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5 The Chinese Menu Theory

When I was forty-two years old, my migraines worsened, becoming so regular that I could predict my periods with them: each month I got a severe migraine the day before my period started. When I began learning stress reduction practices, that pattern changed, and most months my period would arrive without being announced by a disabling migraine.

I started comparing my heavy migraine months with those that were migraine-free and found that when I ate and slept better, drank more water, and was less stressed during the previous month, I would not get the migraine. The opposite was true when my previous month’s activities were not as healthy. Perhaps you have noticed a similar pattern in how several things seem to add up to create your pain.

This led me to concoct the Chinese Menu Theory. The name goes back to my childhood in Los Angeles. On some Sunday nights, my family would go out to dinner at our favorite Chinese restaurant. We would order our food “family style,” meaning each person would choose a dish from column A, a dish from column B, one from column C, and so on. All the delicious dishes of food would be brought out and placed on a lazy Susan in the middle of the table, and we would all partake of each dish to make up our meal.

In that same way, combinations of factors often add up to headaches, whereas one alone might not. Imagine that instead of ordering a family-style dinner, you are ordering your migraine from a menu of triggers. You could choose a potential trigger from column A — skipping meals, for example — which by itself may or may not produce your migraine. You could choose one from column B — for instance, lack of sleep — and again, you might get a migraine, maybe not. Choose another from column C — perhaps shoulder tension — and you may or may not get a migraine. From column D, we’ll choose stress; perhaps you will get that migraine, perhaps you won’t. But . . . if you combine items from columns A and B; B and C; A and D; A, B, C, and D, and so on . . . together they would add up to create your personal migraine stew.

Sample Migraine Triggers Menu


My most reliable trigger combo used to be hours of chewing gum while clothes shopping, plus no water or lunch. (Who needs food?) My energy was powered by dopamine, the feel-good hormone that shopping produced in my brain. It was fun while it lasted, but my jaw was working overtime, combined with everything else, and the next day’s migraine would make me regret it.

Everything Counts

This program works because we consider everything that might trigger a headache — and in all domains.

If you have tried a number of individual self-care strategies with limited success, including a variety of natural methods, it could be that you’re not looking at everything. For example, you might have quit caffeine or eliminated entire categories of foods, such as wheat or dairy products. Then your headaches continued, so you ruled those items out as triggers and put them back into your diet. After all, eliminating them seemingly had no effect. Or perhaps you tried massage or meditation to reduce your stress but concluded they weren’t helpful because your headaches persisted.

That’s where the Chinese Menu Theory comes in: it addresses your whole self. You are not just what you eat or drink or your exercise routine or your stress. You are all of it combined. By taking everything in your life together as a whole — diet, lifestyle, posture, thinking, mood, stressors, and so on — you can gain new insights into how your triggers add up to your headaches.

Common Headache Triggers

The following list of headache triggers is adapted and expanded from one first published in Migraine: The Complete Guide by the American Council on Headache Education (Dell, 1994).1 It’s usefully arranged by category — dietary, environmental, lifestyle, physical, medication, and hormonal — so you can mine each area for clues and look at your life as a whole. You might notice this list is similar to but more extensive than the one you completed in the personal profile in chapter 3.

Lists of headache triggers are subjective. You are a unique individual, a delicate balance of chemistry with a history and an emotional life. What affects you might not affect me and vice versa. With some triggers, quantity also counts: a small amount of chocolate, wine, or exercise might not trigger your migraine, but a larger serving or a longer workout just might.

Perhaps you will recognize some of your triggers and rule out others from the list. Perhaps you aren’t certain, or have no idea. For now, simply read it and see if anything rings a bell.

Headache Triggers

Dietary

additives, preservatives

aged cheese

alcoholic beverages

artificial sweetener

avocado

banana

beans

beer

caffeine

chocolate

citrus fruit

corn

dairy products

fermented food

food allergy

food sensitivity

garlic

high-fructose corn syrup

honey

hot dogs

lack of caffeine

lack of water

liquor

low blood sugar

luncheon meat

MSG

nuts

onion

pickled food

skipping meals

sour cream

sourdough bread

soy sauce

spicy food

sugar

wheat gluten

wine

yogurt

Environmental

air pollution

bright light

chemical sensitivity

dim light

dry air

excessive cold

excessive heat

flashing light

fluorescent light

fumes

high altitude

high humidity

hot, dry wind

loud noise

low barometric pressure

mold, mildew

motion

optical pattern

perfume

scents

secondhand smoke

stormy weather

strong odor

too much sun

weather changes

Lifestyle

anxiety

cigarette smoking

commuting

disrupted sleep

excessive sleep

fatigue

insufficient food

insufficient sleep

irregular eating

let-down headache

recreational drug use

routine change

stress

traveling

Physical

cold, flu, virus

exercise

exertion from sex or sports

head trauma

lack of exercise

medical procedure

posture and ergonomics

sinusitis, rhinitis

temporomandibular joint dysfunction (jaw tension and/or pain)

tension, tightness, pain (in shoulders, neck, head, face)

unsupportive bed, pillow

vision problems (eyestrain)

Medication

analgesic, simple (overuse)

analgesic, combination (overuse)

anti-asthma medicine

anticonvulsant

antidepressant

blood pressure medicine

blood vessel dilator

diuretic

drug “cocktail” (combining several medications)

ergotamine (overuse)

opioid (overuse)

triptan (overuse)

Hormonal

birth

birth control (pills, patch, IUD)

hormone replacement therapy

menarche

menopause

menstrual cycle

ovulation

perimenopause

postpartum

pregnancy

Bodies Change over Time

In trying to solve your headache mystery, also consider that bodies change over time. The factors that cause your headaches now might not be the same as those that triggered them originally. For example, some habits that we had as teenagers or young adults are unsustainable as we get older, at least not without consequences.

Perhaps your headaches began in college, when you would stay up all night studying and writing papers while unconsciously torquing the position of your head, neck, and back. Your younger, more pliable body might have suffered yet bounced back easily. But with age, bodies become less resilient, and recovery time lengthens. Irregular eating habits or food choices, which did not take a toll in your youth, could still influence your choices today. But whereas a skipped meal or snack back then just made you feel weak, dizzy, or grouchy, the same behavior now results in a bad migraine.

Just One More Thing

Keep the ideas in this chapter in mind as you read chapters 6 through 10, where you’ll learn more about specific triggers and how to track them. In these chapters, you’ll notice that some triggers receive more attention than others and that they’re listed in order of the most commonly troublesome rather than in alphabetical order. Although each person’s triggers and combinations of factors are different, certain triggers appear to be universally problematic — yet headache sufferers might give them less exploration than needed. You might be surprised to find that your triggers are different than what you thought they were.

The Headache Healer’s Handbook

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