not consider these to be allergies. For this reason, allergy
testing usually does not benefit the migraine sufferer.
When a trigger food is suspected, the actual dose or
amount of the food is a factor. Some people notice a
headache threshold above a certain size portion.
Sleep
The importance of proper sleep patterns cannot be
overstated. Sleep deprivation is a common trigger of
headaches, and many people are sleep deprived because
of insomnia. Insomnia needs to be managed as part of
the headache treatment strategy. Sleep disorders can have
many causes and these need to be evaluated and treated.
Irregular sleep patterns, common in night shift workers,
are another frequent trigger. Those of us who experienced
migraine as teenagers probably remember the weekend
headaches that seemed to relate to being sleep deprived
during the week and then oversleeping on weekends.
Again, an irregular sleep pattern can provoke migraine
attacks. If a person needs to “catch up” on their sleep
debt, it is better to awaken at the same time as usual, eat
breakfast, and then go back to bed.
Obstructive sleep apnea is often overlooked as a cause
for increased headache frequency. Obstructive sleep
apnea is suspected when you experience non-restorative
(non-refreshing) sleep, nighttime snoring, and daytime
sleepiness. People with obstructive sleep apnea will stop
breathing when their airway is obstructed, and the brain
awakens them before they have a chance to reach deep
sleep, causing sleep deprivation, daytime sleepiness, and
weight gain. Obstructive apnea can be quite dangerous if
it causes you to fall asleep while driving. It is difficult to
get good headache control in people who are not getting
adequate nighttime sleep.
Hormones
Hormonal fluctuations in women are common causes
for migraine, and menstrual-related migraine is not
uncommon. The natural decline in estrogen levels at the
end of the menstrual cycle may be responsible for this
problem. Current data discourage the use of long-term
estrogen in women with migraine, because of the risk of
stroke. If your headache diary indicates a premenstrual or
menstrual migraine pattern, specific medication strategies
might be helpful, including the use of nonsteroidal antiinflammatories (NSAIDs) or long-acting triptan drugs
such as naratriptan and frovatriptan. Again, the headache
diary is very important in making this determination.
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Volume 3, Issue 4 •
141031_LOT A_NHFHeadWise–February.indd 14
Odors
Odors are a common trigger of migraine attacks,
sometimes producing an instantaneous severe headache.
Migraine sufferers generally try to avoid exposure to
perfumes, colognes, or lotions that have a strong smell.
Again, these are not allergic reactions but rather a chemical trigger that leads to a migraine attack. We commonly
hear about inconsiderate coworkers who insist on wearing
offensive scents. In some situations, it can be considered a
hostile workplace because it does cause suffering, absenteeism, and reduced productivity. It is possible to refer to
the Americans with Disabilities Act with the employer
when discussing “special accommodations.” Other odors
such as solvents, paint, glue, etc. can also be a problem in
the workplace. The levels do not need to be toxic in order
to be migraine triggers.
Exertion
Some headache sufferers will notice that their migraine
pain worsens when they exert themselves or strain.
Ironically, regular exercise has a beneficial effect upon
headache frequency, but exercising during a migraine is
often unbearable. At times, a severe headache is provoked
by exertion or exercise. Exertion-provoked headaches are
not