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Trigger-Happy

Red wine, aged cheese, chocolate, beans, grapes, avocado, fresh-from-the-oven bread. . . . The list can practically go on forever. The “short list,” which I’m sure most of you can recite in your sleep, is included in nearly every migraine news story you read. Yet only about 25% of people with migraine have food as a trigger. Yep, that’s right, only a quarter of the estimated 28 million people with migraine in the US alone have to worry about food triggers.

Even then, proof of food triggers is elusive. Most “data” are based on anecdotal evidence and it’s difficult to clearly pinpoint specific foods. Say you’re sure that the onion in your sandwich triggered a migraine. That’s easy — onion is an identified trigger, so it must be the culprit. What about the processed turkey, additive-filled bread, tomato, mayo and mustard? Or the Cheetos and pickles you had along with it?

You get my point: It’s easy to misattribute triggers. I think of it as the fettuccine alfredo phenomenon. When I was a kid, I ate fettuccine alfredo, then came down with a stomach bug. Twenty years later, the completely irrational belief that fettuccine alfredo causes stomach bugs remains.

Compounding the problem is that one of the lesser-known symptoms of migraine is craving foods in prodrome, the period before you actually feel the headache. In particular, carbohydrates have a strong pull. My craving is cookie dough, sometimes even chocolate chip cookie dough. It follows that I could easily assume chocolate was the trigger, not part of the craving.

And yet. Identifying food triggers and subsequently avoiding them has reduced my pain more significantly than any treatment I’ve tried. The impetus for this post is that I’m convinced that my mom’s four bean casserole, the dish that’s synonymous with summer for me, has a trigger hiding in it.

My proof? I made the casserole, which is essentially dressed-up baked beans, for Hart’s birthday. That night a migraine hit. The following week I had a migraine every day—right now an extremely unusual occurrence for me. Every day I also leftover beans a few hours before the headache hit. Still I’m reluctant to assign blame. Sunday night I ate the beans; I got a migraine that night. Beans were my breakfast Tuesday morning; an hour later a migraine followed.

Whether from healthy skepticism or sheer denial, I won’t just give them up. Instead I’ll deconstruct the dish. Starting with the ingredient that’s most likely to be a trigger, I’ll eat each component individually and track my progress. Far from a scientific study, but I’ll adjust accordingly and see if it helps.

It’s double the blow if avoiding food triggers, which I’ve never truly believed in, becomes an integral part of my treatment. Peanut butter can be explained as a fluke, decaf coffee can be blamed on chemicals. Baked beans with chili sauce as the only potentially MSG-laden ingredient? Not so much.

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