Migraine Headache - Causes

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What are migraine triggers?

A migraine trigger is any environmental or physiological factor that leads to a headache in individuals who are prone to develop headaches. Only a small proportion of migraine sufferers, however, can clearly identify triggers. Examples of triggers include:

  • stress,
  • sleep disturbances,
  • fasting,
  • hormones,
  • bright or flickering lights,
  • odors,
  • cigarette smoke,
  • alcohol,
  • aged cheeses,
  • chocolate,
  • monosodium glutamate,
  • nitrites,
  • aspartame, and
  • caffeine.

For some women, the decline in the blood level of estrogen during the onset of menstruation is a trigger for migraine headaches (sometimes referred to as menstrual migraines).

The interval between exposure to a trigger and the onset of headache varies from hours to 2 days. Exposure to a trigger does not always lead to a headache. Conversely, avoidance of triggers cannot completely prevent headaches. Different migraine sufferers respond to different triggers, and any one trigger will not induce a headache in every person who has migraine headaches.

Sleep and migraine

Disturbances such as sleep deprivation, too much sleep, poor quality of sleep, and frequent awakening at night are associated with both migraine and tension headaches, whereas improved sleep habits have been shown to reduce the frequency of migraine headaches. Sleep also has been reported to shorten the duration of migraine headaches.

Fasting and migraine

Fasting may precipitate migraine headaches by causing the release of stress-related hormones and lowering blood sugar. Therefore, migraine sufferers should avoid prolonged fasting.

Bright lights and migraine

Bright lights and other high intensity visual stimuli can cause headaches in healthy subjects as well as patients with migraine headaches, but people who suffer from migraines seem to have a lower than normal threshold for light-induced headache pain. Sunlight, television, and flashing lights all have been reported to precipitate migraine headaches.

Caffeine and migraine

Caffeine is contained in many food products (cola, tea, chocolates, and coffee) and OTC analgesics. Caffeine in low doses can increase alertness and energy, but caffeine in high doses can cause insomnia, irritability, anxiety, and headaches. The overuse of caffeine-containing analgesics causes rebound headaches. Furthermore, individuals who consume high levels of caffeine regularly are more prone to develop withdrawal headaches when caffeine is stopped abruptly.

Chocolate, wine, tyramine, MSG, nitrites, aspartame, and migraine

Chocolate has been reported to cause migraine headaches, but scientific studies have not consistently demonstrated an association between chocolate consumption and headaches. Red wine has been shown to cause migraine headaches in some migraine sufferers, but it is not clear whether white wine also will cause migraine headaches.

Tyramine (a chemical found in cheese, wine, beer, dry sausage, and sauerkraut) can precipitate migraine headaches, but there is no evidence that consuming a low-tyramine diet can reduce migraine frequency.

Monosodium glutamate (MSG) has been reported to cause headaches, facial flushing, sweating, and palpitations when consumed in high doses on an empty stomach. This phenomenon has been called Chinese restaurant syndrome.

Nitrates and nitrites (chemicals found in hot dogs, ham, frankfurters, bacon, and sausages) have been reported to cause migraine headaches.

Aspartame, a sugar substitute sweetener found in diet drinks and snacks, has been reported to trigger headaches when used in high doses for prolonged periods.

Female hormones and migraine

Some women who suffer from migraine headaches experience more headaches around the time of their menstrual periods. Other women experience migraine headaches only during the menstrual period. The term "menstrual migraine" is used mainly to describe migraines that occur in women who have almost all of their headaches from 2 days before to 1 day after their menstrual periods. Declining levels of estrogen at the onset of menses are likely to be the cause of menstrual migraines. Decreasing levels of estrogen also may be the cause of migraine headaches that develop among users of birth control pills during the week that estrogens are not taken.

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See what others are saying

Comment from: kerri, 45-54 Female (Patient) Published: March 25

I've suffered from migraines for more than 20 years. Triggers include aspartame, rainy days and my period. I started taking high blood pressure medication, and now the migraines are gone. I still take amitriptyline every night.

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Comment from: debd, 55-64 Female (Patient) Published: May 14

I started having monthly migraines after giving birth to my first child. The only time I didn't have them was when I was pregnant with my next two children. The migraines returned once I got my periods again. I went through all the OTC pain killers and anti-inflammatories, several prescription meds and many alternative methods. With a very strict diet there was some relief, but the slightest variation would cause a relapse. My migraines always included nausea and vomiting. Once the vomiting started, that indicated the point of no return and I would just have to ride it through for 3 to 5 days. This went on for 21 years. I finally found a godsend through my sister, who also suffered from migraines. She went to a doctor who suggested Indocid in a suppository form. Not so appealing to some, but it worked oral meds. Since taking these nine years ago, I think I've had three full migraines and now that I've reached menopause I rarely need to take them. Phew!

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