The Migraine Triggers You've Never Thought of - and What You Can Do

Did you know migraine is the 3rd most prevalent illness in the world and affects 12% of the US population? 

Migraines are the seventh leading cause of years lived with disability, with a worldwide prevalence estimated at 11.6% (greater than 20% of chronic migraine sufferers are disabled and the likelihood of disability increases with the number of comorbid conditions).

Migraines are most commonly experienced between the ages of 18-44 years and not only affect men and women, but children as well.

• 6% of men experience migraines
• 18% of women experience migraines (about 28 million in the US)
• 10% of children experience migraines

For many migraine sufferers, migraine is a chronic disease that significantly decreases their quality of life and the overuse of medication is the most common reason episodic migraines turn chronic.
 
Interestingly, other common ailments for those with chronic migraine include anxiety, depression, and sleep disturbances.

what is a migraine?
A migraine is a common condition characterized by recurrent, throbbing headaches which include moderate to severe pain that can last up to three days. Migraine sufferers also report symptoms such as photophobia (light sensitivity), phonophobia (anxiety disorder/fear of loud sounds), and nausea.
 
Common migraine-associated signs/symptoms:

• Constipation*
• Mood swings*
• Food cravings*
• Neck pain, or stiffness*
• Increased thirst and urination*
• Frequent yawning*
• Visual phenomena (e.g. shapes, bright spots/flashes of light)**
• Vision loss**
• Pins and needles sensations in arms/legs**
• Weakness or numbness in face or one side of body**
• Difficulty speaking**
• Hearing noises or music**
• Uncomfortable jerking or other movements**
• Feeling lethargic
• Sensitivity to light
• Sensitivity to smells
• Sensitivity to sounds
• Throbbing (head/neck)
• Nausea
• Vomiting
• Auras (e.g. sensory [hearing noises/noise sensitivity], flashing lights, zigzag patterns, tracers)
• Or other vision or hearing disturbances including extreme sensitivity to light and sound

*may occur prodrome (1-2 days prior to experiencing a migraine)
**may occur right before or during a migraine (aura)
 
Migraines are often undiagnosed and untreated. Diagnosis of migraines is highly individualized and is often based on a person’s symptoms.
 
potential migraine causes + triggers
Potential migraine triggers include:

• Hormonal changes in women
• Alcohol (especially wine)
• Too much caffeine (e.g. coffee, soda, etc.)
• Stress
• Sensory stimuli (e.g. bright lights, strong smells, etc.)
• Sleep changes
• Physical factors (e.g. intense physical exertion)
• Weather changes
• Medications (e.g. oral contraceptives, vasodilators, etc.)
• Foods (e.g. aged cheeses, salty foods, processed foods, etc.)
• Food additives (e.g. artificial sweeteners such as aspartame, monosodium glutamate [MSG], etc.)

With this, the expression of a migraine may be influenced by specific dietary and/or nutrition-related factors that can play a role in inflammation, vasodilation, glucose metabolism, and attack frequency/severity.

Many foods are known to cause neurovascular and neurochemical effects in individuals prone to migraines either directly (i.e. endogenous or artificial chemicals) or indirectly (release of immune mediators such as inflammatory cytokines).

Examples of endogenous chemicals are the amines:

• Histamine
• Octopamine
• Phenylethylamine
• Tyramine (naturally found in aged cheese; aged, canned, cured, or processed meats; beans [e.g. fava beans, broad beans]; pickles; and canned soups)

Additionally, food additives such as nitrates (often found in processed meats) and MSG (found in meat tenderizer, soy sauce, Asian foods, and a variety of packaged foods) have also been associated with the presentation of migraines.

Other food substances often considered to be triggers include tannins and phenols found in:

• Apple skins
• Bananas
• Black tea
• Red wine
• Sulfites (prevalent in wines)

Other diet-related factors that may be associated with increased expression of migraine symptoms includes:

• Dehydration
• Fasting
• Skipping meals
• Alcohol use/withdrawal
• Caffeine withdrawal

common food-related migraine triggers

• Aged cheeses (e.g. blue cheese, cheddar, feta, gorgonzola, parmesan, Swiss)
• Alcohol (especially wine)
• Aspartame
• Caffeine
• Canned soups
• Canned, cured, or processed meats
• Certain beans (e.g. fava, broad, garbanzo, lima, pinto)
• Chocolate
• Citrus
• Histamine-releasing foods: bananas, strawberries, raspberries, oranges, and grapefruit
• MSG
• Nitrites
• Nuts
• Olives
• Onions
• Overripe avocados, tomatoes, and bananas
• Pickled foods
• Raisins
• Salty foods
• Smoked fish and cured meats
• Soy sauce
• Sulfites
• Yeast extract (not the same as nutritional yeast)
• Other:
  • Foods containing tannins and phenols (e.g. apple skins, bananas, black tea, red wine, sulfites)
  • Foods containing tyramine (e.g. aged cheese; aged, canned, cured, or processed meats; beans [e.g. fava beans, broad beans]; pickles; and canned soups)
  • Food containing additives (e.g. nitrates, MSG, etc.)

​determining food triggers + cause
When it comes to determining the root cause of migraines, there is much controversy as to what exactly to consider. How a practitioner accurately determines the specific food triggers and/or nutrition intervention to mitigate or eliminate migraines is still inconclusive. There's a lot of discussion as to whether or not dietary intervention and/or elimination protocols are an appropriate, successful intervention in migraine prevention.

Emerging studies have identified support for the role of comprehensive diets in the prevention of migraines (performed under the care of a credentialed practitioner ensuring adequate macronutrient and vitamin/mineral intakes).

It has also been reported that a diet rich in omega-3 and low in omega-6 polyunsaturated fatty acids (PUFAs) appeared to decrease migraine frequency.

It may also be possible that a migraine is associated with a woman’s menstrual cycle, celiac disease, gluten sensitivity, or vitamin and mineral deficiencies, which is why an in-depth symptom diary and health history is vital for a practitioner in getting to the root-cause of the presenting migraine.

Migraines can also be triggered by impingement of the vertebral artery which is encased in the first 6 cervical (neck) bones of the neck.

Finally, keep in mind food sensitivities can be dose-dependent. This means that a client may experience symptoms with a certain amount of a specific food consumed (e.g. ¼ cup nuts = no symptoms vs. 1 cup nuts = symptoms present).

what you can do...
Because there are so many 'unknowns'' surrounding migraine, a full evaluation by a licensed chiropractor and integrative dietitian is a great place to start. Practitioners who focus on a root-cause approach can help to identify triggers or 'blindspots', address these areas, or suggest further testing. 

Once environmental, lifestyle, and hormonal factors have been ruled-out, a practitioner may suggest nutrition intervention in which the elimination of food triggers is used. If, after an introductory elimination diet is implemented and migraines persist, Mediator Release Testing (MRT) and a Lifestyle Eating and Performance (LEAP) dietary approach may help to identify food sensitivities that are contributing to migraine symptoms and allow a practitioner to suggest a more long-term approach to eating to best support the clients and his/her nutrition needs and symptoms.

Testing to identify food allergies and/or sensitivities can be useful in identifying an appropriate anti-inflammatory or anti-migraine diet. MRT and the LEAP protocol help to correctly identify foods or food chemicals that may be responsible for symptoms/hypersensitivity reactions and give the practitioner a framework for constructing a diet plan that will be beneficial for the client using ‘safe foods’.

The key? Every body is different. It may take time to experience symptom relief, identify triggers, etc.

nutrition + lifestyle practices to consider​

• Consume foods that help ease migraines such as Omega-3 containing foods (nuts, seeds, wild-caught fish such as salmon, sardines, etc.).
• Get adequate, uninterrupted sleep along with a consistent sleep-wake cycle.
• Engage in regular mindfulness and mediation practices.
• Engage in practices to reduce or manage stress.
• Limit stimuli such as strong smells, loud noises, or flashing lights.
• Optimize and support gut health.
• Keep a symptom diary; this will help you to track how/what you are feeling and when. This information also helps a practitioner to pinpoint whether or not specific foods or food additives are contributing to migraine incidence. In the diary, document the following (and timing of occurrence):
  • Foods consumed
  • Medications/supplements taken
  • Amount of water consumed
  • Notably, some reactions may not be immediate and could present over the course of a few hours to several days after a specific food is consumed.

• Get evaluated by a wellness-focused, licensed chiropractor.
• Meet with an integrative practitioner to identify food triggers, implement an elimination diet, and get appropriate supplementation recommendations (if appropriate).

supplementation considerations

• Studies have illustrated that a magnesium deficiency may play a role in migraines.
• CoQ10 has been shown to reduce migraine frequency.
• Riboflavin supplementation has been shown to prevent migraines.

For a complete nutrition assessment including nutrition-focused examination, recommendations, and more information on lab testing, contact our us!

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[notes: this post was also shared on The Wellness Pointe's blog page as a guest blog post.]