The Migraine Brain
Page 10
How to Avoid Your Triggers
Let’s look more closely at the most common triggers. Some are more avoidable than others, and we’ve assigned each of them an “avoidability quotient,” a measure of how easy it is to avoid. If you know that bananas make you sick, you almost certainly can avoid that trigger. But you can’t avoid weather changes. When we assign an avoidability quotient, this isn’t to blame you if you can’t avoid it—it’s to help you see where you might have more control over your triggers.
Stress or Tension
“Stress seems to be the biggest one for me. I seem to get migraine every time I’m about to see my mother, or around other things like that, mainly things I couldn’t be honest about.”
—Bethany, 32, graduate student
“Good stress or bad stress—If I was going on a shopping trip and I was excited about it, I’d get a headache.”
—Clare, 44, middle-school teacher
Avoidability Meter: Medium to Low. Stress is the number one migraine trigger for many people. Yet reducing stress in today’s world—when you’re balancing work, family, and other obligations—is like trying to win the lottery. It’s not likely you can stop working, helping the kids with homework, or keeping the house clean.
Stress causes an increase in cortisol and adrenaline, hormones that have a wide range of effects on your body. Your blood pressure increases, your heart races, and other reactions take place. Stress can lead to an attack of irritable bowel syndrome, tachycardia (racing heartbeat), and other symptoms. It can also trigger a migraine, probably because your Migraine Brain is unhappy with all these chemical and metabolic changes, which is why even pleasant or exciting events can trigger migraines in some people.
Possible Solutions. Section Three of this book, and also Chapter 11, have many suggestions on how to take care of yourself to reduce the effects of stress. Exercise is key. Other stress busters include yoga, meditation, psychotherapy, and relaxing hobbies. Build these into your life! Taking time to take care of yourself isn’t just an option for you—it’s mandatory—if you want to avoid as many migraines as possible.
Related Issue: The “Letdown Migraine.” One type of stress-induced migraine is a letdown migraine, which occurs after a stressful event is over. Many migraineurs work very hard to not let migraines ruin their lives or those of their loved ones. They somehow manage to ward off a migraine attack during a critical event, only to get very sick once it’s over and they can “let down.”
How can you avoid a letdown migraine? First of all, recognize that you’re vulnerable at this time. Focus on wellness—exercise, sleep, nutrition. And be ready with a treatment plan, including medicines if you choose to take them.
Sleep
“I know if I stay up past 1 a.m., which I rarely do, I’ll have a migraine in the morning.”
—Ciara, 36, computer programmer
Avoidability Meter: Sometimes. Problems with sleep are a very common migraine trigger: Too little sleep, too much sleep, interrupted or restless sleep, poor-quality sleep, sleep where your room isn’t quiet enough, sleep after you’ve had too much alcohol (which induces poor sleep in many people)—these things disrupt the consistency your Migraine Brain demands.
Our Migraine Brains want our sleep patterns to be exactly the same every single night. Most migraineurs also need at least seven hours of sleep a night (in Chapter 12, we’ll show just how critical it is to get enough sleep each night). Sometimes that’s easier said than done. If you have a new baby, or you are traveling, or you work a job with an unusual shift, you may not be able to control your sleep.
In general, you want to sleep about the same number of hours every night, at around the same time, in a quiet, peaceful room. That’s your goal. When that’s not possible, you have to be ready to halt a migraine that you weren’t able to avoid.
Not Enough Sleep or Too Much Sleep:
Possible Solutions: Make sure you get at least seven or eight hours of sleep each night. It’s critically important to your migraine health. It’s often hard to make this happen, I know. But it will be a huge benefit to you. Go to bed at the same time every night and wake up at the same time, which studies show can significantly reduce the number of migraines you get. If you don’t, it’s very likely your migraine attacks will increase. See Ch. 14.
If you simply can’t do this—because you work a night shift, for example—take extra care of your health in other ways. Eat well and on time to keep your blood-sugar levels consistent. Drink lots of water. Figure out how you’ll get to sleep in the morning when you get home. That may mean taking a mild sleeping pill, or getting someone to watch your baby. But make it a priority, and plan for it ahead of time.
It can be hard to get good sleep when you’re traveling, especially on long airplane trips. For more help on staying migraine free during travel, see Chapter 14.
Bad-Quality Sleep. Sleep that isn’t deep and restful can trigger migraines. You may not even realize this is a problem for you.
Possible Solutions. You need to make your bedroom as sleep friendly as possible. You may need deep quiet and dark. Consider these options:
White-noise machine. A white-noise machine or wave-sound machine makes gentle noise that masks street sounds or other sporadic noises that disrupt good sleep.
Earplugs. I don’t recommend these because I worry you’ll become dependent on them and unable to sleep without them. Still, some migraineurs swear by earplugs, which don’t cut out all sound but only reduce the decibel level. In a noisy hotel, earplugs may be a life-saver.
Blackout curtains. Curtains or shades for your bedroom that block out the light from outside are inexpensive and very effective.
An eye shield. You know those goofy-looking masks that you see in movies, like the one the old woman wore in There’s Something About Mary? As silly as they may look, they can be wonderful for migraineurs. They block the light and help you get a good night’s sleep.
Get rid of your light-up clock dial! Cover it with a towel or turn it away from you. These clocks cause some poor sleepers to be hyper-vigilant and keep looking at the clock.
Sleep Apnea. Sleep apnea is a dangerous health problem that causes you to stop breathing for short periods of time while you sleep, usually because your airway is obstructed for such reasons as the shape of your tongue, a deviated septum in your nose, or enlarged tonsils. Sleep apnea is a migraine trigger for many people. Symptoms include headache upon waking up, loud snoring, waking up unrefreshed, and drowsiness during the day. If you have it, your brain isn’t getting the oxygen it needs during sleep. Sleep apnea can be fatal. If left untreated, it can result in stroke, heart attack, high blood pressure, or other serious health problems. Sleep apnea gets worse as you get older, too. If you suspect you have sleep apnea, you should talk to your doctor immediately.
Possible Solutions. Treating sleep apnea has helped a remarkable number of migraineurs. Some find that they have markedly fewer migraines. With your doctor’s guidance, you may be able to find an effective apnea cure. It may be as simple as losing weight. There are also medical devices that can address the physical problem; for instance, one that you wear in your mouth stops your tongue from blocking your breathing.
A CPAP unit is very helpful for many migraineurs. CPAP stands for continuous positive airway pressure, and is a mask that you wear over your face at night, connected to a machine that blows air into your nose to keep your airways open. But some people can’t stand sleeping with a mask on, and don’t get good-quality sleep with it (the cure being almost worse than the problem). A newer system, called a C-Flex, works on a different technology and is much more comfortable for many patients.
You can also consider surgical options, depending on the physical cause of the apnea. These include surgically removing the tonsils or altering other parts of your throat. An even newer option is a surgical procedure called somnoplasty, involving radio waves that shrink tissues inside your mouth and throat. You can discuss these options with your doctor
.
Foods
Avoidability Meter: High. For many years, it was believed that certain foods were the cause of migraines, but significant research in recent years shows that foods have been overimplicated as migraine triggers. The more likely culprit, it seems, is low blood sugar—that is, eating certain foods that cause your blood-sugar levels to soar and plummet, the kind of inconsistency your Migraine Brain abhors.
Still, it is true that some migraineurs have a reaction to certain foods. This is very possibly due to chemical properties in certain foods, which may influence or interact with certain hormones or chemicals involved in the migraine chain reaction. (This is yet another area where more research is needed.)
It’s worthwhile to figure out if any foods trigger your Migraine Brain. If so, this does not mean you are allergic to that food. An allergic reaction is a response by your immune system to a particular irritant—food or otherwise—where your symptoms may include shortness of breath, hives on your skin, watery eyes, sneezing, or more serious consequences such as your throat closing up so you cannot breath. A migraine response has nothing to do with your immune system; it is your brain chemistry being overly sensitive to that food, resulting in the migraine chemical chain reaction.
It’s just incorrect that certain foods trigger migraines in everyone, but many websites, books, and even medical personnel continue to blame these foods, including chocolate, nuts, salami, and MSG. So-called “migraine-free diets” touted by these books or websites claim to “cure” migraines by having you restrict your diet to certain foods. One diet recommended that you eat nothing but bananas and yogurt. Like all extreme diets, it’s not only ridiculously hard to stick to, it’s bad for your health. These extreme diets are unsound nutritionally, depriving you of the vitamins and other nutrients you need to stay healthy. And you’re wasting your time: little solid data support their claims to eliminate migraine. The more effective approach is to eat a healthy diet, avoiding any foods that are your particular triggers.
Possible Solutions. To avoid food triggers, you must be very aware of the ingredients in the foods you eat. Read food labels. Don’t even consider eating a food that gives you a migraine simply because you don’t want to offend a tablemate or hostess! If you were deathly allergic to a certain food, you wouldn’t feel bad about turning it down. Empower yourself the same way about your migraine. If something’s going to make you sick, you don’t have to eat it.
Common Food Triggers
Aspartame. This artificial sweetener goes by the brand names of Equal and Nutrasweet, and it’s found in numerous food products including diet soft drinks. Many migraineurs have a notable problem with aspartame. I have one patient who can actually feel her trigeminal nerves begin to throb if she has more than a few sips of Diet Coke. Aspartame’s function in triggering migraines may be due to its effect on serotonin levels. I strongly recommend that all my patients avoid aspartame or at least try to figure out if it’s a trigger for them.
Aged Cheese. Aged cheeses can trigger migraines, possibly due the fact they often have high amounts of tyramine, see below. Aged cheeses include: blue, Camembert, cheddar, feta, Gouda, mozzarella, Muenster, Parmesan, provolone, Romano, Stilton, and Swiss.
Chocolate. Poor chocolate! For years, it’s been implicated in migraines. While chocolate can be a trigger for some people, it’s simply a myth that it triggers migraines in everyone. Many migraineurs have absolutely no problem with it. I actually prescribe a small piece of dark chocolate before bed for my patients who don’t have a problem, since it may help them sleep and has other health benefits.
Chocolate also contains caffeine, though, so if caffeine is a trigger for you, you may need to avoid it. Milk chocolate can also be a trigger because it contains a kind of sugar called lactose, which some people just can’t digest. Also, the high sugar content of many chocolate candies can wreak havoc with your blood-sugar levels, which may be the real reason it triggers migraines in some people.
MSG. Contrary to popular myth, monosodium glutamate (MSG) does not cause migraines. But it can be a migraine trigger, although not for everyone. Some migraineurs are very sensitive to MSG, a very common food additive found in a wide range of foods, from barbecue sauces to, most famously, Chinese food. If MSG is a trigger for you, read all food labels in order to avoid it. (You may be surprised at how ubiquitous it is!) At restaurants, request that your food be prepared without MSG.
Pepperoni and Other Processed Meats. Pepperoni, packaged ham, bologna, and other processed meats contain high amounts of tyramine, a migraine trigger for many people. See “Tyramine,” below.
Soy Sauce. Soy sauce is a migraine trigger for some, probably because it contains tyramine. See “Tyramine,” below.
Tyramine. Tyramine is an amino acid present in certain foods, especially aged and fermented foods, including certain cheese, meats, and even breads and fruits. Tyramine has been shown to trigger migraines, for a variety of possible reasons, including, perhaps, its interaction with serotonin, norepinephrine, or other chemicals involved in the migraine process, although there is much more research to be done. (If you are taking a monoamine oxidase inhibitor such as certain antidepressants, you should limit your intake of tyramine, which can be dangerous to you.)
There is still controversy among researchers over the migraine-tyramine connection. Many believe it is overstated. But if you have problems when you eat foods or drink alcohol with tyramine, avoid it. It’s your Migraine Brain, and you know best how to handle it. You don’t need a scientific study to back up your experience of migraine pain after you eat these foods.
In general, to avoid tyramine, stick with fresh foods, which are better for you, anyway. Aged and fermented foods, or fruits that are ripe or overly ripe, have a higher tyramine content.
Here are some common foods and their tyramine amounts. As you can see, tyramine content can vary widely depending on a number of factors, including how aged or ripe a food is. If you suspect tyramine is an issue for you, do further research on the Web to find specific tyramine amounts in the brands or types of food you are eating or the type of alcohol you are drinking.
Food
Tyramine (mg/100 gms)
Cheese
Brie, Camembert
0–200
Farmers, cottage, cream
0-trace amounts
Hard cheese
0–250
Roquefort
0.7–110
White flour
0.03–0.25
Potatoes, tomatoes, spinach
0–0.4
Most fruits
0
Bananas
0.2–9.5
Raspberries
1.28–9.25
Avocado
2.3
Oranges
0–2.5
Smoked ham
0–62
Salami
0–125
Fresh pork
0.5–4.1
Fresh beef
2
Poultry
2
Chicken liver
10
Pork liver
27
Frozen fish
0
Canned fish
0–60
Chocolate
0–1
Soy sauce
0.941 mg/ml
Beer (depends on brand)
0–167
Champagne
0.3–2.4
Vermouth
0–6.7
White wine
0–2
Red wine
0.05–1.99
Hunger and Low Blood Sugar
Avoidability Meter: High. For some people, it’s not specific foods that trigger a migraine but the failure to eat regular meals or a healthy diet. In other words, it’s not the chocolate in the candy bar that triggered a migraine but the fact that all you ate that morning was a candy bar, so your body didn’t get the fuel it needed to stay well.
Not sticking to
a healthy diet can upset your blood-sugar levels. You want to keep these levels even so that you have a steady supply of energy. Eating too many highly processed foods like junk food or white bread products will spike your blood-sugar level as well as insulin levels, so you soon feel hungry and tired—which can trigger a migraine. Eating healthy foods like whole grains, fruits, and vegetables will keep your glycemic (blood-sugar) index even and help you avoid migraines.
Possible Solutions: Be very disciplined about eating healthy foods on time. Don’t skip meals. See Ch. 12.