Friday, 4 September 2015

Headache & Migraines Part 3 - What Triggers a Migraine

WHAT TRIGGERS A MIGRAINE?

The most frustrating thing about Migraines is their unpredictability. Most sufferers are obviously desperate to find what their triggers are because they think this will help stop the problem.  The problem is these triggers seem to keep changing. One day it will be red wine then the next week you can drink a glass of wine without a problem. You can happily eat  almonds one month then the next month they seem to trigger migraines. Theoretically it should be easy you keep a diary pinpointing  the trigger for each migraine and try to avoid these triggers. The problems is this approach sometimes works and sometimes doesn't. Plus if you read the list of possible trigger foods you start to wonder if you can eat anything at all.

The reason why the triggers seem to change is that it is never one thing that triggers a migraine. What actually happens is every migraine sufferer has a number of triggers. Each trigger acts as a  brick in the wall and when the wall reaches your specified height you will trigger a migraine. Obviously the more susceptible to migraines the lower the  wall has to be before a migraine is triggered. The plan then is to try and figure out what your bricks are and try to prevent your wall getting high enough to cause a trigger.

BRICKS IN THE WALL

Family History 

There is a strong genetics component to migraines and it is obviously the one you obviously cannot control.

Neck Vertebra 

It is agreed that many that many headache sufferers experience neck symptoms. Joints of the upper neck are positioned right next to the lower brainstem. Abnormal signals from the neck lead to increased sensitivity of the brainstem.  I will discuss how research has shown physiotherapy can identify and treat this cause of headache.

Sinus Congestion 

An acute sinus infection or allergic sinusitis can trigger a migraine. Sinus problems are most likely over diagnosed as a trigger for headaches but it can be significant. Now we are coming into spring I am beginning to treat a lot of hay fever sufferers. Acupuncture has been found to be very effective at treating allergic sinusitis and sufferers of chronic sinus infections so this trigger can be treated.

Hormones  

The hormonal shifts that occur just prior to and during menstruation have long been linked to migraines. Some women only have migraines around the time of menstruation. Many women also experience worsening of their migraine symptoms with birth control pills as do post menopausal women on hormone replacement therapy. The interesting thing with this trigger is the hormone levels of women who suffer from menstrual migraine when tested are within normal limits. This indicates a normal signal to the brain leads to a migraine indicating there is a problem elsewhere in the system.

Even though the hormone level itself is not the problem in  my experience if a women is experiencing significant premenstrual symptoms it is worth addressing these with Acupuncture. This will reduce stress and increase dopamine production and lead to less headaches. 


Bright Light 

Light particularly coming in at an oblique angle, like sun through a side window of a car or strobe lighting.

Food Triggers

Caffeine – Caffeine particularity in the afternoon can trigger a migraine. Many people can tolerate a coffee in the morning but continued coffee throughout the day can become a trigger. Ironically some sufferers find when a migraine is coming on caffeine can help prevent onset. There is no clear understanding of why this is at this stage.

Alcohol – Alcohol is one of the strongest triggers of headache. Obviously some  migraine sufferers can get away with one or two drinks but others one sip can be a trigger.

MSG – Can be a major trigger for some people. Also known as glutamic acid, glutamate.
Chocolate – Less of a trigger than some think as a migraine can cause a chocolate craving which leads it be be blamed more than it probably should be.

Processed Meats – salami, pepperoni, ham and any other meat you don't have to cook. It is thou=ght the nitrates in the meat are the trigger.

Cheese – normally aged cheeses.

Milk – particularly low fat milk which have a higher concentration of milk sugars.

Nuts – Almost any type of nut can act as a trigger

Citrus – Grapefruit, oranges, lemons particularly on an empty stomach

Banana – Any sweet fruit eaten to satisfy hunger can be a trigger. The advice is to only eat sweet fruit after  meals not too satisfy huger.

Artificial Sweeteners – particularly aspartame & saccharin.


 Lifestyle Triggers

Stress  - It is clear stress emotional or physical significantly raises the migraine risk level. Stress management plays a big part in controlling your headaches. Stress commonly adds tension to your neck which we have already discussed as a major headache trigger.

Sleep – Any sleep disruption can be a trigger. The most common are insomnia, too late a night on Friday night, new born baby or flying into a different time zone. Oversleeping can also trigger a migraine is some.

Poor Posture -Poor posture particularly at a work station leads to tension in the neck which as stated earlier is a major cause of tension headaches.

Hunger – Skipping or delaying meals is a well documented headache trigger. The drop in blood sugar is thought to be the trigger. Make sure when you feel hungry you do not eat a sweet food to satisfy the hunger as this will cause the headache to escalate.

Dehydration – An obvious trigger that every headache sufferer knows about. Carry a water bottle with you and if you sweat a lot with exercise take an electrolyte replacement drink.

Frequent use of Migraine medication – Ironically each time you take a medication to abort a migraine you are increasing your likelihood of triggering a migraine when the medicine wears off. This is called a rebound headache.

Medications – Asthma inhalers, No Doz, Nitroglycerine for heart disease, acne medication. Obviously if you have been prescribed these medication you can discuss with your GP if there are alternatives or if you can safely withdraw and check to see if the medicine is in fact a trigger.

Depression – Commonly a significant increase in headache can be  a sign of depression. If the depression is not treated it is unlikely the headaches will improve.

The next blog entry will look at the all important question of what can you do about preventing the wall building up to a level that you are susceptible to a headache or migraine.