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Even though new medications and procedures are investigated, patients shouldn’t forget the role daily choices play in their health, says Dr. David Buchholz, author of “Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain.” He is an associate professor of neurology at Johns Hopkins University in Baltimore.

Patients should do whatever they can to prevent headaches, he says. Everyone has a host of triggers, such as stress; hormones; lack of sleep; medications such as birth control pills; food sensitivities; and the influence of the weather, including drops in barometric pressure. The triggers can add up, placing a burden on the body.

Common food triggers include caffeine; chocolate; monosodium glutamate; processed meats and fish; aged cheese; yogurt; nuts; alcohol; vinegar; certain fruits and juices, such as citrus fruits; certain vegetables, especially onions; fresh yeast-risen baked goods; aspartame; and possibly soy, tomatoes and mushrooms, he says.

“In your migraine control center, you have an individual tolerance, a threshold,” Dr. Buchholz says. “You can tolerate up to a certain level; that’s when the migraine becomes turned on. The higher the trigger level above the threshold, the more activated the migraine will be, with a larger headache.”

Many times, medication has just made matters worse for patients, Dr. Buchholz says. However, aspirin, Tylenol and ibuprofen are acceptable. He recommends that patients do not take certain painkillers for headaches more than two days per month.

“As much as they help temporarily, they produce a rebound effect,” Dr. Buchholz says. “Your exposure to the drug makes your next headache more likely. It pushes your threshold down. As your threshold is lower, it becomes easier to cross with more headaches.”

Most patients have to stop the drugs to become responsive to preventive treatment, such as over-the-counter products with caffeine and prescription drugs, including triptan drugs such as Imitrex, he says.

“Most doctors don’t help this because the path of least resistance is to give another drug,” Dr. Buchholz says. “The good news is that the substantial portion of overload is avoidable triggers. Aim to keep it below the threshold.”

Sitting on a bus by a person who is wearing too much perfume, being exposed to cigarette smoke or driving along a road by the water with flashing lights might trigger a migraine, says Dr. John W. Cochran, medical director of Inova Fairfax Hospital’s stroke program. He also is involved in the patent foramen ovale trial at the hospital with Dr. Thompson.

“Some people know if they skip a meal they will get a headache, or if they don’t get enough sleep, they get a headache,” Dr. Cochran says. “If you figure out what your trigger is, you should try to avoid it.”