Precipitating Factors

Although the tendency to have frequent headaches is probably inherited, the way you live your everyday life could influence how often those headaches occur. If headaches are a serious problem for you, it makes sense to pay extra attention to factors that could trigger or aggravate headaches.

Potential headache precipitating factors (triggers) are many and varied. Different types of headaches have different triggers. Triggers are not the same for everyone, and not necessarily the same for different attacks in the same person. Identifying triggers may be complicated by the fact that it often takes a combination of triggers to set off a headache. For example, a stressful day followed by a few glasses of red wine that evening and oversleeping the next morning might trigger a migraine whereas red wine at lunch may have no effect. The major groups of precipitating factors are: dietary, environmental, hormonal (women), medications and physical and emotional factors.

Diet

Headaches can be triggered by insufficient food, missing meals, delayed meals, eating too little and dehydration. Fasting is recognized as a trigger and could be due to a lowered blood sugar level. Eating every four hours during the day will help keep blood sugar stable. Those who frequently wake with a headache may find a snack before bed will help.
Dehydration should be guarded against. The average person needs 1-2 litres of water per day to keep blood volume level high. In periods of high temperature or high activity, the body loses extra water through perspiration, and one needs to drink more.

There has been a great deal of interest in nutrition and dietary factors, and it is natural for patients with a chronic problem like headache to wonder about substances in food that might affect headaches. Although there are some exceptions, in general patients who suffer from migraine notice more food related problems than do patients with tension-type headache. People with cluster headache should avoid alcohol during cluster periods but generally do not report food sensitivities. Most adverse reactions to dietary ingredients are probably sensitivities rather than true food allergies. There is insufficient evidence linking headache and dietary agents, apart from alcohol, but there is no harm in determining triggers and restricting diet accordingly, providing a balanced diet is maintained.

Specific Foods regularly mentioned as potential triggers include:

  • chocolate: recent research, however, indicates that craving for sweet things is a pre-headache symptom (as much as 48 hours prior) and, if chocolate is eaten, can wrongly be though to have triggered a headache. If this could apply to you, try eating slow release carbohydrate such as a wholegrain sandwich, pasta, or fruit, when the hunger cravings strike, instead of a sugary snack.
  • citrus fruits
  • some dairy products (aged cheeses and cultured products)
  • Monosodium glutamate (MSG)
  • nitrates and nitrites found in processed meats such as sausage
  • Aspartame (artificial sweetener)

Foods less frequently mentioned include:

  • bananas (esp. overripe) and avocados
  • fermented products such as beer, soy sauce, sauerkraut, vinegars (use white)
  • pork products
  • peanuts, peanut butter
  • lima beans, navy beans, pea pods

Alcohol especially red wine, has been long thought of as a cause of headache, as is too much of any alcohol.

Caffeine can be both a treatment and a cause. In small amounts caffeine can improve the analgesic affects of paracetamol and aspirin and is a common ingredient in medications. Some find strong coffee or a cola drink early on during a headache will abort or modify the attack. However, caffeine consumed frequently or in large amounts can cause a withdrawal headache.

Environment

Environmental triggers reported include:

  • Bright or flickering lights
  • Bright sunlight, glare
  • Computer – overuse, incorrect use
  • Loud sounds
  • Pollution
  • Strong smells, e.g. perfume, gasoline, chemicals, smoke-filled rooms, various food odours
  • Travel, travel-related stress, high altitude, flying
  • Weather changes, changes in barometric pressure (likewise, decompression after deep-sea diving).

Hormonal (Women)

As three times as many women suffer from migraine headaches than men, and this difference is most apparent during the reproductive years, female sex hormones are implicated as a significant trigger for women. Hormonal triggers may be:

  • Climacteric (final menstrual period)
  • Menstruation
  • Ovulation
  • Oral contraceptives
  • Pregnancy (may worsen for first few months but usually improves in latter part)
  • Hormone replacement therapy (HRT)
  • Menopause

Medications

Certain medications may cause headache as a side-effect such as

  • some medications for heart conditions such as glyceryl trinitrate
  • some drugs for high blood pressure
  • overuse of symptomatic pain killers (such as paracetamol), triptans and ergotamine
  • stopping use of some medications can precipitate “rebound headache” because of the rebound dilation of vessels following use of any substance causing them to constrict.

Physical and Emotional

Physical and emotional factors that can precipitate headache include:

  • lack of, or too much, sleep such as oversleeping (even as little as half hour difference in routine, e.g. sleeping in on weekends)
  • stiff and painful muscles, especially in scalp, jaw, neck, shoulders, and upper back
  • health problems such as eye and dental problems, sinusitis, colds and flu; spinal problems, and high blood pressure
  • sudden, excessive or vigorous exercise
  • sexual intercourse (coital headaches): affects men more than women and is more common in people who have migraine or high blood pressure
  • blows to the head (footballers’ migraine): some young men develop blurred vision within a few minutes of being hit on the head by a football, the visual disturbance can be followed by a headache; and pressure on the head
  • goggle migraine: some swimmers experience throbbing headaches in both temples one to two hours after swimming, the solution is to wear goggles with a single soft-rubber rim that fit around both eyes, and do not require a tight head-strap
  • emotional triggers such as arguments, excitement, stress and muscle tension
  • relaxation after stress (weekend headache): it is probable that during prolonged stress, tone in the brain and scalp vessels is maintained by the nervous system or by chemicals in the bloodstream such as serotonin and noradrenaline and when the working week ends, and the person can relax, the vessels tend to dilate causing headache

References

  • Migraine and Other Headaches 2000 Professor James Lance
  • Understanding Migraine and Other Headaches 2002 Dr Anne MacGregor
  • Headache in Children and Adolescents 2001 Paul Winner & A. David Rothner
  • Littlewood et al., 1998 from Mechanism and Management of Headache 6thed James W. Lance and Peter J.Goadsby
  • Headaches Paul Spira 2000 Health Essentials
  • Migraine Association of Ireland
  • The Migraine Trust, United Kingdom
  • Migraine Action Association, United Kingdom