The GUIDE: Migraine triggers

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Since writing my Migraines posts, I have been asked about triggers for migraines.

Many of you should be aware that migraine sufferers report many different types of triggers for their symptoms.  The most common headache triggers - eyestrain, polluted/stale/contaminated air, stress, disrupted sleep cycle - can also trigger migraines, but there are some very specific food and environmental triggers as well.

The food triggers - artificial coloring agents, cured/preserved meats, sausage, pepperoni, yeast breads, pizza, cheeses, caffeine, etc. can be found at WebMD (http://www.webmd.com/migraines-headaches/guide/triggers-specific-foods) which is a good start for migraine information.Understanding *why* there are specific triggers to migraines involves going back to the mechanism of what a migraine is - a reaction of the blood vessels in the brain - and the feedback loop of serotonin and histamine release that both result from and promote the vascular "spasm." 

Foods such as peanuts, sourdough, yeast breads, certain fruits... can trigger food allergies.  Even non-obvious allergies such as mold and mildew allergy can be triggered by yeast - thus resulting in increased histamine levels in the blood, triggering the vascular reaction in sensitized blood vessels in the brain. 

Preserved, cured meats contain nitrates.  In particular when those meats are fried or grilled (bacon, sausage, steak), nitrites and nitrosamines are produced, and those chemicals are also known to irritate sensitized blood vessels.  In addition, nitrosamines are metabolized by some of the same pathways as serotonin, and can lead to increased serotonin levels.

Many "stinky" or aged cheeses contain tyramine:  Bleu cheese, brie, aged cheddar, stilton, feta, gorgonzola, mozzarella, parmesan, muenster, swiss - the list goes on, and tyramine is also found in processed meats, fava/garbanzo/lima/pinto beans, avocados, raisins and fruit.  Tyramine is one of the chemicals in the pathway by which serotonin (chemical name 5-hydroxy-tryptamine) is made and broken down.  Tyramine containing foods boost the serotonin levels in the blood.

Monosodium glutamate, caffeine and aspartame (containing phenylalanine and aspartate), as well as similar chemicals, contain components of common neurotransmitter chemicals.  They can cause abnormal dilation or irritate the blood vessels as well as interact with normal brain function when levels are too high. On the other hand, if a person is used to high dietary levels, headache and migraine can occur from abstinence or lack of those chemicals:  A person who consumes 5 cups of coffee a day during the week may suffer caffeine-withdrawal headaches on the weekend.

Other environmental contaminants such as pollution, perfume, typically interact with allergy and histamine reactions of the immune system.  Chemicals such as histamine, nitrates, alcohol, and some of the neurotransmitters which dilate blood vessels are positive reinforcers of the vascular reaction that promotes a headache/migraine.  The lack of chemicals such as glutamate, aspartate, caffeine, that constrict blood vessels leads to a "rebound" dilation which acts the same ways.  Understanding that histamine and serotonin are the primary chemicals involved, and any food or reaction that increases histamine and serotonin levels will go a long way to understanding and controlling migraines.

For food triggers, doctors recommend trying an "elimination diet" - go to WebMD or MyChronicMigraine for lists of foods - eliminate them *all* from your diet for 2-4 weeks, then gradually add one food from the list back into your diet each week. If migraines stop or are reduced with all trigger foods eliminated, then a trigger food is like a culprit.  If migraines return after a particular food is restored, it is likely a trigger (but not the only one), remove it for a week, then resume by adding back in other foods until you have identified the one or more foods that trigger your migraines.

Keep a food and migraine diary.  It is extremely important and will help you and your doctor identify your trigger foods.

Until next time - feed your brain... the right foods!