydrolyzed proteins, autolyzed yeast) is added to many commercial foods (should be mentioned on the nutrition facts label), like croutons, meet tenderizers, frozen foods, gelatin, potato chips, pre-prepared soups, salad dressings, soy sauce, spices, stuffing; it is commonly added to Asian foods (causing ‘Chinese restaurant syndrome’).
- “Natural flavors” can form MSG during food preparing.
- Phenylethylamine is in berry pie filling and canned berries, cheesecake, yellow cheeses, citrus fruit, chocolate, cocoa, red wine.
- Sodium nitrite/nitrate is often added to ground meat. It can cause migraine, called a ‘hot dog headache’.
- Sulfites are preservatives used in wine (especially red wine), dried fruits (apricots, figs, prunes, dates..), canned vegetables and other processed foods.
- Tannins are in alcohol (red wine and dark alcohols), alfalfa, apple juice and cedar (and skin of red-skinnd apples and pears), berries, carob, chocolate, coffee, dates, kiwi, peaches, pecans, walnuts.
- Tartrazine or yellow dye #5 (E210 in Europe) is added to many foods and drinks (4).
- Textured protein
- Tyramine is in aged cheese (MAO inhibitors), aged, canned, cured or processed meats, avocado, beans (fava, broad, garbanzo, lima, pinto, Italian), lentils, peas, canned soups, miso, nuts, onions, olives, pickles, raisins, tempeh and anything aged, dried, fermented, salted, smoked or pickled.
- Tyrosine is an amino acid (part of protein) found in soy, chicken, turkey, fish, peanuts, almonds, avocados, bananas, milk, cheese, yogurt, cottage cheese, lima beans, pumpkin and sesame seeds (5).
- Whey and skim milk powder
- Yeast and yeast extract
Migraine Related to Eating Habits
- Large, especially sugary or starch meals, irregular meals, skipping meals, hunger, fasting and other causes of hypoglycemia may trigger migraine.
- Dehydration, which can develop within a day, if you do not drink enough, may trigger migraine.
Which Foods Do NOT Likely Trigger Migraine?
- Fresh fruits and vegetables (also juices without additives and home made soups), except those listed above
- Fresh, non-processed meats and fish
- Rice, corn, millet, quinoa, bulgur
- Non-yeast breads, hot and cold cereals (unless you are sensitive to gluten)
- Rice milk, natural mineral water
3. PSYCHOLOGICAL STRESS
- Repressed emotions, worries, anxiety, depression, conflicts in relationships, life changes, unresolved problems from the past, unrealistic timelines may all trigger migraine.
- Stressless periods following stressful periods can also trigger migraine. This usually happens during weekends, on beginning of vacations, after completing exams or demanding projects.
4. SENSORY STIMULI
- Intense, flashing, glaring lights, sunshine, ultraviolet light, TV or cinema movies
- Loud sounds
- Prominent smells, like perfumes or paint thinners, air pollutants and secondhand smoke may all trigger migraine attack.
5. SLEEP DISTURBANCE
- Lack or excess of sleep, shift work, or travel across time zones (jet lag) can trigger migraine.
6. PHYSICAL CAUSES
- Eye strain (computer work, reading, inappropriate lenses)
- Bad posture
- Bending down (gardening)
- Sexual activity
- High altitude
7. WEATHER AND ENVIRONMENTAL TRIGGERS
- A change of weather or barometric pressure, extreme temperatures or humidity may trigger migraine and so may a high altitude.
- Stuffy indoor air (central heating)
8. HEALTH DISORDERS RELATED TO MIGRAINE
- Painful conditions in the head or neck area: toothache, sinusitis, congested nose
- Low blood level of vitamin B12
- Low blood level of serotonin
9. MEDICATIONS AND SUPPLEMMENTS
- Ibuprofen or Excedrin Migraine can cause rebound headache, if overused
- Interferon-beta in treatment of multiple sclerosis (6)
- Nitroglycerin, indomethacine or a missed dose of these medications can trigger migraine
- Medications containing caffeine: some forms of aspirin,
- Niacin in excess
- Sleeping tablets (some types)
- Vitamin A (over 25.000 I.U. daily)
So, How Can You Prevent Migraine Attacks?
If you suffer from migraines, you probably do not need to avoid all things mentioned in this article. Instead, you can start a migraine diary, where you make notes about your meals, activities, mood, sensory stimuli and weather, and find out what triggers migraine in your case. A migraine usually occurs within 12 (or at most 24) hours after exposure to a certain trigger. It is possible you will find out other triggers, not listed here.
General recommendations to prevent migraine:
- Birth control pills
- Processed and non-fresh food of any kind; a food sitting in a refrigerator for few days can trigger migraine.
- Alcohol, cigarettes, caffeine
- Physical activities and sensory stimuli for which you know that may trigger migraine
- Emotional conflicts
- Regular diet and eating, working and sleeping habits
- Attitudes, relationships, work and activities that bring peace and joy in your life
- Headache Causes; symptoms, Diagnosis, Treatment
- Types of Headache
- Sudden Severe Headache
- Chronic Headache
- Throbbing Headache
- Headache, Nausea and Vomiting
- Constipation and Headache
- Migraine cause and mechanism (headaches.org)
- Migraine triggers (uhs.berkeley.edu)
- Migraine can be related to gluten (celiac disease) (medscape.com)
- Tartrazine is a migraine trigger (ukfoodguide.net)
- Tyrosine can trigger migraine (umm.edu)
- Interferon-beta can trigger migraine (ncbi.nlm.nih.gov/pubmed)
- No study has confirmed existence of dietary triggers of migraine (achenet.org)