We have all heard about triggers and migraine. The word 'trigger' is a common term used to describe those things that seem to set off a headache. Sometimes it seems quite obvious as to what may have pushed us into a headache or dreaded migraine and other times there does not seem to be any pattern or reason to it.
How can we make sense of such a confusing subject and how can understanding our 'triggers' help us manage our Migraines better?
From the research, we know that Migraine brains are overly sensitised. This means that a migraine brain responds differently to various stimuli. Its fight or flight system is slightly more wound up, its reflexes are a little more responsive and it struggles to dampen down signals from our sensory system. This sensitisation can happen to varying degrees and seems to be further sensitised by our 'triggers'. This system is quite complex but a way to get your head around it is to think of it using the following analogy.
Picture the migraine brain as an empty glass with a set capacity or 'threshold'. This glass can only hold a certain amount of fluid (triggers) before it breaches its threshold and spills over. Now think of your genetic predisposition to migraines as already partially filling that glass.
This means that everyone's starting level is different and your 'triggers' are the things that intermittently add more fluid to this already partially filled glass.
How much each trigger fills the glass and how long it keeps this level raised is unique to the trigger and each individual. For some, it only takes one trigger to fill their glass to overflowing. Others can tolerate several triggers some of the time because their glass is reasonably empty, but if the glass is already close to full, one more trigger will take you over your threshold and can send fluid in the glass to overflowing.
When the glass flows over the flood gates open! A cascade of events is initiated. The result is a full blown migraine. For most, this is the point of no return and the migraine just has to run its course.
These events are poorly understood and debate continues as to their role in migraine, but the current research suggests 'CGRP' an inflammatory chemical in our brain is released and 'Cortical Spreading Depression' (a physiological/neurological process) is activated.
This is where 'trigger' management can be a big part of getting control of your headaches and migraines. Knowing your triggers, addressing them and being respectful of them can go a long way in preventing the glass from overflowing.
Some common reported triggers are
various chemicals in foods such as tannins, tyramine, nitrates, sulphites, MSG etc...
particular foods - oranges, chocolate, alcohol etc
hormonal fluctuations seen in females and to some extent in males,
stress,
poor sleep patterns,
certain postures eg. sitting at the computer or driving,
exercise or lack of exercise,
changes in weather,
change in routine,
dehydration,
bright lights, strong smells, loud noises,
etc, etc, etc...
Everyone has varying degrees of sensitivity to these 'triggers' and it can be a tricky task working out which of these you may be highly or moderately sensitive to. Sometimes these 'triggers' are not triggers at all but just signs that you are already over-sensitised. Instead they could be a warning sign that you are close to hitting your threshold eg feeling overly sensitive to light, smell or sound.
Interestingly we are finding that one of the biggest triggers that seems to fill that glass with a greater volume is the upper cervical spine. The cervical spine is implicated in many triggers - eg. sitting, driving, office or computer work, neck positions, stress, exercise. If your upper cervical spine is misbehaving, it's constantly keeping the volume of that glass quite full. This is due to its intimate connection to the brain stem and the Trigemino-Cervical Nucleus. It's misbehaviour seems to be winding up that sensitivity and pushing you closer to your threshold.
The exciting news is, if your upper cervical spine is a trigger, address its misbehaviour and the volume of fluid in the glass can be reduced. The result is that the glass has more capacity to cope with a higher load of other triggers and the risk of it overflowing into headache and even migraine has been reduced.
If you want to delve further into understanding sensitivities (triggers) this video may be helpful.
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