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When you go to your doctor's office to have a headache treated, many times you will hear him or her use the word "trigger" when referring to your headache. In the case of a headache, the word trigger means something that starts the headache-in other words it initiates it. This does not mean that the triggers are direct causes of the disease, but they facilitate or provoke the beginning of an attack in a patient who already suffers from headache. For example, I have a patient who has the start of a headache attack every time she goes to a department store and walks by the cosmetics department. Her headaches are triggered by the perfume aroma.

Most Common Triggers in Headaches

     There are many different kinds of triggers, and every person has different ones. You may have some triggers that start your headache attack at one time, and then these triggers can change. Triggers can be divided into different groups, including: Emotional triggers: These are triggers that have to do with emotions and your state of mind. Some examples of emotional triggers are: family problems, problems at work, success at work or school, anticipation, anxiety, an emotional crisis, the post-crisis period, a new job, a new school, weekends, and so on. Stress triggers: These have to do with physical effort, such as strenuous exercise, excessive physical work at the work place or at school, physical sickness, not enough sleep, too much sleep, and so on. Environmental triggers: These triggers are responses to our surroundings. For example, bright lights, different kinds of aromas like perfume, tobacco, or any kind of odor. We can also include loud noises, altitude, weather, and barometric pressure changes. I have a patient who can predict rain two hours before it starts because of the barometric pressure change that triggers her headaches. Chemical triggers: The most common chemical triggers are hormonal changes that occur during the premenstrual period, during a woman's period, or during the post-menstrual period. These triggers are extremely common in women who suffer headache. But there are a variety of chemical triggers, such as low blood sugar that results after not having eaten for many hours. This is a very common trigger for headache. Food and beverage triggers: Rarely do we connect our eating habits with headaches, but there is a strong relationship that often goes unnoticed. Some foods are commonly related to headaches. Some of the most common trigger foods are: hard cheese hot dogs chocolate nuts Less common food triggers are: smoked fish vinegar fermented food (cream, yogurt) freshly baked yeast products peanuts (and peanut butter) monosodium glutamate (commonly found in Chinese food) soybean onion canned figs citric food bananas pork caffeinated beverages avocado liver In my practice, I have noticed that a few of the above-mentioned triggers are more common than others. Bananas, pork, and Chinese food seem to be high on the list. You have to take into account that certain foods may serve as intermittent triggers, but once a food has affected you once, it becomes a risk factor. In addition, almost any alcohol drink may trigger a headache, but red wine is the most common culprit.

How Can You Recognize Your Triggers?

     One of the most important aspects of headache treatment is your own control over your headache, and control starts with identifying your own triggers, and learning to avoid them.

     I recommend writing down your triggers in a trigger diary. Each time you have a headache, try to relate it to one or more of the triggers that are listed above. At the end of the month you can sit down and analyze your results to see which are the most common triggers in your case.

     This is a sample of your trigger diary: Date Emotional Stress Environmental Chemical Food and Beverages October 25 Fight with family x x x x November 3 x x x Didn't eat breakfast x November 10 x 2 hours exercise x x x December 13 x x x x Had a beer

     Using a trigger diary allows you to track your headaches, and become more aware of what your personal headache triggers may be.

How Can You Use This New Knowledge?

     When you review your triggers, you will notice that some of them occur only once, while others have a tendency to repeat themselves. By studying these patterns you can determine which are your important triggers. For example, if every single time you eat chocolate you get a headache, then you know that one way to avoid an attack is to avoid chocolate. If you get a headache after you arrive home from your daily jog, you may want to consult your doctor because there is some medication you can take before doing exercise that will prevent the attack. This way you will gain more and more knowledge and as a result, control over your headaches. Remember I said before that triggers might change, so if you haven't noticed a known trigger actually inducing an attack, you might want to expose yourself to that trigger to see what happens. The important thing is that now you are aware of its existence and you have the control .

Summary

     If you are a headache sufferer, you know that certain situations or things you do or foods you eat, will cause an attack to start. There are different kinds of triggers and they work differently in each person. The trick is to recognize your own triggers so you can avoid them and by doing that, diminish the number of headache attacks.

     When you feel pain, there is a feeling of helplessness-you feel the pain is bigger than you and that you have no control over it-just the thought of it makes you shiver. Getting to know and manage your triggers will give you a sense of power over your headaches, you will very soon see a decrease in the frequency, which you can obtain just by avoiding your personal triggers. It doesn't take much work-just some discipline and awareness, and then you will be on the road to improve your quality of life.

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