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Migraines and triggers and misinformation

Phaycops

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Hi All! Haven't posted in a while, and I'm hoping the brilliant minds here can help me out a bit. I've been getting migraines with aura with increasing frequency. My primary care doc is going to send me to a neurologist in a couple months; meanwhile I'm supposed to keep a "headache diary" and try to identify my "triggers."

So I did some checking around on teh interwebs (reputable sites, mainly -- it's easy to tell the other kinds from their links and ads), and it seems like just about anything is someone's migraine trigger. Not to mention, every website seems to have different lists of "safe" or "unsafe" foods, with some of them bordering on the extreme. Nobody seems to be able to tell me (my doctor included, but that may be a language barrier thing) how long it takes between a migraine "trigger" and the headache onset, and I certainly can't find any information related to the mechanisms for things like avocados, beans, or citrus fruit "triggering" migraines.

So my questions are these:
1. Are these lists of migraine "triggers," particularly foods, supported by any evidence-based science, or is this just a collection of anecdtodal evidence? Is there a likely mechanism proposed for any of them? If there isn't, does keeping a diary really help?
2. How long does it take for a "trigger" to trigger a migraine?

Thanks for your help!
 
In regards to (1), I don't know, but in regards to (2) aged cheese - especially provolone - triggers a migraine within 30 minutes for me.

My migraines cut waaaaaaay down once I learned to stop clenching my back teeth in my sleep - I had to wear a dental appliance for several months to do this. I went from having approximately 20 migraine days/month to about 5 days/month. Those last 5 days are due to hormones. I owe an eternal debt of gratitude to a forum homeopath who told me about how teeth clenching relates to migraines.
 
I suffer from migraine with aura also - for me usually zig zag line(s) in vision sometimes accompanied by a kind of fuzzy dissociation, and very occasionally a brief loss of feeling at the tip of a finger or two.

I have never figured out any particular trigger, but find that when an aura occurs it gives between 20 - 30 minutes warning before a headache hits. I'm always grateful for the aura as it gives enough time for an immediately wolfed down couple of paracetamols to kick in and rarely nowadays get caught out by the pain.
 
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No personal experience of migraine, but I heard a radio item about a year ago in which it was said that persistent migraine can be associated with a particular genetic heart defect. Heard of that at all?
 
Soapy Sam said:
No personal experience of migraine, but I heard a radio item about a year ago in which it was said that persistent migraine can be associated with a particular genetic heart defect. Heard of that at all?
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Hmmm...interesting. Thanks (I think :)). Not heard of that.

I only found out last X'mas that my father also suffers from migraine with the zig zag aura so there may perhaps be a genetic disposition in there. Although he's always had thyroid problems and a couple of years ago a minor'ish stroke, I'm not aware of any heart problems.
 
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While each person's triggers are unique to that person, there are trends, which is where the list comes from, common triggers.

As for me, I may have a food trigger, but I have never found one. Stress is definitely a trigger for me, but I suffer from Post-stress migraines. I get about 90% of my migraines on Saturday morning, after a rough work week.

Caffeine, or the lack of it, is another trigger for me. If I do not get caffeine every 12 hours or so, I will have a MASSIVE migraine. This makes sense, since migraines are caused by a dialation in a particular artery in the brain, and caffeine acts as a vasoconstrictor.

I don't generally get auras, but I can become sensitive to light and sound, and I sometimes become very nauseous, vomiting every 15-20 minutes until the attack ends (About 8 hours).
 
genesplicer said:
While each person's triggers are unique to that person, there are trends, which is where the list comes from, common triggers.
Click to expand...

Yeah, see, this is where I'm getting skeptical (and frustrated). It seems like migraine headaches are caused by something specific -- blood vessels dilating when/where they're not supposed to. Certain things could cause this, but how could it be so different for each person, if there were actually *something* *causing* it? Does that make sense? It just seems like, based on what we know about how people like to find reasons and causes for things, it could be all too easy to construct a faulty correlation.

Also, again, I'm not finding any information on HOW these "triggers" supposedly work, in terms of actual biological action. Maybe someone who's got access to a medical research database could do a quick search. I can tell you mine appear to be related to sleeping late and bright flashing lights, but I can't even find any information on why/how this would make my blood vessels dillate inappropriately. Maybe once I get to see the specialist I can get some better answers.
 
Lisa Simpson said:
In regards to (1), I don't know, but in regards to (2) aged cheese - especially provolone - triggers a migraine within 30 minutes for me.

...snip...
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My mother and brother both suffer from migraines - my mother's can be so bad her speech is slurred, she loses sight in one eye and she literally cannot stand. Hard cheeses such as cheddar, Lancashire and so on are a trigger for both of them but sometimes it can be several hours after they've eaten the cheese.
 
I wanted to add that I am not trying to contend that your or your friend's or your mum's migraines *aren't* caused by something in particular. What I'm questioning is whether there is any medical reason why a particular food could cause a migraine -- in a medical way. I'm also wondering whether some of the more peculiar foods listed on these websites could also be a result of a faulty correlation, not accusing EVERYONE of having made such an error. The web is full of crap information, and I'm just looking for some clarification! Hope that helps. I'm not trying to insult anybody!
 
Check out yesterday's Talk Of The Nation. They devoted the entire hour to the subject, and talked about triggers, auras, and the like.
The shows can be downloaded or are available in streaming audio.
 
No food connection for me. They're post-stress for me. I believe the term is 'classic migraine'. Numbness in hand/arm, zig-zags, numb tongue and slurred speech. But they hit me most often at lunch. Take a break, put my feet up in the shade, the arm starts tingling...

If it occurs to me soon enough, I try some bio-feedback, tell myself to raise my blood pressure. Almost always works.
 
genesplicer said:
While each person's triggers are unique to that person, there are trends, which is where the list comes from, common triggers.
Click to expand...
Triggers are very often linked to allergies in a lot of migraineurs. Having a list of food and inhalant allergies can be very helpful in narrowing down potential triggers. I find that the frequency and severity of my migraines greatly increases during the spring and fall peak-allergen seasons (tree and grass pollens in the spring, mould spores in the fall).

Also, keep in mind that there are threshhold levels for nearly all triggers; that is, a minimum amount required in order to trigger a migraine. Like the types of triggers, threshholds will vary individually as well.

On top of that, migraine suceptibility has also been strongly linked to hormone cycles; and suceptibility to triggers will vary considerably over the course of the cycle. This is particularly dramatic in female migraineuers, but has been observed in male sufferers well. I have one friend who is a FtM TG, and suffered from disabling migraines; He started taking testosterone supplements and estrogen blockers as part of is transition process, and found that the frequency and severity of his migraines were reduced to almost nothing.

Although triggers are highly individual, as genesplicer noted, there are a few which are common and widespread enough for all types of migraines (common, classic, and cluster) to be almost universal. Stress is the most common trigger, and I've found that relaxation exercises can stop or decrease the intensity of a migraine if performed very early in it's onset (during the "aura" phase).

Monosodium Glutamate is another very common trigger, particularly in the amounts commonly used in Chinese and other Asian cookig; and after stress, is probably the closest thing to a universal migraine trigger that exists. Alcohol is also a very widespread one. Other very common triggers are nitrates (found in cured meats); sulphites and tannins (found in red wine, white wine is typically safe for migraineurs who are not highly sensitive to alcohol); chocolate (IIRC the theobromine); sharp cheeses; and caffiene.

Phytoestrogens are suspected as a trigger; but this is still highly controversial, due to the low bioavailability of phytoestrogens, and their unproven effect.

Also, are you diabetic or hypoglycemic? (I'm the latter.) In both cases, improperly-managed blood glucose causes severe alterations in body chemistry which can trigger migraines.
 
luchog said:
Triggers are very often linked to allergies in a lot of migraineurs. Having a list of food and inhalant allergies can be very helpful in narrowing down potential triggers. I find that the frequency and severity of my migraines greatly increases during the spring and fall peak-allergen seasons (tree and grass pollens in the spring, mould spores in the fall).

Also, keep in mind that there are threshhold levels for nearly all triggers; that is, a minimum amount required in order to trigger a migraine. Like the types of triggers, threshholds will vary individually as well.

On top of that, migraine suceptibility has also been strongly linked to hormone cycles; and suceptibility to triggers will vary considerably over the course of the cycle. This is particularly dramatic in female migraineuers, but has been observed in male sufferers well. I have one friend who is a FtM TG, and suffered from disabling migraines; He started taking testosterone supplements and estrogen blockers as part of is transition process, and found that the frequency and severity of his migraines were reduced to almost nothing.

Although triggers are highly individual, as genesplicer noted, there are a few which are common and widespread enough for all types of migraines (common, classic, and cluster) to be almost universal. Stress is the most common trigger, and I've found that relaxation exercises can stop or decrease the intensity of a migraine if performed very early in it's onset (during the "aura" phase).

Monosodium Glutamate is another very common trigger, particularly in the amounts commonly used in Chinese and other Asian cookig; and after stress, is probably the closest thing to a universal migraine trigger that exists. Alcohol is also a very widespread one. Other very common triggers are nitrates (found in cured meats); sulphites and tannins (found in red wine, white wine is typically safe for migraineurs who are not highly sensitive to alcohol); chocolate (IIRC the theobromine); sharp cheeses; and caffiene. Bright flashing lights at certain frequencies are also a common problem, with the frequencies similar to those which are known to trigger epileptic seizures.

Phytoestrogens are suspected as a trigger; but this is still highly controversial, due to the low bioavailability of phytoestrogens, and their unproven effect.

Also, are you diabetic or hypoglycemic? (I'm the latter.) In both cases, improperly-managed blood glucose causes severe alterations in body chemistry which can trigger migraines.
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I feel for you. I haven't had one in years. I'd get flickering in both eyes and I would eventually go blind in my right eye. I'd take a strong pain killer then go to sleep. Several hours later it was gone and I was fine.

I got one every six months or so for about 10 years then they stopped. It's been about 4 years since I had one.

I don't know of a definite trigger, but my suspicion (purely conjecture) for me was long exposure to inside flourescent lighting.
 
Phaycops said:
Yeah, see, this is where I'm getting skeptical (and frustrated). It seems like migraine headaches are caused by something specific -- blood vessels dilating when/where they're not supposed to. Certain things could cause this, but how could it be so different for each person, if there were actually *something* *causing* it? Does that make sense? It just seems like, based on what we know about how people like to find reasons and causes for things, it could be all too easy to construct a faulty correlation.

Also, again, I'm not finding any information on HOW these "triggers" supposedly work, in terms of actual biological action. Maybe someone who's got access to a medical research database could do a quick search. I can tell you mine appear to be related to sleeping late and bright flashing lights, but I can't even find any information on why/how this would make my blood vessels dillate inappropriately. Maybe once I get to see the specialist I can get some better answers.
Click to expand...

They've linked migraines to a phenomenon called, "cortical spreading depression." I don't really know what that is either. But wiki: http://en.wikipedia.org/wiki/Cortical_spreading_depression

For me, I know that perfumes are a definite trigger. Bad sleeping doesn't help either.

ETA: Here's wiki's bit on CSD and migraines:

e thought to be initiated by problems with blood vessels. This theory is now largely discredited.[28] Current thinking is that a phenomenon known as cortical spreading depression is responsible for the disorder.[29] In cortical spreading depression, neurological activity is depressed over an area of the cortex of the brain. This situation results in the release of inflammatory mediators leading to irritation of cranial nerve roots, most particularly the trigeminal nerve, which conveys the sensory information for the face and much of the head.

This view is supported by neuroimaging techniques, which appear to show that migraine is primarily a disorder of the brain (neurological), not of the blood vessels (vascular). A spreading depolarization (electrical change) may begin 24 hours before the attack, with onset of the headache occurring around the time when the largest area of the brain is depolarized. The effects of migraine may persist for some days after the main headache has ended. Many sufferers report a sore feeling in the area where the migraine was, and some report impaired thinking for a few days after the headache has passed.
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http://en.wikipedia.org/wiki/Migraine#Pathophysiology
 
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This seems like just the thread I've been looking for. I already asked about this in the thread regarding Head On but I didn't get any satisfactory answers.

As I've said, I've been suffering from chronic migraines for most of my life now. Most manifest themselves as cluster headaches, however there are a number of significant differences between my migraines and the ones most sufferers get. They have no auras and come as they please, without warnings. They have no food triggers that I am aware of, and I've tried ruling many of them out without avail. As far as I can tell, these are not your typical migraines.

Finally, and I say this without exaggeration, there is always a certain degree of undue and often debilitating pain at any given moment of my waking life. Because of the chronic headaches, I cannot function normally or lead a normal life in any sense of the word. The pain has knocked me out, impaired my mental functions, and has driven me to self injury at certain points in my past.

I've been to a couple of neurologists, but they couldn't figure it out. One told me to get my depression treated, because he believed that was the cause. My psychiatrists tried this, but all that accomplished was my being drugged up AND in constant pain. OTC painkillers do not work anymore because I've built up such a resistance to them, and the rebound headaches don't make them worth it. I have not gone on prescription painkillers because my physician was reluctant to prescribe them, since they're habit forming. I've tried caffeine too, but I've found out that like the OTC painkillers, it only works for an hour or so, and then I have to deal with all the side effects.

To repost what I said in the other thread, the causes I have identified as most likely are sleep deprivation, stress, changes in blood pressure, bright lights, smoke, motion sickness, or anything that causes a dilation or constriction of blood vessels in my head. In other words, life itself is my trigger. To phrase it more cynically, it hurts to live. The headaches never truly go away; at the most they lessen to the point of being somewhat tolerable for a short time.

What can I do?
 
About 10 years ago, I had a "spiral" thing happen while I was teaching. I said, "wow we were talking about subjective experiences, I am having one. And I read a paper once by a MD who had these before his migraines. It was published in 1880 something." I drew it on the blackboard as it progressed from a little arc of flashing white dots with some red and green dots to a spiral going counterclockwise. I have experienced that about 6 times since then, but never a migraine headache ensued.
 
Jeff, try looking up 'optical migraine', they effect only the vision.
 
Chocolate is my main trigger. VERY strong correlation. They nearly stopped when I stopped eating ANY.

Another thing that has significantly reduced my migraines is Magnesium Chloride. Slo-Mag brand (the pharmacist may have a cheaper generic behind the counter) 6 per day. Reason it works is that it prevents the muscle spasms that cause the migraine initiation, and makes them release more quickly when they do spasm.
 
I have had migraines since I was about 5. From then until about the age of 15 my mom and dad tried everything. I have even been to Elizabeth Taylor's personal migraine doctor in NYC. My mom kept logs and journals. She tried cutting out dairy, cutting out bread, cutting out foods with dyes in them (I really liked hot dogs). I have been to allergists. I was on weekly allergy shots for years. I am sorry to say that we never really found any correlation between diet and migraines or allergy's and migraines. I started a thread on biofeedback.
http://www.internationalskeptics.com/forums/showthread.php?t=104733migraines.

Biofeedback works, but for me is not practical because I have to be in a sound and light free environment and I am rarely able to do that. Liz's doc told me to start taking Excedrin as soon as I started having the aura or the flashing lights and that worked really well for the next 30 years until I ended up in the hospital with ulcers. I now have a neurologist that has me on the right path. I take 2 prophylaxis meds, nortrytilene and verapamil and when I feel a headache coming on I take a relpax. WOW! Who new you could take a pill to make a migraine go away? The best a part is it is a non-narcotic. I am in recovery from addiction and would not be able to take anything else. My headaches are down from daily to 2-3 per month. I feel like now I have my triggers fairly well isolated. 1)If I forget to eat and 2)stress.
 
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