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Sometimes, it can seem that migraines start for no reason. One minute, you're fine, the next minute, each whisper feels like a shout, lights have you screwing your eyes tight in pain and you want nothing more than to creep off into a darkened room with a bucket and a cold cloth.
It seems like migraines have no rhyme or reason, however, every migraineur has one or more (usually more) triggers that lead to migraine if we are exposed to them.
What is a trigger?
A trigger is an event, stimulus or physical change which results in a migraine up to six or eight hours later.
Triggers don't always lead to a migraine; however they make you more predisposed to suffering migraine.
What are my triggers?
Every migraineur has different triggers. It's worth identifying your triggers. Not every trigger can be avoided all the time (stress, for example), but by knowing what they are, you can minimise them and so work to reduce your attacks. You might not know what your triggers are. If not, try keeping a daily diary for between two weeks and a month.
The Migraine Trust recommends that, in your daily diary, you note things such as:
- when you wake up and go to bed, and how many hours sleep you have
- what you eat/drink and when (everything, snacks too!)
- when you go to work, and what you do when you're there (such as hours on the computer)
- what you do for recreation (hours spent watching the TV; exercise)
- when you have bowel motions (and are you constipated)
- what the weather is like
- (women only) your menstrual cycle (phase/PMS/menstrual cramps/other symptoms, etc)
- your mood
- the medications you take, including dose
- anything else in your lifestyle.
Although this sounds like a lot of work (and is), it's an excellent way to help you identify your triggers. For example, if you suffer more in the week, stress may have a role to play. If you have more migraines on stormy days, the weather may be partly responsible for your migraines.
When You Know Your Triggers
Depending on the number and nature of your trigger(s), you may be able to prevent many or all of your migraine attacks from happening. If you have a single, easily-avoided trigger (such as an additive or red wine), you might be able to prevent almost all your attacks. However, if your migraines are caused by several triggers, of factors that are impossible to avoid unilaterally (like bad weather), you may be able to reduce a few attacks by adapting better lifestyle management, but not prevent attacks altogether.
Trigger 1: Rich Food
Aged cheeses (brie, Cheddar, Stilton, Camembert, Roquefort, Swiss and Parmesan), citrus fruits, nuts, chicken livers, and chocolate are all rich in tyramine. Tyramine is an amino acid that causes migraines in some migraineurs.
Tyramine triggers migraines in some people by causing vasoconstriction in the brain followed by rebound dilation.
Trigger 2: Low Blood Glucose Levels
Hypoglycaemia (low blood glucose levels) can lead to migraine. This happens when people don't eat enough, or don't eat regularly enough. Hypoglycaemia related migraines are usually particularly severe.
If hypoglycaemia is the cause: have small but regular meals and never miss a meal. Make sure to always carry a healthy snack if you might be home late for dinner. By preventing your glucose levels dropping, you may prevent a migraine.
Trigger 3: Menstruation
60% of female migraineurs suffer menstrual-related migraines, which occur either around the time of the period or at ovulation. It's thought that changing oestrogen levels may be to blame. Many women who experience menstrual migraine seem to experience migraine without aura. Try keeping a diary for three months to see how regular your symptoms are.
Women who experience menstrual migraine may benefit from preventative treatment: an effective triptan 24 to 48 hours before the onset of the menstrual migraine has been used. Alternatively (especially with migraine accompanied by PMS or pre-menstrual dysphoric disorder) an antidepressant such as Fluoxetine may be used.
Trigger 4: Stress
Redat (2012) found that between 50 and 80% of migraineurs report that stress is one of their triggers. Migraineurs are thought to be more responsive emotionally, and any increase in emotion (stress, sadness, anger, or excitement) can trigger a migraine. Oddly enough, many migraineurs can cope when the pressure is on. The migraine starts at the weekend, when the deadline is met, the feet are up and the pressure is off.
Trigger 5: Food Additives
This is a little controversial. However, a recent publication by Harvard Medical School says that there are some foods that may cause migraine in some individuals, although there is little research supporting the claims. However, many individuals have reported that by removing some or all of these things from their diet, they have significantly improved their migraines.
- Aspartame: An artificial sweetener found in many products. A study in the New England Journal of Medicine failed to find a significant effect, but Dr. Robert Kunkel, neurological consultant at the Cleveland Clinic, says:
I have had a few patients over the years who have been able to definitely identify aspartame as a trigger.
- Yellow Dye Number 6: (also known as Sunset Yellow and E110). Artificial colour.
- MSG: A flavour enhancer, used in many foods. Some new research suggests that MSG (monosodium glutamate) may cause headaches and face pain in susceptible people. It may be wise to avoid this one.
- Nitites and Nitrates: Nitrites are used to preserve the red colour in processed meats (bacon, salami, etc), while nitrates are used in medicines and processed foods. May cause migraines in sensitive people.