NHF Regional Conference - Part II

Migraine Triggers

Dr. Frederick Freitag

Dr. Freitag recently stepped down as co-director of the Diamond Headache Clinic in Chicago, IL. His new position is at Baylor University Medical Center in Dallas, TX. He is very active in headache initiatives (including clinical research, lecturing, etc...).

Migraine Facts:

• 1 in 4 households has a migraine sufferer
• Migraine affects women more than men (3:1)
• ~30 million people in the U.S. have migraine
• 12-18% of the population have migraine (more than asthma and diabetes combined)
• If one parent has migraine, his/her child has ~50% chance of also having migraine
• 75% of migraine sufferers have neck pain/tenderness

Migraine is...

• Genetic - brain programmed to be sensitive
• Hyperexcitability / hypersensitivity of the brain
• Neurologic process
• Whole-body disorder
• Chronic systemic disease
• Attacks vary (between migraineurs and migraine attacks)
• May be progressive
• SULTANS --
  
  • (moderate to) Severe pain
  • Uni-Lateral
  • Throbbing
  • Aggravated by activity
  • Nausea or vomiting
  • Sensitivity to light and sound (environmental)

Premonitory Phase (can include any combination of the following symptoms):

• Fatigue
• Thirst
• Yawning
• Dizziness
• Increased energy
• Food cravings
• Frequent urination
• Poor concentration
• Hypersensitivity to sound
• Neck pain/tightness
• Blurred vision
• Irritability/emotional

Aura - builds gradually 5-60 minutes (usually visual)

Prodrome Phase ("Migraine Hangover") can include any combination of the symptoms from the Premonitory Phase

Comorbidities (more prevalent in people with migraines than the normal population):

• Depression
• Anxiety
• Bipolar
• Obsessive-compulsive disorder (OCD)
• Panic
• Sleep disorders
• Heart disease
• Irritable bowel syndrome (IBS)
• Fibromyalgia
• Stroke
• Obesity
• Migral valve prolapse
• Back/neck pain
• Patent foramen ovale (PFO)

Risk Factors (Triggers):

• Stress (or let down)
• Hormonal changes
• Diet (skipping meals; specific foods)
• Sleep disruptions
• Weather
• Head trauma

Food Triggers (not an exhaustive list):

• Additives - aspartame, MSG
• Vasoactive amines - aged cheddar, fava beans, soy products, left overs, lunch meats
• Other foods - long list of possible food triggers
• Alcohol - red wine, other wines/beers
• Caffeine

Protective Factors:

• Eat regular meals
• Standardized sleep pattern
• Exercise
• Stress management (biofeedback, recreation/have fun, massage)
• Post-menopause