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Causes of Migraine
by Sue Dyson
Anyone who has ever suffered from migraine will be only too aware of the
effects of the illness on daily life. According to the National Headache
Foundation — an organization set up to help migraine and other headache
sufferers — American industry loses around $50 billion from absenteeism and
medical expenses, all linked to headache pain. In fact, headaches account for
about 157 million lost working days in a year.
But we are not just talking about inconvenience and economic difficulties;
the cost in terms of individual suffering is infinitely higher. Apart from the
practical problems they face, sufferers and their friends and families are often
in a state of anxiety and bewilderment, particularly in the days following
There is no doubt at all that migraine has a significant effect on the
daily lives of all sufferers and their families. Even those who suffer mild
and infrequent attacks — and try to carry on their lives regardless — admit
that their quality of life is diminished during attacks. For those sufferers who
live with migraine on an almost daily basis, life can become almost unbearable.
Indeed, in some (thankfully rare) cases, sufferers have become so depressed and
overwhelmed by it that they have had to give up their jobs; a few have even
attempted suicide. This sad fact is made even more tragic by the fact that their
despair was unnecessary: all sufferers can be helped significantly, by a
combination of therapies, changes in lifestyle, and sympathetic and practical
support from others.
If you asked people in the street what they thought caused migraine, they
would probably mention chocolate, cheese, stress, anxiety .... some of the
things most commonly associated with migraine attacks.
But they would only be partly right. For cheese, stress, and so on, are
only a few of the trigger factors that can combine to produce an attack in a
Why we get migraine in the first place is a moot point. However, once that
predisposition has been created (whether from heredity or other causes, or an
amalgam of factors), there still need to be triggers that spark an attack.
Doctors now believe there has to be a combination of triggers present for
an attack to start. Some triggers, like stress and certain foods, are well
known; but everyone's triggers are different. If you can identify and remove one
or more of your personal trigger factors, you may be able to stop having
migraine attacks for good.
There is no justice in migraine, and there are no hard and fast rules
about who gets it and who doesn't. But there are recognizable patterns that
suggest that some people are more at risk than others. The important thing to
remember is that one factor alone is unlikely to give you migraine; all the
evidence points to attacks resulting from an "explosive" combination
of cause and circumstance. Some of the factors are unalterable
and constant, yet others are amenable to change. Therefore, removing some of the
ingredients from the volatile mixture may help to deactivate your migraine
before its fuse goes off.
Food and Fasting
Some people know that certain foods, drinks, or additives will trigger a
migraine attack; some of these are listed later in this section. Others know
that going without food for too long will have the same effect.
When I was a teenager, I used to get up late on a Saturday, eat very
little breakfast, and go out shopping with friends. We were having so much fun
that we stopped only for a bar of chocolate before returning home for a very
late lunch (often cheese, which was quick and easy). Every single Saturday
evening, I had a terrible migraine attack. It didn't occur to me for ages that I
was doing everything wrong.
By getting up late, I was getting too much sleep and depriving my body of
food for longer than it was accustomed to. My blood sugar level was low and I
was missing my morning "fix" of coffee or tea. My tiny breakfast did
little to raise my blood sugar level, and I rushed about all morning, expending
lots more energy and producing loads of adrenaline because I was excited and
having fun after the stresses of a week's studying. The sugar in the bar of
chocolate boosted my blood sugar level sky-high for a little while, after which
it plummeted again. When I finally did get to eat something substantial it was
cheese — a food well-known for its migraine-inducing properties, as it is rich
in tyramine, which has an effect on the blood vessels in the head.
Looking back, it's hardly surprising that I was ill every Saturday. At the
time I attributed it to relaxation after the working week, but the more I think
about it, the more likely it seems that food — and the lack of food — contributed
to my downfall.
Not everyone is sensitive to the typical migraine foods (cheese,
chocolate, oranges, red wine). The lack of food, or the wrong sort of food, can
be just as important, as blood sugar swings are a common factor in migraine
attacks. Eating a slice of cake or a few cookies may boost your blood sugar in
the short term, but your body may overcompensate by producing too much insulin,
dramatically lowering it again. Overdoing a weight-loss diet may also cause
problems, as may strenuous exercise coupled with delayed meals.
You may find that you can eat a "problem" food at some times and
not at others. Some women find they can eat chocolate any time except just
before a period. To complicate matters, some people can be sensitive to common
foods that we eat in large quantities — often several times a day — such as
wheat or milk, and this can make identifying them very difficult.
It's not just the foods, either — it's the things we put into them, the
flavorings and preservatives, thickeners and colorings. For a small number of
sufferers, these may be a genuine problem.
The good news is that, for many migraine sufferers, food is not a problem
at all. No one can tell you whether it is going to be a problem for you. But,
you should be able to identify your own personal dietary triggers — if
any exist. If you find that you do not have any, the freedom from worrying about
everything you eat may just be enough to reduce the frequency of your attacks.
The following foods and drinks are known to precipitate migraine attacks in some
people (a minority of sufferers):
- Cheese (especially matured cheeses; cottage cheese and cream cheese
tend to be all right)
- Oranges and other citrus fruits
- Alcohol, especially red wine, brandy, and whisky
- Vinegar and pickled foods
- Smoked foods
- Sour cream and yogurt (some people are sensitive to all dairy products)
- Caffeine (found in tea, coffee, cola drinks, and chocolate)
- Foods containing nitrites and nitrates (such as hot dogs, salami)
- Foods containing monosodium glutamate (avoid all processed foods unless
you're sure they do not contain it — it gets into almost everything!)
Interestingly, a study at Charing Cross Hospital in London, England,
involving 60 migraine patients isolated the following foods as the most
common culprits in causing attacks:
- Wheat (found not just in bread, but in all flour-based products and
also as a thickener, as in soups): 78%
- Oranges: 65%
- Eggs: 45%
- Coffee and tea: 40%
- Milk and chocolate: 37%
- Beef: 35%
- Corn, cane sugar, and yeast: 30%
- Peas: 28%
This is a very exhaustive list and it is highly unlikely that you would be
sensitive to more than one or two of these foods — if any.
Many of these foods are not thought of as typical migraine triggers. So,
the moral is that you really have to monitor your own consumption and symptoms
if you are going to be successful in eliminating any food triggers you might
have. Not everybody does. It is important to remember that food is an important
trigger for some people, and not important at all for others. Many migraine
sufferers deprive themselves unnecessarily of favorite foods: it's worth
remembering La Rochefoucauld's maxim, "To safeguard one's health at the
cost of too strict a diet is a tiresome illness indeed".
Obviously it would be dangerous to cut out large numbers of foods from
your diet, especially all at once. You would be not only reducing its variety,
but also damaging your nutritional intake. So, take advice from your doctor, or
eliminate only one food at a time, making a careful note of any effects.
Dr. Anne MacGregor emphasizes: People who suffer from true food intolerance are in a minority, yet this
is a subject that is always focused on. Even if you are sensitive to some foods,
it will only be a part of the problem. If you become obsessed with food
sensitivity, you are just creating another extra illness, as well as isolating
This is definitely a factor in some headaches, especially cluster headaches. One
study indicated that an astonishing 53 percent of migraine sufferers became
migraine-free when they gave up smoking and other migraine triggers — whereas
only 13 percent of nonsmokers became migraine-free when they gave up trigger
You may find that you suffer from attacks not during periods of stress,
but immediately afterward. It's as though your body manages to cope until the
crisis is over, and then forces you to take a rest. Many people find that they
get attacks on the weekends, when they are relaxing after a long and hectic
week. This can be exacerbated by too much sleep, a late breakfast, and caffeine
You may also find that chronic stress causes recurrent attacks. After a
while, your body can take no more and forces a sort of "power-dip" on
you (like an electrical "brownout" that dims the lights in your
This is another form of stress. No matter how much you are enjoying
yourself, you can still be experiencing stress, as you are producing lots of
adrenaline. Once the "high" is gone, you may have an attack. You need to plan ahead, learn to relax properly, and eat a balanced diet.
These preparations will help you enjoy yourself without fear of unpleasant
consequences later on.
If you have a bad back, shoulders, or neck, this can give you a headache.
Lots of us have poor posture without even realizing it, and sitting at computer terminals all day, on cheap chairs with glaring or dim
lighting, is a notorious cause of postural problems. An osteopath, chiropractor,
physiotherapist, or teacher of the Alexander Technique may be able to advise you
you can consult your health and safety or union representative at work. Larger
businesses now can call on ergonomic experts to forestall health problems among
Too much or too little sleep may bring on an attack. Try not to disrupt
your routine, particularly if it means you will eat late. Fasting for long
periods lowers your blood sugar and makes you vulnerable to an attack. Getting
up at your normal time may eliminate "weekend" headaches.
You may find that your attacks are worse or more frequent when you are ill
and at a low ebb.
Quite a lot of sufferers find that they are sensitive to bright light,
flickering light, strong smells, stuffy atmospheres (particularly in newer
office buildings with no fresh air circulating), and fluorescent lighting. Some
may find they cannot tolerate certain household chemicals.
Your Personal Triggers
As we have seen, migraine is a complex disorder and there are no easy
answers. Each individual will have his or her own personal triggers, and it is
only by identifying and — if possible — eliminating those triggers that the root
cause of the problem can be addressed.
Not everyone is sensitive to individual foods, but most migraine sufferers
will find that there is a dietary element to the incidence of their attacks — if
only because of overenthusiastic weight-loss regimens, eating too much sugar, or
exercising on an empty stomach.
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