Migraine: Triggers You May Not Know About

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)
• travel
• 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.

READ Headaches: Home and Natural Remedies for Migraine

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.

Be realistic.

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.

READ Treating Menstrual Problems with Yoga

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.

READ Food Additives that May Affect ADHD

• 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.

12 More Migraine Triggers

Trigger 6: Dehydration

Not drinking enough water has been found to lead to migraine in up to 40% of migraineurs. To avoid this, drink eight glasses of water a day (just avoid fizzy drinks with aspartame, if that's a trigger for you).

Trigger 7: Caffeine

Caffeine's a tricky beast. A little at the onset of migraine can be helpful. However, too much caffeine can act as a trigger for migraines. Also, having a large amount of caffeine one day and then less caffeine the next can cause caffeine withdrawal and trigger a migraine.

Trigger 8: Strong smells

Migraineurs report that strong or strange smells, especially perfume, are a trigger for migraine. Additionally, almost half of patients experience "osmophobia", intolerance for strong smells (especially perfume, cigarette smoke, or strong food scents), during migraine.

Trigger 9: Exercise

A 2013 study by Koppen and Veldhoven found that 38% of migraineurs experience exercise-related migraine, particularly after intense exercise. They also found that exercise-related migraine was distinct, featuring a higher-incidence of neck pain.

Trigger 10: Bright Light

Bright artificial lights, flickering lights, and strobe lights are known triggers of migraine. There's some question over whether sunlight alone can cause migraine. A 2014 study by Sethi, published in the journal European Neurology, opines that sunlight can only cause migraine in people who are already sleep deprived, stressed or dehydrated. However, a 2013 study by Tekatas and Mungen suggested that sunlight alone can trigger a migraine.

To combat this, try wearing a hat and sunglasses when you go out.

Trigger 11: Weather

Several types of weather are common migraine triggers:

• Storms
• High winds
• Changes in temperatures
• Changes in humidity
• Changes in altitude
• Dry and/or dusty environments

It's thought that migraineurs are more sensitive, and feel pressure changes more acutely. Also, it's thought that there's an evolutionary benefit to weather-triggered migraines: compelling the migraineur to seek a less hostile environment.

READ Does Weather Affect Our Mood?

Trigger 12: Alcohol

Alcohol can cause migraines for a number of reasons. First, it can cause dilation of the vessels in your head, which may cause headache. Second it's a diuretic, which leads to an imbalance of salts and can cause dehydration (another cause of migraines). Red wine may be a particular trigger because it's particularly high in tyramine.

Trigger 13: The computer screen

Working in front of screens for a long time is a big problem for migraineurs. A mixture of lights, eye-strain and stress leave those of us who use computers and screens a lot for work and recreation at high risk of migraine.

If screens are a trigger use anti-glare screens, take regular breaks (try a weekend digital detox), and make sure to use a computer in a well-lit room.

Trigger 14: Irregular Sleep

Insufficient sleep, or disturbed sleep (such as with jet-lag) has been found to trigger migraine. However, as little as half an hour extra sleep - such as at the weekend - has also been found to act as a trigger. Keeping regular sleep habits could be one of the best things you can do for yourself.

READ Weird Ways to Beat Insomnia

Trigger 15: Physical problems

There are several problems that may trigger migraines:

• Tooth grinding: If you grind your teeth in your sleep, it may cause headache upon waking. If this is a trigger, see a dentist, who can fit you for dental splints to prevent grinding, relieving the problem.
• Head injury: Sometimes migraines start after receiving a head injury
• Coughing: A violent coughing fit can trigger migraine in some.

Trigger 16: Illicit Drugs

Cocaine and marijuana use can act as migraine triggers. Cocaine withdrawal can also cause migraines.

Trigger 17: Medication overuse headache

If you regularly use opioids, ergots or triptans as a treatment for migraine, you may develop medication overuse headache. Overuse of triptans or opiates is deemed to be ten days or more per month. It happens, quite simply, due to a wish to control chronic and pervasive pain. But the effectiveness wears off quicker, leading to a background, rebound headache, which is then treated with more painkiller. The migraineur is now trapped in a vicious cycle.

As the Migraine Trust says:

[Medication overuse headaches] have nothing to do with addiction, and everything to do with trying to cope.

Making Changes

When you've identified your triggers, it's time to make the necessary lifestyle changes. What do you have to do?

• What changes can you make on your own?
  • Do you have to change your diet?
  • Do you have to put an anti-glare screen on your computer?
  • Should you practice meditation for stress?
• What changes will require more support?
  • Do you need to talk to your doctor about a migraine preventative?
  • Do you need to talk to your employer about altering your work schedule so you can spend less time looking at the screen?

Aim to have a healthy lifestyle, with a balanced diet and plenty of fluid; sensible, gentle exercise, and appropriate rest. Just these simple changes will greatly improve your health, leaving you better able to cope with your migraines.