This is another draft extract from a book based on my personal experience of migraine which I am currently writing and hope to publish next year. I would like to include some short contributions from other people too, so if you have anything you would like to share about this or any other aspect of migraine, please leave a comment below or write to me through the contact page of my website jenniferbarraclough.com.

Stress is known to contribute to many medical disorders, presumably because of the impact of hormones such as adrenaline and cortisol, generated through the sympathetic nervous system, upon the body and brain. Many migraineurs cite stress as their top trigger factor, while others vehemently deny that stress has anything to do with it at all. Some of my own attacks have clearly been induced by stress, whereas others have apparently come out of the blue. Many people talk of stress without really thinking what they mean, and it is too easy to say of migraine or any other condition “It’s due to stress” or worse “It’s just due to stress”, when this may not be the case at all and is certainly not the whole story.

Feelings of stress are usually blamed on outside circumstances, the negative events and ongoing difficulties which are an inevitable part of life. But it is individual responses which determine how stressful these experiences are perceived to be. Responses depend both on mental attitudes and physical constitution. There is evidence that the sympathetic nervous system tends to be overactive in migraineurs even between attacks, causing them to live in a state of chronic low-grade physiological stress, perhaps without knowing it. This would explain why therapies which promote relaxation, such as biofeedback, are effective for migraine prevention.

One common source of stress is an accumulation of the hassles and demands of everyday life in the modern world – juggling work, household and family responsibilities, financial strain, discord in relationships, transport delays, a deluge of emails and media posts. Pressure can intensify at times which are supposed to be enjoyable, such as holidays or Christmas, when organising the preparations is combined with changes to routine and possibly physical stress from lack of sleep, unfamiliar foods or missed meals, and excessive exertion.

Even when there is no external cause, people can generate stress for themselves by setting unrealistically tight deadlines or high standards, mulling over regrets about the past or anxieties about the future.

Migraine itself is a potent source of stress, and vicious circles can develop, as in the case of someone who is worn out after a busy period at work, gets a severe migraine and has to take a few days off. There is nobody else to cover for them, so on returning they find a backlog of tasks has built up so that the workload intensifies, and leads to another attack. After this scenario has been repeated a few times they either lose their job because of being unreliable, or feel compelled to resign, and then experience the stress of unemployment and financial hardship. 

The relationship between stress and migraine is not straightforward. It is recognised that some migraineurs manage to cope with intense pressure during the week, but get an attack at the weekend when in theory they have time to relax. Not all stress is bad. In the days when I was prone to severe migraines, I found that working very hard on a project that was important to me did not bring on an attack. Situations in which I felt frustrated and not in control, for example having to attend long meetings of little interest or wait hours in airports for delayed flights, often did.

I may be wrong but I have the impression that major crises, stressful though they are, do not necessarily trigger migraines and might even protect against them. A woman once told me that her severe and frequent attacks had stopped for several months following the sudden death of her child. I experienced something similar a few years ago when my husband was critically ill at the same time as my mother was dying. Although I became unwell myself with other mental and physical symptoms during this period, I did not get any migraines. I have never seen this phenomenon described in the literature and would be interested to know if others have experienced it.

This is a draft extract from a book, based on my personal experience of migraine, which I am currently writing and hope to publish next year. I would like to include some short contributions from other people too, so if you have anything you would like to share about this or any other aspect of migraine, please leave a comment below or write to me through the contact page of my website jenniferbarraclough.com.

People who are vulnerable to migraine often report that dietary factors – foods, drinks, and meal patterns – can trigger their attacks, and this is certainly true in my case. Eating cheese is the worst thing for me. It took many years to recognise this, which now seems strange, but because it was something I used to eat almost every day when I was younger I didn’t notice a connection. Also, this was years before it was possible to look up health information on the internet, and we were not taught much in medical school about relationships between diet and disease. Cheese, especially strong aged ones, is implicated for other migraineurs too and this is believed to be because it contains high levels of a biogenic amine called tyramine. This substance gets metabolised in the gut by an enzyme called monoamine oxidase, but people who only have low levels of this enzyme cannot process it fast enough, so that it builds up in the body and can cause not only migraine attacks but also increases in blood pressure and symptoms such as nausea, sweating and anxiety. Other high tyramine foods which are sometimes implicated in migraine include chocolate, processed meats such as bacon and salami, smoked fish, raw onions, fermented or pickled vegetables, broad and fava beans, oranges and other citrus fruits, ripe bananas, pineapples and avocados. None of these disagree with me like cheese does, so I suspect that the combination of chemicals besides tyramine found in different items of food is involved in individual sensitivities. While some migraineurs benefit from a low tyramine diet, others have reported benefit from gluten-free, dairy-free or ketogenic diets, or from giving up all forms of sugar.

While some foods may be best avoided, the good news is that others – those containing high levels of omega-3 fatty acids – have been found to reduce the frequency and severity of attacks. They include oily oily fish, dark leafy greens, chia seeds, flaxseed, tofu, walnuts, and eggs. 

Alcoholic drinks are often blamed for precipitating migraine attacks. This may not be due so much to the alcohol itself, as to the fact that they contain various other chemicals, again including tyramine. I love wine, so am glad to say that white or rose in moderation is not a problem for me, in fact it is probably helpful because of its relaxing effect. Red wine is more risky, and is notorious for provoking headaches even in people without migraine, probably because of its quercetin content. I seldom drink more than one glass of anything nowadays, having found in the past that just a slight excess can be followed by a whole day of feeling very ill with a ghastly mixture of migraine and hangover symptoms. When cheese and wine parties were fashionable they often proved a disaster for me.

Coffee, and other caffeinated drinks, are migraine triggers for some people. I am fine with one double shot flat white or Americano mid-morning, but not more. Sudden withdrawal of caffeine can also lead to an attack, so it is best to keep a fairly constant intake. A few years ago I spent a week at a health resort where coffee was forbidden. I had cut down on it the week before but still had a nasty headache for the first three days, though this did not develop into a full-blown migraine. Paradoxically, caffeine is present in some over-the-counter medicines for migraine, and black coffee has been found helpful during attacks as a treatment for people who do not usually drink coffee at all.

The timing and size of meals is important, as well as the type of food and drink they contain. Going too long without food or water can precipitate a migraine attack, but so can eating too much at one time, so it is important to maintain a reasonably regular meal schedule and to avoid dehydration.

Food triggers may be hard to identify because there can be a delay of hours or even days before their effects develop. If someone gets a migraine soon after eating a certain type of food they may develop a fear of that item and avoid it in future, although the attack may actually have been caused by something else. There may be a psychological element involved – for example if I have given in to the temptation of eating a piece of cheese, I usually worry about it afterwards and my anxiety may increase the likelihood of an attack. 

Avoiding alcohol, caffeine and all suspected food triggers requires a lot of will power, is awkward in social situations, and makes for a somewhat joyless existence for those who enjoy eating and drinking. Some of the “migraine diets” to be found on the internet appear impossibly restrictive and might even cause nutritional deficiencies in the long term. Dietary triggers are not the same as allergies in which eating even a tiny amount of a certain food, peanuts for example, is quickly followed by a severe reaction or even death. Many migraineurs can get away with eating their trigger foods in small amounts now and then provided they are not exposed to other risk factors at the same time.