Alcohol is a trigger for every Clusterhead I know

The effect of chocolate on a group of volunteer migrainous subjects, who had observed that headache regularly occurred after the ingestion of small amounts of cocoa products, was investigated. Two separate studies were carried out in a double-blind placebo controlled manner. Only 13 headaches occurred to chocolate alone in 80 subject sessions, and only two subjects responded consistently to chocolate in the two studies. This suggests that chocolate on its own is rarely a precipitant of migraine. Other possible implications of the results are also discussed.

We did a population study to identify the prevalence of reactions to eight foods commonly perceived to cause sensitivity in the UK. A cross-sectional survey of 7500 households in the Wycombe Health Authority area and the same number of randomly-selected households nationwide was followed up by interviews of positive respondents from the Wycombe Health Authority area. Those who agreed entered a double-blind, placebo-controlled food challenge study to confirm food intolerance. 20·4% of the nationwide sample and 19 9% of the High Wycombe sample complained of food intolerance. Of the 93 subjects who entered the double-blind, placebo-controlled food challenge, 19·4% (95% confidence interval 11·4% -27 4%) had a positive reaction. The estimated prevalence of reactions to the eight foods tested in the population varied from 1·4% to 1·8% according to the definition used. Women perceived food intolerance more frequently and showed a higher rate of positive results to food challenge. There is a discrepancy between perception of food intolerance and the results of the double-blind placebo-controlled food challenges. The consequences of mistaken perception of food intolerance may be considerable in financial, nutritional, and health terms.

Both CH and migraine can be triggered by alcohol, and relieved by triptans, but CH necessitates parenteral routes of administration. Stress, foods (like chocolate) and menstrual cycle, are not typical triggers for CH.

Diet can play an important role in the precipitation of headaches in children and adolescents with migraine. The diet factor in pediatric migraine is frequently neglected in favor of preventive drug therapy. The list of foods, beverages, and additives that trigger migraine includes cheese, chocolate, citrus fruits, hot dogs, monosodium glutamate, aspartame, fatty foods, ice cream, caffeine withdrawal, and alcoholic drinks, especially red wine and beer. Underage drinking is a significant potential cause of recurrent headache in today’s adolescent patients. Tyramine, phenylethylamine, histamine, nitrites, and sulfites are involved in the mechanism of food intolerance headache. Immunoglobulin E-mediated food allergy is an infrequent cause. Dietary triggers affect phases of the migraine process by influencing release of serotonin and norepinephrine, causing vasoconstriction or vasodilatation, or by direct stimulation of trigeminal ganglia, brainstem, and cortical neuronal pathways. Treatment begins with a headache and diet diary and the selective avoidance of foods presumed to trigger attacks. A universal migraine diet with simultaneous elimination of all potential food triggers is generally not advised in practice. A well-balanced diet is encouraged, with avoidance of fasting or skipped meals. Long-term prophylactic drug therapy is appropriate only after exclusion of headache-precipitating trigger factors, including dietary factors.

Five hundred seventy‐seven consecutive patients attending the Princess Margaret Migraine Clinic from 1989 to 1991 have been questioned about dietary precipitants of their headaches. Four hundred twenty‐nine patients had migraine, of which 16.5% reported that headaches could be precipitated by cheese or chocolate, and nearly always by both. Of the migraine patients, 18.4% reported sensitivity to all alcoholic drinks, while another 11.8% were sensitive to red wine but not to white wine; 28% of the migrainous patients reported that beer would precipitate headaches. There was a definite statistical association between sensitivity to cheese/chocolate and to red wine (P<0.001) and also to beer (P<0.001), but none between diet sensitivity and sensitivity to alcoholic drinks in general. None of 40 patients with tension headache (diagnosed by International Headache Society criteria) reported sensitivity to foods, and only one was sensitive to alcoholic drinks. The prevalence of sensitivity among 46 patients with some migrainous features was intermediate between the migraine and tension headache categories. It is concluded that cheese/chocolate and red wine sensitivity, in particular, have closely related mechanisms, in some way related more to migraine than to more chronic tension‐type headache, while quite separate mechanisms play a major role in sensitivity to alcoholic drinks in general.

The objective was to examine potential trigger factors of migraine and tension-type headache (TTH) in clinic patients and in subjects from the population and to compare the patients’ personal experience with their theoretical knowledge. A cross-sectional study was carried out in a headache centre. There were 120 subjects comprising 66 patients with migraine and 22 with TTH from a headache outpatient clinic and 32 persons with headache (migraine or TTH) from the population. A semistructured interview covering biographic data, lifestyle, medical history, headache characteristics and 25 potential trigger factors differentiating between the patients’ personal experience and their theoretical knowledge was used. The most common trigger factors experienced by the patients were weather (82.5%), stress (66.7%), menstruation (51.4%) and relaxation after stress (50%). The vast majority of triggers occurred occasionally and not consistently. The patients experienced 8.9±4.3 trigger factors (range 0–20) and they knew 13.2±6.0 (range 1–27). The number of experienced triggers was smallest in the population group (p=0.002), whereas the number of triggers known did not differ in the three study groups. Comparing theoretical knowledge with personal experience showed the largest differences for oral contraceptives (65.0 vs. 14.7%, p<0.001), chocolate (61.7 vs. 14.3%, p>0.001) and cheese (52.5 vs. 8.4%, p<0.001). In conclusion, almost all trigger factors are experienced occasionally and not consistently by the majority of patients. Subjects from the population experience trigger factors less often than clinic patients. The difference between theoretical knowledge and personal experience is largest for oral contraceptives, chocolate and cheese.

Bright lights and too much exercise are well-known migraine launchers, but the latest study hints that sufferers may not be as sensitive to these triggers as previously thought. Researchers report in the journal Neurology that commonly suspected migraine triggers might not be responsible for a hurting head after all.

Unlike previous studies of migraine triggers, in which sufferers were asked about what conditions or situations preceded a headache, the scientists exposed 27 migraine patients in a lab to flashing lights, intense exercise or a combination of both to provoke a migraine with aura, a type of headache accompanied by often debilitating visual disturbances. Only a handful of subjects experienced any sort of migraine, and those who did had exercised, suggesting that bright lights may not be to blame. The participants ran or used an exercise bike at maximum effort for an hour, while researchers used a combination of lamps, flashes and other visual stimuli to mimic light disturbances for up to 40 minutes in order to study the combined effect of light and exercise. After these sessions, only 11% of the participants — three patients — experienced migraines with auras, and an additional 11% experienced migraines without auras.

“What have generally been reported as sure triggers for migraines are not so sure when you actually expose people to them” says Dr. Jes Olesen, the study’s corresponding author from the University of Copenhagen in Denmark and a fellow of the American Academy of Neurology.

(MORE: Can Brain Freeze Solve the Mystery of Migraines?)

Dr. Stephen D. Silberstein, a professor of neurology at Thomas Jefferson University and the director of the Jefferson Headache Center who co-wrote an accompanying editorial for the study, suggests that some of what people think are triggers may actually be symptoms of migraines instead.

“You eat chocolate and you get a headache. Does that mean chocolate triggers the headache?” Silberstein asks. “What probably happens is the first symptom of your migraine attack is the desire to eat chocolate. Just like when you’re pregnant, you might want pickles or ice cream. That’s one end of the spectrum, where the desire to do something is part of the migraine attack, not the trigger.”

Distinguishing between triggers and symptoms is challenging, not just for those who study migraines but for patients as well. Silberstein says there are some known triggers, such as certain odors, hunger, chemicals in alcohol and hormonal changes linked to menstruation, but that other factors may fall somewhere between an actual trigger and a symptom. How can patients tell? “Everybody with a migraine should try to find out what is triggering their attacks,” Olesen says. “When they have a suspicion, it would be a good idea to try and see if it induces an attack. In most cases, it’s probably not going to be true.”

Both Olesen and Silberstein say there are a number of factors that determine whether these suspected triggers will actually lead to an attack. Patients likely have individual thresholds that vary from day to day and from environment to environment: some days your brain is less vulnerable to certain triggers, while on other days the conditions might be right for a migraine.

(MORE: Migraines May Raise Risk of Depression in Women, Study Says)

Stress, for example, is one of the most commonly reported migraine triggers, and bright lights and exercise may simply be markers for when stress levels are high. The fact that only exercise appeared to trigger migraines came as a surprise to Olesen, considering a majority of the study’s participants believed bright lights induced migraines more than half the time upon exposure. “The patients were almost apologetic to us because they had indicated it would cause an attack, but it didn’t,” Olesen says.

If these suspected triggers aren’t causing migraines, though, why have they been fingered as responsible for the headaches? Most of the evidence linking the triggers to migraines comes from studies in which patients self-reported what they thought were the factors responsible for their headaches; for the most part, these factors weren’t tested in the way that Olesen analyzed the effect of bright lights and exercise on migraines in the lab.

People’s beliefs about migraines may also complicate how researchers explore migraine causes. Similar to the placebo effect, how patients think about migraines will often influence how they experience them. If you’re convinced a certain food will a trigger a migraine, your suspicion might become a reality; if you’re worried you’ll get a migraine, you might just bring about one.

(MORE: Migraines Linked to Brain Lesions in Women)

That’s not to say lights will never cause a migraine. Because the study was conducted in a lab setting, the exposure to triggers may not accurately replicate the conditions that launch a real-life headache. For example, if a migraine strikes after you exit a dark movie theater and walk into bright light, it could be the sudden contrast from the darkness of the theater that made the light problematic. Or, you might have been hungry or sleep-deprived before being exposed to a bright light, which would still make the light a trigger, albeit one of a combination of factors that prime your brain for the headache.

Olesen says researchers have a better understanding of migraines without auras — they have identified certain chemical triggers that have led to the development of a new class of migraine drugs, for example — but migraines with auras continue to be more of a mystery. The findings hint, however, that some long-held truths about avoiding triggers that can induce migraines with aura may be outdated.

“Trigger avoidance is overdone,” Silberstein says. “If you know something is going to cause your headache, whether you believe it as a result of conditioning or reality, avoid it. But people who take away everything in life that they love because it might trigger their headache, that’s useless.” He argues that it’s worth trying to find out what truly triggers your migraines, even if the process is painful. That suffering may be worth it in the long run.