Migraine Triggers : External Triggers

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Q:	Which foods and food additives can trigger a migraine attack?
A:	As with other triggers, such as stress or menstruation, vulnerability to food triggers varies widely among individuals. The food triggers most commonly reported include wine, aged cheese, aged meats, caffeine, and citrus fruits. Others have been reported, but are not as widely accepted by experts. These include chocolate, aspartame, glutamate, and other food additives containing glutamate .

Q:	How do food and drink trigger migraine attacks?
A:	Theories on how food or food additives trigger migraine vary considerably, with studies showing mixed results. Each food, food additive, or drink may act as a stimulant and excite brain cells, thus triggering an attack. Some food triggers may cause the release of epinephrine, triggering an attack indirectly, while others, such as glutamate, can act directly on brain cells, causing excitation.

What substances in a food or drink can trigger a migraine?

Various substances in food and beverages can trigger migraine. These include tyramine, phenylethylamine, monosodium glutamate, aspartame, and caffeine. Despite the lack of scientific evidence, many experts believe that avoiding these dietary chemicals may help reduce attacks. Most treatment programs advise avoiding alcohol, chocolate, matured cheese, wine, and monosodium glutamate (MSG). If you are finding it difficult to control your migraine, it may be worth trying a migraine-friendly diet for a few months. Once the attacks are well controlled, you can experiment with reintroducing specific foods or beverages, provided no other migraine triggers are present.

How can a change in my schedule, sleep patterns, or eating habits trigger a migraine attack?

The cells in your body need to be maintained in stable, constant conditions. Any change in your external or internal environment requires that the body makes adjustments in its physiology (biological functions). Unexpected variations in your schedule, sleep patterns, or eating habits require such adjustments. All of these situations have been found to trigger migraine attacks. It is not well understood why, but it is recognized that people with migraine benefit from following strict routines. Further, the use of medications to prevent attacks can raise the threshold and help people with migraine to be less vulnerable to these triggers.

Why do I have migraine attacks during or after a stressful event?

Emotional stress triggers an attack because it leads to the “fight-or-flight” response. The cause of stress varies among individuals. What may seem very stressful to one person may be a mere aggravation for another. The important point is that emotional stress is the most commonly reported trigger for a migraine attack. Reducing stress is very important for the successful treatment of migraine.

Why do I often have a migraine attack on weekends?

Many people with migraine can get through a busy or stressful week without an attack, only to experience one when everything calms down. The stressful situation may have passed, but the biological changes caused by it continue. For those with migraine, the genetic problem with serotonin (a “calming” brain chemical) makes it difficult for the brain to decrease the excitation caused by epinephrine released during the stress response. Stress, like other migraine triggers, may need to be present for a few days before it causes the brain cells to be excited enough to trigger a migraine attack.

Q:	How can weather and altitude changes trigger an attack?
A:	Although migraine attacks are frequently triggered by weather and altitude changes, we do not know why. Migraine attacks may occur because the body needs to make adjustments in physiology related to changes in atmospheric pressure.

Q:	Why do I get a migraine attack when I travel?
A:	Travel is often associated with several migraine triggers in the same time period. For example, the time zone may change or the travel may lead to a change in eating habits or in sleep patterns, so it is not surprising that migraine attacks occur while traveling. All these changes can trigger attacks because they require that the body makes adjustments to its biological functions.

Q:	How do some odors, bright light, or loud noise trigger migraine attacks?
A:	It is not well understood why odors, bright light, or noise may trigger a migraine. We do know that the brain is very sensitive to input from the body’s senses. Since the brain cells of those with migraine are thought to be hyperexcitable, an exaggerated reaction to sensory input is a possible explanation.

Does the environment trigger an attack or am I only sensitive to environmental changes because I am having a migraine attack?

This is an excellent question—unfortunately, no one knows for certain. We do know that an attack can be triggered by a visual stimulus, because this method has been used to study migraine. But it does also appear that the better you control migraine the less sensitive you will be to triggers. It is important that you treat the illness so that you do not find yourself living in an environmental bubble, fearful that a trigger is lurking around every corner. On the other hand, it is also important to identity factors in your environment that can trigger migraine and try to avoid them as much as possible.

How do medications trigger attacks?

The overuse of certain medications, especially those used to stop migraine attacks, can also trigger more attacks. Medications for other illnesses may also trigger migraine. Many over-the-counter drugs and “natural” herbal remedies cause medication overuse headaches, while others simply trigger an attack because they are stimulants. It is important to reduce or eliminate any medication that increases the frequency of headaches.

Q:	How can “natural” herbal supplements trigger headaches?
A:	Many “natural” supplements used for weight loss or fatigue contain caffeine or “caffeinelike” chemicals and are stimulants. Any stimulant can increase the level of epinephrine in the blood and brain, as does stress or certain foods and beverages. To avoid repeated migraine attacks, you must avoid as many triggers as possible, including “natural” stimulants.

Q:	Does smoking trigger migraine?
A:	Smoking (or using nicotine in other forms, such as chewing tobacco or snuff) may trigger migraine and those addicted to smoking should quit. You can expect some withdrawal headaches when you first stop using nicotine but these will clear up with time. Even if you are not a smoker yourself, you still need to avoid exposure to second-hand smoke.

Q:	How does smoking or the use of nicotine trigger migraine attacks?
A:	Nicotine affects the brain cells in 2 ways. For a short time it acts as a stimulant, then, within a few minutes, it has a sedative effect. By stimulating brain cells, nicotine can act as a trigger. Subsequently, once its level in the blood drops, the withdrawal of its sedative effect can also trigger an attack. Additionally, cigarettes contain other chemicals that could trigger a migraine attack.

Q:	Can the use of recreational drugs worsen migraine?
A:	Recreational drugs are harmful for several reasons, but stimulants such as cocaine and methamphetamine can cause a stroke in those with migraine. More sedative drugs, such as marijuana and heroin, can cause medication overuse headaches, as can prescription narcotics, such as codeine and hydrocodone, and anti-anxiety drugs, such as diazepam or alprazolam.

Does the use of recreational drugs do more than trigger a migraine?

Stimulants such as methamphetamine, cocaine, and ecstasy not only overstimulate the epinephrine chemistry of the brain but damage the serotonin system as well. Serotonin not only prevents a migraine attack but also balances the functions of epinephrine and dopamine in the brain. Dopamine, like epinephrine, excites brain cells. For example, people with schizophrenia have increased dopamine levels as well as severe intractable headaches. Excessive use of cocaine, ecstasy, or methamphetamine increases dopamine levels, causing drug-induced, schizophrenic-like symptoms.

How do sedative drugs trigger migraine attacks?

Drugs that sedate, including alcohol, do so by decreasing the excitability of brain cells. These drugs typically have a direct effect on brain cell receptors that are usually used by brain chemicals (neurotransmitters) that are naturally calming. The continued use of sedative drugs causes the brain to be less responsive to these neurotransmitters. When the drug is no longer present in the body, the brain is unable to decrease brain cell excitability, which then leads to a drug withdrawal headache. The same mechanism causes medication overuse headache when medications that stop migraine attacks are used too frequently.