Guidelines for the nonpharmacologic management of migraine in clinical practice

Table 1: Potential triggers of migraine headache (level III evidence, class A recommendation)

Emotional Stress

Changes in behaviour    Missing a meal; hypoglycemia    Sleeping more or less than usual

Environmental factors    Bright or flickering light    Loud noise    Weather changes    Strong odours    Allergens

Foods and beverages    Chocolate    Cheese    Cured meats (e.g., hot dogs, bacon)    Caffeine-containing beverages    Alcoholic beverages, especially red wine    Other, individually recognized dietary factors

Chemicals    Aspartame    Monosodium glutamate (MSG, natural flavour,      hydrolysed vegetable protein)    Benzene    Insecticides    Nitrites (as in preserved meats)

Drugs    Atenolol    Caffeine (and caffeine withdrawal)    Cimetidine    Danazol    Diclofenac    H2 receptor blockers    Hydralazine    Indomethacin    Nifedipine    Nitrofurantoin    Nitroglycerin    Oral contraceptives (ethinyl estradiol +)    Reserpine

Note: This is not an exhaustive list. The headaches caused are not always characteristic of migraine, and their occurrence varies from person to person and from occasion to occasion.

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