By Mary Franklin, executive director of the National Headache Foundation
Awareness can help reduce incidence of migraine and improve quality of life.
When obtaining a history from a headache patient, one of the most important questions is “Do you know of any triggers for your headaches?” Often, patients offer a variety of potential causes for the acute attacks, including menstrual periods, stress, diet, alcohol, sleep, and exertion. For those experiencing migraine and other chronic headaches, it is important to identify potential triggers and avoid them. Using a daily headache calendar may help the patient recognize the precipitant for a particular attack. By avoiding triggers—or at least learning to react appropriately to triggers—patients assume an active role in improving their headaches.
The incidence of migraine is higher in women, particularly during childbearing years. Many women with migraine will associate their headaches with menstrual periods, and this trigger is identified with the fluctuations in the hormonal levels that occur at menses.
At the time of your period, a decrease in estrogen hormone occurs, and for those with migraine, that drop will trigger an acute headache. Similar headaches will occur with women using birth control pills, who experience a headache during the seven days off the pill.
For older women, the use of hormone replacement therapies may continue a pattern of headache that may have disappeared with menopause.
And, many women will note that their headaches disappear or greatly decrease during pregnancy, usually after the first trimester. These headache patterns are associated with hormonal changes.
Chocolate and cheese are common triggers of migraine. Many foods (aged cheese, yogurt, pickled and fermented foods) identified as migraine triggers contain a substance, tyramine, which may be the culprit in producing a headache. Processed meats such as hot dogs contain nitrites, which can also be a trigger. Phenylethylamine, contained in chocolate, may be the reason for its association with migraine attacks. High amounts of monosodium glutamate (MSG) found in certain Asian dishes are associated with “Chinese Restaurant Syndrome,” with headache as one of its symptoms. The artificial sweetener aspartame is also a trigger.
In alcoholic beverages, it is not the quantity consumed, but the tyramine and sulfites contained in these beverages (including red wine, brandy, and port) that is the trigger. Champagne and beer may also trigger migraine attacks.
Caffeine, contained in many over-the-counter (OTC) remedies, is effective in relieving headaches. It is believed to enhance the action of the analgesics, such as aspirin and other nonsteroidal anti-inflammatory agents (NSAIDs) including ibuprofen or naproxen sodium.
Unfortunately, when consumed in large quantities, caffeine can be a trigger. Migraine patients should limit or completely cease intake of caffeinated beverages (colas, coffee, tea); moderation may be important for relieving daily headaches.
Rather than avoiding all suspect foods, the headache sufferer may try elimination diets and a daily headache diary to determine if a food item or beverage is causing some headaches.
For those with chronic headaches, it is essential that the individual maintain regularly scheduled meals, and avoid fasting or skipping meals. Hydration is also essential but may be difficult during a migraine attack when the patient has nausea and vomiting.
Odor Triggers and the Workplace
Odors can provoke a migraine attack, including perfumes, colognes, lotions, and cigarette smoke. Avoiding these scents may be difficult in the workplace.
Workplace exposure to paints, solvents, and glues can also provoke a headache.
Requesting a scent-free environment should be undertaken with the supervisor, although the headache sufferer may face some hostility from coworkers.
Bright or flashing lights can trigger migraine headaches. During an acute migraine attack, the patient will prefer to be in a dark room. But even without a headache, exposure to fluorescent lights, sunlight, and television and computer monitors may provoke headaches.
Switching to LED or incandescent lights may provide relief, and the use of tinted lenses in specialty “migraine glasses” may prevent headaches.
Most health care practitioners who treat patients with migraine and chronic headaches emphasize the importance of sleep hygiene. Sleeping difficulties and insufficient sleep can contribute to chronic headache patterns.
It is essential that the person with migraine or chronic headaches maintain a regular sleeping schedule—going to bed and waking up at the same times each day. “Catching up” on our sleep may not be helpful, and some patients experience holiday or weekend headaches. Getting up each day at the same time, no matter what, may prevent that type of headache.
Exercise and Exertion Triggers
During a migraine attack, the headache patient will want to stay still; any activity can increase their pain. That does not mean patients should avoid regular exercise. Many patients find exercise helpful in avoiding headaches.
However, certain types of headaches can be caused by exertion through bending, coughing, straining at stool, or orgasm. These headaches may be more serious, and the patient should be evaluated to rule out a neuro-vascular problem.
Stress is a major trigger for headaches. Problems at work, school, or in the family may contribute to a chronic headache problem.
There is also the “letdown” headache, which occurs after a stressful or difficult event, such as planning a wedding or hosting a large gathering.
It is important to identify the stress components of a headache problem. Avoiding situations that cause stress may be the answer, and may include difficult decisions such as changing jobs. Learning to deal with stress may greatly benefit the person with headaches.
Some tactics include regular exercise, yoga, relaxation and deep breathing exercises, and meditation. The health care practitioner may recommend counseling (personal or marital) or psychotherapy.