Identifying triggers for migraine

Dear Dr. Roach: Is it true that fructose is a trigger for migraines? — L.J.S.

Migraine headaches are a form of episodic headache. There are many subtypes of migraine, including migraine without headache. It’s possible fructose is a trigger for some people.

Stress and sleep changes are among the most common. Women sometimes get migraines around the time of menstruation. These are called catamenial migraines.

Among foods, caffeine and wine are very commonly identified triggers for migraine. Some people identify chocolate as a trigger. It’s possible to get food cravings at the beginning of the migraine syndrome. Fructose is not a commonly identified trigger. It may be that some people have a craving for fruit even before an aura, or the headache, begins.

Dear Dr. Roach: I take 25 mg of Benadryl every night to go to sleep. Without it, I get a terrible night’s sleep. I recently read there is a link between Benadryl and dementia. Do you know if there is a correlation? — L.C.

There is a correlation between certain drugs with anticholinergic properties and dementia. “Anticholinergic” means that the drug works against the effects of the neurotransmitter acetylcholine. The most common anticholinergics are older antihistamines like diphenhydramine (Benadryl), tricyclic antidepressants like amitriptyline and bladder antispasmodic agents like oxybutynin (Ditropan).

However, the word “correlation” is important, because it is not clear that taking these drugs increases the risk of developing dementia. It may be that people with very early dementia are more likely to be prescribed anticholinergic medications.

Diphenhydramine in particular can adversely affect the quality of sleep, decreasing the restorative deep sleep and dream sleep in most people.