Almost anything can trigger a migraine attack in a person predisposed to the condition.
A trigger may not cause an attack every time so patients can keep a detailed diary of the events before and during an incident, said Dr Jonathan Jia Yuan Ong, president of the Headache Society of Singapore and a consultant at the division of neurology at National University Hospital.
These include the onset of headaches, associated symptoms such as nausea or neck aches, the frequency and duration of an attack, the location and nature of the pain, any treatment taken and its effectiveness as well as trigger factors.
Dr Ong said it helps to record as many aspects of your daily life as possible, such as what and when you ate, how much sleep you had, the exercise you did, your social and work activities, the effect of the weather on your headaches and, for women, the details of their menstrual cycle.
A migraine attack can be triggered by various factors up to 48 hours before the headache comes on, but, in particular, take note of events six to eight hours before the attack.
He noted these common migraine triggers:
Changes in routine: Some people find that altering their routine - such as changing sleep patterns - can trigger a migraine. Even pleasant changes in routine such as taking a holiday can be implicated.
Some migraineurs suffer from migraines only during the weekend, when there may be changes to their daily routine such as eating their meals at a later time.
Stress: This is strongly linked to migraines. Anxiety, excitement and any form of tension may lead to an attack.
However, some people have reported that their migraine attacks start only when the stress is reduced. This is sometimes experienced as a "weekend headache" when, after a stressful week at work, an individual might get a migraine at the end of the week when he is more relaxed.
Sleep: Too much or too little sleep can lead to a migraine. Sleepless nights, keeping late nights and being over-tired can also be triggers.
Caffeine: Excessive consumption of caffeine may contribute to the onset of a migraine attack.
Limit the intake of caffeinated drinks to not more than four or five cups of tea, coffee or cola a day.
Some migraineurs found that their attacks were triggered by a sudden and complete halt in caffeine intake. If you suspect this, gradually cut down on caffeine.
Hormonal changes in women: Fluctuations in oestrogen can trigger headaches in women. This may explain why more women than men experience migraines.
Some women have experienced migraines since puberty and found that their migraines are linked to their menstrual cycles.
Menopause is often the most difficult time for women suffering from migraine due to fluctuating hormonal levels.
Others have an increased tendency to develop migraines during pregnancy or menopause.
The environment: The factors that can provoke a migraine attack are variable and affect only a small proportion of migraineurs. Commonly reported environmental triggers include bright or flickering lights, loud sounds and intense odours or smells (including from cigarette smoke).
During a migraine attack, sufferers experience a heightened sensitivity to these sensory stimuli, some of which can be as uncomfortable as the pain.
Computer screens: Using a computer for long periods of time can cause problems for a migraineur. Taking regular breaks, using anti-glare screens and having good lighting can help prevent this.
If you use a computer a lot at work, make sure you have a comfortable space. This is so that you can avoid muscle tension building up in the head, neck and shoulders. This muscle tension is implicated in the onset of migraine.
Food: Food-related triggers occur in about 10 per cent of migraineurs.
Many of them crave sweet food items such as chocolate before the start of a migraine, leading them to conclude that the sweet food is a cause. However, the craving itself can signal the start of the migraine.
There is some evidence red wine may trigger a migraine because it contains tyramine, which has been linked to migraine. Tyramine is also found in other food products such as soft cheeses.
Other foods that may trigger an attack include processed foods, which contain nitrates; fizzy drinks, which may contain the artificial sweetener aspartame; and food that has monosodium glutamate or MSG.
Hunger: Missing meals or eating sugary snacks instead of a balanced meal can contribute to a migraine attack.
Insufficient food is probably one of the most important dietary triggers. Eating small snacks at regular intervals can help.
Dehydration: Avoid this by consuming at least eight glasses of water a day.
Exercise: Like sleep, exercise can help to prevent migraine or trigger it.
Regular exercise which is built up gradually can help prevent migraine. This also stimulates the body to release its own natural painkillers as well as improves the individual's sense of well-being and general health.
But sudden vigorous exercise, particularly for people who do not usually exercise, can be a trigger factor.
Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.
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