Life StoryJune/July 2008 Issue

Chronic Migraines - Solving the Mystery

A combination of triggers, including certain foods, can make your head pound.

About two years ago, all I wanted to do was sleep. I was caring for my 10-month-old daughter, Nora, and napping whenever she did. Yet it didn’t matter how much rest I got, I needed more.    

Hoping to find an underlying physical explanation, I visited my doctor. He drew blood, ran some tests and ruled out anything medically wrong. I was left without answers—and still craving sleep.

A few months later, still tired, I returned to the doctor's office but this time because of headaches. I’d started suffering from occasional migraine headaches in 2001 and at the time was given a prescription of naproxen, the same medicine in over-the-counter Aleve. As the years passed and the number of headaches increased, I'd begun using the drug almost every day. Ultimately, the daily dosing had prompted such stomachaches that I just decided to quit. It wasn’t long before the headaches returned—with an intensity that ibuprofen and other over-the-counter medicine couldn't assuage.   

The doctor examined me and diagnosed mixed headaches— a combination of tension and migraine—and prescribed another medication, Midrin (Motrin mixed with a muscle relaxant), to control them.

"We’ll talk about the next step if you don't feel significantly better within two weeks," he said.

Chronic Migraines

I didn't. The next step was a neurologist who promptly diagnosed migraine and a form of chronic daily headache, specifically an analgesic rebound headache.

About 4 percent of Americans suffer from chronic daily headache—a headache that occurs at least 15 days out of every month. The specific type I had, medication-overuse headache, occurs in about 1 percent of people in North America, Europe and Asia. Those years of daily dosing on naproxen had left me physically dependent on the drug; my headaches were withdrawal symptoms.    

The treatment? No more naproxen or Midrin. Two to three months without analgesics of any kind to let my head regain equilibrium.

Once off the meds, I discovered that the drugs had been managing—and masking —massive amounts of pain. Within 24 hours, my head began to throb like it was swelling from the inside out. Over the next two months, I spent nearly as much time in bed as on my feet. Nora, by now a toddler, began saying "my-gain" and brought me gifts of yarn when I was in particularly rough shape. (Not that I was in any condition to knit, but the thought was sweet.)

After this withdrawal period, I began to feel optimistic. For the first time in months, I actually had a few days that were headache free. I also had much more energy. When I asked my doctor about this, he pointed out that one effect of migraines is fatigue; while the naproxen and midrin had eased the pain of the headache, they apparently had not addressed the fatigue that often accompanies a migraine, which was why I’d been so tired.

Even with the good news, however, I was growing more frustrated and discouraged. It was true that the daily headaches were now less frequent. But now it was becoming clear that the migraines were growing more severe. Before long, they were happening four or five times a month and lasting approximately four days apiece.

All in Your Head
Migraines are common in the United States. A 2007 study found that in any given year, more than 17 percent of women and over 5 percent of men will experience a migraine. Of those, 60 percent suffer self-described "severe impairment," requiring bed rest. About 22 percent experience recurrent migraines that cause moderate-to-severe levels of disability, limiting their ability to work, attend school or enjoy family activities.

Neurologists generally recommend two methods to assist patients—medication and lifestyle adjustments, such as regular bedtimes, stress reduction techniques and elimination of potential triggers, often foods.

I have so-called "classic migraines," which means that many of my migraines begin with an aura—a visual or tactile phenomenon that develops before the migraine starts and ends as the pain begins. My aura is one of the more common types, resembling a visual "flash” that grows larger until I go nearly blind on one side. About 20 minutes later, my sight returns and the headache begins. Like most people with migraines (called migraineurs), I usually feel severe aching on one side of my head, throw-up while I'm having a headache and experience such grinding pain that performing even the most basic of daily activities—cooking, driving, standing upright, you name it—can become virtually impossible.  

Finding the Cause
For the next few months, I visited my neurologist regularly as he adjusted my medications and monitored the progress of the migraines. At one of my appointments, we carefully went over a list of foods that are often linked to migraines—aged cheeses, red wine, nitrates, preserved meats. I had either eliminated each of these items for months at a time or had never eaten them in the first place. Then the doctor mentioned Chinese food.

"Seriously?" I asked. My husband, who'd come to my appointment, and I looked at each other. We'd begun to frequent a Chinese restaurant that was gracious about adapting their food to my gluten-free diet and as I'd been feeling more ill and fatigued over the past many months, we’d been eating there three or four times a week.  

"Actually, we eat tons of Chinese food," I told the doctor.

"Give it a shot," he said. “Stop eating Chinese.”

So we cut out our favorite Asian restaurants entirely for a few weeks. And amazingly, I had my first headache-free week in many months. But I still didn't know exactly why. Was it an additive in the food—MSG (monosodium glutamate), too much salt, something I didn't know about? Or was it an ingredient I was eating in Chinese cuisine and at other meals that I should cut from my diet—mushrooms, bok choy, tofu?

I began to strongly suspect MSG when, over a long weekend of travel, I shared a bag of chips that contained MSG with my husband. On our way home, I had one of the worst migraines of my life.  

Chronic Migraines

"MSG is a guaranteed trigger for most patients," explains Christine Lay, M.D., director of the Women's Comprehensive Headache Center at St. Luke's-Roosevelt Hospital Center in New York City. "Food colorings, preservatives, stabilizers—these things are fairly potent triggers for migraines."  

My rescue medication, one of a class of drugs called triptans that are commonly used to treat migraines, barely touched the headache I had after eating those chips. It was a week before the pain subsided completely. My sudden sensitivity to MSG really puzzled me. I'd eaten the same foods before with no ill effects.

Part of my confusion stemmed from my misunderstanding about how migraines work. When I was first diagnosed with migraines in 2001, they were very infrequent. At that time, the doctor handed me a list of potential triggers— common foods and situations that were thought to directly cause migraines in many people. The explanation was one of cause and effect. Drink a glass of red wine on Monday evening; wake up with a migraine on Tuesday morning.

What’s Eating You?
The list of migraine-aggravating foods still stands but newer research on migraines has changed the way doctors look at the relationship between food and headaches.
"It's pretty rare for a person to say, 'If I eat a certain food, I always get a headache. And if I never eat this food, I almost never get a migraine,'" Lay says.

The prevailing medical thinking puts tension and migraine headaches on a continuum rather than considering them separate entities. It posits that the brain is pushed toward a migraine by environmental stresses that can build over time. The brain can turn off the process that causes a headache at any point—after the aura (in people who get an aura) or even in the period before a headache starts when many migraineurs are tired or moody. In people prone to migraines, the brain tends not to "turn off" before a headache starts.  

"We generally believe that migraines occur in people who have genetic susceptibility to them. For some reason, this susceptibility makes people who suffer with migraines more likely to get a headache if certain conditions occur. For instance, when the weather changes, or, in a woman, during a hormonal fluctuation. These triggers tend to build to a threshold to turn on a migraine,” Lay says. “So you may have a patient whose menstrual cycle is due and who has a glass of red wine. She gets a headache and thinks, 'Gosh, it must have been the red wine.'"

In people who are susceptible, the combination of environmental and food triggers can push them over their personal threshold for developing a headache. For migraineurs, that threshold can be low, indeed. This means that there is a relationship between foods, associated medical conditions and lifestyle issues that can cause migraines—but it’s looser than previously thought.  

This is why discerning food issues for migraineurs can be so complicated and why, unlike celiac disease or food allergies, there may be some cases where migraine patients who are sensitive to certain foods can eat small amounts of their danger foods without getting a headache. When other aggravating factors are absent, depending on the person, problem foods may be okay in limited amounts.  

"It's good in a way because patients who, for instance, like chocolate or love ginger ale know they can enjoy it sometimes," says Lay.  

Teasing out exact food issues, however, is challenging for many migraineurs. It can be difficult to separate what you've eaten from any emotional and environmental stressors that may also be playing a role. For me, an elimination diet was the key to figuring out my major food sensitivity. I had already eliminated all my migraine food triggers—except for the MSG.

Lay recommends that patients keep a food diary as a way to determine with their neurologist the foods that might be culprits.
"We try to see if certain food items tend to pop up more often than others and then look at them more closely," Lay says.  

As for me, I still get migraines, most of which I can trace to hormones, changes in barometric pressure or a rough night's sleep. But now that I’ve eliminated MSG from my diet, I have many more pain-free days. Most important, my migraines don't rule my life and the life of my family any more. I've gone from being "sick" to having a condition I can manage. LW

 

Comments (15)

I have suffered horrendous Migraines all my life. I was in the emergency room half of my kids childhood. Then I started using Imitrex shots. Yes, they would take the edge off and eventually the pain would subside, but the headaches with severe nausea continued. After changing Doctors 30 or more times, Someone FINALLY gave me a blood test for PROLACTIN. I had a brain tumor. It probably is NOT what everyone is experiencing, but if you can find no other answers, get a blood test!
It can't hurt, but it may save your life or your eye sight. No kidding. It can be very bad. I am approaching my 10th anniversary after surgery. Was it pleasant? Hell No! Am I alive and fairly back to my "old" self, you better believe it! The life you save my be your own.

Posted by: BG31 | September 25, 2014 7:28 PM    Report this comment

Sulfites!! (AKA Sulphites). Even after avoiding msg by any name (some foods disguise it as 'hydrolyzed plant protein" etc.), as well as my personal triggers, I still get unaccounted-for attacks at times when the weather is not a factor. Imagine my surprise to find out that a common and often natural component of many or most foods is to blame: SULFITES. Since doing all I can to reduce my intake of these salts, daily life is much less painful.
One free comprehensive resource that has helped many comes from a fellow victim. It's a NON-COMMERCIAL link for those interested. The researcher/author includes a LOT of information, yet it is worth it, believe me, if you are still wondering about other factors in your own migraine case: google some terms like learningtarget and nosulfites

Posted by: Merrikate | September 23, 2014 5:08 PM    Report this comment

I too suffered from migraines for most of my life but thought it was normal because so many of my female relatives did. I finally reported the headaches to my doctor. After a few years he told me he couldn't help me anymore and sent me to the ER. I have suffered from migraines, chronic headaches, rebound headaches, severe fatigue and depression and am now under a neurologist's care (for 4 years) trying to get the migraines and chronic headaches under control. I never knew there was such a thing as rebound headaches from taking too much Tylenol. I now am not allowed to take Tylenol at all. Food and especially barometric pressure are the triggers that I can control and anticipate however tension and emotional stress are triggers of some of the worse migraines I have. I am 60 years old, have changed my life style, left my job and take medications. I live a very simpler life now and love it. I am not free of daily headaches but they are manageable and I don't have as many migraines, about 1 a month now. Being under a neurologist doctor's care was the best thing I did for myself. I found out that I needed VitD, Vit12, Vit6 as I was deficient in all of these. Changing my lifestyle, especially what I ate helped calm my headaches. I eat no red meat, no processed meats, eat mostly organic vegetables, fruits and seeds and have switched to almond milk. I also have to mention that my adult children and husband support all my decisions

Posted by: Mynnie | September 23, 2014 12:32 PM    Report this comment

My life with migraines began when I was 16. I am now 64. Yes, to many of your symptoms and solutions. However, having taken naproxen regularly for 10 years, I damaged my kidneys. I highly recommend that this medication be used sparingly, which brings us back to all of those issues - environment, stress and foods that can trigger a migraine. I had a very helpful physician who worked with me, but still encouraged taking naproxen with cafergot as a 1 + 1 = 3 punch. Yes, it worked, but finally I had to go on an elimination diet (which I researched and insisted upon). I have been gluten free for 14 years. While not pain free, I began averaging one a month after having them everyday. Recently I had more food allergy tests and am now dairy free. I still need a daily medication for increasing my sleep.. more seratonin, but I rarely have a migraine!

Posted by: barabann | September 23, 2014 11:45 AM    Report this comment

I have suffered recently with 48-hour migraines which were making my life miserable. I kept a food diary for a while and learned that dextrose/maltose/maltodextrin were clear triggers for my migraines. There is research that links these additives to adverse impacts in gluten sensitive people. I now religiously read labels. Sometimes I forget and I get a migraine and THEN I read the label only to find one of those offending ingredients. If I avoid them I'm headache free. They're implicated in leaky gut syndrome, which is related to inflammation and to migraine.

Posted by: InNane | July 25, 2013 10:24 AM    Report this comment

I have suffered with migraines since I was about 13 and now at 56 I have tried every thing w/out much relief until I went gluten free about 2 years ago and instead of taking prescribed migraine control medication I now take about 1200 milligrams forabout 3 months and not only are my headaches gone it has also helped with my chronic constipation. BH

Posted by: Unknown | May 31, 2013 8:47 PM    Report this comment

Wow I have experienced migraines for years. I thought they were only triggered by environment. Now I am thinking they maybe triggered by what I eat. I am gluten free but do occasionally eat lunch meat. Thank you for sharing your story.

Posted by: grandma | May 29, 2013 8:06 PM    Report this comment

After 13 years of horrific migraines, I just recently found a doctor who suggested I remove GLUTEN from my diet. WOW...not only have I been migraine free...but no longer have chronic pain. No more joint pain, bursitis or fibromyalgia!!! And I've lost 30 pounds. No one needs gluten. It is the culprit in many illnesses today!

Posted by: Tracy G | May 29, 2013 12:13 AM    Report this comment

As a child, I had violent migraines many times a week, as did my dad, my brother, my grandsons now. My doctor, back in "the good old days", put me on one Dramamine and one sulfa drug per day, for a year. The migraines disappeared until I reached middle age. They then returned the week before my period and lasted most of the week. Since menopause, they have again disappeared. I tried lots of prescription and OTC drugs, but the Dramamine worked the best. Glad I had an old fashioned doctor back in the 50s (before they had publish or perish "research" policies in order to treat patients!)

Posted by: Unknown | May 28, 2013 7:01 PM    Report this comment

Sinus headaches are my primary trigger. I avoid the foods to which I'm allergic/sensitive: corn, soy, citrus, peanuts. Hormones were a problem, but I'm past that now. Sinus headaches are the main thing I can't control except by using Sudafed whenever I have a cold or sinus infection.
Interesting that gluten is a trigger for some. I'm not sensitive to gluten, but I wonder if somehow the mechanism is the same.

Posted by: ThedaAmy | May 28, 2013 3:22 PM    Report this comment

I suffered from migraines for over 30 years. I cut out all sorts of foods - chocolate, alcohol, msg, nitrates etc. etc. etc. Still migraines. I got them whenever I got tired, before my period, after my period, when I travelled anywhere. My life with three toddlers was a torture. Then the discovered I had a dermoid tumour. After it was removed I have never had another migraine. Heaven

Posted by: Unknown | May 28, 2013 12:17 PM    Report this comment

I have had migraines since I was 12. Usually 2-4 per week. After reading "Heal Your Headache" by Dr David Buchholz my life changed. I've been headache free for 2 months. It is all about diet. Wish I had figured it out 28 years ago! I highly advise anyone with headaches to read and follow this book

Posted by: Dawn P | May 28, 2013 11:53 AM    Report this comment

For years I suffered from blinding Migraine headaches. In 2003 my GI doctor determined that I have Celiac disease. I immediately went on a gluten free diet. After about 3 months it dawned on me that I hadn't had a Migraine in 3 months. What joy! Reason enough to stick to a strict gluten free diet.

M. A. Young

Posted by: Cranky Yankee | May 28, 2013 10:25 AM    Report this comment

Food triggers are definitely significant. Supplements can also be helpful, namely Riboflavin (vitamin B2) and magnesium. I was able to completely stop Rx meds with the supplements and monitoring my trigger foods.

Posted by: wellagain | May 28, 2013 9:13 AM    Report this comment

After 20 years for daily migraine, I found out that for me the trigger was GLUTEN!!! I am now migraine free ;o)

Posted by: Tyna P | May 28, 2013 8:12 AM    Report this comment

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