Migraine Pain

Heading Off Migraine Pain

By  Mona Nada

Professor of Neurology


It is very rare to find someone who has never suffered from a headache before. A lifetime prevalence study revealed that as many as 99 percent of women and 93 percent of men experienced a headache one time or another (Rasmussen).Fatima Fouad, a 24-year-old lady, burst one day into my clinic, desperate and in agony. She was suffering from a severe headache that had kept her at home for two days.

As she slowly took a seat, she began explaining the onset of the headache. Before the attack, she started seeing flashes of light and irregular zigzag lines. She thought there was something wrong with her eyes. A few minutes later, these flashes disappeared. However, they were replaced by a severe headache on the right side of her head.

Fatima said she used to have these attacks for almost four years. They usually occurred when she was stressed or overloaded. But this time, it came over the weekend. She was out with her friends for pizza. Since then, she got a severe attack of headache.

“What is the possible trigger for the headache this time?” She wondered. “Is it pizza?”

The simple answer is yes. A slice of pizza can trigger an attack of headache. Other types of food can do so as well. These foods are called migraine triggers.

From Fatima’s story, she was suffering from an attack of migraine which was preceded by what is called an “aura”. This headache attack was most probably triggered by the pizza she ate.

Many people suffering from migraines have higher frequency of attacks during the weekends. This is called a “weekend migraine.” This is probably due to less coffee intake over weekends. The decreased caffeine is considered one of several migraine triggers. Another possible cause is changes in one’s sleeping pattern over the weekends. Sleeping late, which could lead to either oversleeping or sleep deprivation, could trigger a migraine episode.

Relaxation after a period of stress is also suspected of causing migraines, but no explanation has been found. These could have been triggers for Fatima’s migraine attack as well.

To understand what migraine triggers are, we first need to understand what migraine and aura mean.

What Is migraine?

A headache is a pain or discomfort anywhere between the eyebrows and the upper part of the back of the neck. Migraines are one of the most common types of headaches.

The word “migraine” comes from the Greek word “Hemikrania” where “hemi” means half and “crania” means head. This word was changed to “Hemigrania,” finally becoming “migraine.”

Migraine is characterized by repeated attacks of headache, usually on one side of the head. It is frequently pulsating in nature. The pain of a migraine attack can actually feel like several headaches put together. It is usually associated with nausea, loss of appetite, and/or vomiting. It is also often accompanied by abnormal sensitivity to light and noises.

A migraine attack can last 4 – 72 hours. The frequency of attack is very variable. It could be a few each week to a few in a lifetime.

There are several types of migraines, according to the International Headache Society (IHS). The most important of these types are classic migraine and common migraine. The main difference between the two types is that classic migraine is preceded by an “aura” while common migraine is not (Blau).

Aura refers to a group of symptoms that the person experiences before the onset of the headache itself. The aura can start right before the headache and up to one hour before it. These symptoms usually consist of sensory or visual problems, such as the flashes of zigzag light that Fatima mentioned seeing.

A normal tension headache may sometimes be confused with migraine. This type of headache consists of an overall dull, persistent pain throughout the entire head. It can occur as often as once a week. People usually complain of a feeling of pressure, heaviness, or tightness, and describe it as a “band-like headache.” This is different from migraines, which are centered on one half of the head.

Migraine attacks can result in lost workdays and a disrupted family life. Knowing its triggers and alleviating them can help sufferers and their families lead a better life. This can break the vicious circle of suffering and treating migraine attacks and worrying about the next attack, which eventually leads to stress that could trigger another attack.

What Triggers a Migraine Attack?

Most neurologists agree that food can affect headaches. Food is particularly suspected of playing a major role in migraines. According to the Lancet, 93 percent of migraine sufferers find an improvement on eliminating allergenic foods from their diet. This improvement can come in the form of less severe attacks and/or decreased frequency of attacks.

The connection between food and migraine is a negative relation. This means that eating certain foods will likely cause migraine attacks. Studies implicating food as a trigger for migraines date back to the 1920s when researchers began to examine and manipulate the diets of individuals suffering from migraines (Vaughan). Headache experts have estimated that 10 to 30 percent of headaches are related to food sensitivities.

Although the list of foods implicated as headache triggers is quite long, there are some that are commonly known to affect migraines.

The “three Cs” are the most well-known foods that trigger migraines. These three types of food are cheeses, chocolate, and citrus fruits.

Ripe cheese contains a type of protein called tyramine. Sensitivity to tyramine depends on both the dose and the presence of other food triggers. This substance affects blood vessel elasticity and the brain’s serotonin system. Serotonin is a substance in the brain known to be involved in migraine (Smith).

Tyramine is also found in beers, wines, overripe bananas, beans, onions, and some nuts.

Chocolate and citrus fruits contain compounds similar to tyramine that are believed to trigger headaches by the same mechanism.

In addition to cheese, other pizza ingredients, such as pepperoni, salami, and hot dog, are also possible migraine triggers.

Nitrites and nitrates, preservatives used in most meat preparations, are responsible for migraines. They can be found in pepperoni, salami, bacon, smoked fish, and seasoning mixes. Some people develop what is called a “hot dog headache.” This is a headache attack accompanied by flushing in the face, occurring after having hot dogs or lunch meats.

Foods containing monosodium glutamate (MSG), a flavor enhancer, are also a trigger for migraine. Presence of MSG in food may be unclear because on some food labels it may simply be listed as “natural flavoring” or “seasonings.”

Aspartame, a popular artificial sweetener, can be a headache trigger for some people.

Caffeine-withdrawal headaches may occur when a heavy, daily coffee drinker skips their morning cup. It is due to the release of a substance called adenosine into the bloodstream. It increases blood flow to the brain, hence causing headaches.

Alcohol (especially beer and red wine) is also a common trigger, probably due to a substance present in it called histamine. It is also present in egg whites, some types of fish, strawberries, tomatoes, and citrus fruits.

Identifying Food Triggers

Food triggers can be very variable as mentioned above. The best way to identify them is through keeping a “headache record”. A person writes down any type of food or drink, plus any exposure to other triggers, in the 24 hours before the headache begins (if they can remember them).

If a certain food is suspected of acting as a trigger, then the person should try the “Two-Weeks Test”. They avoid the suspected trigger for two weeks then reintroduce it to their diet for two weeks, and then eliminate it for another two weeks. They then observe any changes in headache frequency that does not seem related to other factors and record them in their headache diary.

The detective work of identifying a food trigger can be mind-numbing. However, it’s wise not to remove an important food, such as dairy products or cheese, until a certain connection is established.

Preventing a Migraine Through Food

Just as food can be a trigger for headaches, some types of food can also offer relief. The best advice is to simply eat a balanced diet with plenty of fresh, non-processed foods with no added preservatives. Here are a few specific foods that are believed to reduce pain:

· Cayenne pepper

· Ginger

· Peppermint

· Seafood and fish oil

· Calcium-rich food (such as spinach, broccoli)

· Oatmeal

· Wheat

· Garlic

· Vitamin E

· Magnesium-rich food (such as milk, green leafy vegetables, nuts, beans, and peas) 

· Nuts (almonds and cashews)

· Legumes (soybeans)

· Whole grain cereals and breads

· Riboflavin (vitamin B2) (found in dairy products, liver, meat, dark-green vegetables, eggs, and dried beans and peas)

There are two ways to determine if these natural remedies are helping decrease migraine:

1. Maintain a headache diary; preferably, start noting before you start using the headache remedy. This will give you an idea if things are improving or not.

2. Try removing only one suspected food item at a time from your diet. Remember, it may take 2-3 months before things actually start to improve.

By time, migraine sufferers are usually able to develop their own coping mechanisms. These suggestions can be fine-tuned by each individual until they are comfortable with them. While migraines do not usually go away by time, there are ways to be able to live with them.


Blau JN. “Migraine.” Theories of Pathogenesis. The Lancet. 1992; 339 (8803):1202-7.

Rasmussen BK, R Jensen and M Schroll, Epidemiology of Headache in a General Population – A Prevalence Study. J Clin Epidemiol 1991; 44, 1147-1157.

Smith I, AH Kellow, and E. Hannington. “A Clinical and Biochemical Correlation Between Tyramine and Migraine Headache”. Headache. 1970; 10:43-51.

Vaughan TR. “The Role of Food in the Pathogenesis of Migraine Headaches”. Clinical Reviews in Allergy. 1994; 12(2):167-80

Courtesy: islamonline.net


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