1. A Visual Guide to Migraine Headaches Slideshow Pictures
2. Headache and Migraine Triggers Slideshow Pictures
3. Take the Migraines Quiz

Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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An estimated 20% to 50% of migraineurs (people who have migraines) are sensitive to foods. These dietary triggers are thought to cause a change that provokes a migraine attack. Helping children learn to recognize and avoid these triggers is helpful but often difficult. The following are some common dietary triggers:

• Tyramine: Individuals with low levels of a substance called phenol sulfotransferase P are believed to be sensitive to dietary monoamines (a type of molecule) such as tyramine and phenylethylamine. Cultured dairy products (for example, aged cheese, sour cream, buttermilk), chocolate, and citrus fruits are believed to cause vasodilation (widening of the blood vessels) in certain people. Some migraines may be triggered by artificial sweeteners.
• Beverages: Alcoholic beverages (especially red wine) and excess of or withdrawal from caffeinated drinks such as coffee, tea, cocoa, or colas may trigger a migraine headache. Migraineurs should limit caffeinated sources to no more than two cups per day to prevent caffeine-withdrawal headaches. Caffeine can be found in chocolate-containing foods and candies; therefore, children with migraines should avoid them.
• Nitrates and nitrites: These vasodilating agents are found in preserved meats. Examples of foods containing these chemicals include lunch meats, processed meats, smoked fish, sausage, pork and beans with bacon, sausage, salami, pastrami, liverwurst, hotdogs, ham, corned beef, corn dogs, beef jerky, bratwurst, and bacon.
• Monosodium glutamate (MSG): MSG is a flavor enhancer and vasodilator found in many processed foods. Food labels should be checked carefully. MSG sources include Accent seasoning, bacon bits, baking mixtures, basted turkey, bouillon cubes, chips (potato, corn), croutons, dry-roasted peanuts, breaded foods, frozen dinners, gelatins, certain Asian foods and soy sauce, pot pies, relishes, salad dressing, soups, and yeast extract.
• Citrus fruits, avocados, bananas, raisins, and plums: These foods may be triggers. Although few individuals are sensitive to fruit, children with migraines should still eat a well-rounded, natural diet that includes fruits and vegetables and avoid processed foods. A headache diary may be helpful (a pattern often emerges after 6 to 8 weeks). Care must be taken to avoid creating an unnaturally limited diet that harms a child's growth and development.

Both OTC and prescription medications can trigger or worsen migraine headaches. Cimetidine (Tagamet), estrogen (Premarin), histamine, hydralazine (Apresoline), nifedipine (Procardia), nitroglycerin (Nitro-bid), ranitidine (Zantac), and reserpine (Serpasil) are examples of medications that can increase migraine frequency.

Excessive use of OTC pain medications and analgesics can cause occasional migraine attacks to convert to analgesic-abuse headaches or drug-induced headaches that do not respond to treatment. Children with migraines should avoid frequent or long-term use of NSAIDs, acetaminophen, triptans, or ergotamines. Migraineurs who have been treated for a long time with amphetamines (Biphetamine), phenothiazine (a type of antihistamine), or propranolol (Inderal) should avoid sudden withdrawal from these medications because migraine headaches may result.

In children who have an inborn tendency for migraine headaches, attacks can occur as a result of psychological (emotional), physiological (internal body processes), or environmental triggers. Physical exertion and travel or motion can be triggers.

• Psychological triggers: These include stress, anxiety, worry, depression, and sadness. Migraine headaches are not an imagined or psychological illness. Stress makes an underlying tendency for migraine more difficult to manage. The frequency of migraines can be reduced but not eliminated by maintaining a healthy lifestyle.
• Physiological triggers: These include fever or illness and not getting adequate food, rest, or sleep. Children with migraines should stick to a routine with regular meal times and adequate sleep.
• Environmental triggers: These include fluorescent light, bright light, flickering light, fatigue, barometric pressure changes, high altitude, strong odors, computer screens, or rapid temperature changes. Some migraineurs report that complex visual patterns like stripes, checks, or zigzag lines trigger their migraines.
• Physical exertion: Activity can trigger childhood migraine. Some migraineurs report that they are more likely to get a headache after participating in sports or being extremely active. Minor head trauma (for example, being hit in the head with a ball, falling on one's head) may also result in a migraine attack.
• Travel or motion: This may cause migraine, particularly in young children.

If headaches cannot be reasonably controlled within 6 months, the child should see a pediatric neurologist (a physician specializing in the treatment of brain/nerve disorders). Children who suddenly develop new neurologic problems such as weakness, thinking difficulties, or seizures, should also see a pediatric neurologist.

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