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How to Diagnose & Avoid

What foods and drinks are thought to trigger headaches in susceptible people?

First, it’s important to note that most of the information about possible food triggers of headache come from patient self reports and not from randomized scientific studies. Despite the lack of science, the most common foods and drinks reported to be potential headache triggers include:

  • Aged cheese (blue cheese, brie, cheddar, English stilton, feta, gorgonzola, mozzarella, muenster, parmesan, swiss)
  • Alcohol (red wine, beer, whiskey, Scotch, and champagne are the most commonly identified headache triggers)
  • Peanuts, peanut butter, almonds, and other nuts and seeds
  • Pizza or other tomato-based products
  • Potato chip products
  • Chicken livers and other organ meats, pate
  • Smoked or dried fish
  • Pickled foods (pickles, olives, sauerkraut)
  • Sourdough bread, fresh baked yeast goods (donuts, cakes, homemade breads, and rolls)
  • Brewer’s yeast found in natural supplements
  • Bread, crackers, and desserts containing cheese
  • Most beans including lima, Italian, pole, broad, fava, navy, pinto, snow peas, garbanzo, lentils, and dried beans and peas
  • Onions, garlic
  • Avocados
  • Certain fresh fruits, including ripe bananas, citrus fruits, papaya, red plums, raspberries, kiwi, and pineapple
  • Dried fruits (figs, raisins, dates)
  • Soups made from meat extracts or bouillon (not homemade broth or bouillon cubes that do not have MSG or “all natural preservatives” on the label)
  • Canned soups
  • Cultured dairy products, sour cream, buttermilk, yogurt
  • Chocolate
  • Caffeinated beverages, including coffee, tea and colas
  • Aspartame and other artificial sweeteners
  • Nitrate/nitrite-containing meats including hot dogs, sausage, bacon, lunchmeats/deli meats, pepperoni, other cured or processed meats
  • Monosodium glutamate (MSG) containing products including soy sauce, meat tenderizer, Asian foods, and a variety of packaged foods. MSG is an often disguised ingredient; also look for these common aliases: monopotassium glutamate, autolysed yeast, hydrolysed protein, sodium caseinate

How common are food triggered headaches?

Only about 20% of headache patients are thought to be food sensitive.

How do I determine which foods and drinks are my headache triggers?

One common suggestion for figuring out your own personal headache triggers is to track the foods and drinks you consume in a daily food headache diary. You may consider yourself to be sensitive to a certain food or drink if you get a headache consistently 20 minutes to 2 hours after eating that certain food.

However, keep in mind that even though it sounds simple to track what you eat to try to figure out what foods and beverages might trigger your headache, it’s not this simple.

Problems with food headache trackers

Is it truly the food or drink that is causing your headache or is it one of the many ingredients or chemicals in these foods? Foods consist of many ingredients that contain many chemicals. Chemicals include nitrates/nitrites, phenylethylamine, sulfites, tannins, tyramine, salicylates, aspartate, added sugar, alcohol, caffeine, gluten, glutamate and capsaicin to name a few.

Even beyond consumed foods, drinks and ingredients/chemicals are other factors that must be considered that may complicate identifying the true trigger of your headache. These factors include:

  • Have you had a recent change in headache medication or dose?
  • Did you miss/skip a meal or eat earlier or later than usual?
  • Are you staying well hydrated or do you think your intake of fluids was lower than typical before the headache started?
  • How many hours of sleep did you get the night before the headache?
  • What physical activity were you doing before the headache occurred?
  • Did any stressful events occur before the headache started?
  • What stage of the menstrual cycle (hormonal changes) were you in when the headache started?
  • What was the weather like before your headache started? (weather triggers may include bright sunlight, high humidity, stormy weather, high humidity for example)
  • Do you have a family history of headache?

With so many complicating factors, what’s the best approach to reduce my chance of getting a headache?

Being aware of foods, drinks and most importantly, the ingredients and chemicals that have been reported as headache triggers can be a helpful tool, a good starting point. Keep in mind that headache triggers vary from person to person. Also understand that pinpointing a headache trigger goes far beyond food/drink products that may have been consumed in the hours or even days before the headache started. So many other factors influence the occurrence of a headache.

So then, what can you do to lower your chance of headache? The best approach may be to begin to control known influencers of headache. A family history of headaches is something you cannot control. However, getting a good night’s sleep, not skipping meals, drinking enough water to stay hydrated, and exercising regularly are some of the other things you can control.

As far as foods, drinks, and ingredients are concerned, it certainly doesn’t hurt to try to figure out if one or more food items (or ingredients) might be triggering your headache. Eliminate one item at a time over weeks or months and record this information in a headache diary. Only cut out a food if you have a high suspicion it causes headaches, otherwise you might remove foods you enjoy! In this diary, also track other factors that occurred within 24 hours of the headache (did you eat on time, skip meals, experience a stressful event, stage in menstrual cycle etc). With all of this information in hand, you can begin to sort out and discover for yourself the factors that provoke your headache.

Final advice about reducing the chance of any foods being headache triggers:

  • Eat a well-balanced healthy diet full of vegetables, fresh foods, and low fat protein.
  • Avoid processed (packaged) foods.
  • Do not miss meals.
  • If you do not recognize what is on the label, it is probably best not to eat it.

Diet and Migraine | American Migraine Foundation

Studying Your Diet & Making Changes Could Help Reduce Migraine Attacks

When it comes to living with migraine, sometimes you are what you eat. It’s not uncommon for migraine patients to notice that their symptoms  correspond with certain food triggers, however, which  foods or ingredients contribute to head pain varies widely from person to person. Some people report having more migraine attacks after eating processed foods or drinking alcohol, while others have more frequent head pain after fasting. Others don’t have any food triggers at all. Still, examining your eating habits can help you maintain a balanced diet and identify patterns that could help reduce migraine attacks.

Establishing Healthy Habits

While not all people with migraine will find triggers in the foods they eat, everyone can benefit from making healthier choices. A diet of five or six small portions of fresh food throughout the day can prevent migraine attacks in a variety of ways. It can prevent hunger-based headaches, reduce the likelihood of eating multiple, potentially triggering chemicals or foods at once, and help avoid weight gain, another possible factor that may increase the frequency of migraine attacks. Once you’ve established healthy habits, you’ll have a neutral baseline to compare against foods you suspect may be triggering your migraine. Any observations you can make about how your diet relates to your migraine attacks can be useful in helping you understand and possibly reduce your symptoms.

Isolating and Identifying Triggers

If you’re committing to taking a close look at your possible food triggers, there are steps you should follow to get the best results. Test foods one by one—don’t cut out all of your potential trigger foods at once or for an extended period of time. This can cause stress, which can compound your symptoms, and also makes it more difficult to determine which food, if any, triggers your migraine attacks. Use a headache diary to keep track of any changes you are making to your diet, and note how severe and frequent your headaches are, and which foods you were eating or avoiding when they occurred. You should also record how your headaches respond to treatment during this time. For any single food to qualify as a potential trigger, a headache should occur within 24 hours, at most, of eating it. Frequently reported migraine triggers include alcohol, including red wine and beer, artificial sweeteners, caffeine withdrawal, chocolate, processed meats and foods containing MSG, histamine, and tyramine, but you know your body best—so take inventory of any foods you eat often that you suspect may be triggering your migraine.

When Multiple Triggers Overlap

Some specialists report that “many factors,” including food, “may tip the scale in favor of a migraine” when people are at risk of an attack. For example, eating a “trigger food” when you’re already experiencing from other triggers—like being stressed—might increase your likelihood of having a migraine. Experimenting with your diet when you’re already experiencing other risk factors will make it more difficult for you to identify if it was food, stress or exhaustion that prompted a migraine attack, so don’t make major changes if you’re already not feeling your best. Don’t use restrictive diets with children or teens, and don’t use restrictive diets when pregnant.

The Benefits of Studying Your Diet

If you identify a food trigger, you will be able to avoid it, especially when you know you’re facing other factors that can trigger a migraine attack. Additionally, confirming that some foods you may have thought were triggers aren’t connected to your migraines will let you resume enjoying those foods worry-free. Any changes you make that encourage you to eat a healthier, more balanced diet will contribute to your overall well-being and increase your chances of reducing your migraine attacks.

In the end, even if food is not a primary trigger for your migraine attacks, identifying how certain foods affect you and maintaining a balanced, scheduled diet gives you more control over your symptoms and your health. For more information and tips to help you explore how food may affect your migraine, download the American Migraine Foundation’s free Meal Planner today.

Foods That Can Trigger Migraines and Modifying Your Diet to Manage Them

If you’ve ever experienced a migraine, you know how debilitating they can be. You have probably tried many methods to help treat the pain, such as over-the-counter or prescription pain medications, ice packs, and a variety of supplements. While each of these things may help provide some relief, they may not be treating the underlying cause of the migraine and may therefore lead to only temporary relief followed by pain that keeps on coming back.

Food is an often underlooked contributor to migraines, but one that deserves attention. This article will take a closer look at the relationship between food and migraines, how to determine your unique food triggers, which foods to potentially avoid, and foods that may help prevent migraines from occurring in the first place.

What is a migraine?

A migraine is a severe type of headache that involves significant pain, which can present as throbbing or pulsing in various parts of your head. This pain can lead to other symptoms such as nausea, vomiting, and sensitivity to light and/or sounds. The headache is often preceded by an aura (visual or sensory symptoms), and followed by a hangover or recovery period.

We aren’t sure what causes migraines. Abnormal behavior in the nerve cells of the brain, combined with inflammation in the brain is currently the best theory researchers have. Many triggers for migraines have been identified, such as lack of sleep, stress, hormones, and eating patterns.  

Can food affect migraines?

In the past, certain foods like cheese, chocolate, and caffeine were thought by many people to trigger migraine attacks. But while these foods may bring on migraines in some people, there isn’t a lot of scientific evidence to suggest that this is true for a majority of people with migraine.

What experts now believe is that the food thought to trigger the migraine is sometimes a craving that is part of the pre-headache phase of the migraine. Confused? Let’s look at an example. 

You eat a whole bar of dark chocolate one night. The next day you wake up with a migraine. You assume the chocolate triggered it. But what is probably going on is that in your pre-headache phase, you are experiencing heightened sensations that are coming out as a craving for dark chocolate. So, the craving for dark chocolate is actually part of the migraine, not the trigger. 

Here’s what we know for sure about food and migraines: Skipping meals is reported as a trigger in 57% of migraines, alcohol in 38%, and food in 27%.  

By far the strongest evidence for foods that trigger migraines is for:

  • Alcohol 
  • Nitrates (found in foods such as hot dogs, bacon, cured meats, and sausages) 

How to determine your food triggers

Similarly to how people’s bodies can respond differently to various medications, they often respond differently to foods as well. So while alcohol and nitrates may trigger migraines in many people, different types of foods may trigger migraines in other people. 

If you have certain food sensitivities, then eating those foods can also trigger migraines. The food intolerance isn’t the cause of the migraine, but it can make the migraine worse, or bring it on. 

For some people, figuring out what foods — if any — trigger a migraine can be very obvious. For others, it might be trickier. The good news is that with a little determination and patience, you can get to the bottom of whether certain food triggers are a feature of your migraines or not.   

The most common way of doing this is to keep a food and symptom diary. This involves carefully tracking factors that may have been at play when a migraine hit. When you feel it coming on, try logging what you ate or drank, how much sleep you got, if you were on your menstrual cycle, and how often you were eating in the days leading up to it. This is detective work: Recording everything in as much detail as possible will help you determine potential associations and culprits. The longer you keep a food and symptom diary, the more likely you are to get the answers you seek. 

The downside of this method is that it can be tedious, and it may take several months to notice a pattern, especially if your migraines are not very frequent. 

Common food triggers for migraines

The following are some commonly reported food triggers for migraines:

  • Natural food chemicals and their food sources, such as:
    • Tyramine from aged cheese; canned, cured, and/or processed meats; some beans such as fava and broad beans; pickles; and some canned soups
    • Tannins and phenols from black tea, bananas, apple skins, and red wine
    • Sulfites in wine, dried fruits, pickled vegetables like pickles and sauerkraut, molasses, and many processed foods
  • Food additives and their food sources, such as:
    • MSG found in many fast foods, particularly Asian foods, some chips, certain seasoning blends, highly processed meats, and some soups and condiments
  • Other common foods that people associate with their migraines include:
    • Caffeine 
    • Chocolate
    • Onions
    • Citrus fruits
    • Olives
    • Nuts
    • Gluten
    • Artificial sweeteners like aspartame and sucralose
    • Soy sauce 

Note that this is not a comprehensive list. Keep in mind that whether or not a reaction occurs can also depend on how much of a certain food you consume, or how often.   

How can I modify my diet to prevent migraines?

If you’re not sure whether or not certain foods trigger your migraines — or what those foods might be — it doesn’t hurt to opt for healthy, natural foods that are beneficial to everyone’s health. 

Examples include:

  • Natural, whole, and minimally processed foods without preservatives or artificial flavorings such as whole grains, fruits, vegetables, and eggs
  • Fresh meats, fish, and poultry like chicken breast, salmon, and lean beef or ham
  • Natural sweeteners like maple syrup and raw honey
  • Anti-inflammatory foods and supplements like omega-3s and turmeric

Does caffeine cause or treat migraines?

Caffeine can be confusing to people with migraines. On the one hand, people report caffeine to be a common migraine trigger, and daily drinkers of coffee are more likely to have chronic migraines than people who don’t consume caffeine regularly.  

On the other hand, caffeine has long been used in combination with aspirin and acetaminophen to effectively treat all kinds of headaches — including migraines. 

What experts believe is that it may not be the caffeine itself that triggers migraines, but rather the caffeine withdrawal. However, not all coffee drinkers will get withdrawal symptoms. So if you are a regular coffee drinker who also gets migraines, make sure you are consistent with when you drink your daily cup. And if you are looking to cut back on your caffeine consumption, try to do it gradually over the course of a week. 

The bottom line

Migraines can be a pain to live with, but the good news is that there are many healthy tweaks you can make to your life to prevent them from troubling you:

  • Eat regular meals.
  • Exercise regularly.
  • Stay hydrated.
  • If you drink coffee, be consistent. 
  • Avoid alcohol and processed meats.
  • Avoid other known triggers (such as exposure to bright lights or noises).
  • Take steps to manage stress levels.
  • Aim to get enough good quality sleep each night, ideally between 7 to 9 hours for most adults.

Diet alone may not be the only solution, but it can certainly play a pivotal role. By first taking steps to identify the food triggers that might be unique to you, and then avoiding or reducing them in your diet, you may be pleased to find significant relief. 

And with your diet, like with the rest of your life — consistency and regularity is key!

How Your Diet Can Trigger Migraines

Dietary migraine triggers are very common. Some people notice migraines within a few minutes or up to several hours after consuming certain foods or drinks. While you may not have migraines in response to every single one of the known dietary migraine triggers, it is a good idea to become familiar with the most common migraine-inducing foods and to be on the lookout for migraine symptoms after eating them.

Illustration by JR Bee, Verywell

Components of Foods That Trigger Migraines

There are several natural components and additives that have been linked with migraines, and the different foods that have been noted to cause these headaches may have one or more of these ingredients. That said, the exact migraine-inducing components of some trigger foods are not known.

Dietary triggers induce migraines through several different mechanisms, such as altering the release of serotonin, causing constriction (narrowing) or dilation (widening) of blood vessels, or by directly stimulating neuronal pathways in the brain.


There are a number of possible mechanisms that may explain the link between alcohol and migraines, including alcohol’s effect on the blood vessels in the brain, inflammation, and neurotransmitter interaction. Alcohol is among the most commonly reported migraine triggers.


Caffeine is a potent vasoconstrictor (something that narrows blood vessels) and it interacts with neurotransmitters that modulate pain. Often, it is caffeine withdrawal that causes migraines, but some people are very sensitive to caffeine and can experience migraines as a result of the caffeine itself.


A preservative that destroys bacteria, nitrates are used to make processed meats last longer; they add a pink color as well. They can produce vasodilation (widening of the blood vessels) and may also directly stimulate the brain’s neuronal pathways, inducing pain.


A substance that is naturally present in many foods, tyramine can alter the neurotransmitters in the brain, including serotonin, which modulates pain and mood. Keep in mind that if you take an antidepressant in the monamine oxidase inhibitor class, you need to avoid tyramine in your diet.


A natural chemical found in some foods that can alter neurotransmitter function in the brain, phenylethylamine has been recognized as a migraine trigger.


A natural component of several foods, histamine can cause a migraine by triggering inflammation.

Monosodium Glutamate (MSG)

Sometimes added as a flavor enhancer in Chinese food, MSG is also found in commercial soups, soy sauce, salad dressings, frozen dinners, soup mixes, croutons, stuffing, and snack chips.

On food labels, MSG may be called by other names such as sodium caseinate, hydrolyzed proteins, or autolyzed yeast. MSG may induce vasodilation or directly stimulate nerve receptors, both of which can trigger a migraine.


An additive component of artificial sweeteners, aspartame may interact with serotonin.


Some reports suggest that yeast in baked goods may contribute to migraines, although the mechanism is unclear and the link is not as consistent as the other dietary migraine triggers.

Migraine-Inducing Foods

Foods that contain MSG or aspartame generally have these additives on the label. You would generally know if you are drinking something that contains alcohol, too. But some migraine-inducing foods aren’t as obvious because their ingredients may be harder to determine.

Some common migraine-inducing components are present in foods that are typically not packaged and don’t usually come with a nutritional label.

Caffeine is present in coffee, as well as other food and drinks, including:

  • Tea
  • Soft drinks
  • Hot cocoa
  • Chocolate
  • Chocolate containing snacks and desserts

Nitrates are found in some types of meats, including:

  • Hot dogs
  • Cold cuts
  • Artificial meat substitutes (often as a color additive)

Tyramine is found in higher concentrations in foods that have been fermented, such as:

  • Aged or blue cheese
  • Yogurt
  • Smoked, cured, or pickled meat or fish
  • Red wine or beer
  • Soy sauce, miso, tempeh

Foods containing phenylethylamine include:

  • Cheesecake
  • Yellow cheeses
  • Chocolate
  • Citrus fruit
  • Cocoa
  • Berry pie filling or canned berries
  • Red wine

Foods containing histamine include:

  • Banana
  • Beef, pork
  • Beer
  • Cheese, especially yellow ripened
  • Chicken liver
  • Eggplant
  • Fish, shellfish
  • Processed meat, such as salami
  • Sauerkraut
  • Tempeh, tofu, miso, tamari
  • Spinach
  • Strawberry
  • Tomato, tomato sauce, tomato paste
  • Wine
  • Yeast and foods containing yeast
  • Pineapple
  • Citrus fruit
  • Chocolate

A Migraine-Prevention Diet

Simultaneously eliminating all possible trigger foods is not a good idea because of the sheer number of potential triggers. Most people would find that type of diet too restrictive and difficult to adhere to. It would also be unnecessary because most people don’t have migraines in response to all of the food triggers.

Instead, keeping a headache and diet diary can help you keep track of when your symptoms begin and which foods you may have eaten before your migraines started. If you can identify trends that way, selectively avoiding the offending foods may help.

Keep in mind that skipping eating can be a migraine trigger, so eating regular, well-balanced meals is a key component of migraine prevention.

A Word From Verywell

If you think foods may be worsening your migraine symptoms or are considering trying a migraine diet, make sure to talk with your doctor. Delaying standard diagnosis and medical care can have serious consequences.

10 Foods That Can Trigger Headaches

There is nothing more annoying than a pounding or throbbing headache. Although common, headaches can disrupt your sleep or productivity.  

According to the World Health Organization, “almost half of the adult population have experienced a headache at least once within the last year.”

If you are suffering from frequent headaches but are unsure what’s causing them, it may be the foods you are eating. Certain foods trigger headaches due to the chemicals and ingredients in the foods such as tyramine and histamine. Foods that give you headaches range from chocolate and alcohol to citrus fruits and aged cheese.

 Not all headaches are triggered by foods but if your headaches are, it is important to know your triggers and how to avoid them. 

Here are 10 foods that can trigger headaches according to the National Headache Foundation: 

 10 Foods That Trigger Headaches 

1. Excess Caffeine 

Some of the most common reasons people experience headaches are drinking excess caffeine and caffeine withdrawals. Although a healthy amount of caffeine can treat oncoming migraines, too much caffeine can trigger a headache according to the American Migraine Foundation.  

2. Alcohol 

Studies show that two chemicals, tyramine, and histamine, which are found in alcohol, especially red wine, trigger headaches and migraines. According to the American Migraine Foundation, about 1/3 of migraine sufferers reported alcohol to be a trigger for their occasional migraines.  

3. Milk chocolate 

The second most common trigger after alcohol is chocolate according to the American Migraine Foundation. Chocolate contains both caffeine and phenylethylamine which are both known to be headache and migraine triggers. 

4. Citrus fruits 

Although not a common trigger, citrus fruits have been known to trigger headaches occasionally. Fruits such as oranges, grapefruits, lemons, and limes could be responsible for triggering your headaches therefore you may want to limit the number of citrus fruits that you consume. 

5. Artificial sweeteners 

Found in many calorie-free drinks, artificial sweeteners have shown to increase your risk of migraines. Aspartame which is one of the most popular artificial sweeteners is 200 times sweeter than natural sugar and is a common trigger for migraines. 

6. Yeast 

Foods that contain yeast such as donuts, cakes, and certain bread contain high amounts of tyramine, a natural compound found in foods. Tyramine-rich foods are known to significantly trigger headaches and migraines. 

7. Cured meats 

Bacon, pepperoni, and deli meats are all cured meats. Cured meats contain preservatives called nitrites which release nitric oxide into your blood and dilate blood vessels in your brain. The nitric oxide that is released into your blood has been shown to cause and trigger headaches. 

8. Nuts and certain seeds 

There are high levels of tyramine in almonds, peanuts, and other nuts and seeds which contribute to headaches. These salty snacks are also known for dehydration which is one of the most common reasons people experience headaches. 

9. Aged cheese

Blue cheese, cheddar, feta, and mozzarella are all considered to be aged cheeses. Foods that are aged cause the proteins in the food to break down and create tyramine, which is a headache trigger. Therefore, the longer the cheese has been aged, the more tyramine it contains. 

10. Pickled and fermented foods 

Pickled foods such as pickles, kimchi, kombucha, or pickled okra all contain high levels of tyramine. Like aged cheese, pickled and fermented foods have also been aged therefore containing high amounts of tyramine which triggers headaches. 

Tip: If you find that you are suffering from frequent or chronic headaches, try tracking your headache or migraine with a journal to learn and have a better understanding of what is causing or triggering your headaches. Generally, migraines will start within 12-24 hours after consumption of the trigger food so try to narrow it down from the food that you ate the day before. 

An important reminder: Trusted Medical does not promote “fear-based nutrition,” i.e. these foods could also have health benefits that may outweigh the risk of a headache. Therefore, if you feel that your diet may be the cause of your headaches, we always recommend you consult a Registered Dietitian and/or a physician before making any changes in your diet.

How Can Trusted ER Help You?

Being aware of the foods you eat and their ingredients can help you better understand how to treat your headaches. 

If your headache or migraine is more severe than an OTC medication like Tylenol or Ibuprofen can manage, be sure to seek emergency care at one of our Trusted ER locations near you. At Trusted Medical, we are here for you and ready to treat any illness or injury. 

We have 8 locations where we provide the best-in-class healthcare to patients in the most comfortable environment with exceptional care. Our ER offers limited wait times, as each of our patients is roomed and seen by our clinical team within a few minutes, and we are open 24 hours a day, 7 days a week. 

Trusted ER is “Doing the right thing. Every patient. Every time.” 

What Foods and Drinks Help Headaches – SAPNA Pain Management Blog

Table of Contents

  1. Understanding Headaches
  2. Managing a Headache with Good Food Choices
  3. Be Careful About Drinks, Too!
  4. Food and Drink Additives
  5. What Foods are Good for Headache Relief?
  6. Eliminating the Food and Drink Culprits

According to the International Classification of Headache Disorders, there are up to 150 different types of headaches. Most headaches fall within one of four main categories: migraine, hypertension, stress and cluster headaches. Certain foods and drinks can trigger various types of headaches, or they can help ease headache pain. Learning the best foods and drinks to consume can potentially reduce the frequency and endurance of headaches.

Understanding Headaches

People experience different types of headaches, and headache causes and symptoms will vary from person to person. Headaches are primary (not caused by something else) or secondary (a symptom of an injury, medications, disease, sinusitis, caffeine withdrawal, etc.).

In the case of a primary or secondary headache, food and drinks can influence whether the headache occurs and/or headache severity and the length of time the headaches last. Most headaches do not last a long time and are manageable, like stress headaches or headaches due to overexertion or lack of sleep. Other ones, like migraines, can be debilitating for days or weeks.

Medical research has found that certain food and drinks are headache triggers. The tricky thing is knowing which specific ones are triggers for the individual. Bananas and corn may be triggers for one person, but dairy products and tomatoes are triggers for someone else.

Managing a Headache with Good Food Choices

The Cleveland Clinic notes that most information about food that triggers headaches was gathered from people self-reporting their experiences. There have been research studies conducted in the past, and many ongoing right now. The challenge for researchers is that each case is different. The first step is avoiding foods that are known to trigger headaches. Should a headache develop, there are foods that may spur a faster recovery period.

Knowing what to eat when your head hurts can help you make good choices. The most common foods and drinks that have been reported to help headaches include:

  • Leafy greens
  • Fresh fruits, especially brightly colored ones high in antioxidants
  • Low sodium foods
  • Almonds
  • A small cup of coffee for a caffeine headache

Avoid consuming processed foods, aged cheeses, smoked or dried fish, cultured dairy products, high sodium foods like potato chips and foods high in carbohydrates and sugar. Sometimes, headache relief comes from knowing what not to eat.

Be Careful About Drinks, Too!

There are some drinks that have been linked to headaches.

Milk has casein (the group of phosphoproteins) which makes up 78.7 percent of all milk protein. Casein can trigger milk migraine and other types of headaches in some people. Milk, drinks made with milk and buttermilk are reported to cause headaches. Just to show how complex headaches can be, some people drink whole milk to relieve headaches, including migraines, because the electrolytes and protein are beneficial.

Mixed drinks, beer, wine and champagne have alcohol in them. Alcohol impacts brain chemicals and blood vessels in a way that may cause a pounding headache. Drinking alcohol and not drinking adequate water multiplies the effects.

Red and white wines have alcohol, tannins and sugar, creating a perfect mix for triggering headaches. Like other alcoholic drinks, champagne can also cause dehydration by suppressing the hormones that balance the body’s hydration, but the carbonation can make headaches even more painful. Carbon dioxide in carbonation competes with the oxygen in the bloodstream, causing a host of symptoms that include dizziness, nausea and headaches.

Caffeine is in more drinks than many people realize. It is commonly known to be in coffee, tea and some soft drinks. However, it is also in chocolate, so hot cocoa is a potential headache trigger. If prone to migraines, a cup of hot chocolate made with milk should be avoided. Not generally known is that caffeine is also found in foods, like ice cream and breakfast cereals. Drink several cups of coffee while eating cereal for breakfast, and the caffeine dose is significant.

Water is good for headaches! Drink plenty of water to prevent dehydration, one of the top causes of headaches. In fact, drinking water is sometimes all it takes to relieve a headache.

Food and Drink Additives

Food and drinks today have many additives. There are flavorings to enhance the flavor of foods and preservatives (like nitrites) to extend shelf life and sugar substitutes to replace real sugar. The various chemicals, including artificial sweeteners like aspartame, can produce headaches.

Though monosodium glutamate (MSG) is not used as much as it once was, it is still found in products like soy sauce, packaged foods and meat tenderizers. Other additives triggering headaches include substances like phenylalanine and nitrites.

What Foods are Good for Headache Relief?

People ask how to cure migraines permanently. Unfortunately, and essentially because medical researchers have not yet pinpointed the specific cause of migraine headaches, there is no permanent cure. However, they have identified specific nutritional vitamins, minerals, and other elements that can bring headache relief from migraines and other types of headaches.

Though instant migraine relief is difficult to achieve, some foods can work rapidly, like ginger and nuts. Following are some foods that fight migraines, tension headaches, cluster headaches, caffeine headaches, and headaches in general.

1. Leafy greens 

Leafy greens contain a variety of elements that contribute to headache relief. For example, research has shown taking magnesium can reduce migraine pain because many migraine sufferers have low magnesium levels (PMID: 9523054).

The Journal of Headache and Pain reported a study that found a combination of folic acid, B6, and B12 reduced migraine symptoms. The National Headache Foundation reported on a European study that found vitamin B2 could reduce migraine frequency.

Following are some of the leafy greens that contain all of these elements and a variety of other anti-inflammatory antioxidants.

  • Kale
  • Spinach
  • Collard greens
  • Turnip greens
  • Broccoli

2. Nuts 

Nuts are rich in magnesium, which soothes headache pain by relaxing blood vessels. They also contain a significant amount of vitamin E that research has shown can help control migraines with aura and migraines triggered by hormonal fluctuations. (PMCID: PMC4359851) For some people experiencing a headache, immediate relief is found by eating a handful of almonds or other nuts.

  • Almonds
  • Walnuts
  • Cashew nuts
  • Brazil nuts

3. Fatty fish

Fatty fish is rich in omega-3 fatty acids EPA and DHA, which are anti-inflammatory foods. They contain B vitamins, including riboflavin (B2), which has been shown to help manage migraine attacks. Research also found that salmon contains coenzyme Q10 and vitamin D, which combined provided migraine relief. (PMID: 28854909)

4. Fruits

Some fruits are rich in magnesium and potassium. Research is continuing, but some studies suggest potassium may help alleviate migraine pain by contributing to healthier nerve functioning. Bananas are good for headaches because they deliver a dose of potassium, magnesium, B vitamins, and complex carbohydrates, all of which contribute to reducing headache pain. If a headache is due to dehydration, the fruits containing high water content can combat headache pain.

  • Apricots
  • Avocados
  • Bananas
  • Figs
  • Raspberries
  • Melon
  • Cantaloupe
  • Watermelon
  • Honeydew

5. Seeds

The following list of seeds contains omega-3 fatty acids which fight inflammation. They also contain significant amounts of magnesium, which may help prevent blood vessel spasms. Medical research continues to explore blood vessel spasms due to constricted blood vessels as a possible migraine trigger.

  • Poppy seeds
  • Sesame seeds
  • Pumpkin seeds
  • Sunflower seeds (without natural flavors)
  • Chia seeds

6. Whole grains

Whole grains contain complex carbohydrates, and they work to increase glycogen stores in the brain. They help relieve headache pain because low blood sugar (hypoglycemia) can trigger headaches. One study found a correlation between iron deficiency anemia and migraines in women. (PMID: 31649807) Whole grains provide a wealth of nutrients that include vitamin E, B vitamins, iron, coenzyme Q10, magnesium, and fiber.

  • Quinoa
  • Barley
  • Buckwheat
  • Bulgur
  • Whole oats
  • Whole grain bread

7. Legumes

Legumes contain protein and fiber that help maintain blood sugar levels and magnesium and potassium to relieve blood vessel constrictions. Legumes also supply coenzyme Q10, which may, per a study, reduce the number of days a migraine lasts. All of these nutrients can help relieve headache pain.

  • Lentils
  • Beans
  • Peas
  • Soybeans
  • Chickpeas

8. Hot peppers

Hot peppers contain capsaicin, which numbs the brain’s trigeminal nerve and inhibits the neurotransmitter responsible for causing migraine pain. They may also relieve cluster, tension, and other headaches. Besides, eating hot peppers can help open up clogged sinuses, causing a sinus headache. Hot peppers also contain vitamins C, A, B, and E.

  • Jalapenos
  • Habaneros
  • Cayenne
  • Anaheim

9. Small amount of coffee or tea

One or two cups of coffee or tea each day may provide headache relief, especially if it is a headache triggered by a lack of caffeine. Caffeine can decrease the size of blood vessels, enabling better blood flow. The key is to find a balance and not consume too much caffeine. Too much caffeine can trigger a headache.

10. Ginger

Ginger contains a natural oil with chemical compounds important to helping headache sufferers find relief. It increases the chemical messenger serotonin, and that reduces inflammation. A medical research study on ginger powder found it significantly decreased headache severity in patients with acute migraines without aura. (PMID: 23657930)

  • Ginger spice
  • Ginger powder
  • Ginger tea
  • Ginger supplement

11. Chocolate

Dark chocolate that is at least 70 percent cacao contains a high amount of magnesium and riboflavin. Both nutrients help manage migraines by assisting with the relaxation of blood vessels.

A medical study also found that people who intake a higher amount of tryptophan (a serotonin precursor) daily reduced their odds of developing a migraine by 54-60 percent. Chocolate contains tryptophan and serotonin. (PMID: 32110888)

Is there food to cure migraine headaches? The general recommendation by the Physicians Committee for Responsible Medicine is to eat foods that are generally known to not contribute to headaches in most people. A simple diet during the headache period can often bring relief.

  • Brown rice
  • Well-cooked green, orange and yellow vegetables, i.e. squash, carrots, spinach, etc.
  • Dried or cooked non-citrus fruits, like cherries and cranberries

Eliminating the Food and Drink Culprits

Since each person is different as to which foods and drinks cause and relieve headaches, it takes giving the special diet attention to determine what triggers headaches and what helps headache pain. It may be possible to link certain foods to your headaches, so you can eliminate them from the diet, or to link them to headache relief and add them to the diet.

Developing a healthy lifestyle is also crucial to headache management. You should not rely only on medications for relief. Many headaches are caused by stress and tension, so address the stress factors in your life. Eat a healthy, well-balanced diet. Limit alcohol intake. Do not skip meals. Drink lots of water every day. Get regular good sleep. Exercise regularly. These are behaviors that anyone can control and will go a long way towards preventing headaches and/or minimizing headache pain.


  1. https://www.healthline.com/health/magnesium-for-migraines
  2. https://pubmed.ncbi.nlm.nih.gov/23657930/
  3. https://pubmed.ncbi.nlm.nih.gov/9523054/
  4. https://pubmed.ncbi.nlm.nih.gov/28854909/
  5. https://pubmed.ncbi.nlm.nih.gov/31649807/
  6. https://pubmed.ncbi.nlm.nih.gov/32110888/

10+ Foods That Might Help Migraines

If you’re someone who suffers from migraines, you’re probably willing to do just about anything to make them go away. A migraine isn’t just a headache you can deal with while waiting for painkillers to kick in. The American Migraine Foundation calls migraines a disabling neurological disease, and notes the pain can be “unbearable.” The tricky thing about migraines is that often there is no one specific cause, meaning it can be difficult to actually prevent them.

What you can (and should!) do is focus on figuring out how to treat them when they do occur, and that’s where food comes in. While there is certainly no promise that eating particular foods will magically make a migraine disappear, there is some evidence that some foods can help prevent—and maybe even lessen the severity of—a migraine. Now, you definitely shouldn’t toss your migraine medication to focus on eating the following foods. When figuring out how to treat a migraine, you should always talk to your doctor to figure out what works for you. But trying to incorporate some of these foods into your diet just might help.

It’s also important to remember that while these foods might help some people, they won’t help everyone (remember when we said migraines are tricky? We weren’t kidding). Still, it’s worth trying these foods, and honestly? It doesn’t help that they’re delicious.

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Leafy Greens

Leafy greens like spinach, kale, and Swiss chard, are loaded with both magnesium and the B vitamin folate, both of which might affect headaches. Research on women from 2015 found that a diet low in folate might increase the frequency of migraines compared to women with adequate levels of folate in their diet.

In 2013, the Association of Migraine Disorders stated that several studies have shown that many people with migraines have low brain magnesium levels. Leafy greens are rich in magnesium, so eating more of them may help.


Research from 2020 has shown that omega-3 fatty acids, a natural anti-inflammatory, can be beneficial and can be used as a treatment for migraine symptoms, which seems to back up a much older study from 2002 that had similar findings. A 2017 review of clinical studies of omega-3 fatty acids in people with migraines found that they can significantly reduce the duration of attacks. So, there’s plenty of evidence! Salmon is a great source of omega-3 fatty acids and there are so many ways to incorporate it into your diet.


Mushrooms are a great source of riboflavin, a B vitamin that may be effective in treating migraines. A 2004 study gave patients 400 mg riboflavin capsules each day and then recorded their headache frequency, duration, and intensity. They found that the frequency of headaches was significantly reduced, although the intensity and duration did not change. In 2012, the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society found that riboflavin is “probably effective” in preventing headaches.

And it’s not just regular old mushrooms: In November 2020, scientists began to investigate the effect of psilocybin on migraines. (Psilocybin is the substance that is primarily responsible for the psychedelic effects of “magic” mushrooms.) They found that psilocybin can provide long-lasting benefits for those suffering from migraines.

Sweet Potatoes

Sweet potatoes are high in anti-inflammatory nutrients like beta-carotene, as well as vitamin C, copper, manganese, niacin, potassium, vitamin B2, and vitamin B6. Inflammation has been linked to migraines, so it’s never a bad idea to eat anti-inflammatory foods.


Bananas are a great source of both magnesium, which, again, can be an important nutrient in combatting migraines. The American Migraine Foundation has stated that magnesium’s calming effects can be helpful when preventing and treating a migraine.


Using coffee as a migraine treatment isn’t as simple as it sounds. Too much coffee may trigger migraines and make them worse, but research has found that small amounts of caffeine might help. A 2014 systematic review of studies found that having about 100 mg of caffeine each day along with pain medication can provide more relief than just medication alone. So, a small cup of coffee a day could definitely make a difference—just don’t overdo it.


Beets contain a lot of manganese, potassium, and vitamin C, and they also happen to be an excellent source of folic acid. A 2016 study published in The Journal of Headache and Pain found that migraine patients who were given 2 mg of folic acid along with vitamins B12 and B6 were more successful in reducing their migraine symptoms than patients who received just 1 mg of folic acid along with vitamins B12 and B6.

Dark Chocolate

Again, magnesium is probably one of the most important nutrients that can potentially fight migraine symptoms, so any food that’s high in magnesium might be helpful. Dark chocolate happens to be rich in magnesium, and that can contribute to relaxation and decreased stress.


Broccoli and other cruciferous vegetables might be particularly helpful for premenopausal women dealing with migraines. A 2012 study, which defines menopausal migraines as a subtype of migraine that occurs within two days before or three days after the onset of menses, found some evidence that the phytoestrogens in these veggies might help prevent menstrual migraine attacks during PMS.


If fish isn’t your thing, then a plant-based source of omega-3 fatty acids is avocado. A 2015 study published in The Journal of Head and Face Pain found that the antioxidants in healthy fats like this can help fight oxidative stress and migraines. Avocados also contain vitamin D, and a 2015 study found that vitamin D can prevent oxidative stress, which can lead to migraines.

Vegan Diet

If you experience bad migraines and you’re willing to do just about anything to get rid of them, then it may be time to give up cheese and try a vegan diet. A 2014 study published in The Journal of Headache and Pain found that a plant-based diet followed by an elimination diet might reduce migraine pain. The study was small, and only looked at 42 adult migraine sufferers, half of whom followed a vegan diet for four weeks, then an elimination diet. They concluded that while the vegan diet seemed to help, more research was necessary.


OK, so it’s not a food, but water is such an essential part of helping migraines that it felt foolish not to bring it up. Dehydration is one of the leading causes of headaches. A 2020 study looked at 256 female migraine sufferers and found that the duration, pain severity, and frequency of migraines was significantly lower in those who consumed more water. Drink up!

Jessica Booth
Jessica is a freelance writer from New York who loves kale salads and hanging out with her cats.

This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses. You may be able to find more information about this and similar content at piano.io

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Migraine provocateurs

People with migraines often report that their attacks are caused by some kind of provoking factor (trigger).

A study involving 200 people with migraines showed that 90% of them know at least one provocateur of their own migraines. The most frequently cited were physical or emotional stress (77%), menstruation (72% of women), bright lights or flashes of light (65%) and harsh odors (61%) [1].

How do migraine triggers work?

According to modern concepts, the cause of migraine is the increased excitability of nerve cells (neurons).This is a hereditary feature of the brain. Neurons in people suffering from migraines are very sensitive to various external and internal influences. May be affected by:

  • Changes in hormone levels during the menstrual cycle,
  • stress
  • and, paradoxically, the resolution of stress,
  • sleep disturbance (both insufficient and excessive sleep),
  • alcohol,
  • bright light or flash light.

In response to the trigger, the electrical activity in easily excitable nerve cells changes and a cascade of biochemical disorders is triggered that cause symptoms of a migraine attack [2].

What is important to know about migraine provocateurs (triggers)

  1. Sometimes “your” attack provocateur can cause it, sometimes not.
  2. A migraine attack requires a combination of two or more triggers.
  3. What is a trigger can also relieve a migraine attack (eg, caffeine).
  4. “Classic” migraine triggers: red wine, dark chocolate, stress – not all migraine sufferers have an attack.
  1. A word about caffeine

Having heard from a doctor or acquaintances that caffeine can provoke an attack, many people with migraines completely refuse tea and coffee and look for a pill in horror after accidentally drinking a caffeine-containing drink.

Indeed, caffeine can cause migraine attacks in some. But he can also take it off!

It works like this. During a migraine attack, the work of the gastrointestinal tract slows down. Taken tablets remain in the stomach, but must be absorbed in the intestines. Caffeine increases gastrointestinal motility and helps pain relievers be absorbed.

And caffeine also has a direct anti-migraine effect – therefore, it is included in various combined painkillers.But it is important to remember that such medications should not be overused, as excessive caffeine intake can make migraine attacks more frequent and worse [5].

Should I stop eating certain foods?

There is no scientific evidence that would confirm or deny the effectiveness of “anti-migraine” diets. People with migraines tend to notice which foods are causing their attacks and learn to avoid them. Foods that can trigger a migraine attack include red wine, beer, dark chocolate, hard cheeses, citrus fruits, nuts, foods containing preservatives, and fast food.

Hunger can also trigger migraines. Therefore, it is important to eat regularly and in a balanced way (eg following a Mediterranean diet). And it will be much more effective in preventing seizures than complex diets [4, 5].


  1. Andress-Rothrock D., King W., Rothrock J. An analysis of migraine triggers in a clinic-based population. // Headache. – 2010. – v.50. – 1366-1370.
  2. Chakravarty A. “How triggers trigger acute migraine attacks: a hypothesis.” // Med Hypotheses. -2010. – v.74. – p. 750-753
  3. Dodick D.W. Migraine triggers. // Headache. – 2009. – v.49. – p. 958-961
  4. Martin P.R. “Behavioral management of migraine headache triggers: learning to cope with triggers.” // Curr Pain Headache Rep. – 2010. – v.14. p. 221-227.
  5. Rothrock J.F. “The truth about triggers.” // Headache. – 2008. – v.48. – p. 499-500

Photo by alexey-turenkov_unsplash

90,000 10 headache-causing foods

Headache can be provoked by various, sometimes unexpected, reasons or triggers. Their identification is often very difficult. These include environmental factors, concomitant diseases, fatigue, stress. Food is also one of those triggers.

Food triggers in combination with other causes of migraine are among the most significant, according to the Migraine Research Foundation.

“Up to 10% of the population is sensitive to food triggers that can cause migraines.However, it is very difficult to identify the food that provokes it, ”says Belinda Savage-Edvards, headache specialist.

Since every person is different, it is impossible to give absolute and clear recommendations on what food to avoid. What works negatively on one will not necessarily act in the same way on another. However, there are some foods and ingredients that are relatively common in headaches and migraines.

1. Drinks containing caffeine – tea, coffee, cola. Scientists have conducted studies in which people suffering from headaches gradually stopped consuming caffeinated foods. In one study, focusing on children and adolescents, 92% of participants (33 people) had headaches after stopping caffeine. In another study, quitting it worked better than medication for many adults.

2. Aged cheeses – blue cheese, brie, cheddar, English stilton, feta, gorgonzola, mozzarella, muenster, parmesan, Swiss.The point is a substance called tyramine, which is formed during the breakdown of proteins in the processes of aging and decay. The longer the cheese is aged, the higher the tyramine content.

3. Alcohol – one of the main provoking factors of migraine. Red wine, beer, whiskey, and champagne are triggers for about 25% of people with regular migraines. The tyramine and tannins found in drinks play a role, as well as dehydration after drinking.

4. Chocolate is a trigger affecting approximately 22% of people who experience migraines. In addition to the already mentioned caffeine, it contains beta-phenylethylamine, which dilates the blood vessels in the brain.

5. Artificial sweeteners. They are found in many processed foods and are also used as a sugar alternative for people with diabetes. In particular, the most popular trigger is aspartame, according to the Mayo Clinic.

6. Products containing monosodium glutamate – frozen and canned food, snacks, salad dressings, sauces. The researchers note that glutamate can provoke migraine attacks in 10-15% of those who suffer from it. Instead of MSG, foods may contain potassium glutamate, autolyzed yeast, hydrolyzed protein, and sodium caseinate. All of these ingredients are also triggers.

7. Processed meat – deli meats, ham, sausages, sausages.In addition to the already mentioned monosodium glutamate, they contain nitric oxide, thanks to which the color and taste of the food is preserved. When nitric oxide enters the bloodstream, blood vessels in the brain dilate, triggering headaches or migraines.

8. Pickled and fermented foods – olives, sauerkraut, kombucha. They also contain high amounts of tyramine.

9. Frozen food – ice cream, smoothies, ice-cold milk. Eating or drinking them quickly after physical activity or when overheated can cause severe stabbing headaches.

10. Salty food , increasing blood pressure, causes headaches and migraines. Salty processed foods that additionally contain the aforementioned preservatives are especially dangerous.

At the same time, there are also paradoxical studies that the increased amount of salt in the diet is associated with fewer attacks of severe headaches and migraines.

Nutritionists do not recommend giving up these products right away. It is necessary to remove one of them for about 2 months, and then reintroduce it into your diet.If a headache occurs within the next 24 hours, and there are no other aggravating factors (menstruation, lack of sleep, hunger or thirst), the culprit may have been found.

Eye migraine – what is it? Causes, symptoms, treatment. Is it dangerous?

Ocular migraine is a rare disease characterized by temporary visual impairment or even temporary blindness of one eye. Eye migraines are caused by decreased blood flow or spasms of blood vessels in the retina or behind the eye….

In ocular migraine, vision in the affected eye is usually restored within an hour. Ocular migraines may be painless or may occur at the same time as (or after) a migraine headache.

Unfortunately, the term ocular migraine is often used to describe a much more common (and harmless) condition – called visual migraine or migraine aura – characterized by temporary
visual impairments that usually go away within 30 minutes.

Unlike ocular migraines, visual migraines usually affect both eyes.

Consider ocular and visual migraines in more detail.

Symptoms of ocular and visual migraine

Symptoms of ocular migraine usually include a small blind spot that affects central vision in one eye. This blind spot is enlarged, making it impossible for the affected eye to drive or read safely.

In some cases, the entire field of view of one eye may be affected.The attack usually lasts less than an hour.

Symptoms of a visual migraine can be different and may include:

Visual migraines often appear suddenly and can make you feel like you are looking out of a cracked window. The visual migraine aura usually moves across the visual field and disappears within 30 minutes.

  1. Flickering blind spot in or near the center of the field of view

  2. Wavy or zigzag colored ring surrounding the central blind spot

  3. Blind spot that slowly moves across the field of view

Symptoms of vision usually affects both eyes and lasts no more than 30 minutes.The headache may not occur or may occur soon after the symptoms of the visual migraine have subsided.

If you have a blind spot or other visual impairment and you are not sure if it is an ocular migraine or a visual migraine, cover one eye. If the visual impairment is present in only one eye, it is most likely an ocular migraine. If vision is impaired in both eyes, it may be a visual migraine.

But don’t risk it. If a blind spot appears in your field of vision, consult an eye doctor immediately to determine if the condition is harmless or possibly indicates something more serious, such as retinal detachment.

What causes ocular and visual migraines?

Ocular migraines are thought to have the same causes as migraine headaches.

Migraine headaches have a genetic basis, and some studies have shown that up to 70 percent of people with this disorder have a family history of migraine.

According to the World Health Organization, migraine headaches appear to be triggered by activation of a mechanism in the deep parts of the brain that releases inflammation-causing substances around the nerves and blood vessels of the head.

Imaging studies have shown changes in cerebral blood flow during ocular migraines and migraine aura. But the reasons why this happens and what leads to the spontaneous appearance of ocular and visual migraines remain unknown.

Common migraine “pathogens” that can trigger a migraine attack in a person (including ocular and visual migraines) include certain foods such as aged cheeses, caffeinated beverages, red wine, smoked meats, and chocolate.

Food additives such as monosodium glutamate (MSG) and artificial sweeteners can also trigger migraines in some people.

Other potential migraine agents include cigarette smoke, perfumes and other sources of strong odor, bright or flickering lights, lack of sleep, and nervous tension.

Treatment and prevention

As already noted, visual impairments caused by ocular and visual migraines usually go away without treatment within an hour or less.

If you are driving or performing other tasks that require good vision, if you have an ocular or visual migraine, stop, relax and wait for your vision to recover. (If you are driving, pull over to the side of the road and wait for all visual impairments to clear.)

If you experience visual impairment that accompanies a migraine headache, see your family doctor or neurologist for an assessment of your migraine attacks.

Your doctor can advise you on the latest medicines for migraine headaches, including medicines designed to prevent future attacks.

It is also helpful to keep a food and activity diary just before an ocular migraine or migraine aura attack to see if you can identify possible pathogens that you can avoid in the future.

If ocular migraines or migraine aura (visual migraines) seem to be related to stress, you may be able to reduce the frequency of migraine attacks without medication by following these simple rules:

  • Eat healthy food regularly

  • Avoid common factors. provoking migraines

  • Get enough sleep

  • Try stress-relieving methods such as yoga and massage

Page published in November 2020

Page updated March 2021

Women’s migraine | Latysheva N.B.

Migraine is widespread in the female population. Its prevalence among women of all ages reaches 18%, while in men over 12 years old – only 6%. The peak prevalence of migraine occurs at the reproductive age of women (30 to 49 years), reaching 27%. Hormonal changes have a significant impact on the course of migraine in women at different periods of life. Menstruation, pregnancy, oral contraceptive use, menopause, and hormone replacement therapy alter the course of migraine and require appropriate adjustments in preventive therapy.

The dynamics of the prevalence of migraine in men and women in different age groups is shown in Figure 1. A clear understanding of the hormonal influences on the course of migraine is important for its treatment in women.

Migraine in childhood

The prevalence of migraine, as well as the features of its clinical picture and course in childhood and adolescence, differ from those in adults. Boys 4–7 years of age have a higher prevalence of migraine than girls, in whom it usually debuts at the onset of menarche.By the time they reach adolescence, the prevalence of migraine in girls is 3 times higher than in boys. In general, most women have migraine onset before the age of 19.

Compared to adults, migraine attacks in children are usually shorter (1–48 hours), headache (GB) reaches its peak intensity faster (usually within 1 hour) and can be bilateral. In young children, migraine equivalents are often observed, such as benign paroxysmal vertigo, paroxysmal torticolis, and cyclic vomiting.In addition, girls often have migraine attacks on weekdays during or after school.

In general, the treatment of migraine in children is more conservative than in adults. Prevention should be aimed primarily at changing lifestyle and controlling provocateurs. Stress and overwork are among the most common triggers of migraines in children and adolescents. In this age group, biofeedback and stress management techniques are highly effective.At the same time, about a third of girls with migraine require medication to control the frequency of attacks. In childhood, for the preventive treatment of migraines, it is possible to use topiramate (especially in girls who are overweight), magnesium preparations, amitriptyline and propranolol.

Menstrual migraine

The menstrual cycle is one of the most important triggers for migraine attacks. The relationship between migraine and menstruation is observed in 60% of women of reproductive age.Usually, this relationship is formed gradually in the second decade of life; in most women, the presence of a migraine attack during menstruation becomes evident by the age of 35.

A migraine attack can occur before or during menstruation. Menstrual migraine attacks, however, are usually more severe, more prolonged, and may be resistant to analgesics. In addition, menstrual attacks are often resistant to prophylactic treatment.

Menstrual migraine is presented in 2 forms: truly menstrual and menstrual-associated migraine (tab.one).

True menstrual migraine is a relatively rare condition that occurs in only 10-14% of women. Menstrual-associated migraine occurs in about 50% of women. Moreover, in addition to a migraine attack in the perimenstrual period, migraine attacks are observed on other days of the month. Menstrual attacks are often the most severe, with nausea, vomiting and significant disability, but other attacks are a particular problem for some women and can be very high.For the relief of non-menstrual seizures, a stratified approach is relevant, where the choice of drug is determined by the severity of the seizure. If the patient has severe seizures in which her work capacity is significantly impaired, triptans should be taken.

By definition, a menstrual migraine is always a migraine without an aura. However, such patients may also experience migraine attacks with an aura on other days of the cycle. This fact must be taken into account when choosing a preventive therapy.

The pathogenesis of menstrual migraine is based on increased sensitivity to normal fluctuations in estrogen levels throughout the menstrual cycle. Figure 2 shows the inverse correlation between the likelihood of a migraine attack and the concentration of estrogen degradation products in the urine.

Treating menstrual migraines is a significant challenge. In many patients, such an attack is not well enough relieved by analgesics, even triptans, the intensity of pain increases rapidly, vomiting is added, and the attack itself can last longer than usual (up to 3-4 days).During this time, the patient takes a large number of analgesics, which bring, at best, short-term relief. This is why a number of patients with menstrual migraines need prophylactic treatment, even if the number and severity of other migraine attacks is small. In some situations, preventive treatment is necessary even for patients with truly menstrual migraines. This means that the patient has to take daily medications for a long time to reduce the severity of the migraine attack, which occurs only 1 r./ month

Keeping a GB diary for at least 3 months is critical in this situation. This will allow not only to establish a relationship with menstruation, but also to assess the effectiveness and number of analgesics used, as well as the overall frequency of attacks.

In the case of insufficient effectiveness of pain relief, as well as a high frequency of attacks (if it is necessary to take analgesics more than 2 days a week), prophylactic treatment is indicated using non-drug and pharmacological approaches traditional for migraine.The purpose of such therapy is to reduce the frequency of migraine attacks, as well as their duration and intensity, which is especially important for a migraine attack during the menstrual period.

However, even if preventive therapy is effective, the severity of a menstrual episode of hypertension may remain significant. If it is the menstrual migraine attack that is a particular problem for the patient, there is a possibility of mini-prophylaxis. It makes sense in patients with a regular menstrual cycle and a documented relationship with menstruation in the diary.This will allow you to predict in advance the day of the onset of the attack.

For mini-prevention, hormonal and non-hormonal agents are currently used. To prevent a menstrual attack, some analgesics are taken throughout the perimenstrual period. For this purpose, naproxen (550 mg 2 times / day), acetylsalicylic acid (500 mg 2 times / day) or mefenamic acid (500 mg 3 times / day) can be used. You should start taking the drug 2-4 days before the menstrual migraine attack and before the 3rd day of menstruation.Since the effectiveness of such prevention is low, you can try various drugs to select the most suitable one. This method can be primarily recommended for patients in whom menstruation is accompanied by abdominal pain.

Triptans are significantly more effective in mini-prophylaxis, however, to prevent a menstrual episode of hypertension, it is necessary to take a significant amount of medication: sumatriptan (25 mg 3 r. / Day), naratriptan (1 mg 2 r./ day), zolmitriptan (2.5 mg 2 times / day). The drug is taken for 5-6 days, starting 2 days before the expected migraine attack.

Since the provocateur of a menstrual migraine attack is a normal drop in the level of estrogen in the second phase of the menstrual cycle, its stabilization throughout the cycle seems to be an effective method of preventing the disease. Hormonal prevention methods are aimed at preventing a decrease in estrogen levels in the luteal phase of the menstrual cycle and can be offered to patients with treatment-resistant menstrual migraine attacks and the absence of contraindications to the use of such methods.For more information on hormonal medications for migraine headaches, see the next section.

As a result of many years of research in the field of hormonal methods of mini-prevention of menstrual migraine attacks, it was concluded that the use of combined oral contraceptives (COC) according to a special scheme is preferable. The use of transdermal estrogen preparations during the perimenstrual period has been found to be less effective.

Currently, patients with severe attacks of menstrual migraine can be advised to take COCs using only active pills (taking without interruption for 7 days or skipping inactive pills).The drug is usually taken for 4 cycles (84 days), then a break is made for 7 days. Thus, it is possible to prevent 3 out of every 4 menstrual attacks. For this purpose, monophasic low-dose (preferably micro-dose) COCs are used.

Oral contraceptive use for migraines

Many migraine patients take COCs for contraception, endometriosis, dysmenorrhea, heavy menstrual bleeding, or acne.The most commonly used drugs contain a combination of ethinyl estradiol and a progestin. These drugs block ovulation and alter the natural dynamics of estrogen levels. For this reason, COCs can have different effects on the course of migraine.

In monophasic COCs, all active tablets contain the same amount of estrogen and gestagen. Low-dose COCs (containing less than 35 mcg of ethinyl estradiol) can be used in most women with migraines. Contraindications to the appointment of estrogens are the presence of migraine with aura, bleeding disorders, diabetes mellitus, arterial hypertension, and smoking.Thus, COCs can be prescribed to patients with migraine without aura, who do not have risk factors for ischemic stroke. This is due to the fact that in patients with migraine without aura, the risk of ischemic stroke and venous thrombosis does not exceed this risk in women without migraine. The risk of stroke in young women aged 25-29 is 2.7 per 10 thousand women. Taking COCs increases this risk to 4. At the same time, in case of migraine with aura, the risk of stroke in case of using COCs increases by 8 times. In patients with migraine with aura, in the case of a combination of smoking and taking COCs, the risk of stroke increases 34 times.In this regard, migraine with aura is a contraindication for taking COCs.

After the start of COC use, it is necessary to carefully monitor the frequency of migraine attacks during the first month of use. In cases of increased frequency of migraines, increased severity of attacks, or the appearance of symptoms of aura, COCs should be discontinued.

The use of COCs for the prevention of migraines cannot be recommended. However, as stated above, COCs can be used for mini-prevention of menstrual migraine attacks.For this purpose, it is preferable to use microdosed COCs with an ethinyl estradiol content of less than 30 μg.

Migraine during pregnancy and lactation

During pregnancy, 50–70% of women experience an improvement in the course of migraine without an aura. Migraine attacks become mild, extremely rare, and in many patients they stop completely. Improvement occurs after the end of the first trimester, starting from 12-14 weeks. pregnancy (Fig. 3). This is due to the fact that by the beginning of the second trimester, the level of estrogen stabilizes – it increases 6 times, and its fluctuations stop.Migraine headaches with aura during pregnancy stop less often – in about 40% of patients.

In patients with migraine, planning a pregnancy is important. By the time of pregnancy, it is necessary to ensure maximum control over the number of migraine attacks. For a number of patients, this requires preliminary preventive treatment in order to reduce migraine attacks, as well as withdrawal of analgesics. At the time of such treatment, it is necessary to convey to the patient the need to comply with contraceptive measures.If it is impossible to stop prophylactic therapy after reaching the optimal frequency of attacks, it is necessary to replace all the drugs used with drugs approved for use during pregnancy.

In preparation for pregnancy, it is necessary to train the patient in the methods of non-drug control of hypertension. This will minimize the need for pain relievers and medications for the prophylactic treatment of migraines during pregnancy.

Relief of migraine attacks during pregnancy

The selection of drug therapy for patients with migraine during pregnancy is a significant challenge.Ideally, drug use should be minimized, especially in early pregnancy, in order to minimize the risk to fetal development.

At the same time, the severity of migraine is especially high during the first trimester of pregnancy. During this period, the course of a migraine can become even more severe than before the moment of conception. Expanded intact migraine attacks are often accompanied by nausea, vomiting and lead to suffering and the development of dehydration, especially in patients with early preeclampsia.

During pregnancy, minimizing the amount of medication taken becomes a priority. A graded approach should be recommended, starting with non-drug techniques for mild and moderate seizures. It is recommended to take medications at the very beginning of an attack only in case of a rapid increase in the intensity of pain and disability.

Nausea is a common symptom during pregnancy, especially in the first trimester.During this period, the most severe course of migraine attacks is observed with the greatest probability of developing nausea and vomiting during an attack of hypertension. Dehydration, which can result from repeated vomiting in pregnant patients, in turn is a provocateur of migraine attacks.

To reduce the severity of nausea and prevent vomiting during a migraine attack, patients should avoid strong odors and drink more fluids, for example, juices diluted with water in a 1: 1 ratio.Feelings of nausea can also be reduced by eating easily digestible foods such as biscuits, applesauce, bananas, rice, pasta, and ginger. An effective remedy is vitamin B6 at a dose of 30 mg / day. In case of severe nausea, medications should be used. Preference is given to drugs with safety category B (metoclopramide, ondansetron).

Drinks containing caffeine (coffee, cola, sweet tea) can relieve GB. With mild hypertension, a short walk, swimming, soft music, a warm heating pad, neck stretching exercises, relaxation exercises, and breathing exercises are also effective.At the first symptoms of aura or at the beginning of GB it is recommended to try to fall asleep. In addition, relaxation and biofeedback (BFB) exercises at the very beginning of a migraine attack are effective in 75% of pregnant women.

The frequency of regular use of drugs for the relief of migraine attacks should not exceed 2 days a week in order to reduce the risk of developing drug-induced hypertension. The range of drugs that are used to relieve migraine attacks during pregnancy is significantly limited.Despite the fact that, in general, paracetamol is less effective in relieving an acute migraine attack than acetylsalicylic acid and nonsteroidal anti-inflammatory drugs (NSAIDs), its safety during pregnancy is higher.

Taking NSAIDs early in pregnancy is associated with an increased risk of abortion, perinatal mortality and intrauterine growth retardation. For these reasons, the use of NSAIDs should be limited to the second trimester. Acetylsalicylic acid in analgesic doses is also recommended for use only in the second trimester.

Caffeine is an important adjunct to analgesics and has the ability to enhance their analgesic effects. Among the combined analgesics during pregnancy, preference is given to drugs containing only paracetamol and caffeine. In addition, a caffeinated drink can be added to a simple analgesic (Table 2).

Triptans are the most effective analgesics for relieving migraine attacks. The safety of their use during pregnancy is assessed by the pregnancy registers.The largest amount of data collected is for sumatriptan. There is no evidence of an increased risk of congenital malformations with its use. At the same time, an insufficient amount of data has been accumulated for the formation of official recommendations.

Currently, the widespread use of triptans during pregnancy is not recommended, except for the use in patients (based on expert recommendations) who have severe migraine attacks, leading to serious disability and vomiting.

The use of analgesics containing codeine is undesirable due to the possibility of constipation and nausea. Preparations containing phenobarbital are prohibited for use in pregnant women.

The schedule of follow-up visits agreed with the patient will allow her to adhere to a clear treatment plan, and will also enable the doctor to prescribe a course of preventive migraine treatment in time, if necessary. In order to monitor the incidence of hypertension and the effectiveness of the analgesics used, the patient needs to keep a diary of hypertension, recording information on the use of non-drug methods, the frequency, severity and duration of hypertension attacks, the presence of attacks of other forms of hypertension.This will determine the degree of adherence to the recommendations and the need for preventive treatment.

Preventive treatment for migraines during pregnancy

The neurologist needs to timely identify the group of patients who need preventive treatment for migraines. Preservation of frequent migraine attacks by 10-12 weeks. pregnancy indicates a high likelihood of maintaining GB throughout its entire length.

Prophylactic treatment of migraine is necessary for patients in the following cases:

  • high frequency of attacks (more than 2 days a week) due to the high risk of drug-induced hypertension;
  • the presence of severe or prolonged seizures;
  • significant disability;
  • the development of dehydration and insufficient absorption of nutrients;
  • poor response to accepted approved analgesics.

Pain management techniques (relaxation, biofeedback and stress management techniques), lifestyle adaptation to control seizure provocateurs, and dosed physical activity are highly effective. Patients with musculoskeletal disorders should be advised to regularly perform special exercises, as well as a course of massage or manual therapy in early pregnancy.

Beta-blockers have the best combination of efficacy and safety in the treatment of migraine in pregnant women.Due to the widespread use of propranolol in the treatment of hypertension during pregnancy, a significant amount of safety data has been accumulated for this drug. Propranolol is considered the first choice for prophylactic treatment of migraine during this period. The drug should be used with caution in patients with bronchial asthma, a tendency to arterial hypotension and bradycardia. The dose of β-blockers should be gradually reduced during the last weeks of pregnancy (starting at 36 weeks.).

Tricyclic antidepressants are highly effective in the prophylactic treatment of migraine. At the same time, there is evidence of a possible teratogenic effect of amitriptyline. Selective serotonin reuptake inhibitors are not recommended for use due to their significantly lower efficacy compared to the efficacy of tricyclic antidepressants. While the use of antidepressants during pregnancy is essential for the treatment of severe affective disorders, their use in migraine patients who are not depressed is limited due to the low risk of teratogenicity associated with the use of most antidepressants at different stages of pregnancy.In addition to the above preparations, the use of magnesium is recommended.

Recommendations for the preventive treatment of migraine during pregnancy are summarized in Table 3.

Migraine during lactation

Despite the fact that chronic hypertension in the II and III trimesters of pregnancy in most women is not intense, it usually recurs after childbirth. Breastfeeding can delay the return of HD, so breastfeeding should be encouraged.Such patients should be provided with information on the safe use of drugs during this period.

During the period of breastfeeding, it is necessary to use analgesics to relieve seizures of moderate to high intensity no more than 2 days a week.

Certain drugs, such as paracetamol and ibuprofen, can be used by a breastfeeding mother regardless of the feeding time. If unsafe drugs are used, breast milk must be expressed for several hours after taking them, and pre-stored milk must be used for feeding.

Information on the use of analgesics during lactation is shown in Table 4.

The safety of triptans during lactation is still not fully understood. However, the data collected to date does not allow us to talk about their possible harm to the child. The American Academy of Pediatrics authorizes the use of sumatriptan during lactation. For other triptans, as well as generic sumatriptan, there is insufficient data on the safety of use during breastfeeding.If you take these drugs, you must express milk for at least 4 hours after taking them.

In case of insufficient effectiveness of non-drug approaches, patients with frequent or severe migraine attacks need to choose a drug therapy regimen.

Propranolol and timolol are more effective in the treatment of migraine, the safety of their use during lactation has been studied quite well. For these reasons, propranolol is the first choice for the treatment of migraines during lactation.Valproic acid is compatible with breastfeeding. Other antiepileptic drugs are not recommended for the prophylactic treatment of migraine during lactation due to the lack of convincing safety data. The use of antidepressants for the prophylactic treatment of migraines during this period is highly undesirable.

Recommendations for the prophylactic treatment of migraine during breastfeeding are presented in Table 5.

Medicines for the prophylactic treatment of migraine should be taken before the longest break in feeding the baby (ideally, before the baby’s longest sleep period).

Migraine during menopause

Migraine headaches usually get better with age. However, this occurs only in about a third of women, more often in those patients who have had a menstrual migraine. At the same time, during the period of perimenopause, when the menstrual cycle becomes irregular, many women experience a worsening of the migraine. This period can last over 10 years. At this time, there are irregular fluctuations in hormone levels and a gradual decrease in it, which can lead to the appearance of symptoms such as fatigue, insomnia, irritability, hot flashes, decreased libido and impaired concentration.Worsening migraines can signal the onset of perimenopause and make treatment more difficult.

Some women use hormone replacement therapy to treat menopausal symptoms. For this purpose, estrogen preparations can be used. The impact of this treatment on migraines varies. If the course of migraine worsens by analogy with the use of COCs, the need for therapy should be reviewed. In general, the worsening of the course of migraine occurs somewhat less frequently with the use of transdermal estrogen preparations due to the creation of a more stable physiological concentration of hormones than with the use of tablet preparations.

Migraine in old age

The appearance of migraine after 60 years is an extremely unusual fact and requires additional examination of the patient to exclude secondary causes of hypertension, the frequency of which is about 30%.

Migraine in older women can be accompanied by an aura, and attacks occurring in the form of an aura without hypertension (“headless migraine”) are also common. Such seizures require differential diagnosis with transient ischemic attacks.

The presence of comorbid conditions and the use of a large number of drugs for the treatment of somatic diseases often complicate the treatment of migraines in older women. At the same time, the prevention of migraine in patients with coronary heart disease is of particular importance due to the fact that triptans are contraindicated in these patients. In this case, as well as in arterial hypertension, a β-blocker may be the first choice for the prophylactic treatment of migraine. Despite the high efficacy of tricyclic antidepressants, in this age group, the appointment of these drugs is problematic due to the frequent presence of contraindications.In general, all migraine medications should be prescribed at lower doses than in younger women to reduce the risk of adverse effects.

Conclusion. Migraine is widespread in the female population. At the same time, there are features of its course in different periods of a woman’s life. In recent years, new methods of migraine treatment have been developed based on an understanding of the peculiarities of its pathophysiology in women of different ages. Taking these features into account will allow optimizing the methods of relieving migraine attacks and choosing the most successful preventive therapy.


90,000 5 unexpected factors that aggravate migraine attacks

I have an extensive list of the causes of migraine headaches. Some of those that lead to migraine attacks include lack of sleep, stress, lack of food, dehydration, drinking milk or anything high in sugar, and not having enough breaks during the day, and flights.

In addition to my usual factors, migraine attacks occur in me in response to some rare circumstances that may surprise you.

Here are some unexpected factors that make migraine attacks worse.

1. Exercises

Do you know the feeling when you have just finished a great workout, the energy is pouring through your body, and you are just bursting with, after all, you have achieved positive results? I’m familiar.

How I liked this feeling when I successfully trained. It was like recharging the battery for the whole day or the whole night.

Unfortunately, I haven’t experienced anything like this in years.Thanks to the migraine, when I finish my workout, I’m just exhausted. There is no energy so much that I can hardly stand on my feet.

The head becomes heavy and it seems that it is being pulled to the ground. Then pain comes. I feel a sharp pain around the eyeballs and in the back of my head.

Instead of feeling uplifted after training, I am overwhelmed. This happens after jogging, jumping onto the bench, pedaling, and almost any cardio workout. Now, a former college athlete, I can’t run for a few minutes now.

What to do about it? I have found other types of workouts that are effective but not painful. I enjoy doing yoga (even hot yoga) and pilates on a reversible platform and it doesn’t hurt me. The only caveat is to avoid handstands or upside down movements that put extra pressure on my head and cause pain. With hot yoga, I can even sweat a little without any problems.

And yet, what is effective (or not effective for me) can have a completely opposite effect on other people with chronic migraines.

2. Stress Reduction

You might think that the most stressful moments in my life cause migraine attacks. But in fact, I found that the migraine attack begins immediately after the end of the tense moment.

This was when I was younger and in school. As soon as I passed the last exam, a migraine began. Likewise, after a busy week of work or after resolving a difficult personal situation, a migraine begins.

These stressful situations are often inevitable.At times like this, I try to focus on breathing exercises and write down my emotions to release negativity and anxiety.

3. Differences in atmospheric pressure

Strange as it may seem, changing weather can trigger migraines.

In most cases, I feel like it’s going to rain or the temperature is about to change, because I can feel the pressure in my head changing. Sometimes, even in a day, I can feel that the weather will change soon.When the temperature drops or rises by 3-9 degrees, I often have a migraine attack.

As a result, I often avoid weather forecasts.

4. Perfume and cologne

There is nothing worse than a walk in a perfume cloud or an occasional visit to the perfumery section of a store. It hurts me even to walk past the entrance to a perfume shop. The smell can instantly trigger migraines or exacerbate existing pain.

I am very sensitive to aromas. Therefore, I have to ask loved ones not to use certain perfumes.I also tell them not to light candles if I’m around.

In addition, I often have to cover my face when I ride the subway next to a person who is profusely perfumed.

5. Bright, yellow or flashing lights

I love the dark. I avoid strong yellow lighting or bright lighting whenever possible. As with my nose, my eyes are sensitive to light – all due to changes in the brain caused by migraines.

Whenever I see an ambulance passing by, or even a flash of bicycle headlights, I have to cover my eyes.Moreover, even if I closed my eyes, these flashes still continue before my eyes.

Light from the screens of electronic devices also negatively affects the head. Thus, the brightness level on the displays of my phone, computer and TV is set to minimum. I even put screen protectors on my computer monitors for added protection from light.

Many other people have their own amazing causes of migraines too

While writing this article, I searched the Internet via Instagram to find out what unusual factors cause migraines.

Some of this list surprised me: supine position, sun, high pitches, repetitive sounds, deep sleep, rain, long car rides, beer, jumping, tied hair, smoke, limes, deli meats, sex, etc. White chocolate.

Obviously, the causes of migraine headaches vary widely. It is important that we all respect each other’s contributing factors, regardless of their nature. Ideally, maybe we will all agree to stop using perfume around people with migraines.

NPS-EE-NP-00004 August 2020

Migraine | Stavropol Regional Clinical Hospital

What is a migraine?

“When I have a migraine attack, I am completely broken and completely pulled out of my daily life for a day or more. Once it starts, the seizure gets worse and I feel so awful that I have to go to bed. The pain becomes stronger and stronger, nausea appears, sometimes I can vomit; finally, the pain starts to subside.The next day my head is heavy, I feel empty, but still much better than the day before. ”

Migraine is a neurological disease. It manifests itself in seizures, which can occur with varying frequency – from 1-2 times a year to several times a month.

The main manifestation of a migraine attack is headache, which can be very severe. Other common symptoms include nausea and vomiting, and intolerance to light and sound.
If during a headache you feel nauseous, irritated by light or sound, and the headache interferes with your usual activity, it is most likely a migraine.

Why do migraines occur?

The cause of migraine is in the brain. Migraine pain is associated with abnormalities in structures that are responsible for carrying pain and other sensations. There is a hereditary predisposition to the development of migraine: that is, you can inherit it from one of the parents.

Who gets a migraine?

Every seventh adult suffers from migraine, so the disease is quite common. Women have three times more migraines than men.It usually begins in childhood or adolescence. In girls, migraines usually start around puberty. Since there is a hereditary predisposition to the development of migraine, this disease is transmitted from generation to generation.

What are the types of migraines?

The most common type of migraine is migraine without aura (aura will be discussed below). This type of migraine occurs in three quarters of migraine patients; only migraine with an aura occurs only in every tenth person, the rest may have attacks of both migraine with an aura and migraine without an aura.Much less often (more often in older people) attacks of only aura without headache are observed. There are other types of migraines, but they are extremely rare.

How does a migraine manifest itself?

All migraine symptoms occur during an attack that has four stages of development, although not all of them can be fully represented. Most people with migraines feel good between attacks.

  1. The phase of precursors of migraine (prodrome) occurs earlier than all other symptoms of an attack and in no more than half of the patients.If you have a prodrome, you may feel irritable, depressed or tired for a few hours or even a couple of days before the headache develops. On the contrary, some may notice an unusual increase in activity. Some people may have an increased appetite, some “just know” they are going to have a seizure.
  2. The aura, if present, is the next phase. Only a third of migraine patients have ever experienced an aura, and it may not develop in every attack. Aura is a reflection of a certain process (transitory and harmless to health) that takes place in the brain and is associated with the mechanism of a migraine attack.It lasts 10-30 minutes, but it can be longer. Most often, there is a visual aura. You may “see” blind spots, flashes of light, or a multi-colored zigzag line extending from the center of the field of view to the periphery. Less commonly, sensitive symptoms occur – a tingling sensation or numbness that occurs in the fingertips on one side, spreads up to the shoulder, sometimes spreads to the cheek or tongue on the same side. Sensitive symptoms are almost always accompanied by visual disturbances.In addition, during the aura there are speech difficulties or difficulty in finding words.
  3. The headache phase is the most severe for most people, lasting from several hours to 2-3 days. A migraine headache is usually very severe, often occurs in one side of the head, but can also affect the entire head. Most often, pain occurs in the frontal or temporal region, although it can be localized in any part of the head. This is usually a throbbing or bursting pain that worsens with movement and exercise.Often there is nausea and even vomiting, which subjectively relieves the headache. Light and sounds can be unpleasant during an attack, and most patients prefer to be alone in a quiet and dark room.
  4. The headache phase is followed by a resolution phase. During this period, you may again feel tired, irritable or depressed, it is difficult for you to concentrate. These symptoms can persist for up to 24 hours before you feel completely healthy.
What is the “threshold for the development of a migraine attack”?

A migraine attack is not predictable, it can begin at any time. However, some people are more prone to having seizures. The higher your threshold for developing a migraine, the less likely you are to develop an attack; the lower the threshold, the more likely you are.

A significant role is played by provoking factors (triggers) of migraine. The trigger can trigger a migraine attack (although how this happens is not known).This happens especially quickly if the migraine threshold is low. If your threshold is high, then in order for an attack to develop, two or three triggers must be active at the same time.

Triggers must be distinguished from predisposing factors, which lower the threshold for the development of an attack, whereas triggers trigger an attack. Predisposing factors are chronic fatigue, anxiety and stress; in women, this can be the period of menstruation, pregnancy and menopause.

What are migraine triggers?

Every migraine patient would like to know what can trigger an attack.This is usually difficult or impossible because each patient has different triggers; even in the same patient, different seizures can be triggered by different triggers. Many patients are unable to identify their triggers because they are so diverse.

  • Diet: some foods (and alcohol), but only in a subset of patients; much more often, an attack can be caused by skipping meals, inadequate nutrition, withdrawal of caffeine and inadequate water intake.
  • Sleep: Change in sleep patterns, both lack of sleep and excess sleep
  • Other vital factors: intense physical activity, long journeys, especially with a change of time zones.
  • External: bright or flickering light, strong odors, change in weather
  • Psychological: emotional stress or, oddly enough, relaxation after stress.
  • Hormonal factors in women: menstruation, hormonal contraceptives and hormone replacement therapy.
  • One of the most common triggers is hunger or not eating enough. This is especially true for young patients – children with migraines should not skip breakfast! In women, a significant potential trigger is hormone fluctuations associated with the menstrual cycle.

These and most other triggers represent some kind of stress, which supports the assumption that people with migraines generally do not respond well to any changes.

What treatment can I use?

Medicines that are used to relieve an existing migraine attack are called migraine relief agents. The right medicines can be very effective when taken correctly and in small amounts.These drugs include over-the-counter analgesics, most of which contain aspirin, ibuprofen, or paracetamol; paracetamol is the least effective among them. Soluble forms of these drugs, such as effervescent tablets, work faster and better.

If you are very concerned about nausea or vomiting, antiemetics can be used. Some of them actually enhance the action of analgesics, as they increase their absorption in the gastrointestinal tract. If you are experiencing severe nausea or vomiting, then you can use these drugs in the form of rectal suppositories.

When buying a drug, the pharmacist can advise you on which OTC analgesic is best to take. If none of the drugs in this class helps you, or you need a dose of the drug that is higher than the recommended dose, then you should consult a doctor.

Your doctor may prescribe you one of the specific anti-migraine drugs. These drugs should be used if analgesics and antiemetics do not relieve your symptoms and do not quickly return you to daily activity.According to the principle of action, anti-migraine drugs differ from conventional pain relievers. They act not on pain, but on pathological processes occurring in the brain during a migraine attack. These drugs include ergotamine, which is widely used in some countries and not available in others, and a group of newer drugs called triptans. If the doctor has prescribed these drugs for you, then, if necessary, you can combine them with analgesics and antiemetics.

There are several techniques that can improve the effectiveness of drug treatment for a migraine attack:

  1. Take at the very beginning of an attack …
    Always carry at least one dose of the drug recommended by your doctor. Take the drug as soon as you feel the onset of an attack. The sooner you take the medicine, the more effective it will be. During a migraine attack, the gastrointestinal tract slows down, so drugs taken in pill form are absorbed into the blood more slowly than usual.If your condition allows, eat something or drink something sweet.
  2. … but not very often
    Always strictly adhere to the directions for use of the medicine. In particular, do not use headache relievers too often, as this can lead to headaches from taking pain relievers. This is the so-called headache associated with overuse of drugs (abusal headache), and a separate leaflet is devoted to it, which you can look at if necessary.To prevent you from developing such a headache, in any case, do not use remedies for stopping migraines on a regular basis, that is, more than 2-3 times a week.
What if this treatment does not work?

If migraine attacks are very frequent or severe, and do not respond well to treatment with relief drugs, then there is a prophylactic treatment. Unlike remedies for arresting an attack, preventive treatment requires taking drugs every day, since this treatment is aimed at preventing the development of migraine attacks.In other words, preventive treatment can raise the threshold for a migraine attack.

Your doctor will advise you on medications for preventive therapy and warn you about possible side effects. Most of them were originally developed to treat other conditions, so you should not be surprised if you are prescribed a drug from the group of antidepressants, antiepileptic drugs, or used to lower blood pressure. You were not prescribed treatment for these indications, it is just that these drugs also have an anti-migraine effect.

When prescribing one or more drugs to you, carefully follow the instructions for their use. Studies have shown that the most common reason for the lack of effectiveness of preventive treatment is non-adherence to the therapy regimen.

What else can you do to help yourself?
Regular exercise and staying in shape will significantly improve your well-being. It is advisable to avoid predisposing factors and triggers, so it makes sense to know all possible provocateurs.Try to rule out at least some of them, even if other triggers are difficult to detect or cannot be avoided.

Keeping a headache diary

Keeping a diary will help collect important information about your headache: how often the headache hurts, when and how long the headache lasts, what symptoms accompany it. This information is very valuable for making a correct diagnosis, identifying factors that provoke headaches and assessing the effectiveness of treatment.

What if you suspect you are pregnant?

You should consult your doctor as some of the anti-migraine drugs are contraindicated during pregnancy.

Do you need additional examinations? In most cases, the diagnosis of migraine is straightforward. There are no examination methods to confirm the diagnosis of migraine. The diagnosis is based on your description of the characteristics of the headache and accompanying symptoms, and it is imperative that there are no abnormalities in the medical examination.Try to describe your headache as much as possible to your doctor. It is very important to tell your doctor how often and how much you are taking pain relievers or other medications for your headache.

Brain scans are generally not informative. If your doctor is not sure of the correctness of the diagnosis, he may prescribe additional methods of examination for you to exclude other causes of headache. As a rule, this is not often necessary.If your doctor has not ordered additional examinations, this means that he is confident in the diagnosis and conducting examinations will in no way facilitate the appointment of treatment.

Can migraines be cured?

There is no complete cure for migraines. However, for most people with migraines, attacks become less frequent with age.

The tips and tricks in this leaflet will help you manage your migraines effectively.

ASCOFEN ULTRA 0.25 + 0.065 + 0.25 N20 TABLE P / PLEN / SHELL

Acetylsalicylic acid

Other non-steroidal anti-inflammatory drugs: Increased damage to the gastrointestinal mucosa, increased risk of gastrointestinal bleeding.If necessary, the simultaneous use of gastroprotectors is recommended to prevent NSAID-induced ulcers of the gastrointestinal tract, therefore, simultaneous use is not recommended.

Glucocorticosteroids: Increased damage to the gastrointestinal mucosa, increased risk of gastrointestinal bleeding. If necessary, the simultaneous use is recommended to use gastroprotective agents, especially in persons over 65 years of age, therefore, simultaneous use is not recommended.

Oral anticoagulants (eg coumarin derivatives): Acetylsalicylic acid (ASA) can potentiate the action of anticoagulants. Clinical and laboratory monitoring of bleeding time and prothrombin time is required. Simultaneous use is not recommended.

Thrombolytics: Increased risk of bleeding. The use of ASA in patients during the first 24 hours after an acute stroke is not recommended. Simultaneous use is not recommended.

Heparin: Increased risk of bleeding. Clinical and laboratory monitoring of bleeding time is required. Simultaneous use is not recommended.

Platelet aggregation inhibitors (ticlopidine, paracetamol, clopidogrel, cilostazol): Increased risk of bleeding. Clinical and laboratory monitoring of bleeding time is required. Simultaneous use is not recommended.

Selective serotonin reuptake inhibitors (SSRIs): Concomitant use can affect blood clotting or platelet function, which leads to an increased risk of bleeding in general, and in particular gastrointestinal bleeding, therefore, simultaneous use is not recommended.

Phenytoin: ASA increases plasma phenytoin concentration, which requires monitoring.

Valproic acid: ASA interferes with plasma protein and therefore may increase its toxicity. It is necessary to control the plasma concentration of valproic acid.

Aldosterone antagonists (spironolactone, canrenoate): ASA can reduce their activity due to impaired sodium excretion, proper blood pressure control is necessary.

Loop diuretics (eg, furosemide): ASA can reduce their activity due to glomerular filtration disorders due to inhibition of prostaglandin synthesis in the kidneys. Concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs) can lead to acute renal failure, especially in dehydrated patients. If diuretics are used concomitantly with ASA, it is necessary to ensure sufficient rehydration of the patient and monitor renal function and blood pressure, especially at the beginning of treatment with diuretics.

Antihypertensive drugs (ACE inhibitors, angiotensin II receptor antagonists, blockers of “slow” calcium channels): ASA can reduce their activity due to inhibition of prostaglandin synthesis in the kidneys. Concomitant use can lead to acute renal failure in elderly or dehydrated patients. If diuretics are used concomitantly with ASA, it is necessary to ensure adequate rehydration of the patient and monitor renal function and blood pressure.When used simultaneously with verapamil, the bleeding time should be controlled.

Uricosuric agents (eg probenecid, sulfinpyrazone): ASA can reduce their activity by inhibiting tubular reabsorption, leading to high plasma ASA concentration.

Methotrexate? 15 mg / week: ASA, like all NSAIDs, reduces the tubular secretion of methotrexate, increasing its plasma concentration and thus toxicity. In this regard, the simultaneous use of NSAIDs in patients receiving high doses of methotrexate is not recommended (see.section “Contraindications”). In patients taking low doses of methotrexate, the risk of interactions between methotrexate and NSAIDs should also be considered, especially in renal impairment. If a combination therapy is necessary, it is necessary to monitor a complete blood count, liver and kidney function, especially in the first days of treatment.

Sulfonylurea derivatives and insulin: ASA enhances their hypoglycemic effect, therefore, when taking a high dose of salicylates, a decrease in the dose of hypoglycemic drugs may be required.It is recommended to monitor blood glucose more often.

Alcohol: Increases the risk of gastrointestinal bleeding; simultaneous use should be avoided.


Inducers of liver microsomal enzymes or potentially hepatotoxic substances (for example, alcohol, rifampicin, isoniazid, hypnotics and antiepileptic drugs, including phenobarbital, phenytoin and carbamazepine, even with paracetamol): Increased toxicity, leading to liver damage, even paracetamol non-toxic doses of paracetamol, so liver function should be monitored.Simultaneous use is not recommended.

Chloramphenicol: Paracetamol may increase the risk of elevated chloramphenicol concentrations. Simultaneous use is not recommended.

Zidovudine: Paracetamol may increase the tendency to develop neutropenia, and therefore hematological parameters should be monitored. Simultaneous use is possible only with the permission of a doctor.

Probenecid: Probenecid decreases the clearance of paracetamol, which requires a reduction in the paracetamol dose.Simultaneous use is not recommended.

Indirect apticoagulants: Repeated intake of paracetamol for more than one week increases the anticoagulant effect. Occasional intake of paracetamol has no significant effect.

Propantheline and other drugs that delay gastric evacuation: Reduce the rate of absorption of paracetamol, which may delay or reduce rapid pain relief.

Metoclopramide and other drugs that accelerate gastric evacuation: Increases the rate of absorption of paracetamol and, accordingly, the effectiveness and onset of analgesic action.

Cholestyramine: Reduces the rate of absorption of paracetamol, therefore, if maximum analgesia is required, cholestyramine is taken no earlier than 1 hour after taking paracetamol.


Hypnotics (eg benzodiazepines, barbiturates, H1-histamine receptor blockers): Concomitant use may reduce the hypnotic effect or reduce the anticonvulsant effect of barbiturates, therefore concomitant use is not recommended.If it is necessary to use it simultaneously, it is advisable to take the combination in the morning.

Lithium: Withdrawal of caffeine may increase the plasma lithium concentration as caffeine increases renal clearance of lithium, therefore, a reduction in the dose of lithium may be required when withdrawing caffeine. Simultaneous use is not recommended.

Disulfiram: Patients on disulfiram treatment should be warned about the need to avoid the use of caffeine in order to avoid the risk of aggravating alcohol withdrawal syndrome due to the stimulating effect of caffeine on the cardiovascular and central nervous systems.

Ephedrine-like substances: Increased risk of drug dependence. Simultaneous use is not recommended.

Sympathomimetics or levothyroxine: May enhance the chronotropic effect through mutual potentiation. Simultaneous use is not recommended.

Theophylline: Simultaneous use reduces the excretion of theophylline.

Antibacterials from the quinolone group, enoxacin and pipemidic acid, terbinafine, cimetidine, fluvoxamine and oral contraceptives: Increased half-life of caffeine due to inhibition of liver cytochrome P450, therefore patients with impaired liver function, impaired cardiac arrhythmias and impaired cardiac epilepticus should be avoided caffeine.