Headache Triggers and Treatments

Headaches come in many forms and intensities, with causes that can range from genetics, anxiety, stress, a lack of sleep, excess sleep, what you eat, breathe, feel, and the list goes on. The one thing any headache sufferer will agree on is that chronic headaches are painful and can interfere with life in a significant way.

First and foremost, a complete medical checkup is an important preliminary step for all headache sufferers. Gavin Brown, M.D., a general neurologist at the Laureate Medical Group and director of neurology at Northside Hospital System, said, “The COVID pandemic has brought a host of new stressors. The isolation, employment concerns, and upended work and school schedules can all exacerbate headaches.”

Atlanta neurologist Dr. Gavin Brown shares promising news about headaches and migraines.

He added, “The two most common types of headaches that I see are migraines and tension headaches. It is an exciting time for migraine therapeutics. Over the past four years, several new classes of medications have emerged which seem as effective and much better tolerated than the older drugs. Two examples are CGRP inhibitors (monthly shots for the prevention of migraine) and gepants (pills to take acutely when a migraine is coming on in order to ‘abort’ the headache). Within each of these classes, there are several unique new medications.”

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When it comes to headache triggers, Brown lists “certain foods, stress, and disrupted sleep patterns,” and suggests that those who experience headaches keep a detailed diary to narrow down the potential causes. “Trigger avoidance is an important non-pharmacological measure to reduce the impact of migraines,” he says.

If you live with someone who suffers from migraines, Brown advises that you try “to be kind and sympathetic when your loved one is in pain. Ask what you can do to help.” Above all, don’t give up. “The migraine treatment toolbox has grown considerably in recent years,” Brown says. “Seek out a neurologist who will engage with you to design the right treatment program.”

Diets play a big role, as well. Cheryl Orlansky, a registered dietitian nutritionist at the Laureate Medical Group, says, “Diet may or may not impact headaches. There are multiple reasons that people get migraines or headaches including genetics, environment, lifestyle, and diet. The following three are potential headache instigators: stress, lack of sleep and certain food triggers.” There are also three compounds often found in food that can lead to headaches in some people: histamine, tyramine and MSG. Orlansky breaks these down further:

Cheryl Orlansky weighs in on the common culprits that can contribute to headaches.

Histamine is a bioactive chemical that our body uses as a neurotransmitter. It is released when our immune system is activated in response to an inflammatory process. Histamine intolerance is not an allergy; sometimes the symptoms occur hours after a food is eaten (unlike an allergy, which is an immediate response). A small amount of histamine may not cause a response, but a larger amount can. Histamine is found in aged or fermented foods: cheese, alcohol, vinegar, sauerkraut, soy sauce, processed meats like salami, pepperoni and hot dogs. It may occur in ripening fruits and vegetables. Preservatives such as benzoates or sulfites or food dyes such as tartrazine may also lead to a histamine response. Having one of these foods may not cause a response, but if you had a meal of pizza with pepperoni, cheese and tomatoes with two glasses of wine, the response could be immediate.

Tyramine is created in our body from the amino acid tyrosine. Tyramine acts as another central nervous system neurotransmitter. Similar to histamine, tyramine is found in foods that are fermented and in foods that are starting to spoil or are contaminated with microbes. Tyramine is found in aged cheeses, fermented meats and sausages, chicken liver, yeast extract, wine (especially red wine), beer, soy sauce, vinegar and pickles, raspberries, avocado, figs, eggplants and tomatoes.

MSG, or monosodium glutamate, is a flavor enhancer. Some people report symptoms such as flushing, nausea and vomiting, headaches and rapid heart rate. Research is mixed when it comes to evidence of MSG sensitivities. MSG is listed on the “Generally Recognized as Safe” (GRAS) list and food manufacturers are not required to list it on the label. Alcohol increases the rate of absorption of MSG so drinking while eating food with MSG may increase symptom severity. Popular flavor enhancers such as Accent-brand seasoning, hydrolyzed vegetable protein (HVP), flavorings or kombu extract may include MSG. Prepared foods such as canned meat, canned soup, gravy mixes, croutons, bottled or canned sauces, and frozen food or prepared snacks and salad dressings may have MSG.

Orlansky adds, “Everyone has their own level of intolerance. Food intolerances can be dose related. The higher the dose of food/intolerance, the more severe the symptoms. If you struggle with headaches, examine your lifestyle habits. Are you getting enough sleep or exercise, how are you managing stress? Learning how to cope with stress by using meditation or yoga can be helpful. Finding a routine or pattern of eating and sleeping may also prevent headaches. Look to your diet to be diverse in fruit, vegetables, whole grains, beans and lean protein. Aim to eat seasonally, which will also help diversify your diet.”

Visit www.eatright.org for more information.