Migraine is believed to be a genetic neurological disease. As persons with migraine, we are thought to have an inherited sensitivity of the nervous system, which makes our brains hyperexcitable. This hyperexcitiability gives us a predisposition to migraine attacks.
Once we have been diagnosed with migraine, we need to know about triggers. Although much is written about triggers and scientific evidence is often insufficient, inconclusive, and debatable, seven important things we should be aware of are:
Triggers are internal and external stimuli that "set off" (provoke, initiate) migraine attacks in those of us who have the disease. In other words, migraine disease makes us vulnerable to triggers.
NUMBER TWO :
It is important for us to know that triggers do not cause our symptoms. "During a migraine attack, a storm of electrical and chemical activity 'switches on' different areas in the brain and surrounding nerves to cause migraine symptoms" (Dr. Andrew Charles, AHS14AZ).
Triggers thought to be associated with an increased probability of an attack over a brief period of time include:
- Altered sleep patterns (poor sleep, interrupted sleep, oversleeping).
- Hormonal changes like estrogen withdrawal.
- Hunger (missed and skipped meals, fasting, hypoglycemia).
- Stress, including perceived emotional stress and "let-down" stress. As well, stress can make us more susceptible to other triggers. For example, perceived emotional stress may interrupt our sleep or make it difficult for us to fall aseep.
- Environmental factors like weather changes, bright or flickering lights, loud noises, and strong odors.
- *Dietary factors including magnesium deficiency and chemicals and additives in foods, such as tyramine (e.g., aged cheeses, bananas, avocados, fava beans, garbanzo beans, lima beans, organ meats like liver, pickled foods, canned soup, nuts, peanut butter, tomatoes, and soy sauce), tannin (e.g., chocolate, cheeses, ice cream, nuts, bananas, smoked foods, and cigarette smoke), aspartame (e.g., diet sodas), phenylethylamine (e.g., chocolate), sulfites (e.g., fermented foods and beverages), nitrites (bacon, ham, pepperoni, and other processed meats), gluten (e.g., wheat, barley, rye, and may be added to number processed foods as thickener,stabilizer, emulsifier, starch, or hydrolyzed plant protein), MSG (e.g., sauces, gravies, processed meas, packaged foods, and canned soups and vegetables).
- Exposure to, or withdrawal from, certain medications, caffeine.
*Food cravings (hunger) in the premonitory phase may be mistakenly identified as triggers. For example, declining estrogen levels that occur at the time of menstruation as well as low levels that are encountered during the menopausal transition, are triggers for some women. Low estrogen levels are associated with low serotonin levels. Low serotonin levels may promote food cravings for starches and sugars, including chocolate. If we mistakenly identify a food craving as a trigger, we may unnecessarily avoid something we enjoy.
While specific triggers may be controversial, in a study where respondents were presented with a list to choose from (Kelman, 2007, cited in Pavlovic et al, 2014), the most commonly occurring triggers were:
- Missed meals.
- Sleep disturbances.
While a single trigger may initiate an attack, a single trigger (apart from menstruation) may not be powerful enough to consistently initiate an attack by itself. In other words, we need to know if a specific trigger is always followed by an attack. Since it may take a combination, or loading of triggers (additive effect, stacking, cumulative) to provoke an attack, it is helpful for us to know which triggers occur either singly or in combination with others. For example, high stress plus poor quality sleep or oversleeping, is associated with an increased chance of an attack. (Spierings et al, (2014).
Perhaps, the most important thing to know about triggers is they are unique to the individual. Keeping a diary can help us identify our personal triggers and make associations between these triggers and our attacks. An advantage of electronic diaries is they can capture data on the same day and eliminate the inaccuracy of recall, along with the frustration of flipping through pages to try and figure everything out.
Once we identify our unique triggers, we can avoid or learn to manage them. For example, we can avoid triggers that are not consistent with a healthy lifestyle such as toxic smells; chemicals and additives in foods and beverages; hunger; dehydration; and, lack of sleep or oversleeping. We can learn to manage others like stress.
Murray, S. "Can we use associations between migraine triggers, premonitory symptoms, and migraine attacks, to predict our attacks and decrease their frequency?" Sharron Murray's Articles, December, 2014.
Murray, S. , MS, RN. Migraine: Identify Your Triggers, Break Your Dependence On Medication, Take Back Your Life. San Francisco:Conari Press, 2013.
This article is not intended as a substitute for medical advice. If you have any specific concerns about your health or nutrition, please consult a qualified health care professional.
Updated July 6, 2016
Copyright September, 2015, Sharron E, Murray