Identifying triggers for migraine
DEAR DR. ROACH: Is it true that fructose is a trigger for migraines? -- L.J.S.
ANSWER: Migraine headaches are a form of episodic headache, often associated with nausea, as well as sensitivity to light and sound. There are many subtypes of migraine, including migraine without headache, and any given person may identify his or her own trigger for migraine. 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 (thank you, Dr. Abby Spencer, who taught me that word years ago).
Among foods, caffeine and wine are very commonly identified triggers for migraine. Some people identify chocolate as a trigger, but it may not be. It’s possible to get food cravings, such as for chocolate, at the beginning of the migraine syndrome, so although it seems as though chocolate is the trigger, in fact the migraine caused the chocolate craving. Fructose, a sugar found in honey and fruit, is not a commonly identified trigger. It may be that, similar to chocolate, 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.
ANSWER: 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.
I recommend against sleep medications containing Benadryl, primarily because there is a clear increase in risk of car accidents and of falls among people, especially older people, who take these medications. Diphenhydramine in particular can adversely affect the quality of sleep, decreasing the restorative deep sleep and dream sleep in most people.
Newer antihistamines, such as loratadine (Claritin) or cetirizine (Zyrtec), do not have anticholinergic properties, and are a better choice for a person who needs an antihistamine. Similarly, the SSRI class of antidepressants (sertraline (Zoloft) and many others) have far fewer side effects that the older tricyclic class and are used less often. Pelvic floor exercises, bladder retraining and (if appropriate) vaginal estrogen are appropriate treatment for overactive bladder before trying medication.
The observed risk of developing dementia is higher in people taking larger amounts of anticholinergic medication. Although I am not 100% convinced that these medications really do increase risk of dementia, I think there are other reasons to use these drugs at lower doses for shorter periods of time, and to find alternatives if available.
In your case, if behavioral changes to help sleep are not helpful, there are prescription medications available that may be safer than Benadryl in terms of fall risk, and which are not associated with dementia.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.