Migraines, Triptans and Nitrates

July 4, 2019




As a child, I was a regular victim of the infamous "hot-dog headaches." When I grew older, I found out that they were caused by nitrates that were added to processed meats. It is the common view that nitrates cause migraines by dilating (widening) blood vessels. Therefore, a common treatment for migraines are triptan drugs. Triptans stimulate serotonin, which can, in turn, constrict blood vessels, thereby bringing some relief to the headache sufferer:

"...triptans are considered selective serotonin receptor agonists, meaning that triptans work by stimulating serotonin, a neurotransmitter found in the brain, to reduce inflammation and constrict blood vessels, thereby stopping the headache or migraine."
(National Headache Foundation)


In this article, we will deal with the link between nitrates and migraines. We have discussed some other serious problems with nitrates in the links below:






Nitrates are added to luncheon meats, jerky, etc. "Naturally occurring nitrates" can cause some of the same problems. They are also found in some vegetables (e.g. celerly/celery juice, spinach, lettuce, beets, radishes, carrots, beans, etc.):


"The highest mean nitrate concentrations were found in radishes (2132 mgkg(-1)), butterhead lettuce (1725 mg x kg(-1)), beetroots (1306 mg x kg(-1)) and iceberg lettuce (890 mg x kg(-1)), whereas the lowest were found in cucumber (32 mg x kg(-1))…"
(Rocz Panstw Zakl Hig. 2014;65)


Non-organic produce usually contains higher levels of nitrates. Nitrates can also be found in drinking water.


Therefore, a common meal, with veggies and a glass of water, may be all that is needed to trigger a massive migraine in some people. Researchers have found evidence that some people, due to oral or gut bacteria, are especially sensitive to nitrates:


"Migraines could be caused by gut bacteria, study suggests...Research shows sufferers have higher levels of bacteria involved in processing nitrates, and could explain why some foods appear to act as migraine triggers... The findings raise the possibility that migraines could be triggered when nitrates in food are broken down more efficiently, causing vessels in the brain and scalp to dilate...Migraine sufferers have a different mix of gut bacteria that could make them more sensitive to certain foods, scientists have found...The research showed that migraine sufferers had higher levels of bacteria that are known to be involved in processing nitrates, which are typically found in processed meats, leafy vegetables and some wines...When nitrates in food are broken down by bacteria in the mouth and gut they are eventually converted into nitric oxide in the blood stream, a chemical that dilates blood vessels and can aid cardiovascular health by boosting circulation...However, around four in five cardiac patients who take nitrate-containing drugs for chest pain or heart failure report severe headaches as a side effect."


"Nitrate-containing compounds have been identified as common headache triggers. Food preservatives are frequently identified triggers for those who suffer from migraines...Nitrate-induced headaches typically manifest in one of two ways: 'immediate' headaches with mild to medium severity developing within an hour of medication ingestion and 'delayed' headaches occurring 3 to 6 h after nitrate intake that are much more severe, with migrainelike symptoms...The primary literature suggests two differing mechanisms behind these two headache types. Immediate headaches appear to be connected to nitric oxide (NO)-mediated vasodilation; in contrast, delayed migraines, similarly to migraines triggered by foods, stress, and other factors, appear to be activated by the release of calcitonin gene-related peptide (CGRP), glutamate [etc.]...These results show for the first time a potential link between bacterial nitrate, nitrite, and nitric oxide reducers and migraines, by reporting their higher abundances in the oral cavities of people with migraines than in the oral cavities of those who do not suffer from migraines."
(mSystems. 2016 Sep-Oct; 1(5): e00105-16.)


Things like garlic and onions (as well as exercise) can increase nitric oxide and thus relax blood vessels, bringing efficient blood flow. However, I am not aware of ever getting a migraine from eating garlic. Yet, just a little bit of nitrates in my diet will trigger a terrible migraine. Therefore, there is something unnatural or harmful about the way nitrates dilate (or affect) blood vessels in the brain.

Taking triptan drugs to stimulate serotonin and constrict blood vessels can bring many unwanted side effects. One common consequence is that it leads to more headaches:

"If you take a triptan drug too often, you may start to have medication-overuse headaches (MOH). Instead of easing your headaches, the triptan could start to cause them...try not to use a triptan drug more than 2 or 3 times a week or 10 days each month."


Like triptan, caffeine is also vasoconstrictive. Yet, ironically, this often leads to recurring, rebound-headaches ("caffeine headaches"):


"Caffeine isn't the only trigger, either. Triptan drugs, such as sumatriptan (Imitrex) and other medications, can cause rebound headaches..."


There is much that is not understood about triptan drugs:


"Although sumatriptan was originally selected to target vasoactive properties thought to be fundamental to the etiology of migraine, other studies point to an action of triptans at several levels of the nervous system. To this day, however, it is not clear whether the antimigraine activity of the triptans involves an action only in the periphery or in the CNS as well. Because sumatriptan is hydrophilic, it penetrates the blood–brain barrier poorly, suggesting a peripheral site of action. On the other hand, it has been proposed that the barrier is compromised in migraineurs, so a CNS site of action has not been ruled out."
(Andrew H. Ahna and Allan I. Basbaum, "Where do triptans act in the treatment of migraine?")


Notice that triptans have trouble penetrating the blood-brain barrier. Yet, it is suggested that migraine victims have a compromised barrier. It is commonly argued that serotonin and tryptophan in foods cannot cross the blood-brain barrier. Therefore, it could be argued that it is actually possible to stimulate serotonin in a more natural manner (e.g., through diet, etc.). 

If I was suffering with constant migraines, I would:


1. Try to avoid all luncheon meats, jerky, etc., with added or "natural" nitrates. I would also avoid all vegetables with high nitrate levels (and try to find water without nitrates).


2. I would also try to avoid all MSG (found in almost every packaged or restaurant food), and high glutamate foods (certain aged cheeses, grape juice, etc.), until able to manage them. (For the link between glutamate and migraines, see: Neuroscience. 2013 Dec 3;253:341-9. doi: 10.1016/). [Aged cheeses not only contain high glutamate levels, but also tyramine, another migraine trigger].


3. To help manage glutamate, I would regularly take high amounts of antioxidants, such as cinnamon, natural vitamin C, olive leaf, carob, slippery elm, turmeric, onions, frankincense, and any other natural, Biblical foods known for high antioxidants. (In earlier days, when I would get regular migraines, I would get relief from sipping slippery elm tea, perhaps due to its antioxidant properties). Antioxidants also help keep nitrates from turning into dangerous nitrosamines! These nitrosamines also trigger oxidative stress, the largest migraine trigger! (See: Headache. 2016 Jan;56(1):12-35. doi: 10.1111/head.12725. Epub 2015 Dec 7; Eur J Neurol. 2011 Oct;18(10):1233-9. doi: 10.1111/j.1468-1331.2011.03414.x. Epub 2011 Apr 23;)


4. When necessary, I may try to stimulate serotonin in the brain without pharma drugs (which bring dangerous side effects, or rebound head-aches). 


What Stimulates Serotonin?

"How to increase serotonin in the human brain without drugs... interaction between serotonin synthesis and mood may be 2-way, with serotonin influencing mood and mood influencing serotonin...Exposure to bright light is a second possible approach to increasing serotonin without drugs...In humans, there is certainly an interaction between bright light and the serotonin system...Relatively few generations ago, most of the world population was involved in agriculture and was outdoors for much of the day. This would have resulted in high levels of bright light exposure even in winter...A third strategy that may raise brain serotonin is exercise...The fourth factor that could play a role in raising brain serotonin is diet..."
(J Psychiatry Neurosci. 2007 Nov; 32(6))


There is a powerful gut-brain connection that is only beginning to be understood. Many natural health researchers therefore suggest adding plenty of wild salmon and poultry to the diet to stimulate serotonin. Dates, the fruit of the Biblical palm tree, are high in serotonin; and many have felt increased calmness from date seed coffee:
"One unexpected compound in date tissue is serotonin at levels of 850 mg per 100 g."
(James A. Duke, Handbook of Energy Crops, 1983)

Constricting blood vessels can increase stroke risk. This is another reason I would avoid unnatural (i.e. Big Pharma) approaches.

Furthermore, researchers are starting to question the whole idea that migraine pain is connected to dilated blood vessels:

"...this idea of blood vessels as the source of headache has recently been viewed with increasing skepticism by headache researchers. Not all effective anti-migraine agents constrict blood vessels in the head, and evidence that blood vessels were dilated during migraine was weak at best. On top of this, a couple of recent studies have found that the throbbing pain of the migraine is not in synch with the heartbeat...With the demise of the blood vessel theory, we are now starting to recognize that migraine is a disorder of the brain itself...There are also a whole host of migraine triggers, ranging from foods to hormones, to light and stress. The tremendous variety of stimuli that can trigger a migraine implies that there are many brain systems that feed into the pathways that ultimately give rise to headache...patients and their doctors should consider the full range of factors that can trigger pain in a 'migraine brain' - things like diet, stress, exercise, hormones, or even just bright light."
(Mary Heinricher, Ph.D., Professor, departments of Neurological Surgery and Behavioral Neuroscience, OHSU Brain Institute)

"...basic physiology and underlying mechanisms contributing to the development of migraine is still poorly understood and development of new therapeutic targets is long overdue. Until recently, the major contributing pathophysiological event thought to initiate migraine was cerebral and meningeal arterial vasodilation. However, the role of vasodilation [blood vessels widening] in migraine is unclear and recent findings challenge its necessity...less than 50% of patients taking oral triptans are pain-free at 2 hours, and 30% have a reoccurrence of headache within 24 hours...Although they are the only drugs specifically developed to treat migraine headache, the exact mechanism by which triptans reduce migraine pain is unknown. They possess vasoconstrictive properties and therefore are generally not prescribed in patients with cardiovascular disease or abnormal blood pressure... repeated dosing with triptans can lead to a phenomenon known as medication-overuse headache (MOH) (Kristoffersen and Lundqvist, 2014)...Therefore, triptans are not recommended for daily use and are not prescribed as a migraine prophylactic. As a preventative measure to decrease the frequency of migraine headaches, patients will often be prescribed antiepileptics such as topiramate... However, these drugs can cause severe adverse effects including nausea, vomiting, weight gain, decreased cognition, and withdrawal symptoms upon discontinuation of the medication...studies demonstrate that the blood vessel does not simply provide a conduit for the movement of blood that can constrict and dilate; rather it coordinates a much more complicated web of signaling between multiple cell-types. Dysregulation of any part of this vascular signaling process may contribute to migraine pathology... recent reports indicate that during spontaneous migraine there is little to no dilation of vessels. And importantly, the reverse is also true; blood vessel dilation does not always produce a migraine..."
(Neuroscience. 2016 Dec 3; 338: 130–144.)


Contrary to modern diets, Biblical foods are very low in nitrates. This gives us a Divine model for their avoidance.


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