Tracking down migraine triggers

If you can pinpoint exactly what’s causing your migraines, you might be able to better treat them—or even prevent them from occurring in the first place.

Migraines affect 18 percent of women and 6 percent of men in the U.S. and are a leading cause of absenteeism and decreased productivity at work. The overall cost burden of migraines to society exceeds that of other chronic conditions, including asthma, depression, diabetes, and heart disease. Although medications called triptans, such as rizatriptan (Maxalt) or sumatriptan (Imitrex), can often halt a migraine in progress, nearly half of migraine sufferers who take those or other pain-relieving drugs are still dissatisfied with their ability to function or work afterward. And when used on a regular basis, over-the-counter and prescription pain relievers can even cause headaches. Quite a few commonly used preventive medications, such as amitriptyline or divalproex (Depakote), might have unwelcome side effects, including weight gain and/or sedation. That might be why only 12 percent of migraine patients take them.

A better and more satisfying approach to preventing migraines is to find and avoid the triggers that set them off. Surprisingly, research has shown that more than three quarters of sufferers are ultimately able to identify triggers, such as:

• Beer, red wine, chocolate, and cheeses
• Hunger
• Odors, including perfume
• Bright or fluorescent lights, the sun, or glare from TV or computer screens, particularly if flickering
• Insomnia (regular, but not too much, sleep is known to protect against attacks.)
• Tension, irritability, and stress

But it’s not a precise exercise. Not all culprits cause migraines each time, and sometimes migraines result only when factors occur simultaneously—so-called “stacked triggers.” For instance, while perfume alone might not cause a problem, drinking a glass of red wine might change those odds for the worse. To further complicate matters, some sufferers have a delayed response to stimuli, and triggers can even change over time.

Some doctors recommend keeping a headache diary —a log detailing your attacks and the medication responses that can help patients and doctors identify possible triggers and assess treatment effectiveness. You should document each headache episode, describe its connection to meals and beverages, and note situational factors such as fatigue, sleep patterns, or stress. You should also list the medications you took, and write down how you felt afterward. Women should note their menstrual cycle as well.

If a trigger is a food or fragrance, simply avoiding the offending substance will do the trick. For light-related triggers, sunglasses or tinted glasses can be helpful. Behavioral therapies, such as biofeedback and meditation, are recommended when stress is a factor. Keeping to a regular sleep schedule can help with sleep-related headaches. Alas, some triggers, such as weather and time zone changes, can’t be easily manipulated.

Visit our conditions section for more details about migraines, our detailed Treatment Ratings (for subscribers), and our free CR Best Buy Drugs report on triptans.

—Orly Avitzur, M.D., medical adviser to Consumers Union

See Dr. Avitzur talking about migraine triggers and treatments on ABC news.