One in five women in America suffer from migraine headaches. In the throes of a migraine attack, simple head movement intensifies the pain. Eating or exercising is out of the question. Sometimes a migraine sufferer can’t even get out of bed.  There are 28 million Americans who have these disabling headaches — three times as many women as men. Almost half of them don’t see a doctor, don’t know their headaches are migraine or are trying to treat them on their own.

There are many new treatment options to keep migraineurs on the tennis court, at their son’s soccer game and alert and energetic at the office or factory … and not in bed! Consulting a physician is the first step. But there are many ways to avoid migraine triggers in everyday life.

What people with migraine experience as a headache is actually the final stage of a complex process. Many factors appear to set off, or “trigger,” the cascade of events in the brain. Migraine triggers include an odd array of sensory inputs, as well as substances contained in certain foods and beverages. Recognizing and avoiding specific triggers can enable migraine sufferers to craft a headache-free lifestyle.

Practical Tips for Preventing Migraine

• Wake up early on Saturday and Sunday. Get up the same time each day, even if you have stayed out late the night before. Change in sleep routine can make you vulnerable to morning headache. And, when you sleep in till noon on Sunday, you’ll most likely drink less coffee or tea, putting you in “mini-caffeine withdrawal” and inviting a headache.

• Drink water instead of diet soda. Diet drinks contain artificial sweeteners, such as aspartame, and many have caffeine, both of which can trigger migraine headache.

• Use the money you’ve saved on diet drinks to purchase sunglasses with photochromic lenses that automatically darken when exposed to UV rays. Wear prescription sunglasses while driving. Even on an overcast day (which NEVER happens in Portland, of course!) glare from the windshield and reflected light from nearby cars can cause you to squint, tensing the muscles of your scalp and face. Many individuals with migraine are exquisitely sensitive to light, called photophobic; and bright, reflected light while driving, or on computer screens placed near windows, can precipitate headache.

• Begin your exercise routine with a slow and gentle warm up. Abrupt vigorous exercise can rapidly increase blood flow to the brain and dilated vessels throb and may set in motion the cascade of changes in blood vessels and electrical activity of nerve cells that characterize what’s happening in your brain during migraine pain.

• Watch for abrupt changes in weather. The medical literature is controversial about barometric pressure or wind patterns being true provokers of headache, but most of my patients report a sensitivity to weather pattern change. While of course we can’t alter the weather, we can be vigilant about avoiding other migraine triggers, such as lack of sleep or red wine, during rapid weather fluctuations. Often it’s a combination of two or more migraine triggers that actually result in full-blown migraines.

• Be wary of common food “triggers” of migraine. Culprits include wine (especially red), aged cheese such as Brie, blue, cheddar (pizza!), MSG, aspartame, peanuts or peanut butter, processed and preserved foods such as luncheon meats, and onions. Not all of these foods serve as triggers for all migraineurs. But being a food-detective, keeping a brief food diary for a week or two, can be a smart preventative move.

• Be especially cautious with alcohol. Alcohol serves as a cerebral vasodilator, activating nerve endings that supply these vessels as they expand, triggering vascular headache. In addition, alcohol acts as a diuretic; dehydration can compound many types of head pain.

• Avoid dehydration. Dehydration, in children as well as adults, makes nausea and vomiting from any cause, including migraine, worse.  Sufficient water intake, especially when exercising, can protect against the headache and accompanying nausea of migraine symptoms. A feeling of thirst is not an early indicator of your body’s volume status. By the time you feel thirsty, your plasma volume is already low. Your best guide to your body’s hydration status is the color of your urine. It should be pale yellow. Any darker means you need to increase your daily water intake. Remember many foods have high water content: watermelon and celery, of course, but also many fish, such as salmon, and eggs.

There are many factors we can’t control that influence headache vulnerability, such as genetics and hormonal changes. But fortunately, we are able to modify many aspects of our lifestyle to reduce migraine frequency and intensity.

Tarvez Tucker, M.D.
Associate Professor of Neurology and Neurocritical Care
OHSU Brain Institute