The Migraine Brain

by Bernstein, Carolyn; McArdle, Elaine

  Alcohol

  Avoidability Meter: High. Many migraineurs have such a strong negative response to alcohol that it’s almost as if they are allergic to it (although the physiological reaction isn’t an allergic reaction at all). Even one alcoholic beverage can trigger a severe migraine in some people.

  If alcohol is a problem for you, there are several possible reasons. One is that alcohol dehydrates your brain, which your Migraine Brain doesn’t like. Or it may be that your Migraine Brain dislikes a particular substance in a particular alcoholic beverage, such as the tyramine content of red wine. There may be other chemical interactions that explain your brain’s aversion to alcohol.

  Possible Solutions: Don’t drink alcohol. (If you have a problem cutting back on alcohol consumption, please read more in Chapter 13.)

  If you choose to drink alcohol, you’re going to have to get used to drinking a lot of water at the same time. For every glass of alcohol you ingest, drink at least one eight-ounce glass of water. If you have one beer, for example, drink at least one water chaser with it, but you may need more even more water. One of my patients who’s very sensitive to dehydration drinks three glasses of water for every bottle of beer. (And—unless you don’t mind spending your time running to the bathroom—this naturally limits how much alcohol you can drink!)

  Red Wine. Red wine does trigger migraines in many people. It contains high amounts of tyramine, the amino acid that appears to have a strong connection to migraine. (See “Tyramine,”) White wine does not contain high doses of tyramine and so isn’t as big a problem for many people, although it can trigger migraines in some people and so they should avoid it. Red wine contains a number of other chemicals that have been theorized as the cause of wine headaches, but the data isn’t conclusive. Still the point is that many migraineurs have a problem with it.

  The combination of tyramine in red wine and the dehydrating effect of alcohol may mean that you have to avoid red wine entirely. But some people can have one glass of red wine without a problem—and one glass a day is good for your heart, according to numerous studies—if you counteract it with a water chaser.

  Possible Solutions: Drink lots of water when you drink wine.

  Organic wine may be a safe alternative, because it is produced from grapes grown without pesticides and other chemicals. It typically has reduced amounts of sulfite, a chemical that can trigger migraines.

  Strong Smells

  Avoidability Meter: Sometimes.

  “On the day we moved onto the new floor of the hospital, there was a strong odor. I got a severe migraine and had to go home. And that patchouli perfume is the worst!”

  —Eleanor, 43, nurse

  Oh, who among us has not been trapped in a tight space—on the train or in an elevator—with someone doused in strong perfume, apparently oblivious to the discomfort they’re causing those nearby? Being stuck in an office meeting in a small room with a co-worker who’s decided to splash herself with liberal amounts of perfume can be torture, and a recipe for a whopping migraine.

  Sometimes even fresh flowers—lilies, for example, which have a strong scent—can trigger migraines. Strong smells are such a serious problem for so many migraineurs that this was a key issue when we designed the Women’s Headache Center at the Cambridge Health Alliance. Our advisory board of women patients recommended that all the magazines in the waiting room be perfume free. Any scented ads—such as those pull-apart perfume ads—are removed. Those of us who work in the center also avoid wearing perfume or using strongly scented shampoos, conditioners, hand lotions, or even scented laundry detergent for our clothes.

  In recent years, churches, schools, and other public places have become aware of the chemical sensitivity that many people—not just migraineurs—have to strong scents. Some have cordoned off areas where perfume wearers must sit, for example.

  But avoiding all strong scents isn’t going to be easy.

  Possible Solutions: You can certainly control what you use—and I hope that your loved ones will also agree to eliminate their use of perfumes and scented products. Be aware of your own soaps, shampoos, laundry detergents, dryer sheets, air fresheners, and any other product that is scented. You may have to use trial and error to find products that don’t cause a reaction for your Migraine Brain. If you try a new perfume at a department store and love the scent, walk around with it on your wrist for a few minutes before buying it to make sure it doesn’t trigger a migraine.

  Controlling odors and scents gets harder when you’re dealing with people you don’t have a close relationship with. You may recoil from the thought of asking a perfume-drenched co-worker to stop wearing her favorite scent. But this is a health issue for you. I recommend a polite but direct approach. Tell her that you’re sorry to have to bring it up, but strong scents—however lovely they may be—trigger migraines in you and actually make you quite ill.

  Other odors are simply unavoidable. If you’re stuck in traffic, the stench of exhaust may be all around. In these cases, you have to be ready to halt any migraine that gets triggered.

  Smoke

  “I was at a party and I came home and just reeked of cigarettes. It gets in your hair, your clothes. I took shower before I went to bed, and when I woke up the next day I had a migraine. I was at the party a very long time, for hours. We were inside and I just couldn’t get away from it.”

  —Kristen, 22, nursing student

  Avoidability Meter: High, usually. Smoking and cigarette smoke, as we all know, are really bad for your health. Smoking harms your lungs and heart, and puts you at a much higher risk for developing various kinds of cancer. If you’re pregnant and smoke, you are seriously harming your fetus. If you smoke, you need to stop—if you want to be healthy. Smoking can trigger migraines, and almost certainly is a factor in cluster headaches.

  By the way, it’s not just cigarette smoke that can trigger a migraine. Cigar smoke, marijuana smoke, and wood smoke from a fire also can be a problem.

  If you need help to quit smoking, please talk to your primary care doctor or headache specialist about the many good options today including certain medications or hypnosis, which are very effective in helping some smokers quit.

  What if you don’t smoke but are in situations where other people do? These days, fortunately, such situations are fewer and fewer since many restaurants, office buildings, and other public places ban smoking indoors.

  Possible Solutions: If for some reason you are in a situation where smoking is allowed and there is cigarette smoke around you, the best choice is to leave. This isn’t always the most enjoyable option, especially if it’s a party where you want to be. But it’s the healthiest option if you don’t want to be sick later. Another option is to ask the smokers to leave (something they are used to), to open windows near the smoker, or to stand outdoors where the smoke is less concentrated.

  Weather

  Avoidability Meter: Very low (unless you jump in your car and race ahead of the weather front!). It’s amazing how many migraineurs can tell you when a weather front is approaching. Changes in the weather are a very common migraine trigger. One day, when there was a rapid change in the weather in Boston, six of my patients showed up at the Headache Center with severe migraine. I gave each of them a shot of a nonsteroidal anti-inflammatory drug that’s very effective in acute treatment of migraine. All of them felt much better quickly, and avoided a trip to the emergency room. The change in barometric pressure may cause your sinuses to expand or become inflamed, which may in turn trigger a migraine. We don’t really know why weather affects migraine. But research strongly confirms the weather-migraine connection.

  Possible Solutions: You probably can’t avoid weather triggers, so you’ll have to be ready to halt any migraines that arise. Try to avoid other triggers such as dehydration: Keep yourself well-hydrated by drinking at least six to eight glasses of water on days when the weather is changing. Keep your sinuses clear with decongestants, steam from a hot shower, hot drinks, or by using a
saline rinse system such as a neti pot.

  Light

  Avoidability Meter: Sometimes. Light can trigger migraines in many people—bright light, fluorescent light, flashing lights, strobe lights, light glaring off the ocean or other water body. People with migraines often have a heightened light sensitivity—a form of allodynia, when what’s normally a painless stimulus becomes painful because of the Migraine Brain’s wiring.

  Possible Solutions: Wear sunglasses outdoors—a good-quality pair of sunglasses with 100-percent UVA and UVB rating.

  Leave any club that has a disco ball or strobe lights.

  At home, replace lights that make you sick with lights that don’t. Energy-saving fluorescent bulbs can trigger migraines.

  In your workplace, ask that fluorescent lights or other lights that bother you be replaced with more healthful lighting. You have a right to ask for this under the Americans with Disabilities Act. See Ch. 14.

  Computers and Video Games

  Avoidability Meter: Depends. Similar to the reaction to light, some people have real trouble with computer screens and/or video games and related devices. The flashing lights of video games may trigger a migraine.

  Of course, you can avoid video games, but computers are almost ubiquitous.

  Possible Solutions: Put a glare screen on your computer monitor.

  Keep your computer facing away from any windows to cut back on glare.

  Limit the time you spend in front of your computer, if possible.

  Caffeine

  For many people, caffeine is an excellent migraine treatment rather than a trigger. See Ch. 9

  But for some people, it can trigger migraines.

  If caffeine is a trigger, you should eliminate or drastically reduce your intake. Be aware of the caffeine in such products such as chocolate and soft drinks, including Mountain Dew. There is lots of information on the web about caffeine amounts, including at www.cspinet.org/new/cafchart.htm. If caffeine isn’t a migraine trigger for you, you should still stick to a reasonable amount of caffeine: no more than 200 mg a day.

  Possible Solutions: Avoid caffeine. Gradually wean yourself off. Never quit caffeine cold turkey, even if it is one of your migraine triggers. Caffeine is a drug, and your brain—especially a sensitive Migraine Brain—is likely to get angry if you don’t wean yourself off it gradually. A caffeine withdrawal headache can be almost as painful as a migraine.

  Noise

  Avoidability Meter: Sometimes. Your success in avoiding noise probably depends on the source. If it’s a loud stereo your spouse is playing, ask him or her to turn it down. That’s simple. Loud noise on the street outside is harder. And if you’re a construction worker, and you aren’t going to be leaving your job anytime soon, you’re going to have to devise a noise-reduction plan.

  Possible Solutions: A white-noise machine isn’t useful only while you’re sleeping. It can also help mask noises during the day that trigger your migraines. You can also play soothing music on a sound system to mask unhealthful noises.

  Earplugs are a very good solution if you work in a loud environment. They not only may help you avoid a migraine but will protect your hearing.

  Headphones that reduce noise tend to be expensive but could be worth it for you. Bose is probably the best-known brand of noise-reduction headphones but there are many other brands, too.

  Dust

  Avoidability Meter: Can be high. I had a patient who woke up every single day with a migraine and couldn’t figure out what she was doing wrong. She went to bed at the same time each day, exercised, ate well, and avoided her known triggers. Then she went out of town and spent the night at a friend’s house, and woke up migraine free. She realized it was something in her bedroom, and when she got home, she figured it out.

  Under her bed was a nest of dust bunnies. She had not realized that dust was a migraine trigger, but, applying the take-charge attitude that’s best for all migraineurs, she didn’t need scientific studies to back up her theory. She just needed a Swiffer (a Swiffer is an inexpensive kind of mop that’s very effective in attracting and cleaning dust).

  She “swiffered” her bedroom vigorously, and then the rest of the house. That night, she slept well—and woke up without a migraine. Now she swiffers her house with a religious fervor. She feels much better, and her house is ready for guests at any time.

  Possible Solutions: Be meticulous with your housekeeping. Swiffer the dust.

  You can also purchase an air-purifying machine from Sharper Image or elsewhere to help keep your environment clean.

  Wash duvets, comforters, and mattress covers regularly.

  Get rid of carpets and rugs. Bare floors are easier to keep clean and dust-free. Dust mites may be a problem for some migraineurs. If so, cover your mattress and pillowcases with dust-mite covers.

  Cleaning Fluid and Other Chemical

  Avoidability Meter: High. One of my patients got the single worst migraine of her life after she had a cleaning company come in to clean the carpets in her home. Within an hour after the cleaners left, she had a pounding headache and was vomiting violently. (Not coincidentally, both her husband and her son—who don’t get migraines—also found the smell very annoying and felt ill.)

  Many chemicals are highly toxic to humans and even those that are deemed safe may not really be so safe.

  Possible Solutions (no pun intended): In general, avoid harsh cleaning chemicals and related products. Today, most grocery stores sell organic cleaning products, which are much gentler to your body. If you can identify which chemicals in particular make you sick, read labels and avoid them. Working in a dry-cleaning operation is probably not the job for you.

  If you’re a student in a science lab that uses formaldehyde to preserve specimens, you may need to wear a mask that filters out the smell—or you may need to get excused from the lab for health reasons. Your doctor should be willing to write you a note.

  I have one patient who can’t pump her own gas for her car because even the brief smell of gasoline triggers a migraine. It’s worth it to her to pay more for full service.

  Exercise

  Avoidability Meter: Tricky. Exercise is essential to good health, including good migraine health. Yet, unfortunately, exercise seems to trigger migraines for some people. For a significant number of migraineurs, vigorous exercise can trigger a migraine.

  Possible Solutions: Talk to your headache specialist and make sure that there isn’t some more serious problem when you exercise, such as high blood pressure, which is very serious. Once your doctor gives you a go-ahead to exercise, find a style that doesn’t trigger migraines. Walking is perhaps the most innocuous exercise of all, with almost no downsides.

  You can also take medications, such as certain calcium channel blockers, before you exercise to avoid a migraine. See Ch. 12.

  Sex

  Avoidability Meter: Well…If you get headaches triggered by sex, called orgasm migraines, you can avoid sex. But I wouldn’t recommend it. Regular, healthy, happy sex is very good for you physically and emotionally, and there are numerous scientific studies to support something that we already know.

  Possible Solutions: If you get sex-triggered or orgasm headaches, please see your doctor to discuss treatment options. There are effective treatments to address this problem. Sex is an important part of life, and you shouldn’t have to avoid it. See Ch. 13.

  Dental Problems

  “I went to the dentist a few years ago and afterwards my bite wasn’t right. I started getting a lot more migraines. So I went to a new dentist, and he manipulated my bite, and I felt a pop in my jaw, and I haven’t had nearly as many migraines ever since.”

  —Monica, 53, retired electronics worker

  Avoidability Meter: Medium to high. Dental problems can be a significant migraine trigger and something worth investigating as you try to reduce the triggers in your life. If you have a misaligned bite or TMJ (a dysfunction of your jaw joint), or grind your teeth at night, these may be creating problems
for your Migraine Brain by causing your facial and jaw muscles to tense up, perhaps chronically, which can lead to migraines. That’s why so many migraineurs avoid chewing gum, which also causes tense or overworked jaw muscles.

  You may not have any idea whether you have dental problems of this sort, so it’s worth asking your dentist to check out your bite and related issues.

  Possible Solutions: The appropriate solutions depend on the kind of dental problem you have. Your dentist may fit you with a mouth guard to wear at night so you don’t grind your teeth, or may treat your misaligned bite through orthodontia or bite manipulation. This may have a significant effect in reducing the number of migraines you get.

  And…Anything Else Your Migraine Brain Dislikes

  Your Migraine Brain may have other triggers we haven’t listed here. One of my patients found that pineapple was a trigger, to her surprise. Pineapple is pretty innocuous for most people, but once she started keeping a migraine diary, she found the link. You may be surprised when you really start to investigate the factors surrounding the time of your migraines.

  Be creative in finding solutions to avoid these triggers. You’re not being self-absorbed. You’re taking care of yourself and staying healthy for the benefit of you, your loved ones, and the greater world.