People often refer to one’s migraine trigger, in the singular, but in reality …

… most migraineurs are affected by a number of contributing factors that combine together to reach a migraine tipping point. This is what many writers refer to as the migraine threshold.

Once the factors have combined to reach the tipping point, the migraine sets in.

Prior to this many people start getting signals that forewarn of an impending migraine. These are known as prodromal symptoms - that irritable feeling, not being able to concentrate, increased sensitivity to smells, sounds and light, niggling pain in the back of the neck, the tingling in the fingers, blurry vision, flashing lights, aura, hunger, nausea, itches, twitches and many other possible symptoms.

Imagine that in your brain is a bucket

To illustrate the above let’s imagine that in your brain is a bucket half-filled with liquid. Various stressors are put into the bucket, each one raising the level of the liquid.

We know that for each migraineur their triggers can be very different.

So, for example, let’s imagine that Hugo rises early to his morning alarm after a disturbed and short sleep.

His body is already not fully refreshed. His brain did not benefit from a full night’s REM sleep cycles and, as a result, the cerebrospinal fluid did not fully flush out all the toxins from the brain and down into the spine.

He regrets staying out late the night before in a noisy bar entertaining important clients. His ears ring a bit from the loud noise, a low-level stressor that triggers cortisol and adrenaline release.

In the bathroom, he notices that he is slightly more paunchy than a few weeks back. He laments not having had time to get to the gym… for weeks. 

He then downs 2 strong coffees.

Imagine that all these factors go into the imaginary “bucket”. The liquid rises.

Unbeknownst to him, he has a slight, barely detectable allergy to coffee and this causes the liquid to turn slightly more acidic and the size of his bucket to shrink, meaning he can tolerate less before reaching his migraine threshold.

His pulse rate ticks up a few beats in pace. Nothing huge, no big deal on its own. He never really noticed it in the past, but nowadays he is aware of it because he has a Fitbit on his wrist, giving him a pulse reading all day.

Hugo then quickly eats a breakfast of cereals, milk and sugar. And a large orange juice for the vitamin C.

They all go into the bucket, raising the level of the liquid.

The cereal also causes the liquid to become more acidic, as does the milk. Again, nothing hugely noticeable but it does cause him catarrh, and a slightly stuffy nose and occasionally an itch at the roof of the back of his mouth. He actually doesn’t even know that he has a dairy allergy. He does not realise that the itch is connected to the dairy consumption.

The orange juice raises the level of the “bucket liquid”, and the high sugar content of the juice and its salicylates cause the liquid to become more acidic. Again he does not know that he has a slight reaction to orange juice, even though it is very common.

His wife Maria says she is making bacon and eggs… and would he like some…

“Yeah go on then but I have to be quick!”

Maria lost her job recently and is struggling to find work. The family finances have taken a hit in recent weeks. Things have been a little tenser at home lately. More cortisol.

Hugo watches the news while urging the kids to get themselves ready for school.

Daughter Jody has not done her homework and little Freddy reminds Hugo that he is still waiting for him to pay for the school trip to Spain. (Spain!! Why not just a bus trip up to the camping grounds in the forest a few hours away like back in our day??)

He takes an active interest in politics, but his party got crushed in the elections. Worse still his football team got crushed again.

The stress builds feeding cortisol and adrenaline into Hugo's “bucket”.

The drive to work is worse than usual. There is heavy traffic and roadworks and some clown has had an accident and blocked a lane. More cortisol and adrenaline.

As breakfast digests the wheat germ agglutinin works its way through his gut lining and into the bloodstream, then up through to the brain. The nitrates from the bacon work their way into the bloodstream, triggering a release of nitric oxide into the brain. Nitric oxide is an important neurotransmitter, but too much… leads to overload in the brain cells.

The eggs are also something to which he has a slight allergy, although he does not know it. The soybean oil that was used for the fry-up is heavy in omega-6 oils which are highly inflammatory to Hugo’s body and heavy in glutamic acid. They all go into the bucket and raise the level of acidity.

Hugo is busy busy with back to back meetings at work. More cortisol, more adrenaline.

Little time for lunch. A cheeseburger, chips and a doughnut for a sugar blast to pick up that mid-afternoon energy lull. He works late then rushes home to take the family to an Asian restaurant where the food shines with MSG… and is delicious.

The MSG increases the glutamate levels in his brain causing excitotoxicity. Glutamate, like nitric oxide above, is another important neurotransmitter, but too much… leads to overload in the brain cells, and excitotoxicity.

More gluten and wheat germ agglutinin in the wheat flour of the noodles to further inflame his leaky gut and slightly irritable bowel. All go into the bucket.

Hugo sips several glasses of red wine with dinner. The tannins, tyramines, sulfites and histamine in red wine are all identified as migraine triggers. Imagine these add to the bucket and add to its acidity.

All the ingredients and triggers, big and small, the stresses, the cortisol and adrenaline, combine over the day raising the acidity of the liquid and raising the level of our bucket’s liquids to a tipping point.

Imagine this as the acid liquid overflowing from the bucket and into Hugo’s brain.

Next morning, Hugo wakes up with a head-crushing migraine.

So what then is our Migraine Threshold or tipping point?

An accumulation of one or many inflammatory triggers, and/or hormonal, vitamin and mineral deficiencies that irritate the body or brain to a tipping point or threshold where the body’s immune system reacts with its defensive responses.

This immune system response includes the release of a cascade of chemicals, some of which attack the irritant and defend and/or repair the irritated area. The chemicals released can include ones that cause significant neurological effects, like the release of peptides that cause significant pain in the form of severe headaches or migraines.

The immune response often involves oxidative stress. This is where excess free radicals are produced or introduced and the body is unable to release or produce sufficient antioxidants to neutralize them or detoxify their harmful effects.

Continued migraines can also possibly be an indicator of more serious long-term health effects if one continues to be subjected to the accumulated triggers and combinations of triggers. Epilepsy, seizures, depression, stroke, Alzheimer's can, in some cases be manifestations of the same triggers as migraines.

So what can be done?

As you can see, there are many, many triggers in Hugo’s day that fill the bucket.

There are also many mitigating factors that Hugo can address to lower the number of ‘bad’ things going into the bucket.

If he learns what things trigger his migraines, he can avoid them.

A great method is an elimination-reintroduction diet.

For stress, there are numerous ways to relax and lower those stress levels. He takes various supplements like magnesium, Co-enzyme Q10, various B vitamins.

Meanwhile, plants like ginger can reduce the intensity and frequency of migraines. There are many anti-inflammatory foods that he can replace those inflammatory ones.