HEADACHES, MIGRAINE and DIET *
Are Headaches and Migraines different conditions?
The terms Headache and Migraine are often loosely used, and used interchangeably. However, it is worthwhile to try to separate them and differentiate them from each other.
The following is but a brief overview.
Headaches usually involve pain resulting from irritation to nerves and pain-sensitive structures in and around the head and face.
Whereas Migraines, although often involving similar mechanisms to headaches, also generally involve the blood vessels and the blood supply to the head and face.
Headaches are considered to be less severe than migraines. There is a lower intensity of pain, often aching in quality and variable in location. Unlike migraines, headaches are not usually associated with aura-like symptoms (such as visual changes or disturbances) and are infrequently associated with nausea, vomiting or other complaints.
It is generally believed that headaches are the result of irritation to nerves and pain-sensitive structures in the head and neck regions. Because of the way our nerves are arranged in the head and neck, pain in one area can travel or ‘refer’to another part of the head. Hence a problem in one area of the head or neck can be perceived as pain in another part of the head or neck.
The level or intensity of the pain is a poor indicator of the severity of the problem and recurring, persisting or sudden onset headaches always need to be properly investigated.
Common headaches involve pain in or around the head and face regions, on either or both sides, with the pain quality varying from an ‘ache’to deeper ‘boring’pain and even ‘pounding’. The pain may be focused around a particular area (eg in sinusitis) or widespread around the head (eg in a tension headache). As already mentioned, other symptoms such as visual changes, nausea and sensory changes do not usually accompany common headaches.
Headaches secondary to, or as the result of, specific disorders are referred to as secondary headaches. An abbreviated list of disorders and conditions causing secondary headaches follows:
Dietary triggers and eating habits
Dental and jaw problems, including tempero-mandibular joints
Ear, nose and throat problems.
In these various conditions, an appropriate specialist may need to be consulted.
All of the above can cause irritation to the nerves around the face, head and neck, and even inside the skull, resulting in ‘Headache’, secondary to the underlying condition.
Migraines often have similar underlying causes and many people suffer from both, with headaches often progressing to migraines, especially in those who are migraine-prone.
If the headache is associated with one or more of the following, it is quite a possibility that it is a migraine:
- Prodrome –knowing a headache is coming, even before it starts
- Extreme pain
- A feeling as if going mad
- Flashes in vision, or ‘zigzags’, things looking patterned or strange
- Light (photo) sensitivity
- Noise sensitivity
- Pain in one side of the head
- Sense of smell is different
- Difficulty in thinking or speaking
- Increased headache with movement
- Tingling, weakness or numbness in limbs
- Headache lasting between 4 hours and 3 days
In migraine, the pain can be severe enough to disrupt work, home and social life and to make if very difficult to concentrate.
The cause of migraine is not certain. The various disorders and conditions causing secondary headaches may also result in migraine. However the bottom line is that migraine is probably due to changes in blood vessels around the brain. Initially, there may be narrowing of some of the blood vessels taking blood to the brain, ie the arteries. This is responsible for the visual problems that may occur before the attack (seeing flashes of light and colours, having double vision or even a temporary loss of sight). This is then followed by dilation of the arteries, with associated stretching of the nerves around the arteries resulting in the pain.
Migraine sufferers often notice that certain things trigger off the attacks. There may be more than one ‘trigger’involved. Several may be required to reach the threshold level (the full barrel concept) before a migraine results. It is often the final ‘trigger’that is recognised as the ‘cause’of the migraine, whereas it is really the cumulative effect that leads to the threshold being exceeded and the migraine resulting. If one of the earlier factors is not present, then the final factor will not result in a migraine. This explains why some factors, eg a food like chocolate, at times ‘cause’a migraine and at other times can be consumed without a headache.
The things that can trigger a migraine include:
Certain preservatives, eg sulphur dioxide (220)
Lack of sleep
Changes in weather
Some drugs, including the oral contraceptives
Different phases of the menstrual cycle
Weekend or holiday migraines are triggered by hard work ending –a type of withdrawal
There may be no obvious trigger, just the cumulative effect of some of the above until a threshold is reached.
The Prevalence of Headache and Migraine
In Australia, the Australian Bureau of Statistics (ABS) (1995) revealed that 15% of the population was taking medication for headaches. The ABS also showed that headaches were the “most commonly reported individual recent illness condition”. The ABS (1995) indicated that 2.2 million people reported headaches beginning in recent times and 22,000 reported headaches occurring over the longer term, all due to “unspecified or trivial causes”.
Migraine is less frequent in prevalence. Overall, about 10% of people, including children, suffer from migraine, 5% of the male population and 15% of the female population. It is thought that women suffer migraines more than men due to hormonal factors, although it seems that hormones alone are not enough to cause most sufferers to have a migraine: other ‘trigger’events, with the hormonal changes, are generally needed (see above).
The Role of Stress
It is debatable whether stress alone is enough to induce an attack of head pain. That stress is associated with a number of different types of headaches (eg tension headache, migraine) is not questioned. It is thought that stress may have an effect on the nervous system, altering its control of muscle tone and pain tolerance. As already pointed out, migraines have a number of different contributing causes or ‘triggers’. In most cases, a number of these causes interact, or cumulate, or ‘fill up the barrel’, to produce a migraine attack and there is no doubt that stress can be, and often is, a major contributor.
Most headaches are due to non life-threatening causes and can be relieved through appropriate treatment. If the headache is secondary to problems in the ears, nose, throat, eyes, neck or sinuses, then the underlying cause must be treated appropriately rather than just taking drugs to suppress the symptom of pain (the ‘quick fix’). It is important to remember that there is often more than one factor involved, and all need to be investigated (by the appropriate specialist) as necessary, and treated. Stress management is also frequently needed, especially since suffering from headaches and migraine is a stress in its own right, independent of a possible underlying causal stress.
The Role of Diet
One important cause of headaches, and especially migraine, is diet. The contribution that diet makes is frequently ignored, or its significance downplayed.
Once underlying organic disease is ruled out as a cause of the headache or migraine, or if the headache continues after appropriate treatment of the disease, then DIET must be considered as a possible cause (rather than just being a trigger) of headaches, and especially migraine.
It is important to remember that one or a number of problems may co-exist (independent of organic disease).
The role that foods may have in causing disease and symptoms, which include headache and migraine, is set out fully and in detail in ‘How To Stop Feeling So Awful’(see the homepage of this website). It is not always easy to identify individual food allergies or food intolerances. ‘How To Stop Feeling So Awful’, provides the ‘How To’, and chapter 15, titled ‘Suspect, Exclude and Reintroduce’, specifically sets out a practical way to identify the food or foods responsible for headache and migraine. It is a complex topic, but with understanding of the principles, and patience in following the recommended guidelines, excellent results can be achieved.
What then are the common foods that may be involved in causing headaches and migraine?
The following is Appendix VI from “Why Do I Feel So Awful”(Collison, 1989, published by Angus and Robertson but now out of print) and will act as a guideline in recognising foods that have been shown to be linked to headaches and migraine.
Appendix VI –Headaches and Migraine
# Alcoholic beverages, especially red wine and
Monosodium glutamate (large amounts), eg in
Nuts (mainly peanuts)
Cheese –mainly strong and ripened varieties
(cream cheese and cottage cheese are
Protein extracts (yeast) –Marmite, Vegemite
# Chocolate and any product containing cocoa
and cocoa bean, eg cola drinks (Carob is
Sausages -(fermented: Bologna, salami,
# Coffee (as a beverage and added to any other
# Wheat –especially hot fresh (white) bread
In a clinical trial conducted at the London Headache Clinic, the simultaneous exclusion of eleven foods marked with # resulted in 85% success rate in preventing or ‘curing’migraine in a sequential series of new patients referred to the clinic with intractable and continuing migraine, unrelieved by conventional (drug) therapy.
The foods listed in the table are those commonly causing or contributing to headaches and migraine. However, any food, consumed regularly, ie twice or more frequently per week, could be a food to which there is an intolerance and hence be linked to headaches and/or migraine. Identification of such food intolerances is often an essential part of the effective treatment of and prevention of headaches and migraine.
However the eleven foods indicated with # are to be regarded as highly suspect foods.
It is also recommended (in appendix V1) that the following foods be avoided if possible and practicable. All those foods that are:
Appendix V1 also indicates that other common precipitating (trigger) factors include:
oral contraceptive steroids
smoking (tobacco) –even when the smoking is done by others
household gas, industrial fumes, petrochemical fumes and similar
Drug treatments of headaches and migraine are but a ‘quick fix’. It takes time, patience and perseverance to find and eliminate the underlying cause(s), but the end result is worth the effort –a cure, rather than (drug) suppression of the symptom, namely, the pain of headache or migraine.
* Copyright 2006: The Huntly Centre