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Teeth of the Dragon - a Migraine Survival Guide Print E-mail
Trish Murphy   
Tuesday, 26 July 2005


I SUFFER from migraines. And the worst thing about them, apart from the illness and debilitation, and the accompanying depression, is that they are unpredictable. You have an important presentation coming up? A job interview? A special long weekend? Ten to one, a migraine will wreck it for you.

If like me, you live with the dragon, you also live with the fear of what it can do to your life. I don't know how many days of my life I've lost to migraines, but it's too damn many. In the past my work has been compromised (poor performance, absenteeism), my relationships stressed (or in some cases, terminated due to migraine ill temper) and my social life interrupted (the hot date cancelled, the spoiled long weekend). What I do know is that although I may not be able to escape the dragon entirely, I've learned how to control it. I live 95 percent free of migraines. I know that I'll wake up tomorrow clear-headed and full of energy. It's taken nearly 20 years of trial and error to get there. What follows is an account of how I've done that.

I should point out very clearly that I'm not a doctor or any sort of medical expert. I'm a journalist. What I've learned, and what follows in this article, is the sum of my own experience as a migraine sufferer. Nor am I here to knock the medical profession, I appreciate what they do. However it seems to me that, because of the difficulty of migraines - the wide variety of triggers and responses, the inexplicable symptoms - the medical profession has dumped the problem into the too-hard basket and left it there.

I believe that the long-term assumption that migraines are a neurological affliction, rather than a physiological one, has meant that researchers have been barking up some wrong trees. Oliver Sacks, the famous neurologist, wrote a whole book about migraines, which he tackled from a neurological point of view. They are the result of neurosis, he said. He called us "migraineurs" and he claimed that the "migraineur's obsession with food" was a part of the neurosis. I remember being furious when I read that. A small footnote added to my edition of the book admitted that actually, there might just be a connection with migraines and food, but did not elaborate further. Part of the problem, it seemed to me, was that the doctors weren't listening to us. I don't know that they are now.

The food connection
ChocolateI made the connection between migraines and food by chance. During an attempt to give up smoking, I ate a lot of candy bars, and noticed that the migraines became more frequent. I stopped eating the sweets and they tailed off again. I started keeping a food diary, correlating migraines to what I ate. I added to my list of offending foodstuffs migraine by migraine, over the next few years: Mayonnaise. Instant coffee (but not freshly ground beans). Wine. Bottled fruit juice. Some kinds of chocolate. Blue cheeses. Jam. Pizza. Spaghetti sauce. Cornflakes. Fizzy drinks. Stew. Margarine (but not butter). Dried fruit. Beer. Salad dressing. Stock cubes. Tinned tuna. Biscuits. I remember walking into a supermarket and looking around in despair. Everything on the shelves was poisonous to me, and I didn't know why.

I began going to doctors, trying to get a referral to an allergy clinic. I explained that the migraines were caused by a reaction to certain foods. They wouldn't give me a referral to anybody. "Food does not cause migraines", I was told repeatedly. The most typical - and offensive - response was that it was "just female neurosis". That made me so angry that I tried an experiment. I went to a new doctor and described most of the symptoms, leaving out the instant identifiers such as sensitivity to light. "I've had an episode," I said. "Nausea, vomiting, blurred vision, fever, headache..." He asked me if I'd been bitten by a snake! And that, apart from being asked to guinea-pig some brands of migraine medication (they didn't work), was the total extent of help I've received from the medical profession in 20 years. That, and the offer of "a shot of pethedine" (no thanks).

Bad chemicals
Added ChemicalsI kept going with my food diary, studying the labels on everything. Eventually I narrowed it down to two preservative chemicals: sulphur dioxide and citric acid. You get sulphur in sausages and wine. It is used to preserve dried fruit, sun-dried tomatoes, bacon, cereals, rusks, biscuits and powdery stuff such as instant stock. You get sulphur in almost all fizzy cola-type drinks. Citric acid is used in runny, gooey things: the soft centres of chocolates, jams, tomato paste (hence the pizza migraines), bottled fruit juices, sauces and similar products. Citric acid is a natural chemical. Hence, a bottle that says "no artificial preservatives" or "no preservatives added" spells danger. The only safe one is a label that says "no preservatives", period. Even so, I've become a lot less shy. I ring up customer care numbers and grill them. I always ask at restaurants. If the waitron isn't sure, I ask for the manager. I've also learnt to choose food in restaurants that is likely to be fresh, and when it comes to salads, I request no dressing. If it arrives with dressing, back it goes. Mayonnaise is one of the worst offenders. One or both of these chemicals is often used in medication and health pills such as vitamin capsules. To get multivitamins, vitamin C supplements and so on, I consult staff in health shops and stick to one or two brands that I know are safe. I write them down as allergies on medical forms.

Blood sugar
Beyond these two chemicals, I sometimes would get a migraine when I hadn't eaten anything suspicious. I also often got them on the first day of a period. Back to the food diary, and I discovered that the random migraines were not caused by food, but a lack of it. They inevitably followed a day when I skipped dinner. Migraines associated with starting a period were often not because of the period per se, but loss of appetite preceding it. Thus I concluded that migraines - for me, at any rate - are primarily associated with blood sugar. They are triggered when my blood sugar falls below a certain level. It is possible that the two offending chemicals cause a drop in blood sugar. It also explains why vigorous exercise can trigger a migraine. This makes sense if you look at all the different triggers that people have. Different individuals, and possibly blood groups, might react to different substances. Does stress alone cause a drop in blood sugar? I don't know, only the doctors can research that. Migraine sufferers often get a migraine after the stress. But it can relate to eating. If you finish a big project, or have your last day before holidays, do you kick back with a bottle of wine that evening and say, whew, I can relax? Stress - and its relief - can lead to comfort foods that might be triggers. Some medical web sites, are now starting to list low blood sugar as a "possible" cause of migraines. I've found tentative links to sulphur and migraines (although not to sulphur/blood-sugar/migraines), but very little on citric acid (except a few plaintive voices on the web asking if there is a connection).

Eating correctly
I began to organise my eating habits with blood sugar in mind. I eat a fairly serious breakfast and then a series of small meals or healthy snacks (seed bars, fruit) through the day. I never miss dinner. Often, at the end of a day when I've been especially busy or stressed (and have a low appetite because of it), I have to consider whether I've actually eaten enough and if I haven't, I make myself eat before going to bed. I've found that I have to eat some carbohydrates each day. A weight-loss diet of lettuce and vegetables, for instance, can be insufficient. I eat a lot of fresh fruit and have come to prefer it to starchy, sugary food and sweet things such as chocolate. I also steer clear of any food that might contain the offending chemicals. I try to stick to fresh food, organic cheese and nuts and as little oil or fat as possible. This situation demands a fairly rigid approach to food. I used to take risks, but I've got to the point where, if I don't know what's in it, I don't eat it, period.

Read the label
I shop in my reading glasses, and I read every label. If it hasn't got a comprehensive list of ingredients, I don't buy it. Woolworths in South Africa is pretty good at identifying what's in their products - if it doesn't say "citric acid" or "sulphur dioxide" on the label, then it's means those chemicals are not present (however, you have to be careful of "layers" - a product might not be identified as having sulphur, but it might contain sherry, which probably does have sulphur.)

No-go zones
Red WineI don't touch wine or wine products of any sort; beer; liqueurs; any fizzy drink in a can; processed chips and snacks that have powdery flavouring on them; mass-produced cereals or biscuits; anything with condensed milk (puddings, tarts, etc) or mayonnaise or salad dressing; bottled sauces such as pasta sauces or cook-in sauces (unless the ingredients are clearly marked); powdered soup, noodles or stock (including "soft" stock in cubes or bottles); chocolate candy bars; bottled fruit juice; takeaway "fast" foods; powdered milk; instant coffee. Canned foods are high-risk. They tend to be high in salt or sugar, so I'd rather have fresh anyway. I avoid canned anything, including soups. Blue, soft or fermented cheeses are out. Ice-cream is generally OK, but not if it has fudge or syrup or streaks of berry goo through it. I buy organic honey. Mass-produced cereals such as cornflakes or rice-crispies are often preserved with sulphur, as are rusks and many brands of biscuit. The soft centres of some biscuits contain citric acid. Margarine can be a problem (proper butter is OK), as can cocoa powder and therefore cakes or desserts made with these products. Condensed milk is bad news, I avoid it totally. I drink very little alcohol. When in a situation where I do wish to have a drink, I treat myself to really good whisky. It has no ill effects, apart from making me tipsy. Once, on a snazzy press evening, I was served Veuve Cliquot and Krug champagne. That night I thought, the hell with it, I'll enjoy myself and take the pain later. Only, there was no pain. Both champagnes may be pricey, but they're clean.

Surviving in spite of it
How to avoid all that food and still survive? Quite easily, by sticking to fresh food. Cutting out preserved foods and drinks means a clean diet free of processed, high-fat, chemical-heavy alternatives. Difficulties arise, however, when I have to travel, especially on press trips where food is supplied, or to parties where there is finger food and only wine or beer. I simply take my own. If ever I have to fly anywhere, I carry a bag with my own meals - no airline has stopped me, and you should see the envious glances of the other passengers when I unpack a fresh salad, fruit and a chocolate eclair or two, while they are faced with a gluey airline horror. This system, tough at first and easy once it became habitual, has meant that I live free of migraines 95 percent of the time. Occasionally there is a slip; either in my own discipline or an unclear label. For people used to eating anything off any shelf, this approach to food, and the discipline involved, might be daunting. But anybody who suffers from migraines will know that it's worth doing whatever it takes to keep the dragon at bay. Saying no to a glass of wine is a lot more pleasant than writhing around with your head on fire, or trying to get through a day of work when all you want to do is lie down and die.

The dragon
HeadacheI know I've got a migraine when I wake up in the morning and struggle to get up. The first few hours are usually bearable, but with a 3pm peak (or trough) when the pain is intense. My migraines last for 48 hours (a bad one 72 hours), and the second day is always worse. The migraine brings on an intense associated depression. Two days of it can feel like a very long time. I remind myself that it will pass with the physical symptoms, and try to meditate to settle my mind. I have never found a medication that breaks the migraine. Mostly, medication masks the pain and makes me spaced out, and the migraine comes back with a vengeance when it wears off. Coffee, chocolate and salt - and some "regular" painkillers - intensify the migraine. A sugar hit can ease it for a couple of hours, but won't break it. I worked out a grading system of intensity, from one to five:

  1. Mild, can function but likely to have a bad afternoon and be short-tempered. Ache-type pain. No aura. Irritable. 24 - 48 hours.

  2. Mild to miserable, can function and drive but probably best not to. Unpleasant pain. No aura. Irritable. 48 hours.

  3. Cancel appointments, stay home, cannot use computer or read. Acute pain, occasional aura. Intolerant and depressed. 48 hours.

  4. Severely debilitated, throwing up and feverish, acute pain, disturbed vision, aura. Black depression. 48-72 hours.

  5. Have only had two or three of these. Extremely ill, high fever, nausea, throwing up, acute pain goes right down spine, blurred vision, total intolerance of sound, distressing aura and other visual disturbances, profound depression and wish I was dead, if only to stop the pain. 72 hours plus.

Before I began to control my food, I was getting Level 3 and 4 migraines, sometimes at a frequency of three to five a month. The more I learned to control not only what I ate but how I ate, the intensity and frequency reduced. Five years ago I was getting Level 2 to 3 migraines, still easily one or two a month. Nowadays if I do get one, it's likely to be a Level 1 or 2, and last year I was down to four migraines in the whole year. And that's with no medication at all.

There may be no one answer to this unpredictable, debilitating affliction. But if you are struggling with it, and don't know where to begin, consider the blood sugar angle as a place to start, and try to manage it. Balance your eating and don't skip meals, especially dinner. Keep a daily food diary and see whether you can identify triggers. Avoid the known triggers such as wine and soft cheeses. People who have asked me about this have often said: "Oh, I couldn't give that up!" But if you know that something makes you sick, you tend not to want it anyway. We don't spend our days craving pesticides, cobra venom or drain cleaner, do we? We may not be able to kill the dragon but it can be shut in its cave. I've learned how to do that. If I have a presentation, a job interview or a special weekend ahead, I take particular care not to slip up on food, and I know I'll be healthy and energetic when the day arrives. And for a migraine sufferer, that's true freedom.

You can help
This has been a long article, but I hope it might help other sufferers shut their own dragon in its cave. I'm busy with further research with a view to writing a book aimed at helping migraine sufferers. If anybody is willing to share their own experiences, particularly with regards to triggers, effects of medication and the effect migraines have on your life, I'd be most grateful to receive it at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it . Your experience might be the key to helping somebody else who's suffering. Any and all correspondence is welcome.

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