Frequently Asked Questions

Internal Chronic fatigue, too little sleep, too much sleep Change in sleep-wake cycle from travel or shift work Emotional stress, let down after the stress is over Hormonal fluctuations (menstrual cycle) External Weather and seasonal changes Travel through time zones Altitude Skipping or delaying meals Sensory stimuli Flickering or bright lights, sunlight Odors, including perfume, chemicals, cigarette smoke Heat, loud noises Medications Nitroglycerin Tetracycline (an antibiotic) High doses of vitamin A Some antidepressant medications (selective serotonin reuptake inhibitors or SSRI) Some blood pressure medications Monosodium glutamate (MSG)(a food ingredient) NutraSweet (a food ingredient), Equal (a sugar substitute, possibly Splenda (an artificial sweetener) A variety of factors can trigger an explosive migraine attack. The menstrual cycle is clearly a significant trigger in the great majority of women with migraine, and this is associated with and may be caused by a decrease in estrogen levels; however, hormonal triggers are rarely a cause of chronic daily headache. A second trigger for migraine is food; many food types can trigger migraine in susceptible patients. While many alcoholic beverages are common triggers, red wine, beer and champagne are the drinks most frequently mentioned by patients. The dark-colored alcohols (scotch, bourbon, dark run, and red wine) appear more likely to trigger migraine attacks then the light-colored ones (gin, vodka, white, run, and white wine). Many foods (see Table #2), particularly those that contain tyramine (such as strong cheddar cheese), trigger migraine, but only in some people. Patients seem to have individual sets of triggers that are problematic for them and not necessarily for other. To reiterate, food triggers bring on migraines, but are not generally a cause of daily headaches. Caffeine is a double-edged sword. Because caffeine may help constrict the dilated blood vessels during a migraine attack, it is used in combination medicines to increase relief from headache (eg, Excedrin Migraine is a combination of acetylsalicylic Acid (Aspirin), acetaminophen (the analgesic in Tylenol), and caffeine; Fiorinal contains caffeine; Cafergot contains caffeine, as does Anacin).

Chocolate, onions, NutraSweet, Equal (aspartame), Splenda (sucralose) Nuts, pizza, canned figs, peanut butter, avocado, aged cheese Bananas, processed meats, caffeine Alcoholic beverage, eg, red wine Hot dogs, pepperoni, sausages, bacon, ham, bologna, salami, Pickled or fermented foods Yogurt Sour cream However, habitual consumption of too much caffeine can make headaches worse. How much caffeine is too much? Some patients are sensitive to the small amount of caffeine (approximately 100mg) in one small (8oz) cup of strongly brewed coffee. Many patients who complain of headaches on Saturday or Sunday mornings take in their coffee later in the morning. Headaches that occur under these circumstances could be due to caffeine withdrawal and are more likely to occur in people who are accustomed to drinking more then 300mg of caffeine per day (about three cups of coffee). At 500mg per day or above, caffeinism, with symptoms that include disturbed sleep, anxiety, nervousness, rapid or irregular heartbeat, and irritability, may occur. Table #3 lists the caffeine content of various products and foods. Gourmet coffees can have over 500 mg of caffeine per large-sized beverage. Some triggers, such as caffeine when exposure is frequent, can actually lead to the transformation from occasional headaches to chronic daily headache. That is, if people with migraine consume excessive caffeine frequently or analgesics often, especially those containing caffeine such as Excedrin and Anacin, then these substances actually result in daily headaches. It takes only about 10 days of overuse of these substances per month over several months to take a patient susceptible to this transformation to daily headache. When consumption of these medications is at 10 or more days per month, and the headaches worsens in terms of frequency, severity or duration then medication-overuse headache, as manifestation of daily headache, is likely. Thus, it is important to remember that caffeine is a medication and that overuse of caffeine can lead to a headache. Perhaps overuse of caffeine turns on the central generator as a cause of daily headache, or the patient with excessive caffeine use is in constant caffeine withdrawal, thus developing daily headache as a manifestation of daily withdrawal.