Chocolate – Friend or Foe?

by admin | Jul 31, 2021 | Triggers

Is chocolate a major migraine trigger?

Chocolate gets a lot of bad press as a headache trigger.  Is it really as bad as it’s made out to be?  Actually, it’s not.

A 1995 study found that 22% of chronic headache sufferers reported chocolate to be a headache trigger.  In an interview, one of the researchers, Dr. Lisa Scharff, indicated that many of the women who responded positively on a trigger questionnaire to chocolate did so because they had heard about other people getting headaches from chocolate, or discovered that their personal experience with chocolate as a headache trigger occurred premenstrually, casting some doubt on whether the chocolate was the actual trigger.

Dr. Scharff, Dr. Dawn Marcus, and others studied sixty women with chronic headache in 1997.  The women were asked to follow a restricted diet, and were then tested with four candy bars, two of which were chocolate, and two of which were carob.  All four bars were flavored with mint to prevent identification.  Even the women who believed their headaches were triggered by chocolate did not develop headaches, regardless of whether they had eaten the carob or the chocolate.

Wöber and colleagues at the Medical University of Vienna recently reported similar findings—that headache sufferers theoretical understanding of headache triggers differed from their actual experience.

Chocolate has been blamed as a migraine trigger in the past because it was thought to contain tyramine, but more recent chemical analyses have found it to contain minimal levels of tyramine.  It does, however, contain things that are good for you:  flavonoids and stearic acid.  The stearic acid is part of the fat in chocolate, and most of the studies done to date suggest that it is “cholesterol-neutral.”  In other words, it doesn’t affect your cholesterol in a negative way.  And the flavonoids act as anti-oxidants, and may have anti-platelet (anti-clotting) effects.

Studies of cocoa and dark chocolate found evidence that chemicals in cocoa reduced inflammation, and that chemicals in chocolate lowered blood pressure, increased HDL (good cholesterol), lowered LDL (bad cholesterol), prevented platelets from clumping together (like aspirin does, only not as strongly as aspiring does), improved endothelial function (the inside of blood vessels), and improved insulin sensitivity.

Dark chocolate has five times the amount for flavonoids of blueberries.  Finally, chocolate is high in magnesium.  And there is some evidence that chocolate results in a release of serotonin and endorphins.

I’d say chocolate is your friend.  Unless, of course, it really is one of your migraine triggers.  It is for some people.

References:

1. Marcus, DA, Scharff, L, Turk, L, Gourley, M.  A double-blind provocative study of chocolate as a trigger of headache. Cephalalgia. 1997 Dec; 17(8):855-62, discussion 800.
2. Lippi, G, Mattiuzzi, C, Cervellin, G.  Chocolate and migraine:  the history of an ambiguous association.  Acta Biomed. 2014 Dec 17; 85(3):216-21.
3. Moffet, AM, Swash, M, Scott, DF.  Effects of chocolate in migraine:  A double-blind study.  Journal of Neurology, Neurosurgery, and Psychiatry.  1974, 37, 445-448.

Caffeine

by admin | Jul 10, 2021 | Triggers

Is Caffeine Your Trigger?

Caffeine, which has been called the most commonly used drug in the world, deserve special consideration.  It is estimated that 90% of Americans consume some form of caffeine daily, and more than half in excess of 300 mg a day.  Caffeine, in moderation, is not a problem.  What determines moderation, however, is a matter of both opinion and individual variability.  Many people consider 200-300 mg/day to be moderate use, however, this may be more than can be tolerated without difficulty if you are a migraine sufferer, and if this proves to be a migraine trigger for you.  Also, bear in mind that the DSM-IV defines caffeine intoxication syndrome as symptoms arising from ingestion of more than 250 mg of caffeine.

The US Food and Drug Administration limits caffeine content to 6mg/fluid ounce in soft drinks and energy drinks.  There is not a similar limit in beverages that are brewed at or after point of sale.  The average cup of coffee contains at least 100 mg of caffeine.  (How big is your cup?)

Another important consideration is caffeine-containing medications.  Many headache sufferers take caffeine-containing over-the-counter medications, and are not aware of the amount of caffeine in these preparations, or that they may be getting more caffeine in their pills than in their coffee.

Commonly taken caffeine-containing over-the-counter medications

Caffeine-containing prescription pain medications

Caffeine is in a lot of products, including beverages

Environmental

by admin | Jun 10, 2020 | Triggers

Environmental Migraine Triggers

Environmental triggers are the things around you in everyday life that can serve as a migraine trigger.  Some of these are obvious, but you mat not have thought about some of the others.  Remember that triggers are additive in their effect, so any of these can combine together, or can combine with other types of triggers, to make you more susceptible to a migraine attack.

Environmental triggers can include the following:

Bright light or glare

Alternating light and dark, such as:

• Driving along a tree-lined road
• Stripes, checkerboards or other patterns (on wallpaper, etc.)
• Sitting too close to the screen in the cinema

High ambient heat

Weather changes

Altitude

Loud sounds or commotion

Odors, including:

• Cigarette smoke
• Perfume
• Household cleaners
  
• Gasoline, especially diesel
• Chemical fumes

Travel

Travel – changes in time zones, the way you eat, etc.

Some of these triggers can be avoided more easily than others.

A good way to track your suspected triggers is to jot them down on a headache diary.

by Christina Peterson, MD

updated June 10, 2020

Food Triggers

by admin | Oct 13, 2016 | Triggers

Food Triggers in Migraine

Food triggers are those most commonly talked about – everyone has heard about them. But in truth, only about 25% or so of migraine sufferers have any food triggers, perhaps a bit higher for alcohol as a trigger. For most people, migraine food triggers are not food allergies. Migraine sufferers with various food triggers have been tested for allergies to their offending foods, and no markers of allergy (IgE) have been found.

If you do think you have a food trigger, avoiding that food can reduce the number of headaches you have.

Triggers are additive, so food triggers in addition to other triggers, like sleep deprivation or hormonal changes, can more easily bring on a migraine attack. It is not usually necessary to go on a special migraine trigger elimination diet to discover what your food triggers are. It is usually sufficient to keep a food diary in conjunction with a headache diary.

These are common food triggers:

Aged Cheese, Sour cream, Yogurt, Buttermilk
Citrus
Nuts
Legumes:

Peas
        Beans
Soy:
Soy sauce
Tofu
Edamame
Soy “Nutraceuticals” used instead of estrogen HRT
Soy may hide in ingredients as texturized vegetable protein

Onions
Garlic
Pickled foods, Vinegar: Salad dressings, Ketchup, Relish

These are moderately common triggers:

Aspartame (Nutrasweet®)
Chocolate
Wine, Beer, Other alcoholic beverages
Wheat/gluten*
Caffeine

*This pertains largely to those who have a comorbid condition called gluten insensitivity, or celiac disease.  This condition is a little more common in migraine sufferers than it is in the general population.

Sulfites

The following foods contain sulfites:

Wine, especially red
Dried apricots, apples
Dehydrated potatoes
Shrimp, lobster
Used as a dough conditioner
Used to bleach food starch
Glacéed fruit
Jams
Prepared gravies
Molasses
Soup mixes
Vegetable juices
Fruit juices
Hard cider

Nitrates/Nitrites

The following foods contain nitrates or nitrites:

Smoked fish
Corned beef
Bologna
Pastrami
Pepperoni
Canned ham
Bacon
Sausages
Frankfurters/ Hot dogs
Beef jerky

These are less common triggers:

Bananas
Papayas
Pineapples
Figs
Avocados
Olives
Yeasty foods, like freshly baked bread
Intensely sweet foods
Intensely salty foods

MSG  –  this may hide as the following:
Hydrolyzed vegetable protein
Hydrolyzed plant protein
Natural flavoring
Kombu extract

MSG has been debated as a trigger.  Many people are convinced it is their trigger, even though the scientific basis for this has been questioned, as glutamate is widely distributed throughout the brain as a neurotransmitter.  It may, in fact, be the sodium or impurities in MSG to which migraineurs are reacting.

Here are some links for further information about MSG:

http://www.guardian.co.uk/lifeandstyle/2005/jul/10/foodanddrink.features3

http://www.truthinlabeling.org/manufac.html

Lifestyle Management

by admin | Mar 13, 2014 | Triggers

Trigger Avoidance to Control MIgraines

One of the simplest but most important things to do in the management of migraines is to manage your migraine triggers. While it seems an obvious thing to do, it may not always be easy. Some things are obvious: eat regular meals, maintain good hydration, get enough sleep. Things that are not as easy to accomplish, although we “know we should,” are keeping a regular schedule and a regular bedtime, exercising regularly, and maintaining a moderate caffeine intake.

It is impossible, of course, to control the amount of stress that we are exposed to on a day-to-day basis, but stress management techniques are available to help with managing the toll it takes.

Lifestyle Migraine Triggers

There are many things that count as lifestyle triggers, but if you follow a generally healthy lifestyle, it covers most of them.

• Get enough sleep. Although many people try to skimp on sleep, most adults need 7 to 8 hours of sleep a night.
• Follow a regular bedtime. Did you know that sleeping in more than an hour past your normal awakening time can trigger a migraine for some people?
• Drink enough water – dehydration causes headaches.
• Eat regular meals – skipping meals can trigger a migraine.
• Exercise regularly.
• Use caffeine moderately.
• Use alcohol moderately.
• Take breaks.
• Take vacations.

Sleep disorders deserve special attention. There have been two studies which have identified sleep disorders as a risk factor for the development of chronic daily headache, and improving sleep can help with the control of migraine. If getting on a good sleep schedule does not help, and you are still having trouble sleeping, discuss this with your doctor. A sleep study may be helpful in making a proper diagnosis, as the problem may be more complex than simple insomnia.

Maintaining a healthy weight can also be important in controlling headaches. There have been several studies that have identified obesity as a risk factor for the development of chronic daily headache, as well as several studies linking obesity to the increased frequency and severity of migraine.

If you can maintain a regular schedule, you will be one step ahead of the game in keeping your headaches at bay.

Managing lifestyle triggers can go a long way toward reducing migraine headache frequency and severity, and decreasing the amount of medication you might need.

Triggers

by admin | Mar 5, 2014 | Triggers

What are migraine triggers?

Triggers are not the cause of a migraine, as they would not cause migraine headaches in people without a migraine tendency. But they are the things that trigger an attack in those who do have migraines. It is felt that migraines are an inherited condition in most people. If a careful three-generation family history is taken, a history of migraine can be found in at least one extended family member in 90% of migraine sufferers. The underlying inherited susceptibility to migraine, most likely genetic in basis, is felt to be the cause of migraine.

Triggers are physiological or environmental stressors which serve to further lower the threshold of those already susceptible to migraine, making a headache happen more easily.

It is commonly known that foods can trigger migraine headaches. But did you know that there are many non-food triggers? A poll conducted by the World Headache Alliance asked “What is the most significant factor preventing you from effectively managing your headaches?” Most people indicated that it was the inability to manage stress and other lifestyle factors.

Many migraine specialists consider the “migraine brain” to be more sensitive, in a way, although probably a better way to think of it would be more sensitized. But whichever word you use, it means that if you have migraines, your brain doesn’t do well with changes, like changing hormonal levels.  It also means you are more susceptible to changes in your schedule, and can’t get away with things like skipping meals, skipping sleep, or not drinking enough water.

Explore the content on various trigger types in this section to learn how you can decrease the number of migraines you experience.

by Christina Peterson, MD

updated Mar 5, 2014