Migraine Triggers: A Q&A with Neurologist Dr. Wen Ying (Helena) Wu-Chen

Woman upset holding a coffee mug in bed

Migraine is a largely inherited brain disorder affecting 30 million people in the United States alone. The World Health Organization ranked severe migraine as more disabling than angina, rheumatoid arthritis, and depression. Learn about migraine triggers and what you can do if you suffer from these disabling headaches. 

Changes in the brain’s “excitability” are characteristic in those with migraine. These changes are linked to the release of inflammatory proteins that circulate in the blood. One part of the brain that is activated in migraine is called the hypothalamus. This part of the brain controls the body’s natural circadian rhythm (the body’s internal clock) that runs in the background of the brain and tells the body such things as when to go to sleep, when to awake, changes in mood, thirst, food cravings, and even the drive to eat or not to eat.

What Are Migraine “Triggers”?

Triggers activate an acute attack in those susceptible to having migraine attacks, but are NOT a cause of migraine. Those with migraine often have certain triggers–such as stress, weather changes, not getting enough sleep, or missing a meal–that can make them more likely to have an attack.

It is important to know that migraine triggers are not the cause of migraine and are not the same for everyone. They simply are things that make someone with the tendency to have migraine attacks more likely to have an attack. In people without the susceptibility to migraines, they will not trigger a migraine. For example, everyone has stress, but not everyone with stress has a migraine attack.

What Can I Do to Manage Migraines?

Consider a change in lifestyle. The best advice regarding diet and lifestyle for those with migraine is to manage stress, not skip meals, exercise regularly, and maintain a healthy weight,

You can start by using a diary to help discover potential triggers and manage these when possible. Long before there were pills to decrease migraine pain, doctors recognized that missing meals and certain foods could trigger a migraine attack. In a recent study of more than 1,200 migraine patients, 76% could identify a migraine trigger. Stress was a trigger in 80%, menses in 65%, fasting/missing a meal in 57%, weather changes in 53%, and sleep changes in 50%. In other words, fasting is the second most common migraine trigger in men and the third most common trigger in women.

What About Food Triggers?

Science does suggest likely food triggers, but they occur in only about 20% of those with migraine and they might not be what you think.

For example, chocolate has not been established as a trigger for migraines. Eating chocolate is likely a craving that signals the start of a migraine before the pain begins. Red wine, processed meats with nitrates and nitrites (e.g. hot dogs, sausage), and likely foods with monosodium glutamate (MSG) are migraine triggers. Many believe aged cheeses can be migraine triggers, but the research is not conclusive.

The best advice for food triggers is: “if it hurts don’t do it.” Remove one food over a given time, such as one per month, and reintroduce it later if you see no difference in your headaches.

What Can Help Manage a “Fasting Trigger”?

Try an evening snack. Researchers who looked at eating behaviors in a small group of migraine patients found that although eating an early morning breakfast or having a late dinner did not change the risk of having a migraine attack the next day, having a late night snack after dinner decreased the risk of migraine the next day by 40%. If you decide to add a late night snack into your routine, make healthy food choices. Obesity is associated with an increased risk of migraine; and this risk increases with the level of obesity.

Is There a Migraine Diet?

Although there is no proven “migraine diet,” there are some things to try. Doctors have been debating for more than a century if abnormal fat or protein metabolism contributes to migraine and whether changing your diet can treat migraines.

Many early diet studies had limitations or the diet was just not found to be helpful. The current thinking is that low fat diets, ketogenic (high protein, high fat, low carbohydrate) diets, and diets which are high in omega 3 (salmon, flax seed) and low in omega 6 may have benefit for those with migraine and chronic daily headache.

Never Give Up Hope!

If you have migraines, consider talking with your doctor for advice. If migraines become disabling, you may need to see a specialist. New learnings that can enhance migraine treatment are being discovered every year. Much like Robert Browning’s view of aging, with science and medicine, the best is yet to be.

author name

Wen Ying (Helena) Wu-Chen, MD

Dr. Wu-Chen is a neurologist with LG Health Physicians Neurology. She also has specialty training in neuro-ophthalmology, which focuses on vision issues resulting from brain conditions. Education: Medical School—University of Costa Rica; Residency—Lankenau Hospital, Temple University Hospital, Barraquer's Institute of America; Fellowship-- Johns Hopkins Hospital, University of Minnesota.

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