40 year old banker with severe Migraine headache

Ms. XX is a forty-year-old banker who came to see her doctor, as she was having severe headache. She described it as throbbing, intense, debilitating to the point that she had to take time off from her work for prior three days. She was feeling nauseous and had irritation with bright light and noise. She had history of headaches but nothing recent. Her routine was the same, nothing changed. She was asked if she did anything different or ate anything different before the headaches started. She thought for a moment and said only thing different she did was that she ate her lunch at a Greek restaurant. She had a Greek salad with extra feta cheese. The headache started that evening. After thorough evaluation it was concluded that Ms. XX suffered from Migraine attack triggered by Feta cheese.



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Feta cheese contains tyramine that can initiate migraine attack by activating fibers of nerve called trigeminal nerve which in turn causes complex inflammatory changes leading to various symptoms of Migraine. Other food triggers for Migraine include other aged cheese, alcohol, too much of caffeine, MSG, chocolate, citrus fruits etc. There are other triggers besides food like weather changes, lack of sleep, hormones, emotional stress, neck pain etc.

Ms. XX was treated with sumatriptan (Imitrex), naproxen (Aleve) and nausea medication prochlorperazine (Compazine) to abort her headache. She was advised to make a food diary and stay away from triggers. She responded well and was back to work.


If you have recurrent debilitating migraine even after identifying and avoiding triggers, preventive treatment is the best approach. Various medications for blood pressure (beta blockers – propranolol, metoprolol, calcium channel blockers – verapamil), anxiety/depression (venlafaxine, amitriptyline) and seizure disorder (topiramate, valproic acid) can help to prevent migraine in appropriate patients. Newer injectable medications like galcanezumab & erenumab have also shown significant benefits in preventing migraines. Other treatments like cognitive behavioral therapy, meditation, relaxation techniques, biofeedback etc. may also help.


Note: Inspired from true patient encounters from clinical practice for educational purpose only. Names, characters, businesses, places, events, locales, and incidents are either the products of the author's imagination or used in a fictitious manner. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.


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