What's a migraine?

Classic symptoms involve a headache occurring on one side of the head which can lead to nausea, vomiting, vision or hearing disturbances, and/or sensitivity to light and sound. Migraines generally start off gradually. It's typically dull, deep, and steady pain, but it can become throbbing and pulsating as it intensifies. Migraines affect three times more women than men, and episodes can start as early as 12 years old.

Auras are less common but are still experienced by some. About 20% of migraine sufferers experience symptoms prior to the onset of a migraine, such as flashing lights, bright spots, zig-zag lines, numbness or tingling in their hands, lips, tongue, or face. 

Interestingly, migraines don't always cause a headache, there's a small percentage of people who have visual migraines. These people can lose a portion of their vision during their migraine, but they don't experience a headache.

Causes of migraines

Family history: 90% of migraine sufferers have a family member who also gets migraines.

Lifestyle triggers: dehydration, lack of sleep, hunger, stress, strenuous exercise, or an iron deficiency can all contribute to migraine headaches.

Hormonal imbalances: including menstruation. Commonly, our "time of the month" can cause hormonal imbalances. Whether it's just before, during, or after our periods, these hormone imbalances can lead to the onset of migraines.

Food triggers: our food choices can play a surprisingly big role in preventing and managing migraines.

How diet affects migraines

There are several dietary components that can contribute to headaches. This includes:

• Hunger: migraine sufferers often note that skipping meals can cause headaches. To avoid this, we can consider eating every 3-4 hours.
• Nutrient deficiencies: such as iron, riboflavin (also known as vitamin B2), and magnesium. Learn more about having nutritionally balanced meals in our plate method article.

Potential triggers

Aside from hunger and nutrient deficiencies, certain foods may also trigger migraines. Some foods can cause a change in chemicals in the brain which then lead to headaches. Other foods might cause inflammation which can also lead to a headache. Here are some examples of potential triggers:

Tyramine is a component of food that may be a potential trigger. It's often found in aged cheese, cured/processed meats, pickles, canned soups, overripe fruits, and certain beans.

Food additives such as nitrates, food colouring agents, artificial sweeteners, and monosodium glutamate (MSG) can also be a trigger. These food additives are often found in foods such as sauces and packaged foods.

Tannins, phenols, and sulphites found in black tea, bananas, apple peels, red wine, and dark chocolate may trigger migraines.

Withdrawal from caffeine can also be a major source. Aside from coffee and tea, we can be mindful of caffeine in energy drinks and carbonated soda beverages.

Dealing with triggers

Note that the above are possible triggers, but everyone is unique so what might cause a migraine in one of us might not have any effect on another. If food may be the culprit for causing migraines, try using our headache journal below, or see a registered dietitian for additional support.

If something is suspected to be the culprit, we advise changing only one thing at a time to see if it has an effect on our headaches. Too many changes at once will make it harder to determine what may or may not have been contributing. On that note, we also suggest slowly adding back foods that have been eliminated, to see if they can be tolerated again. Trigger foods can sometimes be "dose" dependant. For example, a whole dark chocolate bar might cause a migraine, but 1/4 of it might not. When going for an elimination-style approach to deal with triggers, we highly recommend seeking guidance from a dietitian, as the journey can be complicated, confusing, and frustrating.

Caffeine: friend or foe to the migraine?

Some of us that have experienced a migraine before might have noticed that drinking some coffee can help. In fact, caffeine is an ingredient commonly found in over-the-counter headache medications. For some of us though, caffeine can be the culprit causing headaches in the first place.

Caffeine's effect on the brain depends on how often we use it. If we're not frequent coffee drinkers, having one cup might relieve our headaches. On the other hand, if we're a regular coffee drinker, our body has likely developed a tolerance to it and it may not be as effective in relieving our headaches. For those with chronic migraines, it's recommended that coffee be avoided altogether.

Note that caffeine is classified as a drug. As with any drug, overuse can cause problems. This means that drinking coffee daily can cause "rebound" headaches, and quitting caffeine "cold turkey" may also cause migraines. If decreasing caffeine intake is desired, we recommend reducing it gradually. Also, keep in mind that caffeine is in more things than just coffee. 

Where to begin

We've created a free PDF headache journal that can be used in our efforts to determine potential migraine triggers.

We suggest tracking for at least 3 months to allow for patterns to develop, but we might notice a pattern within the first month. This tool is also helpful to take to family doctor or dietitian consultations so they can assist us with tracking potential trends.

Other treatments

Lifestyle factors 

Other than food, there are also lifestyle factors that can play a role in migraine prevention and management. Some of these factors may include: 

• taking part in self-care rituals that decrease stress
• ensuring adequate sleep
• ensuring adequate hydration
• applying a cold compress to our forehead or back of the neck
• finding a quiet and dark room to rest in
• stretching or taking part in gentle forms of yoga

Medications

Over-the-counter painkillers can be an effective treatment option for migraines. Although, over-using headache medicines can cause rebound headaches. Here at PUL, we suggest trying to avoid using non-prescription medications more than once or twice a week to avoid these rebound headaches. Also, keep in mind that it's advised that Aspirin (ASA) should never be given to anyone under the age of 16.

If migraines are related to hormones, birth control is one approach to reduce the frequency and severity of migraines. If we experience migraines with an aura, we generally shouldn't be taking birth control containing estrogen though. Speaking with a family physician can provide more information and potential suggestions. 

For those of us experiencing chronic migraines, a doctor might prescribe medications that can help to reduce the severity and frequency of headaches. Some types of medications that might be used include blood pressure, anti-seizure or anti-depressant medications.

Herbs and supplements

Herbal treatment options for migraines and headaches are promising, but more studies need to be done to confirm their efficacy. Some supplements that have been researched include:

• Iron: here at PUL, we recommend increasing iron intake from food sources over supplements first when possible. Learn more about iron-rich plant-based foods in our iron article.
• Vitamin B2: also known as riboflavin. Some food sources of riboflavin include leafy green veggies and fortified grain products. 
• Magnesium: see food sources in this Dietitians of Canada article.
• Coenzyme Q10: also knowns as CoQ10, an enzyme that naturally occurs in the human body.
• Feverfew: a plant most widely studied for its potential effect on migraine sufferers.

It's best to start supplements under the advice of a registered healthcare professional as there can be adverse side effects. Since everyone has different requirements and unique situations, we've opted not to discuss potential doses in this article. For more information, talk to a doctor, pharmacist, nurse, dietitian, or another healthcare provider.

Summary

1. Identify potential triggers. These could include caffeine, lack of sleep, certain foods, stress, menstruation, and more. Using a "headache journal" can help to identify trends.
2. Focus on lifestyle management first. This would include getting enough sleep, drinking enough fluids, avoiding skipped meals, and avoiding stressors that could contribute to headaches.
3. If needed, consider medications for migraines. It's most helpful to take the medicine at the first sign of a headache.
4. See a healthcare professional. They are helpful in providing additional support, as migraines can be complex and caused by various factors.