Like many migraine sufferers, I have spent years trying to identify
what brings them on, but to no avail.  The list of things that I think
might have caused a headache at one time or another is so long,
self-contradictory, and random looking that it's laughable (e.g. "too
many peanut M&M's in one sitting"  "change in weather from cool and
cloudy to warm and sunny"  "sat funny in the restaurant booth while
talking to Brenda til 2:00 a.m."   See what I mean?)  So after 25
years I've decided avoidance of known triggers is probably not the
best strategy for me, and maybe I should find out as much as I can
about what is actually going on while I'm under siege in hopes of
derailing the whole process midway.

While the triggers are unpredictable, and the onset of an episode
often hits like a lightning bolt out of the blue, there are a few
consistent and puzzling elements that my doctor, even at $250/hr, does
not have the patience to explore with me.  I would appreciate a
description of the basic mechanics of the migraine headache (don't
need to be reminded of common symptoms, triggers, etc, just what is
actually happening at the time).  I am particularly interested in
information that might explain the following:

*  Though I've averaged roughly 10 bad episodes a year, they occur
irregularly.  For example, one year I had one every couple of weeks. 
This year I've had three so far.

*  WITHOUT EXCEPTION, the perceived location of the pain is on the
left side of my forehead, temple/eyebrow area.  In roughly 250
episodes, I have *never* had discomfort on the right side of my head.
What's up with this?

*  Almost without exception, unless I catch it early enough to stop it
in its tracks (more about that later), my migraine lasts 2 and 3/4
days, during which I scuff around the darkened house with one hand
pressed to my forehead looking like death warmed over and muttering
incomprehensible things to anyone I happen to run into. What is it
that has to run its course for precisely 2 and 3/4 days?

*  If I am aware enough to notice something's not quite right, I can
often derail the whole process  by (don't laugh now), going through the
Burger King driveup window for a jr.whopper, reg. fries, and large Dr.
Pepper, and wolfing the whole thing down in the parking lot.  Go
figure.  I don't eat beef, don't drink coffee and only occasional iced
tea or soft drinks.

*  Likewise, if I catch it in time, a steady intake of Excedrin
Migraine for three days usually holds it off.  This formula contains
aspirin, acetominaphen (sp?? sorry), and *tada*, caffeine.  Why
caffeine?  And why, when I thought I was on to something, did the
large Dr. Pepper not do the trick on its own?

*  Finally, the connection to appetite.  Inevitably I feel ravenously
hungry for the entire three days, but the mere thought of actually
eating something makes me queasy.  What's the deal here?

For $50, I don't expect any diagnoses, prescriptions, or anything of
even a quasi-professional nature.  On the other hand, I have no
interest in half-baked hypotheses from someone with no more experience
in biochemistry or medicine than I have.  However, in the absence of
concrete explanations, I would certainly accept informed speculation
from a qualified researcher, and references to any recent research
being conducted on the subject.  I would gladly submit to a year's
worth of testing and monitoring if it would allow me to identify the
precise moment my body swings into migraine mode and effectively
redirect it into something more like, oh, I don't know, maybe the way
I feel at the end of an hour-long massage.

---

Clarification of Question by yreka-ga on 21 Jul 2002 13:08 PDT

BTW...that last sentence is a joke.  I don't expect any referrals to
migraine researchers.  I would appreciate a clear description of the
nature of migraines, and any *qualified* researcher's thoughts on the
specific "symptoms" I described and how they are related to the
general migraine process.

Hi,  yreka-ga,

There are many resources online for migraine sufferers. It's a very
widely studied phenomenon because it directly impacts commerce through
lost revenue. I am also a migraine sufferer, and have mostly
eliminated migraines from my life through use of diaries, and
eliminating/moderating controllable triggers.

I'll summarize the findings here, but you may be interested in
perusing the resources yourself periodically for updates on current
research. There is a list at the end of this Answer.


---------------------------------------------
- General Theory on Mechanics of a Migraine -
---------------------------------------------

Migraine is a disease or disorder. Episodes are triggered by many
environmental and physical states. These triggers cause "changes in
brain activity [that] produce inflamed blood vessels and nerves around
the brain."[1] This inflammation is considered to be the result of
"excessive dilation of the cerebral blood vessels". [2] "During a
migraine, inflammation of the tissue surrounding the brain, i.e.,
neurogenic inflammation, exacerbates the pain."[3] A more detailed
explanation of this is that the trigeminal nerve is stimulated by the
trigger, which causes vasodilation (excessive dilation). When this
happens, neurochemicals are released, which "may in turn activate
specific blood cells and cause them to release substances that cause
inflammation." [4]

You most likely came by this sensitivity through genetics -- the
latest research on the matter indicates "migraine is caused by
inherited abnormalities in certain cell populations in the brain." [8]
As a migraine sufferer you have a "vulnerability of the nervous system
to sudden changes in either your body or the environment".[5] When
these sudden changes occur (from triggers), an episode occurs.

To complicate matters somewhat, there is also the "aura of migraine"
that some sufferers report, a pre-migraine sensation of lights in the
eyes or generalized tension. It is "explained by a reduction in blood
flow to specific areas of the cerebral cortex. (...) This is known as
spreading depression." [6][7] Taking medication for migraine at this
point often circumvents the full onset of the episode.

I realize you feel the analysis of your triggers is a dead end, but
it's the only reliable way to control your episodes. "(...) Migraine
is a disease that involves a heightening of one's senses, all of one's
senses. A Migraineur is more sensitive to his or her surroundings,
including light, sound, smells, taste (chemicals in foods), and touch
(including the touch of the atmospheric pressure on one's body).
Awareness of one's environment is critical for a Migraineur." [9]

Of course, there are also uncontrollable triggers -- weather and
hormones (menstrual). But there are also clearly defined controllable
triggers, which "include bright light, chemical smells, second-hand
smoke, particular alcohols such as red wine and some hard alcohols
such as scotch, foods that are known vasodilator such as fish, some
chocolate, aged cheese, and foods which contain nitrates and/or the
radical vasodilator MSG." [10] If you can avoid the controllable
triggers when you know an unavoidable one is coming, you can also
avoid the episode in most cases.

Basically, a trigger causes a reaction in a sensitive area of your
brain, causing specific blood vessels to over-dilate and increase
blood flow, releasing existing neurochemicals which cause
inflammation, which makes it hurt.

--------------------------------------------
- Your Triggers and Observations in Detail -
--------------------------------------------

"too many peanut M&M's in one sitting"  

Peanuts are a known trigger, so yes, this could be the cause of a
migraine episode.

"change in weather from cool and cloudy to warm and sunny"  

Most definitely a trigger -- weather changes are an uncontrollable
trigger.

"sat funny in the restaurant booth while talking to Brenda til 2:00
a.m."

Lack of sleep and exposure to alcohol and nicotine (even the
second-hand smoke often found in restaurants) are known triggers.

*  Though I've averaged roughly 10 bad episodes a year, they occur
irregularly.  For example, one year I had one every couple of weeks. 
This year I've had three so far.

Environmental triggers, as well as personal triggers such as stress
can cause migraines. If you were in a period of high stress at work or
in your personal life, your likelihood of having migraines would go
up. Stress is not caused by only negative events, but also positive
events. Things like moving, a new job, getting married, having a baby
are equally stressful as losing a job, getting divorced, and losing a
loved one.

Triggers work in combination: it would be better to think of each as
having points -- over a certain level (to be determined with the use
of a migraine diary and careful documentation), a migraine occurs. So
while a cup of coffee won't trigger a migraine one day, another day it
may because you also had less sleep, and got a promotion.

To evaluate your particular experience with migraines, a migraine
diary is required.

*  WITHOUT EXCEPTION, the perceived location of the pain is on the
left side of my forehead, temple/eyebrow area.  In roughly 250
episodes, I have *never* had discomfort on the right side of my head.
What's up with this?

It's one of the defining characteristics of a migraine that it can
happen on one side of the head. That it always occurs on the same side
of the head is an indication that for you that's the area with the
sensitivity, and the location of the nerves involved.[11] Keeping a
migraine diary would help you confirm that it's always that side of
your head. I was surprised to find out that while I thought I only had
migraines on the right side, they also happened on the left.

*  Almost without exception, unless I catch it early enough to stop it
in its tracks (more about that later), my migraine lasts 2 and 3/4
days, during which I scuff around the darkened house with one hand
pressed to my forehead looking like death warmed over and muttering
incomprehensible things to anyone I happen to run into. What is it
that has to run its course for precisely 2 and 3/4 days? 

Migraines typically last 3 - 72 hours; some can last for more than a
week -- the numbers are not entirely agreed upon. There is no
definitive answer about why they have specific lengths -- it is as
long as your body takes to develop, then heal, the inflammation in
your brain. However you can shorten the episode by taking the correct
medication before the episode gets established. The only way to do
that is to keep a migraine diary and learn how to predict the onset of
the migraine. There are always signs, but you have to be paying close
attention as they are very easy to miss if you are concentrating on
other things.

*  If I am aware enough to notice something's not quite right, I can
often derail the whole process  by (don't laugh now), going through
the Burger King driveup window for a jr.whopper, reg. fries, and large
Dr. Pepper, and wolfing the whole thing down in the parking lot.  Go
figure.  I don't eat beef, don't drink coffee and only occasional iced
tea or soft drinks. 

If this is the case, you might want to identify the lack of food as a
trigger. This is a common trigger -- balanced nutrition and regular
meals can help mediate the effects of migraine.

*  Likewise, if I catch it in time, a steady intake of Excedrin
Migraine for three days usually holds it off.  This formula contains
aspirin, acetominaphen (sp?? sorry), and *tada*, caffeine.  Why
caffeine?  And why, when I thought I was on to something, did the
large Dr. Pepper not do the trick on its own?

Caffeine constricts blood vessels. Migraine is caused by the dilation
of blood vessels. However, caffeine can also be a trigger (stopping
having caffeine or having too much). You really need to accurate
record your migraine episodes and eliminate all the triggers, then add
them back in.

*  Finally, the connection to appetite.  Inevitably I feel ravenously
hungry for the entire three days, but the mere thought of actually
eating something makes me queasy.  What's the deal here?

Lack of food seems to be a trigger for you. Migraines cause nausea and
vomiting, so the best way to avoid the cycle is to make sure you eat
properly, all the time. You can find foods that aren't triggers as
well, and eat those while having a migraine episode.

"An important substance within the brain - serotonin - is thought to
be a key chemical compound in antimigraine activity. This accounts for
the fact that many of the agents successfully used to treat migraine
are related to the serotonin molecule and may mimic some of its
actions."
http://www.neurologychannel.com/migraine/


--------------------------
- References and Sources -
--------------------------

The Journal of the American Medical Association Migraine Information
Center

1. http://www.ama-assn.org/special/migraine/support/educate/causes.htm
5. http://www.ama-assn.org/special/migraine/support/educate/causes.htm
11. http://www.ama-assn.org/special/migraine/support/educate/types.htm

Neurology Channel - Migraine

2. http://www.neurologychannel.com/migraine/naturalmedicine.shtml
4. http://www.neurologychannel.com/migraine/
6. http://www.neurologychannel.com/migraine/
7. http://www.neurologychannel.com/migraine/symptoms.shtml#aura

Migraine Action Association

3. http://www.migraines.org/myth/mythreal.htm
9. http://www.migraines.org/myth/mythreal.htm      
10. http://www.migraines.org/myth/mythreal.htm

National Institute of Neurological Disorders and Stroke Migraine
Update

8. http://www.ninds.nih.gov/health_and_medical/pubs/migraineupdate.htm


----------------
- Search Terms -
----------------

migraine

--------------------
- ONLINE RESOURCES -
--------------------

MAGNUM, the [U.S.] National Migraine Association 
http://www.migraines.org/

The Journal of the American Medical Association Migraine Information
Center
http://www.ama-assn.org/special/migraine/

Neurology Channel on Migraine
http://www.neurologychannel.com/migraine/

Migraine Action Association
http://www.migraine.org.uk/



----------------------------------
- DISCLAIMER AND RECOMMENDATIONS -
----------------------------------

While this Answer cannot be construed as medical advice (see Google's
general disclaimer below), I would personally recommend you find a
doctor who will be willing to help you identify the triggers and work
to reduce your occurrences of migraine episodes. (See the Neurology
Channel's Natural Medicine page
http://www.neurologychannel.com/migraine/naturalmedicine.shtml for a
detailed procedure). This will require you to be conscientious in
keeping a migraine diary and working through a controlled test of your
triggers, however a doctor more familiar with migraines as a disease
would be able to help you through the process.

"The fact that so many doctors don't take Migraine seriously can be as
disabling to the Migraineur as the disability itself. The leading
doctors in the areas of neurology and head pain have themselves stated
that this disease is grossly misunderstood and misdiagnosed. In fact,
60% of women and 70% of men with Migraine have never been diagnosed
with this disease. This medical ignorance and corresponding inaccurate
writings unfortunately perpetuate the myths and misunderstandings
about Migraine and convey this to the general public."

from: Migraines: Myth Vs. Reality
http://www.migraines.org/myth/mythreal.htm

:) zerocattle-ga

THANK YOU SO MUCH! As my headaches have been relatively infrequent in
the past couple of years, I really needed a refresher on the subject
and just couldn't face it this weekend.  Thank you for your
intelligent comments linking the general facts you found to my
observations.  I have been looking for a new doctor since this one
listened to my desperate questions about the Burger King meal, looked
at me like I was crazy, and said..."hmmmmm. That's funny.  Well, I can
always put you on something."  Unfortunately there's a shortage of
doctors in my community, and signing on with a new one is difficult,
much less being able to choose based on something like interest in
helping solve migraine mysteries.  At least when I make the rounds
I'll have it fresh in my mind what the issues are.  This was just what
I was looking for, and I appreciate your spending the better part of
your Sunday working on it. THANK YOU.

Hello fellow migraine sufferers. A question for all, since I am a
male, very few males get migraines. I've also suffered with them since
early childhood, are you two male or female. I am the only one in my
family to suffer from them and boy do I have a few migraine tales for
you. Most of mine end up in the ER, last one, took morphine, IV to
control it. Threw up for 14 hours. My late aunt was the only person
that I could talk with and understand  what she and I went through.
yreka, my aunt also had the "dark" room. I wish I could find a trigger
for mine, they are infrequent, but they are B-A-D. I am taking the
following medications to avoid/help my migraines. .05 mg Zanax, taken
in 1/2 (.25) doses along with Tylenol # 3 with codine. Again 1/2
tablet. Excedrine migraine, 1/2 tablet, although yreka, I get "wired"
from all the caffine. Another point about the caffine in soft drinks,
it's diluted and it may not be as readily absorbed as the Excedrine. I
am now 40, and the "doctors" said my headaches would subside, they
did, to a point. I cannot take any medication from the sumatriptin
(Imitrex) family. And finally, my diet, I virtually eliminated
everything "they" told me to, including nuts, I don't eat peanuts
anymore. I still get the headaches. I've experienced the worst of the
worst, is when I awaken with a migraine. I don't know what happens
while I am sleeping, but when I wake up, it's there. Until medical
researchers get some migraine sufferers into a MRI machine and can see
what is happening while its occurring, it will be a while before we
fully understand the key factors that make the migraine happen. One
can only hope.

Hi,

Just wanted to say this was an excellent answer given by zerocattle!

My story: I've been a migrainuer since age 3.  Can remember my dad - a
physician - putting wet rubbing alcohol cloths on my forehead to cool
me down when I was very young.

Over the years they increased to severity proportions that went from
very bad to much worse.  In my 30's (I'm female) they increased in
frequency and also duration.  Very little was understood at the time,
so basically I suffered through the light and sound sensitivity,
nausea, and pain, without much relief until the episode diminished on
it's own... taking doses of tylenol or aspirin.  Nothing worked.

In my 40's I was carried to the Emergency Room several times - to ill
to walk - given demerol and told to go home and sleep it off. I became
allergic to demerol and codeine.

I was also told by doctors more than once I would eventually "outgrow"
the frequency and duration time of flareups.  It was difficult to hold
a job, because of missed work.  Spouse didn't have a clue and got fed
up.

The bottom line is Imitrex Injections were made available to me, once
the FDA approved this drug.  Amazing results.  Once the pills were on
the market I switched to them.

The episodes are less frequent, less severe, and diminish faster.  At
the tender age of going on 60 in 2 months - I finally have "outgrown
them".

Things I did to help not get them when they were most frequent: 
Eat non-triggering foods, get plenty of rest because not enough or too
much sleep can be a trigger, be aware of weather changes and do what I
could to stay mellow during storms (yes atmospheric conditions are
triggers!), avoid all perfumes, smoke, odd smells, keep a diary of day
to day events, foods eaten and amounts of sleep.

Things I did when having a migraine before Imitrex:
Darkened room (bought myself a neat cover for my eyes to cut out the
light, quiet quiet quiet, plenty of water, tylenol or similar meds,
eat lightly when I was up to it (for some reason bagels were very
appetizing and comforting to me), and generally waiting until the
pain/discomfort/nausea dissipated before returning to humanity. 
Sometimes this would take up to 4 days from start to finish.  I also
suffered the "auru" effect during the flare and had many lightshows
going on inside my head.

The hunger you mentioned is another thing that I went through prior to
an attack.  Some people (I'm one of them) will get very hungry right
before the onset.  Sometimes wanting weird combinations of food.

Smells are a huge trigger.  Once I worked on the 3rd floor of an
office building, but the office I was in was located next to an
elevator that opened up to the alley on the ground floor.  Diesel
trucks would park while making deliveries to the building and the
fumes would rise up through the elevator shaft into my office.  The
episodes I had then would be categorized as the worst.

The heat coming out of the top of my head was so intense... I don't
know if you have that also, but any type of cold will pull some of the
heat out.

Cold packs on the eyes help.  In closing, one of the more comforting
factors which mitigated my suffering was when more and more
discoveries were made about the trimengial nerve, causes, etc. 
Finding a sympathetic doctor is paramount.

I wish you good luck and if Google Answers had existed in those days
when I was having frequent attacks I wouldn't have had to do my own
research.  Finding information at the time was very difficult - not
much was known - except over and over I would read: If a family member
had severe one-sided headaches it's most likely a genetic background
thing.

tlspiegel-ga

One more small tip: Goody's Headache Powders contain pretty much the
same ingredients as Excedrin Migraine (acetaminophen, aspirin, and
caffeine), but come in a powder form. I started getting migraines just
a few years back, and had a few horrible ones, but since I've taken to
carrying my Goody's, I take one as soon as I start getting tunnel
vision (which is my first indication), and haven't had one since. My
theory is that the marginal amount of time you save dissolving a pill
can make a difference in getting to the migraine before it's had a
chance to take hold. I have not had a full-blown migraine since I
started this. That's not to say it will work for you, but it might be
worth a try.

If you decide to try this, do not carry the powders individually. Keep
them with the box. The individual doses are a white powder in small,
unmarked pieces of waxed paper, and they look mighty fishy. You don't
want to get pulled over and have one of these lying on the seat next
to you.

You should be able to find Goody's in any well-stocked pharmacy,
particularly those that cater to older people. Other available brands
are Stanback and BC, which I suspect are equivalent, although I
haven't tried them myself.

Oh, and get away from flourescent lights immediately if you feel
something coming on. These are a big trigger for me, and I can't
imagine they wouldn't exacerbate any migraine.

A few more interesting triggers that I've been lucky enough to be able
to pin-point, and do some research on:

1) Aspartame, Nutra-Sweet, Saccharin, or any other form of "artificial
sweetener".    There have been studies done where people (mostly
women, but also men) have had adverse effects from these drugs... if
you search "artifical sweeteners" at http://answers.google.com you'll
be able to look at a few links I posted.  If your Dr. Pepper was diet,
that may be one of the reasons it didn't help.

2) Corn products.  I know it sounds funny, but any kind of oatmeal,
cornbread, etc kind of thing will make me (and actually one of my
friends as well) have horrible migraine headaches.. This is the only
one that I have found no research on, although I'd appreciate it if
someone else knows about it and would let me know. :)  I've been told
that it may be "tannins", which is a VERY INTERESTING migraine theory.
Here's an article: http://www.widomaker.com/~jnavia/tannins/tanngood.htm.
 This part of the page
http://www.widomaker.com/~jnavia/tannins/index.html, could very well
describe why certain smells seem to CAUSE migraines (it's obvious why
any smell could make a migraine seem worse).


3)  Some of us are hypoglycaemic (need more sugar, kinda the opposite
of diabetic), and need to have good blood sugar levels.  Usually this
means eating more frequently (ie, 6 small meals a day instead of 3
large ones)... I KNOW that when I don't eat for more than 4 hours, and
am starving, I get hunger pangs, and then I get a huuuuuuuuuuuuuuuuge
migraine.  And, eating after this will NOT help, after it's already
started, you have to eat beforehand.


I know this isn't much research, more personal opinion, but I've kinda
given up on research right now, and just wanted to add, maybe some
will help. :)

-Rebekah

Since I had my first migraine with the onset of puberty, I had the
foresight to keep a record of what I had eaten and what activities I
had partaken in prior to the attack.

Like some sort of weird combination thing that the Joker uses to
poison people in 'Batman'...

This list may give you a few pointers, but we are all different!

Migraine #1: Sleepover in a living room where the homeowner was a
pipesmoker; VERY stained ceilings!

Conclusion: Lack of sleep/secondhand smoke

Migraine #2: A lunch of: Cheeseburger, pint of Bitter (English ale),
and chocolate cake (rather typical) followed by *gulp* a lengthy
lovemaking session; led to foaming at the mouth and 8 hours in
hospital

Conclusion: Cheese/alcohol/chocolate and physical exertion

Migraine #3: Staying in the single bed of my girlfriend after a heavy
nights drinking (again with lovemaking) AND she smoked a lot...

Conclusion: Again; smoke, lack of sleep, alcohol

Migraine #4: Boring day at work staring at monitor all day,
cheeseburger for lunch, bright office lights

Conclusion: Lights, cheese, tiredness

Please don't assume I'm confusing hangover with Migraine, but I have
only had 4 major attacks in 10 years as I've become adept at catching
them in time.

My remedy if not caught in time: Blindfold, NOTHING to eat or drink,
and SLEEP.

Hope my comments help.

Yreka's headaches always hurt on the left side of the head. Why?
Nobody knows why migraine is so often one-sided. I'd guess it may be
simply because the nervous system and the head are not perfectly
symmetrical.

Why do yreka's migraines always last two-and-three-quarter days?
Nobody knows why migraine episodes last as long as they do. I would
venture that the reason migraines last for hours is that it takes that
long for the nervous system to adjust and correct the neurochemical
malfunction that causes migraine symptoms.

Why is yreka's migraine pain centered on his left forehead, temple/
eyebrow area? Migraine pain is often highly localized. I believe
migraine symptoms originate in the major sensory apparatus of the
head. That would explain the typical locations of migraine pain as
well as the sensory disturbances associated with migraine. The area
yreka describes is near the left retina of the eye and the left
olfactory bulb (just behind the inner end of the eyebrow). I believe
the dense concentrations of sensory neurons (nerve cells) in the
retinas and olfactory bulbs release adenosine during a migraine
episode, and that adenosine causes the pain and other symptoms of
migraine. The pain is highly localized because adenosine, once
released from neurons, is quickly dismantled or removed, so doesn't
travel far.

I believe the nausea and vomiting associated with migraine is caused
by a disturbance in the normal neurochemical functioning of neurons
(nerve cells) in the vestibular apparatus and semicircular canals (the
organs of balance located in the inner ears).

Why does Dr. Pepper and Excedrin relieve yreka's migraines? Because
caffeine blocks the action of adenosine by occupying and blockading
adenosine receptors.

Why does caffeine head off yreka's migraines only if yreka takes it
early enough? Because caffeine can block adenosine receptors but
cannot remove adenosine already bound to adenosine receptors. Once
yreka's adenosine receptors are sufficiently saturated with adenosine,
if yreka takes caffeine, there may not be anything the caffeine can do
to help. All it can do is wait around for adenosine receptors to
become open and available, then must compete with adenosine for access
to the receptors.

That caffeine relieves yreka's headaches suggests yreka's migraines
are caused by caffeine withdrawal. It may be caffeine relieves yreka's
headaches by reversing caffeine withdrawal. That would readily explain
both yreka's headaches and caffeine's ability to relieve yreka's
headaches, anyway. Otherwise, yreka's migraines are a complete
mystery.

Why is yreka ravenously hungry during his two-and-three-quarter day
migraines? I could speculate but I don't really know.

Some of the information in zerocattle's answer is inaccurate. For one
thing: migraine is NOT caused by dilated blood vessels. The vascular
theory of migraine has been discarded by headache researchers and
theorists. The vascular dilation that accompanies migraine is
secondary to migraine (is a symptom of migraine, not the cause of
migraine symptoms).

Caffeine does constrict blood vessels but does not relieve migraine by
constricting blood vessels. Caffeine relieves migraine via a
neurochemical action: caffeine occupies and blocks adenosine
receptors. Adenosine is a neurotransmitter chemical — a chemical used
by neurons (nerve cells) to communicate with one another. Adenosine
causes pain and vasodilation, and caffeine relieves those symptoms by
blocking the action of adenosine (by preventing adenosine from binding
to adenosine receptors). Instead of:

caffeine --> constricts blood vessels --> relieves pain and other
migraine symptoms

...it's:

constricts blood vessels <-- caffeine --> relieves pain and other
migraine symptoms.

Many people believe certain foods give them migraines (or "trigger"
their migraines), but no food has ever been demonstrated to cause or
precipitate migraine. The theory that foods are migraine triggers is
therefore nothing more than a popular myth.

Does the weather cause, trigger, or influence migraine? I've carefully
read all the medical literature regarding this question — ALL of it —
I'm not kidding — and there simply is not any convincing evidence
weather influences migraine. People simply associate their migraines
with certain types of weather or changes in weather, but these
associations are either not real or coincidental. Besides: what can
you do about the weather? Move? Any evidence moving helps migraine?
Unfortunately, no. We have mild weather year-round here in California,
yet we Californians get our fair share of migraines.

Odors don't cause or trigger migraines; it's the other way around:
migraine makes people more sensitive to odors, so they notice the
odors and associate the odors with their migraines. So the idea that
odors trigger migraines is another example (like the vascular theory)
of mistaking migraine effect for migraine cause. The giveaway is that
many people who claim odors trigger their migraines report that the
headache starts immediately (within minutes of smelling the odor).
Well, by the time the headache phase begins, the migraine episode has
been developing for some time, so the odor could not have caused the
closely-following headache. Migraine often causes amplification or
distortion of the sense of smell; this migraine symptom is called
olfactory aura. Some migrainers may even experience olfactory
hallucinations. I believe olfactory aura is caused by a disturbance in
the normal neurochemical functioning of the olfactory bulbs, located
right above and between the eyeballs.

Most suspected triggers are innocent. Peanuts, aspartame (NutraSweet),
monosodium glutamate (MSG) are all accused of triggering migraine, but
none of these have ever been demonstrated to cause, promote, or
precipitate ("trigger") migraine.

The problem with the trigger theory and with encouraging migrainers to
look for associations between anything and their migraines is that of
course they will find associations between all sorts of things and
events and their migraines. But very often these associations are
either not real, or, if real, are coincidental, not causal. Most
non-scientists are terrible observers and keep poor records or no
records. People typically notice and remember positive associations
(it rained and I got a migraine) but fail to notice or remember (or
note) negative associations (it rained but no migraine, it didn't rain
but no migraine, it didn't rain and a migraine), which are just as
important as positive associations. You cannot rule out coincidence if
you observe only one subject (yourself, for example). To rule out
coincidence you have to have a group of people, divide them into two
groups, expose one group to the suspected trigger factor, and see
whether one group gets more migraines than the other.  When you do all
that, turns out foods don't cause (or promote, etc.) migraine. The
other problem with trigger avoidance is that it is NOT an effective
approach to treating migraine. Although almost any change in diet
tends to improve migraine, this is due to the placebo effect. (An
effective therapy is one that is MORE effective than placebo.) It's a
shame so many migrainers have been sent on a wild goose chase and have
limited what they do or eat, all for nothing. You still see the
trigger theory promoted in popular migraine literature, but if you
read the medical literature you will find that years ago scientists
stopped mentioning it.

Having said all that, there are some factors that DO promote migraine
episodes. Such factors include ethanol (drinking alcohol) (grape wine,
especially), intense sunlight, and estrogen withdrawal, among others.
But these factors, though they promote migraine episodes, do not CAUSE
migraine.

A MASSIVE, and frequently overlooked cause of headaches is from being
backed up in your intestinal system [either with or without a feeling
of constipation].  In fact, I would venture to guess that a good
number of them are caused by this.   Mine disappeared when I reaized
the connection.  See how your headaches correspond with eating pizza
for lunch and then a subb for dinner, for instance.  No different than
throwing a potato in the exhaust pipe of a car.  America eats a lot of
meats, white breads [with hardly any fiber], not enough water, and not
enough exercise and fiber.  You can put up wallpaper with white flour
and water.  It turns to a rock in your colon.    Headaches are like
the alerts on the dashboard of a car.  They're your body's way of
telling you something.  I had a colleague at work who was hospitalized
because of his migraines.  They gave him medication.  Had no real
answers for him.  I told him about this connection with
bowels/headaches.  He changed his diet, increased water/fiber,
exercise etc. and his headaches disappeared as quickly as they came.

I'd just like to add, that as a lifelong migraine sufferer that I'm
glad I finally discovered Immigran - a drug that can stop an attack in
its tracks within about 20 minutes.

I'm amazed at how many migraine sufferers don't know about this drug.
Perhaps it's because it's an expensive one, and some countries have
made it difficult to get on it without pursuing all other avenues of
medication first. In Australia, Medicare requires you to go on beta
blockers first for a while to see if they help. My doctor said it
rarely worked for anyone, but she was forced to put me on them due to
the prescriber rules.

Anyway, Immigran in Australia costs about $15 for a pack of two
tablets (much more expensive in the US, I'm sure...) and one tablet
will make an attack go away.

The drug information says it only works well if you catch the migraine
early on, but I've taken it once the migraine was in a fairly advanced
state (started at work, and had to get home before I could take an
Immigran) and it still worked fine.

After taking the drug, I usually lie down and go to sleep for a few
hours. Afterwards, you feel a bit 'washed out' -- but much better than
you would if you had let the migraine run its course.

On a couple of occasions I've felt a migraine coming on at work and
taken an immigran, and been able to keep working. (I wouldn't by
choice, but it was one of those cases where several hundred people
were being flown in for a presentation the next morning, and the
presentation -had- to be done).

Thought I'd pop in here this afternoon to refresh my memory again, and
want to thank everyone who's added comments in the past several
months.  I hope some migraine sufferers will benefit from this ongoing
discussion.  Yreka