British Association of Audiovestibular Physician

BRITISH ASSOCIATION OF AUDIOVESTIBULAR PHYSICIANS

MIGRAINE AND MIGRAINOUS VERTIGO

Information sheet on triggers, diet and lifestyle modifications

Migraine is a well known cause of headaches. It is also a common cause of vertigo and dizziness. It is often treated with over-the-counter and prescription- only medications.

Identifying, avoiding and/or controlling the common triggers can be used along with medications to control or reduce the frequency of the condition.

The triggers are not the same for everyone, but keeping a migraine diary may help sufferers to identify the factors that specifically trigger an attack. This could be several hours beforehand.

This information sheet provides a summary of migraine triggers and lifestyle modifications but does not offer any advice on drug treatment.

The list is not necessarily complete: you may discover triggers specific to your individual situation that are not on the list below.

1 Trigger/Risk Examples Advice factor Foods Chocolate: All forms including  Avoid & flavourings and drinking chocolate Drinks Dairy products: ripened, strong  Cottage and cream cheeses (cheddar, stilton, blue, brie) cheeses are allowed

Alcohol: (especially oaked/aged),  Limit alcohol to beer red wine, port, whisky, brandy or unoaked white wine or, preferably, Meat/fish: canned, aged or avoid altogether processed meat or fish: ham and bacon, game, fermented sausage,  Use fresh or frozen salami, pepperoni, Frankfurter and meat and fish without hot dog sausages, smoked meat, preservatives or pickled herring and dried fish. Also, additives occasionally chicken liver and shellfish

Yeast extract: Marmite, stock cubes,  Make gravy from pan gravy mixes etc juices

Caffeine: coffee and tea, cola  Avoid cola. Take decaffeinated Fruits: red plums, avocado, passion tea/coffee fruit, citrus (orange, lemon, lime, grapefruit) fruits, strawberries, ripe bananas

Vegetables: beans, peas, tomatoes

Others: foods containing MSG  Avoid diet drinks and (monosodium glutamate), canned sweeteners as may soups, non-white vinegars, contain aspartame fermented, pickled or marinated products and artificial sweeteners

2 Trigger/Risk Examples Advice factor Stresses Emotional stress: strong emotions  Relaxation and stress (anger, worry, tension), depression management and anxiety  Anticipate and manage lifestyle changes properly Physical stress: exertion, tiredness,  Take moderate routine poor sleep pattern including jet lag, exercise (eg 3 to 5 dehydration, disruption of lifestyle times a week Irregular eating: skipping meals or  Eat regular meals and bingeing drink enough water

Hormones Hormonal changes: puberty,  Advice from GP may menstrual cycle (especially the pre- be required to avoid menstrual period), oral oestrogen-only oral contraceptive pill, pregnancy contraceptive pills (migraines may cease during pregnancy and may return after), menopause and HRT

Environment  Bright lights eg supermarket,  Wear dark glasses to car headlamps reduce glare from  Flickering or flashing lights bright light (from televisions and  Dim the background computers), fluorescent lights light on the computer  Loud sounds or use a tinted screen  Odours eg: perfume, petrol,  Avoid exposure to paint, cigarette smoke, some strong smells food  Weather changes: rapid changes in atmospheric pressure, rising temperature and humidity  Stuffy environments  Smoking  Stop smoking

3 Adapted from:  Diamond S: Dietary factors in vascular headache. Neurology Forum 1991; 2:2  Tusa R: Migraine, Meniere’s disease and Motion Sensitivity. In Vestibular Rehabilitation, 3rd edition pp195-6 Editor, Herdman SJ.

The following link provides further patient-focussed information: http://www.migraine.org.uk

Compiled by Dr Victor Osei-Lah on behalf of BAAP/2010

Acknowledgements: Dr Veronica Kennedy, Dr Chung Chan, Dr Louisa Murdin, Dr Peter West and Dr Dolores Umapathy