Migraine Triggers: Cup Theory
A large part of migraine management is understanding your individual migraine triggers and how to manage triggers to avoid an attack.
What is Migraine?
Migraine is a complex neurological disease that causes so much more than a bad headache. Scientists are still learning about how the disease begins and progresses, but it seems to have genetic and environmental components. Scientists believe chronic migraine is caused in part by a dysregulation of pain input in the brain. This causes the nervous system to become sensitized or overly sensitive to stimuli that would otherwise be normal. Most people wouldn’t be bothered by something like flashing lights. But, to an overstimulated migraine brain, flashing lights could be enough to push an already overexcited brain into a migraine attack. Any of these otherwise normal stimuli can become migraine triggers for people.
Migraine Triggers
A migraine trigger is a individualized stimuli that can make it more likely that someone will experience a migraine attack. One of the most difficult things about migraine is that while there are common triggers, they are all individual and specific to a person. This means it can take a lot of trial and error for people to find and avoid their migraine triggers. Additionally, everyone’s individual triggers have different thresholds that can cause an attack. For example, I cannot eat any gluten or I will experience an attack. However, with my citrus trigger I don’t have to worry about lime in my rice, but I probably shouldn’t drink a whole glass of lemonade. It takes a lot of observation and documentation for a person to understand their triggers.
Uncontrollable Triggers
Many migraine triggers are environmental and basically impossible to avoid completely. Some environmental triggers can be hot or cold weather, barometric pressure, seasonal allergies, loud noises, and bright or flashing lights. Other triggers that may be out of a person’s control include stress (my first bad attack that sent me spiraling was right before the 2020 election…), hormone fluctuation, and strong smells. Sometimes you are able to remove yourself from these situations, but sometimes you’re just stuck next to someone with strong perfume on. In these situations, it’s handy to have an abortive option ready like this Nerivio device.
Controllable Triggers
Other triggers can be controlled once they have been identified. Things like poor sleep habits or skipping meals can be triggers for people. Many common triggers are dietary. Common dietary triggers are alcohol, caffeine, chocolate, MSG, artificial sweeteners, citrus, and foods containing a compound called tyramine. Trying to identify these triggers is difficult and usually requires a person too keep a detailed food journal. If you suspect you have dietary triggers check out this post and the app N-1 Headache I used to identify citrus as one of my triggers.
Cup Theory of Migraine Triggers
Cup theory of triggers is basically that you have a cup that can only hold so much water. Each trigger will add water to your cup. Some trigger might add a splash while others might a large pour. When your cup is full, it will overflow and cause an attack. When you are in a state of chronic migraine your cup may have gotten damaged from all the attacks or from medication adaptation. So, you have two options lessen the amount of water being added to your cup, or work on heathy habits that will help you build a bigger cup to hold more water. By combining these two ideas hopefully you will be able to avoid future attacks.
How to build a bigger cup?
Like a lot of chronic conditions, healthy habits like a set sleep schedule, exercise, mindfulness, and regular meals can help build a bigger cup to hold more water before you tip over into an attack. Building a bigger cup comes after you begin to get a hold of other triggers. Let’s be honest, you’re not going to go for a run when your dizzy and nauseous. However, once you begin to get a hang of your triggers and begin to avoid attacks building a routine to move your body may help prevent future attacks.
Preventative medications are another big way to get a bigger cup. If you are having 4 or more debilitating headache days a month, a preventative medication on board can help build a bigger cup. Every month when I inject Emgality, I feel like I’m getting a buff in a video game! If you aren’t able to find a doctor, places like Cove and Nurx offer prescriptions through telemedicine.
Diseases affected by lifestyle factors are hard! It takes a lot of commitment and understanding your own body. If you are on the road to identifying your triggers be patient with yourself. It’s a lot of hard work, and unfortunately it’s hard to find doctors who are really knowledgeable about migraine. So, that leaves a lot of us to become experts in our own disease. I’m rooting for you, and I’m happy to answer any questions or help you find the answer. You got this!
