In my 3 part series on the nature of migraines, we covered the ins and outs of just what migraines are. To sum up, they’re a bizarre, excruciating, and masochistic phenomenon in which the brain hijacks its own pain sensing circuitry.
But how does all of it get started to begin with?
As most of you know, migraines don’t just happen. They’re triggered. Though there are many variables to consider, the most powerful triggers are environmental, products of diet and lifestyle. Many of these triggers are well established, culled from the experiences of millions of migraine sufferers over many decades. In this post, we’ll cover these classic triggers, and how significant a role each plays in sparking a migraine.
Migraine Triggers: Why Everything Matters
One of the common misconceptions about migraines is that they are typically triggered by one thing. So many migraine sufferers, list of common triggers in hand, search in desperation to find that one thing that keeps causing their headaches. Most of the time this leads to frustration, as on one occasion you may note a migraine to have occurred after a glass of wine, while on another you drink a glass with no problem.
The truth is, with migraines, everything matters. It’s almost never any one thing that flips the migraine switch. Rather, it’s the culmination of multiple factors that sends you past your threshold into the land of throbbing headed misery.
The Flying Basket Analogy
In the book, I provide the analogy of a migraineur flying in a hot air balloon basket with multiple balloons attached, as well as multiple weights (represented as sandbags) to demonstrate visually how all of this works. More balloons make you fly higher, more weights make you fly lower. If you reach a certain altitude — your migraine threshold — the switch is flipped and the migraine process begins. How close you are to your threshold for triggering a migraine is thus determined by the number and size of the balloons pulling you up and the number and size of the weights pulling you down.
In this model, a bigger balloon will make you fly higher than a smaller one, just as certain migraine triggers may raise your risk more than others.
The Big Balloons
The following are the balloons that, for most migraineurs, will raise their risk significantly. These tend to be big triggers for just about everyone:
Big Balloons You Can Control:
1. Alcohol
2. Sugar
3. Erratic sleep
4. Frequent Use of Headache Medication, aka Rebound headaches (a subject I’ll get to soon)
5. Stress (I didn’t say “stuff you can easily control”, mind you)
6. Processed foods, especially when containing MSG
Big Balloons You Can’t Control:
1. Family History – Your DNA, which you can thank your parents for, plays a significant role in how easily you can trigger a migraine in your brain. Yet, being genetically predisposed towards migraines in now way condemns you to a life of head pain. It just means you have to pay more attention to all this stuff than someone without a strong family history.
2. Hormones – This one applies primarily to woman, as it is well established that migraine risk is heightened during the peri-menstrual period and the early part of pregnancy. On the upside, the latter part of pregancy (late second and third trimester) is associated with a substantial reduction in migraine risk.
Variably Sized, Idiosyncratic Balloons
These balloons are ones that vary considerably in their respective size from one person to another. For some, they can result in a major risk increase. For others, they may be trivial.
Variably Sized Balloons You Can Control:
1. Strong Odors – Strongly-scented manmade chemicals are the biggest offenders here (perfumes, scented lotions, organic solvents, etc.). For the ultra-sensitive, just a whiff of perfume is all it takes to send them over the edge.
2. Sunlight – This is a very specific trigger for a small minority of folks. Fortunately, it’s not just any old sunlight that does it, which would be terribly unfortunate. Rather, it seems to be sunlight that’s coming in at an oblique angle that’s the real problem (i.e. – driving to work during dawn or dusk with the sun shining on the horizon in your peripheral vision).
3. Rapid Changes in Barometric Pressure – Some migraineurs note a marked increase in risk any time a weather front comes through.
4. Artificial Sweeteners – Aspartame and Saccharin are the worst offenders here.
5. Heavy Exertion – For some, intense exercise virtually guarantees a post-exercise headache. For others, it doesn’t pose a problem.
6. Sex – A small number of unfortunate souls experience migraines shortly after intercourse (not surprisingly, these are often the same folks who experience headaches after heavy exertion…)
7. Medications – One question I always ask of folks who’ve experienced a recent surge in migraine activity is whether they’ve begun any new medicines. Here, the biggest offenders include:
– Asthma inhalers (albuterol)
– Oral Birth Control Pills
– Over the Counter Stimulations (No Doz, Vivarin, energy drinks)
– Prescription Stimulants (methylphenidate)
– Nitrates/Nitroglycerin (for heart disease)
– Erectile Dysfunction Medication (sildenafil, verdanafil, tadalafil)
– Acne Medication (isotretinoin)
8. Processed and Preserved Meats – in general, this includes any type of meat product you can buy that doesn’t require you to cook it (salami, pepperoni, jerky, etc.)
The Smaller Balloons
The following factors may raise migraine risk some, but typically don’t do so to the same degree as the previous items.
1. Sinus Congestion (typically from an acute or chronic sinus infection)
2. Caffeine
3. Chocolate (though it’s not clear whether chocolate plays a role in triggering migraines, or whether migraineurs just crave chocolate in the prodrome phase, giving the illusion that the consumption of chocolate triggered a headache)
4. Aged Cheese – hard, strongly flavored cheeses are the primary issue here.
5. Milk – Lowfat and skim milk are the primary offenders. The removal of the milkfat in these products concentrates the milk sugars, which results in a rapid rise in blood sugar when consumed.
6. Citrus Fruits
7. Bananas
8. Onions and Fermented Vegetables
9. Nuts
10. Fresh Yeast Bread
11. Dehydration
A lot to take in, isn’t it?! As I said previously, most of these factors are relevant to some degree for everyone, and their effects are additive. Going back to our flying basket, here’s how things might look after a migraine is triggered by the culmination of stress and frequent use of headache relief medication in a person already genetically predisposed to migraine :
All of this means that:
a) it’s almost always not any one thing that triggers a migraine, but several things adding together to bring you over the threshold. Yet, even though many things may have contributed to a given migraine, it’s often the final trigger that pushes you past your threshold that gets the blame.
b) the factors that trigger a given migraine may vary from one migraine to the next.
And this is why finding your own most significant triggers can pose such a challenge (check out my previous post on finding your migraine triggers, or the migraine trigger tracker app if you have an iOS device to help you meet that challenge)
But wait, there’s more!
The above list summarizes the classic, conventional triggers for migraine. For years, these were the triggers I and my patients focused on. And they’re the triggers that virtually every migraine specialist will focus on.
Yet, the most powerful and significant trigger of all is not here – despite the fact that without it, migraines would likely be relegated to the pages of medical oddities. It’s the one trigger whose elimination has the potential to end your migraines for good, and will be the topic of Part 2. So stay tuned!
