What causes migraines?

Anybody who suffers from chronic migraine headaches knows just how severe and debilitating these headaches can be. In many people, migraine headaches can also be accompanied or preceded by different sensory warning signs such as flashing lights, sensitivity to lights and sounds, etc. The severe pain associated with migraines is known to last for a couple of hours to several days.[1] 

The exact cause of migraine attacks is not yet known. Still, it is suspected that migraines result from certain abnormal activities in the brain that affect how the nerves communicate. Genetics is also believed to make someone more sensitive to the various triggers that cause migraines.[2, 3]

See: Prevent Menstrual Migraines & Hormonal Headaches

What triggers migraines?

Several possible migraine triggers can induce a migraine headache. Some of these common migraine triggers are discussed here.

1. The food you eat

Paying attention to what you eat is perhaps one of the key identifiers to prevent getting a migraine headache. Certain foods are known to be the most common migraine triggers, and identifying the foods that trigger your migraine can help prevent an attack.  A vast majority of people have said that many foods act as their migraine triggers, giving rise to the dreaded migraine headache.[4] In fact, in 2008, a study found that a vast majority of people with chronic migraines have reported having at least one migraine trigger, most common of which was diet. Fasting was also another commonly reported diet-related migraine trigger.[5]

Restricting the number of food triggers in your diet and following a strict policy on what you can eat and what you cannot eat can help reduce the frequency of your migraine headaches. Keep in mind that many food additives and processed foods are also known as common migraine triggers. 

Some of the most common foods that are associated with being migraine triggers include:

·        Chocolate

·        Alcohol (especially red wine)

·        Caffeine

·        Citrus fruits

·        Food additives such as MSG (monosodium glutamate)[6]

·        Nitrites found in foods

·        Certain types of aged cheese

·        Salami

·        Tomatoes

·        Onions

·        Dairy products

·        Aspartame

·        Nuts

·        Bananas

·        Wheat, including bread and pasta products

·        Eggs

It is best to keep a food diary to help keep track of what you are eating and drinking and whether you experienced a headache afterward. This diary can help you and your doctor to identify a specific food or ingredient that might trigger your migraine. 

A small study found that consuming a vegan diet can help people who have migraines.[7] The Physicians Committee for Responsible Medicine (PCRM) actively promotes a plant-based diet for those who have a migraine.[8]

2. Sleep (too little or too much)

Lack of sleep or even jet lag is another very common migraine triggers.[9] Experts cite the lack of sleep as being one of the most common triggers for migraine attacks. At the same time, sleeping too much is also known to be one of the triggers for an acute migraine attack. 

Insomnia, the most commonly diagnosed sleeping disorder, is also associated with chronic migraine.[10] People with chronic migraines who also have insomnia are at a higher risk for depression and anxiety.[11]

At the same time, jet lag and sudden changes in your working schedule are also known to be migraine triggers.[12] 

3. Hormonal Changes

Hormonal changes are also known to be a common migraine triggers in women. Migraine headaches are closely linked to estrogen, the primary female hormone.[13] Estrogen is responsible for controlling the chemicals in the brain that have a direct effect on the sensation of pain.[14] A decrease in the levels of estrogen serves as migraine triggers, causing a headache. There are several reasons why estrogen levels change monthly, including:

·        Pregnancy

·        Menstrual cycle

·        Perimenopause

·        Menopause

·        Hormonal contraceptives

·        Hormone replacement therapy

If your doctor diagnoses hormonal fluctuations as the trigger for your migraine headaches, they may recommend that you start taking preventive medication to stop the migraine attacks. This is, however, only recommended for women who have a regular menstrual cycle. You will need to start taking the medication a couple of days before your period begins, and it will last up to two weeks after your periods' end. In some severe cases of migraine, daily medication might be needed.[15]

A 2012 study discovered that more than half of the female participants reported experiencing severe migraine headaches during their periods. A small percentage of the participants reported experiencing a migraine attack only during their periods.[16]

In many women who use oral contraceptives, the symptoms of migraines are worse, while many women find that their symptoms disappeared when they were pregnant. On the other hand, many women have also reported worsening migraine symptoms while being pregnant.[17,18] 

Women who have reached menopause often find relief from migraines, especially in the frequency and severity of their headaches.[19]

Other Common Migraine Triggers

Apart from the migraine triggers mentioned above, there are many other factors that can set off a migraine attack. These include:

- The environment: Particular trigger factors could be associated with environmental issues like high altitude, weather fluctuations, higher humidity, loud noises, exposure to glare, or flickering lights. It's unclear if sound and light are themselves activates, or if increased sensitivity to them are ancient features in the attack.

- Computer screens: Sitting in front of a computer at work or home for extended periods may cause problems if you encounter migraine. Following common-sense precautions like taking regular breaks, using anti-glare screens, and decent lighting can help prevent this type of difficulty. Sitting posture is important once you use a computer to prevent muscle strain from building up in the head, neck, and shoulders. This muscle strain is implicated in the onset of a migraine.

- Stress: Migraine and anxiety are strongly connected. Anxiety, excitement, and any kind of tension and shock may result in a migraine attack. But some people report that their migraine attacks begin when the anxiety reduces. 

- Caffeine: Excessive use of caffeine may lead to the onset of a migraine attack. You could try not needing over 4 or 5 cups of tea, coffee, or cola daily. Some folks find that suddenly quitting caffeine altogether may also be a trigger element. If you suspect this, you might want to decrease caffeine more gradually. Some folks find that consuming less caffeine in the weekend may affect migraine attacks, but it's also wise to note that caffeine is found in several products such as chocolate and over the counter painkillers.

- Dehydration: Mild dehydration can affect those who have migraines. It's recommended that you ought to drink at least eight glasses of water every day. This water intake is in addition to any other beverages you might have. Sodas can contain the sweetener aspartame, which some folks relate to their migraine.

- Skipping meals: Missing meals or eating sugary snacks rather than a balanced meal may contribute to a migraine attack. Insufficient food is most likely among the most significant dietary triggers. You may realize that eating small nutritious snacks at regular intervals can help control your attacks.

- Teeth grinding: Many who grind their teeth during their sleep find they wake up with head pain. A dentist can help with some mouth plates that can lower the teeth grinding.

- Exercise: Like sleeping, exercise can help stop migraines and conversely, can be a trigger factor. Regular exercise that's built up softly can help prevent migraines. Sudden vigorous exercise, especially for men and women that don't usually take exercise, can be a trigger element.

- Oral contraceptives: Using contraceptives that contain hormones like the contraceptive pill can cause a migraine for some women. You should tell your G.P. that before you begin taking hormonal contraceptives.

- Drugs: Taking cocaine can trigger an attack. Using cannabis can also lead to creating your attacks more challenging to treat. It's critical to never overuse or misuse any prescription therapy for migraine. Misuse of medication may result in greater migraine attacks and chronic migraine symptoms.

- Physical ailments: Head injury: Particular head injuries can lead to headaches and migraines.

Muscle strain: Tense muscles in the neck and shoulder regions can cause headaches and might be a premonitory symptom of this migraine beginning.

- Coughing: Repeated and lingering chronic cough can lead to a migraine for some people.

- Other migraine triggers:

·        Emotional triggers such as depression, anxiety, stress, shock, and excitement can also act as migraine triggers. 

·        Low levels of blood sugar can also cause a migraine headache.[20]

Apart from all these, there are several types of migraine triggers found in the environment as well. Strong smells, second-hand smoke, flickering screens or lights, and loud noise can set off a migraine headache. Temperature changes, bright lights, and stuffy rooms are also possible migraine triggers. 

See: Migraine With Aura Symptoms & Natural Treatments

Summary

There is currently no cure for migraines. If you one of the millions of people who suffer from frequent or occasional migraines, you must identify your migraine triggers. Avoiding these triggers will help a great deal in preventing migraine headaches. If you find that the severity or frequency of your migraines increases despite avoiding the known migraine triggers, you must let your doctor know about these changes.

See: Home Remedies For Migraine

References

1. Goadsby, P.J., Lipton, R.B. & Ferrari, M.D., 2002. Migraine—current understanding & treatment. New England Journal of Medicine, 346(4), pp.257-270.

2. Gardner, K.L., 2006. Genetics of migraine: an update. Headache: The Journal of Head & Face Pain, 46, pp.S19-S24.

3. Ducros, A., Tournier-Lasserve, E. and Bousser, M.G., 2002. The genetics of migraine. The Lancet Neurology, 1(5), pp.285-293.

4. Finocchi, C., and Sivori, G., 2012. Food as a trigger & aggravating factor of migraine. Neurological Sciences, 33(1), pp.77-80.

5. Fukui, P.T., Gonçalves, T.R.T., Strabelli, C.G., Lucchino, N.M.F., Matos, F.C., Santos, J.P.M.D., Zukerman, E., Zukerman-Guendler, V., Mercante, J.P., Masruha, M.R. and Vieira, D.S., 2008. Trigger factors in migraine patients. Arquivos de neuro-psiquiatria, 66(3A), pp.494-499.

6. Freeman, M., 2006. Reconsidering the effects of monosodium glutamate: a literature review. Journal of the American Academy of Nurse Practitioners, 18(10), pp.482-486.

7. Bunner, A.E., Agarwal, U., Gonzales, J.F., Valente, F. and Barnard, N.D., 2014. Nutrition intervention for migraine: a randomized crossover trial. The journal of headache and pain, 15(1), p.69.

8. Physicians Committee for Responsible Medicine. 2020. Migraines. [online] Available at: [Accessed 20 May 2020].

9. Houle, T.T., Butschek, R.A., Turner, D.P., Smitherman, T.A., Rains, J.C., and Penzien, D.B., 2012. Stress and sleep duration predict headache severity in chronic headache sufferers. Pain®, 153(12), pp.2432-2440.

10. Robbins, L., 1995. Anxiety, depression, and insomnia in migraine: a retrospective review of 494 patients. Headache Quarterly.

11. Alstadhaug, K., Salvesen, R., and Bekkelund, S., 2007. Insomnia and circadian variation of attacks in episodic migraine. Headache: The Journal of Head & Face Pain, 47(8), pp.1184-1188.

12. Brun, J., Claustrat, B., Saddier, P., and Chazot, G., 1995. Nocturnal melatonin excretion is decreased in patients with migraine without aura attacks associated with menses. Cephalalgia, 15(2), pp.136-139.

13. Nilsson, S., and Gustafsson, J.Å., 2002. The biological role of estrogen and estrogen receptors. Critical reviews in biochemistry & molecular biology, 37(1), pp.1-28.

14. Sarajari, S., and Oblinger, M.M., 2010. Estrogen effects on pain sensitivity & neuropeptide expression in rat sensory neurons. Experimental neurology, 224(1), pp.163-169.

15. MacGregor, E.A., 1997. Menstruation, sex hormones, and migraine. Neurologic clinics, 15(1), pp.125-141.

16. Karlı, N., Baykan, B., Ertaş, M., Zarifoğlu, M., Siva, A., Saip, S., and Özkaya, G., 2012. Impact of hormonal sex changes on tension-type headache and migraine: a cross-sectional population-based survey in 2,600 women. The journal of headache & pain, 13(7), p.557.

17. Dalton, K., 1976. Migraine and oral contraceptives. Headache: The Journal of Head & Face Pain, 15(4), pp.247-251.

18. Aubé, M., 1999. Migraine in pregnancy. Neurology, 53(4 Suppl 1), pp.S26-8.

19. Fettes, I., 1999. Migraine in the menopause. Neurology, 53(4 Suppl 1), pp.S29-33.

20. Pearce, J., 1971. Insulin-induced hypoglycemia in migraine. Journal of Neurology, Neurosurgery & Psychiatry, 34(2), pp.154-156.

See: How To Get Rid Of Sinus Headache & Migraine

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