September 24, 2008
Trigger foods can play key role in causing migraines
Pamela Yeager used to savor the veal paprikash served at a local restaurant but now avoids it at all costs.
These women gave up foods they loved not because of calories, cholesterol or fat. Instead, they gave up foods that they realized, after some detective work, were almost sure to trigger headaches.
Certain foods and substances, such as caffeine and MSG, are common migraine triggers, but not all trigger foods prompt headaches among all migraine sufferers. This is because headache food triggers vary among individuals, and also because other factors, such as stress, hormone and weather changes, fatigue and hunger, can also raise the threshold that might trip a migraine. Because there can be so many contributing factors, doctors can find headaches notoriously difficult to treat.
"Migraines are generally not prompted by a single food or other environmental element, but doctors often underestimate foods as a risk factor," said Dr. Roger Cady, vice president of the National Headache Foundation and director of the Headache Care Center in Springfield, Mo.
Finding the Connection
Further, many people don't connect what they eat and drink with their pounding headaches.
"It would be logical to think that a trigger food would cause a headache every time you ate or drank it, but that's not the case," said Dr. David Buchholz, associate professor of neurology at Johns Hopkins and author of "Heal Your Headache." "There are also many potent nondietary triggers, including stress, weather and hormonal changes, hunger and fatigue, that pile on the layers that lead to migraine. If the total trigger level is low, you've got a wider margin of error with your diet."
To help patients figure out just what is causing their migraines, both Cady and Buchholz encourage their patients to keep a headache diary. Cadle, who is Cady's patient as well as the research coordinator in his clinic, did just that.
"The migraines were running my life," said Cadle, 42, a registered nurse who used to get migraines about twice a week, each of which could last for up to three days.
Cadle used her diary to track her activities and food intake for the previous 24 hours, noting what she ate, her stress level, odors she may have been exposed to, the weather and her hormonal cycle. She also noted what medication she took for the headaches.
Lowering the Risk
It took a few months to see the pattern, but eventually Cadle realized that her risk factors included many nonfood triggers, including changes in weather, stress levels and hormonal fluctuations. Because many of her triggers were unavoidable, Cadle tried to keep her overall headache threshold level low by drinking enough water, getting enough sleep and avoiding the foods and food additives that could prompt headaches, such as MSG and onions. She also learned to take headache relief medication at the first signal of an impending headache for maximum relief. Since taking these steps, Cadle has cut her migraine rate by about half, to roughly four per month.
Yeager's relief has been even more dramatic. When she began tracking her headaches carefully, Yeager identified several risk factors, including certain perfumes, flashing or fluorescent bulbs and extreme hunger. But her biggest triggers were hormonal changes and foods, including red wine, smoked cheeses and meats, red dyes and dark chocolate, plus MSG.
From more than 100 migraines a year, Yeager, 43, now gets only about four. She's given up on Cajun food but won't give up Chinese and only goes to restaurants where she is sure that MSG won't be hiding in her food.
Buchholz is not surprised by the women's success. He believes that nearly all migraine sufferers can benefit by first cutting as many known headache trigger foods from their diets as possible and then adding them in one at a time until the problem foods are identified.
The Cold Turkey Approach
Buchholz recommends cutting them all at once, as opposed to one at a time, because food triggers are also inconsistent, leading many people to deny the food-headache connection.
"Headache sufferers often convince themselves that some of the foods they love don't contribute to their headaches, either because the foods don't always trigger a headache or because the headache comes a day after the food was eaten, when they assume it would have been immediate," he said.
In fact, a headache may not erupt until a full 24 hours after eating a problem substance.
Buchholz believes that caffeine might be the top dietary headache trigger, yet people are fooled into thinking it's a help, not a hindrance.
"Caffeine helps temporarily to relieve headaches because it constricts the blood vessels, but the rebound effect of those blood vessels expanding again contributes to more headaches in the long run," he said. "When people get withdrawal headaches from stopping caffeine, they may think their headaches are caused by caffeine deprivation, and that reinforces the wrong idea."
Painful as it is for our caffeine-addicted culture, Buchholz recommends that chronic headache sufferers quit caffeine completely, either by going cold turkey (and toughing out the withdrawal headaches that may follow) or cutting it down and then out within two weeks. This includes eliminating headache medications containing caffeine, such as Excedrin.
After caffeine, Buchholz's list of the most potent headache trigger foods are dark chocolate (milk chocolate isn't as bad since it has less cocoa, and white is OK), MSG (which can be hidden by other names, including hydrogenated vegetable protein and "seasonings"), processed meats and fish, cheese and other dairy products, nuts and nut butters, alcohol (especially red wine) and most vinegars, citrus and dried fruits, though even bananas are triggers for some people.
The artificial sweetener aspartame, which goes by the brand name Nutrasweet, is often a trigger for children, as well as adults. Last on the list are vegetables such as pea pods, lentils and other beans and brown onions. Sauerkraut can also be a trigger.
Buchholz acknowledges that it is unclear why certain foods will trip the migraine switch in headache sufferers, but that trigger foods, when added to other nondietary triggers, stack the deck, and migraines can result. He also acknowledges that the list of potential trigger foods is daunting, and that nobody can avoid every one.
But it's not a life sentence, either.
"Eliminating these foods is a golden opportunity to learn to control and heal your headaches," he said. "And after slowly adding foods back in, most people will end up with a small, manageable list of foods to avoid. This can potentially lower the dietary trigger by 90 percent."
And that means a lot fewer headaches and a lot of life restored to migraine sufferers.
As Cadle observed: "The best thing you can do about migraines is to learn to prevent them. That way, you take charge of them instead of them taking charge of you."
Judy Gruen's latest book is "The Women's Daily Irony Supplement." She has written for the Los Angeles Times, Ladies' Home Journal, Family Circle and Natural Solutions, where this article first appeared. Read more of her work on www.judygruen.com.