Pull the Migraine Trigger


This week and next I share with you my recent learnings on the treatment and prevention of migraine headaches. My interest in this topic was sparked through a dear patient of mine whose life is regularly interrupted by migraines. I have experienced a bad headache or two, and I can only empathize with the debilitating nature of migraines.

Migraine headaches are a  true disability. In fact, according to UpToDate, migraines are a major cause of disability and in 2016 they ranked second among all diseases with respect to years of life lived with disability. For all you migraines sufferers, you are NOT ALONE; 12% of the population suffers from migraine headaches.

Migraines are recurrent attacks that unfold through a cascade of events occurring over several hours to days. The typical migraine consists of a prodrome of symptoms like yawning, euphoria, depression, food cravings, neck stiffness, or constipation, appearing 24 to 48 hours before the headache. 25% of migraine sufferers subsequently experience an aura, which most of the time visual. Then the headache; usually unilateral, throbbing, and with features like nausea, vomiting, and/or light and noise sensitivity. Migraines can build in intensity over hours or days.

Migraines are currently believed to be a disorder of nerve cell transmission, inflammation, and excess sensitization in the trigeminovascular system. There is evidence linking impaired mitochondrial functioning and migraines (1). Mitochondria are located inside most cells and are responsible for producing energy; impaired mitochondria means that the cells are energy deficient and unable to function.

The neurochemical cascade that results in migraine begins with a TRIGGER. Identifying your trigger and reducing exposure is a great place to start. In fact, I encourage my migraine sufferers to keep a headache diary as an effective and inexpensive tool to follow the course of your disease.

Common Triggers

  • Lack of sleep or too much sleep

  • Variation in weather and barometric changes

  • Stress

  • Vapors and smells

  • Noises

  • Use of vasodilators

  • Hormonal changes / Oral contraception or estrogen replacement

  • Alcohol, especially wine and beer

  • Caffeine overuse and caffeine withdrawal

  • Chocolate

  • Aspartame (NutraSweet)

  • Monosodium glutamate (MSG)

  • Fruits (citrus fruits, bananas, avocado, dried fruit)

  • Nuts (peanuts, soy nuts, soy sauce)

Tyramine is a compound that accumulates in food as it ages and may provoke migraine headaches (2). The following foods contain tyramine and are worth evaluating as a contributing factor.

  • Dairy - aged cheese, yogurt, sour cream

  • Meat - bacon, sausage, lunch meat, deli meat, pepperoni, smoked or cured meat

  • Pickled foods

  • Heavily yeasted breads such as sourdough

  • Vinegars, especially wine vinegar

  • Some types of beans such as snow peas and fava beans

  • All nuts

  • MSG

  • Fermented soy

Identifying the trigger is foundational in migraine prevention. Aside from the aforementioned common triggers, it is prudent to assess for food sensitivity. The elimination diet is gold standard, however I like to run a food sensitivity panel that looks at your body’s reaction to certain foods through the blood. Migraine headaches is one of the top reasons I order these labs.

Stay tuned next week when I highlight my favorite remedies for prevention and treatment of migraine headache. Thank you Dr. Paul Anderson for providing ample resources regarding this topic.


  1. https://www.ncbi.nlm.nih.gov/pubmed/24331360  

  2. https://www.ncbi.nlm.nih.gov/pubmed/17152742