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Food and Headaches

Pain expert Dr. Scott Fishman answers questions about headache pain:

Q: Are most headaches triggered by certain foods or drinks?

A: The role of individual triggers in bringing on a headache depends in part on the type of headache. The infamous triggers that you may have heard about, like alcohol or chocolate, are probably much less to blame for tension headaches than emotional stress or depression. When depression is fueling a headache, the pain may appear soon after waking.

"The science behind studies of food triggers is very poor. Most of the evidence is anecdotal-it's hard to double-blind red wine," says Dr. Elizabeth Loder, Director of the Headache Management Program at Spaulding Rehabilitation Hospital in Boston, referring to the standard study protocol in which both the patient and doctor are in the dark about who is getting the substance being tested and who is getting the placebo.

"Some patients do have food triggers, but they're very individual. Alcohol is definitely a vasodilator, but the evidence on dairy products is uncertain. Same with fruits. I resist giving patients lists of foods to avoid because they can become neurotic about their eating and lose an important pleasure. I suggest that patients eliminate one food at a time for a week or two, then slowly reintroduce them and notice any effects," says Dr. Loder.

The story is somewhat different for migraine headaches. Individual triggers such as food, stimuli, environmental changes, and personal chemistry are a central cog in the migraine machinery. Researchers are certain that triggers can launch a migraine and suspect they can be influential in starting other types of headaches too.

Scientists at the National Institute of Neurological Disorders and Stroke say about triggers: "It's like a cocked gun with a hair trigger. A person is born with a potential for migraine and the headache is triggered by things that are really not so terrible."

Triggers vary from person to person and there are dozens of suspect substances and events, so each headache patient has to discover on her own what sets off the pain. Lists of likely triggers often start with foods or drinks. The most often mentioned are alcoholic drinks, chocolate, aged cheese, the flavor-enhancer monosodium glutamate (MSG), the artificial sweetener aspartame, caffeine, nuts, and nitrites and nitrates, the chemical preservatives found in meats like baloney and salami.

A change in your habits or environment can set off a migraine. Fluctuations in weather, seasons, altitude, sleeping habits, physical activity, mealtimes, time zones and personal schedules have all been implicated. Also, changes in personal habits or patterns, intense activity or a quick drop-off in activity, moving, a dramatic change in your job, or a personal crisis can set off a migraine. Changing levels of hormones, especially among women, may also precipitate a migraine attack.