Tuesday, December 11, 2012

Let's Not Pull the Migraine Trigger

Do you have issues with migraine headaches? You know, those dreadful life-altering head-splitting stomach-turning things?

And if you do, have you identified what triggers them?

I've come to the reluctant conclusion that I had better start paying more attention to my migraines. I went looking for my Imitrex over the weekend to nip a headache in the bud and panicked because the box was empty. Luckily I had my last pill stashed in my purse. Whew.

The fact that I needed a refill on this medication gave me pause. My first migraine occurred just a month before my daughter's wedding and at a very low energy point in my rituximab cycle, so I chalked it up to stress and fatigue. But I can't blame my most recent headaches on either. And the fact that I used up one whole prescription made me realize that although I certainly don't have frequent migraines, it appears that I do have them often enough that it's time for me to take them seriously.


According to the Mayo Clinic,  common migraine headache triggers include:

  • Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen. Others have an increased tendency to develop migraines during pregnancy or menopause. Hormonal medications — such as oral contraceptives and hormone replacement therapy — also may worsen migraines, though some women find it's beneficial to take them.
  • Foods. Some migraines appear to be triggered by certain foods. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; aspartame; overuse of caffeine; monosodium glutamate — a key ingredient in some Asian foods; salty foods; and processed foods. Skipping meals or fasting also can trigger migraine attacks.
  • Stress. Stress at work or home can instigate migraines.
  • Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Unusual smells — including pleasant scents, such as perfume, and unpleasant odors, such as paint thinner and secondhand smoke — can also trigger migraines.
  • Changes in wake-sleep pattern. Either missing sleep or getting too much sleep may serve as a trigger for migraines in some individuals, as can jet lag.
  • Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
  • Changes in the environment. A change of weather or barometric pressure can prompt a migraine.
  • Medications. Certain medications can aggravate migraines, especially oral contraceptives and vasodilators, such as nitroglycerin.

How on EARTH can you whittle down this lengthy list to identify your own particular triggers?

John suggested that I keep a very precise diary of each day including every type of food that I have eaten (zoiks!), hours of sleep, stress, colors of my socks......you get the idea. And, according to him, after enough data has been collected, we can sort through it all and see if anything appears more consistently on the days that I have the headaches.

This seems logical and a really good idea. But. This also seems to require a great deal of work. Bleah. And even if I do identify some likely triggers, many are simply beyond my control. Studies have linked Sjogren's syndrome and other autoimmune disease to increased migraine prevalence, read the conclusion of this NIH study, found here:
It might be argued that the increased prevalence of migraine found in the patients with primary SS and scleroderma in this survey is a non-specific result of the stress and emotional upheavals associated with the disease.The possibility remains, however, that migraine in primary SS and scleroderma may in part be due to the underlying disease process as in the case of SLE. In view of the findings of this study patients with primary SS and scleroderma should be asked specifically about headaches and, in particular, migrainous headaches as they may be additional disabilities for these patients.The reward of such specific inquiries lies in the availability of specific antimigrainous treatment, which these patients might otherwise be denied.
(SS: Sjogren's syndrome. Bolding mine.)
So. Does the link between Sjogren's syndrome and migraines give me the excuse to ignore any of the other potential triggers, such as salty foods, caffeine, and chocolate in particular?

BICJ: Well, duh. My migraines happen because of Sjogren's syndrome. Doesn't matter if I eat this huge chocolate bar and wash it down with lots of caffeinated coffee which causes me to go for two days without sleep while playing Bejeweled and end up with a monster headache. Nah. 

It appears that my Bratty Inner Child Julia may be wrong, as usual. Even though some of the precipitating factors in a migraine's appearance can't be altered, careful attention to other factors may decrease the headache's severity. In one of my previous posts in which I wah wah wah about my headaches, a reader posted this excellent comment:
My own migraine pattern is undoubtedly due to hormonal fluctuations. I usually have one around day two of my cycle( lasting 24-36 hours) and over the passed two years often will get one day 12-14 (right as I would be ovulating). they are exacerbated by poor sleep, stress and too much caffeine and sugar. During these peak times I have to be diligent or I am in nauseating agony. 
Hm. Her hormonal cycle is her trigger BUT she knows that poor sleep, stress and too much caffeine and sugar will only make her headache much worse.

I guess if I want to avoid these acutely painful episodes, which I DO, I'd better become more proactive in this headache thing. It's time to grab a pencil and notebook and play detective.


Kate S. said...

If it would make it easier for you, there are some online or phone based tracking tools for things like food diaries, pain diaries. Enter food just after I ate it helps.

I tried to do this for a while to help figure out IBS triggers. What I found helpful was not to try assess stress level (cause I can't tell if I'm at a 2 or a 4 when I'm in the middle of the day), but to jot down events. I.e. dogs did the naught on the rug. Went for a ride in Goldie. It was a sunny day.

Best of luck.

kara said...

I've had migraines for several years. They were initially triggered by a medication, but didn't go away after the medication did. Imitrex actually made my migraines worse, but I started using Maxalt a few months ago and it's wonderful. Good luck with figuring out your triggers!

Anonymous said...

I've had migraine since I was 5, and have done many alternative treatments, diets and preventative drug therapies. I've taken low dose anti-depressants, beta-blockers, SSRIs, done biofeedback, acupuncture, physical therapy.
Honestly, what has helped me the most is imitrex. It was a life-changing drug for me. I never leave my house without it. The worst thing is when I cannot take it ( as too often is not good) or when it does not work.
My headaches have been worse and at times, intractable since I've had Sjögrens. I'm not sure why, but it must have something to do with SJS.

What I've learned over the years, is that I cannot combine triggers in a short time period. I won't have red wine, aged cheese, chocolate all in one day. I can't skip a meal or lose too much sleep. I can't tolerate heat at all now, but even before, being too hot or getting too much sun could trigger a migraine, as could strobe lights or perfume. I only eat lunch meat without nitrates and am careful about MSG.
I would suggest you keep a diary for a month. After that, if you get a migraine, try to remember what you consumed or did that might have been the cause. You must remember that it's not always something you did, but, it's helpful if you know what to avoid.
Another trigger for me are tight muscles in my neck and shoulders. I still must remember to stretch the back of my neck a few times/day.
Now, if I just had the energy to exercise, that would be helpful too!
Best of luck, Julia.

Anonymous said...

I have Primary Sjogren's and used to get horrible 3-day migraines. When I cut out all dairy and meat from my diet, the migraines went away.