When keeping a food diary, it is important to write down everything you ate and when, along with any symptoms experienced. Less inflammation makes increases the Migraine threshold, making the body less vulnerable to a Migraine attack. This guide walks you through the current research about Migraine, diet, and food — what to eat and drink to fight off attacks before they happen. Rather, a craving for things like chocolate may be an early sign of a migraine attack.6, Alcohol is another food that’s associated with headaches. There are a handful of different Migraine diets but the research behind them is slim. These are commonly known as “icecream headaches,” although other cold foods like frozen popsicles or cold drinks can also cause this effect. Pain receptors then send a message to your brain, which misreads the discomforting sensations as coming from your head rather than your mouth. Keep a headache diary to identify your individual triggers. Salt For Migraines: To Have Or Not To Have? Some commonly reported food triggers include: (2). Migraine. Vegetables. Click the numbers in the parentheses (. ) The ketogenic diet aims to put your body into a state of ketosis, where your body uses fat as energy instead of carbohydrates. A lot of people suffer from the agonizing pain of migraines these days. There are a number of reasons why skipping meals can trigger migraine attacks, but the short answer is that food has really complex effects on brain function and chemistry that can influence migraine (1). As the award-winning actress and Migraine warrior Kristin Chenoweth said, “Pound the water, people!” She swears by it. Common Migraine Triggers: The Top 10 Offending Foods. Migraine friendly foods that help fight off attacks include: Many people with Migraine are magnesium deficient. Chocolate, alcohol, monosodium glutamate, cold foods, and avocados can all cause headaches. Other factors like differences in fermentation, processing, or degradation can also have an effect on tyramine content. Understand why here. Why Is My Baby Losing Hair And What Should I Do About It? There’s a laundry list of foods known to trigger a migraine attack, the most common ones being foods that contain histamine and MSG, chocolate, cheese and other dairy products, artificial sweeteners (e.g. While adding magnesium-rich foods like greens to your headache diet, you may also want to consider limiting coffee, sodas, salt, sugars, and alcohol. There are some theories that it can help Migraine, too. They are also more common in people who suffer from migraines.11, Avocados, citrus fruits, onions, bananas, and broad beans have been found to trigger migraine headaches in some people.12 One possible reason for these healthy foods going rogue is that they all contain tyramine.13 14, Aspartame is a common artificial sweetener that is added to processed foods. Although most people associate caffeine with coffee, there are many foods and beverages that contain caffeine like (5): If you are trying to cut back on caffeine, don’t quit cold turkey. article is based on scientific evidence from reputable sources including scientific and academic institutions and medical journals. Keep a headache diary where you jot down things like when and where you got the headache, what you ate and drank in a 24 hour period before you got it, how much sleep you got etc. Please use the content only in consultation with an appropriate certified medical or healthcare professional. One substance, phenylethylamine may alter blood flow in the brain or cause the release of other chemicals in the brain leading to migraine. Foods with high levels of tyramine include: Cheddar cheese, blue cheese and other aged cheeses While research may have found certain foods commonly cause headaches, do remember that this is also an individual-specific thing – what acts as a trigger for one person might not act as a trigger for another. Good nutrition and certain vitamins and minerals can help nourish your body and brain. Why That Banana or Onion Might Feel Like Three Martinis. But for people with Migraine, food cravings can be a warning sign that an attack is on its way. One research theory proposes some people might develop Migraine attacks due to the way the body processes certain chemicals such as tyramine, nitrate, caffeine, and sodium (1). In about 10% of people with these headaches, food is a trigger. How Long to Stay on the Diet. We can notify you whenever we have something interesting to share! "There are people who clearly cannot drink alcohol without having it trigger an attack. It’s known as reactive hypoglycemia, and it’s one of the least-known migraine triggers. Disclaimer: The content is purely informative and educational in nature and should not be construed as medical advice. What We Know About Chocolate and Migraine. Inflammation is a source of pain, and during a Migraine attack, the brain can become inflamed. An elimination diet consists of removing a long list of foods from your diet that may be triggering a Migraine attack. Migraine triggers "There is no universal food or beverage that triggers migraines," says Berk. National Headache Foundation. Foods with high levels of tyramine include: Some researchers suspect that some people develop Chronic Migraine when they’re unable to properly process tyramine (3). Talk to your doctor. Add to it the mysteries of finding the best Migraine diet and avoiding reported Migraine food triggers, and you have a recipe for extra stress. to view this reference material in full. Gradually reduce your caffeine intake until you no longer feel the negative effects. Plus different philosophies have different causes and triggers for migraines. Click the numbers in the parentheses (1, 2, 3) to view this reference material in full. Identifying your best headache diet and own Migraine food triggers is not an exact science, but more of a trial and error process. Foods That Trigger Migraines. Cheese contains a compound known as tyramine, which is formed when protein breaks down. American Migraine Foundation. And they often disagree with each others methods. Start small. Snacking throughout the day can help avoid a Migraine attack. “Ketone bodies have an anti-inflammatory effect,” says Cherubino De Lorenzo, a researcher at the Sapienza University of Rome. Have you tried a Migraine diet or headache diet? Citrus fruits, onions, bananas, broad beans, the artificial sweetener aspartame, and fermented foods like teriyaki sauce, miso, and soy sauce are also offenders. Lori Smith is a medical, health and wellness writer who has been published on and off line. Research shows it may not be a trigger after all. Diets that are typically conducive to reducing triggers include the following foods: Rice (Brown rice in particular) Natural Sweeteners e.g. aspartame), caffeine, cured meats, and anything with a strong smell. Or else. In most cases, drinking water will ease the symptoms of dehydration. Migraine food triggers are very individual. Much of what has been reported about triggers is based upon self-reported perceptions. One of our most popular articles, The 10 Best Nutrient-Rich Foods that Help Migraine, dives into the essential foods to add to your diet. What Should You Know About Birth Control and Migraine? Research suggests, though, that those with celiac disease (CD) or other inflammatory bowel conditions may be at a higher risk for developing Migraine and may experience gluten-related Migraine. Every time you reach for a snack or drink, you have an opportunity to either nourish your brain or increase your risk for an attack. If you are getting a craving for chocolate, it may be a sign that a Migraine attack is already on its way. Tyramine, typically found in aged or fermented food, is a widely reported Migraine food trigger. Fermented foods, such as yogurt, beer and breads made with yeast, contain histamine. Gluten is safe for most people but it can trigger a Migraine attack in those with Celiac Disease or inflammatory bowel conditions. Elimination diets are a hot topic of debate within the Migraine community. It is a neurotransmitter within the central nervous system and a vasodilator that causes blood vessels to widen (16). Unfortunately, for some people, excessive sugar intake or low blood sugar (hypoglycemia) can trigger their Migraine. You can avoid a blood sugar crash and the impending pain by eating nourishing meals throughout the day. Red wine, whiskey, beer, and champagne are some alcoholic drinks that have commonly been found to trigger headaches.7, Nitrates and nitrites are used as preservatives in many processed and cured meats. What Foods Can Trigger Migraine? soy sauce), nitrates (i.e. Some of the most popular Migraine elimination diets include: If you suspect tyramine to play a role in your Migraine attacks, a low-tyramine diet is worth a try. Low Tyramine Diet. It reported that Migraine frequency was reduced after using an IgG elimination diet (7). If you want to use caffeine every once in a while, keep your intake to less than 3 servings a week. Note: The ketogenic diet requires close monitoring by a qualified physician. Avoid skipping meals. Mobile apps take the guesswork out since they often factor in weather in your area and perceived sleep patterns, saving you the effort of adding that data yourself. According to some experts, chocolate may not actually be a trigger. Food sensitivity is not the same as food allergies. processed meats), sulfites (i.e. Every person with Migraine is unique, and clinical research on Migraine nutrition is fairly limited. When cheeses are aged they have a higher tyramine content. Anything more than that can lead to a withdrawal headache. The list of Migraine food triggers commonly reported by patients is long, but the list of solid, clinical evidence is short. Getting dehydrated is a surefire way to invite a Migraine attack. Food acts as a trigger for about 10% of people who suffer from migraines. Lipton, Richard B., Lawrence C. Newman, Joel S. Cohen, and Seymour Solomon. Even if you don’t feel like eating or drinking, dehydration will definitely make your symptoms worse. It’s a naturally occurring chemical that tends to increase as food ripens or ages. In ketosis, your liver produces substances called ketones (15). 23 Ayurvedic Herbs That Help Your Body Go From Healthy To Healthier, 6 Reasons To Add Sprouts To Your Diet Today, Risks Of Vaginal Birth After Cesarean (VBAC): 6 Factors To Consider, Cholestasis Of Pregnancy: 6 Things To Know About This Liver Problem, Exercising During Pregnancy Can Benefit You In These 9 Ways. Some people get headaches when cold foods move across their mouth or throat. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.For some people, a warning symptom known as an aura occurs before or with the headache. To identify your personal food triggers, use a headache diary or app, such as Migraine Buddy or N-1 Headache (formerly Curelator Headache), for 60-90 days. 11 Ways To Manage Migraines And Prevent Frequent Attacks, Can Sex Relieve Migraine Headaches? Whether you are dreaming of a salty hamburger or a sweet chocolate bar, we all experience food cravings at some point! Cure After a while, healthy habits will become second nature and Migraine food trigger anxiety will melt away. It is found in many foods like bread, pasta, beer, food colorings, and cereals. The Mayo Clinic explains that an anti-inflammatory diet includes balancing your diet with whole foods like (20): Some of these choices, however, may be a trigger. Testing for food sensitives is done through an IgG antibody test, which is different from a test to detect allergies. However, the connection between food and headaches can be a very personal one. Is caffeine a Migraine food trigger or a Migraine treatment? So how do you identify your individual triggers? Food acts as a trigger for about 10% of people who suffer from migraines. Sulfites present in alcohol could be responsible for that throbbing headache. Food cravings can show up one to two days before the pain of a Migraine attack hits, says The Mayo Clinic (11). The low-histamine diet is similar to the low tyramine diet. If you consume caffeine, it’s best to drink the same amount at the same time every single day. Keeping a headache diary can help you uncover yours. Ever feel like those sugary, yet delicious, desserts are causing you Migraine pain? For example these four potential migraine triggers are taken from the macrobiotic ideology: . Although it’s not completely clear why this happens, it could be because blood vessels at the top of your mouth or the back of your throat constrict and dilate when touched by a cold substance. The Scientific View. red wine) and yeast extract (i.e. Sodium intake and Migraine is a tricky topic for a few reasons. It remains controversial among people with Migraine and the doctors who treat them. Try to prepare fresh food at home whenever possible. That doesn’t mean you … Not drinking enough water, sweating, vomiting, and diarrhea are all causes of dehydration. Chocolate is NOT a proven Migraine food trigger! But did you know that dietary factors can play a part as well, particularly in migraines? Migraine Again founder Paula K. Dumas gave up aged cheese for nearly 15 years before discovering it wasn’t necessary at all. These drinks do double duty by helping you feel better and hydrating you at the same time: It’s crucial to stay hydrated during a Migraine attack. Foods that contain yeast—like sourdough bread and fresh-baked goods like donuts, cakes, and breads—have been known to trigger migraines. It’s also added to certain foods like soy sauce to enhance flavor.10. recognize signs that your body is dehydrated. "Alcohol is definitely a trigger," says Cleveland Clinic neurologist Stewart Tepper, MD. Vegetables like raw onions, fava or broad beans, sauerkraut, and fermented soy products, Citrus based fruits like orange, grapefruit, tangerine, pineapple, lemon, and lime, Foods containing preservatives and artificial colors, Fatty fish like salmon, sardines, mackerel, herring, cod, white fish, tuna, anchovies, Seeds especially hemp seeds, chia seeds, flaxseeds, Know your triggers and avoid them when possible, Avoid skipping meals, especially breakfast, Snack throughout the day to avoid hunger headaches and low blood sugar, Avoid processed foods – focus on the edges of the grocery store instead of middle aisles, Consider taking supplements like Magnesium, Vitamin B2, and Coenzyme Q-10. Salty foods — especially salty processed foods that may contain harmful preservatives — may trigger migraine in some people. You deserve to enjoy your life and every bite of your food! Chocolate also contains caffeine. While this sounds promising, the verdict is still out. This can lead to symptoms similar to an allergic reaction. The sneaky ingredient is (you guessed it) tyramine, the same culprit found within alcohol and cheese. You’d be hard pressed to find someone who’s never had a headache in their life. Pear Ginger Smoothie to Settle an Upset Stomach, Prevent Migraine attacks with evidence-based nutrition and hydration, Identify and avoid your individual Migraine food triggers, instead of all of them, Identify Migraine ‘safe’ foods you can enjoy without stress, Food additives like aspartame (diet drinks), MSG (i.e. Some people have taken that approach and have switched to a diet of plain meat, rice, pasta or potato, plain vegetable and water. Let’s take a look and see if what you’re eating could be causing that headache. One recent study found an increase in reports of Migraine in people with CD or IBD. About 400 mg of magnesium a day is recommended for Migraine prevention (23). Some people have found it helpful to embark on plant-based, ketogenic diet, or veganism as pain-safe migraine diets. Enlist your family to help. Fresh fruits and vegetables, especially greens and magnesium foods, can help prevent attacks. What Studies Say, 13 Home Remedies To Fight Rosacea Or Adult Acne, Get Rid Of Your Bra Bulge With These 9 Exercises And Yoga Poses, 4 Different Swimming Strokes And Their Benefits, 8 Yoga Poses For Abs: Moves To Strengthen And Tone Your Core, Yoga For Migraine Relief: 10 Asanas That Can Ease The Pounding Pain In Your Head, Benefits Of Running: Reasons Why We Love This Heart-Pumping Exercise, 10 Exercises To Tackle Rotator Cuff Pain And Keep Your Shoulder Pain-Free, 5 Benefits Of Using Milk In Your Skincare Routine. Although chocolate is a commonly reported trigger, studies have not been able to show that chocolate consistently triggers attacks. Everyone predisposed to migraines has different triggers, some of which may be food or drink-related. Histamine is not just responsible for seasonal allergies. Foods high in carbohydrates and sugars tend to lead to a blood sugar crash that can trigger an attack. “For example, many people identify chocolate as a trigger, but really it may be that early in the attack they are craving chocolate, they eat it, and then they feel that headache and painful part of the attack after eating it,” Dr. Andrew Charles of UCLA told Migraine Again. Caffeine may not be a direct trigger for headaches but if you habitually consume a large amount of it you could experience “caffeine rebound headaches” or withdrawal. Any food that causes fatigue or indigestion can indicate allergy or food trigger; What Should You Know About Fluctuating Hormones and Migraine? Designed by Elegant Themes | Powered by WordPress, DOWNLOAD & SAVE ARTICLE (PDF) >> CLICK HERE. Let’s walk through what we do know to help you navigate Migraine and diet more effectively. The book seeks to offer a holistic guide to Migraine management, avoiding quick fixes and helping you raise your Migraine threshold. canned soup), Alcohol like red wine, beer, and hard drinks including Scotch and Whiskey, Certain dairy products like aged cheeses, yogurts, sour cream and buttermilk, Aged, smoked, fermented, pickled or salted meats and fish, like hot dogs, bacon, and herring, Certain fresh fruits like citrus, banana, avocado, and dried fruits like raisins, Beans, nuts, and soy like fava or lima beans, nut butters, and tofu, Certain vegetables like onions and tomatoes, Cheddar cheese, blue cheese and other aged cheeses, Sauerkraut, kimchi, pickles and other fermented or pickled foods, Sports and energy drinks, including those that include, Prescription and non-prescription medications like pain relievers, cold medicines, and diuretics. Chocolate contains several ingredients that may play a role in triggering migraine. Whatever the trigger may be, all migraine triggers affect the brain in the same way — by lowering the threshold to migraines. Discovering your best Migraine diet and Migraine food triggers is a tricky process. Many factors can contribute to magnesium deficiency like stress, low dietary intake, excessive magnesium excretion, inherited conditions, and absorption problems (22). Eating a healthful diet can help prevent migraines. Foods to avoid with this headache diet, according to the National Headache Foundation, include (14): Some foods on the low tyramine diet should be consumed cautiously, like nitrate or nitrite-containing foods/beverages, concentrated yeast extracts, and food additives such as monosodium glutamate (MSG), sulfites, and aspartame. The ketogenic diet, or “keto” diet, is all the rage these days for weight loss. But some Migraine warriors find that their attacks are triggered by dehydration and having too little salt. Once you have a clearer picture of your own Migraine food triggers, you can choose to avoid them. Simple, yet nourishing foods without too much added salt or sugar are best. Allow notifications and you will never miss a thing, Questions and Answers on Monosodium glutamate (MSG). Research recently presented at the International Headache Society suggests that cocoa may actually protect the nerve cells that cause migraine headaches. Some people have a low level of DAO which prevents them from completely metabolizing histamine. Tyramine is known to cause migraines. Other foods or additives that may be triggering include: eggs; tomatoes; onions; dairy products From all my added research I have to agree with him, here they are: The advantage of this Does Caffeine Trigger or Treat Headaches? And certain fermented foods like teriyaki sauce, miso, and soy sauce have been found to act as headache triggers.16, Caffeine is found in common foods like coffee, colas, chocolate, and tea. “Central H3 [histamine] receptors seem to have a role in migraine that merit further investigation. Given that migraine can have many triggers, not just food, it may be impossible to go even a week without a migraine. (Remember how sugar crashes can trigger attacks?). Prospective Cohort Study of Caffeinated Beverage Intake as a Potential Trigger of Headaches among Migraineurs. Both. What to eat during a Migraine attack depends on your symptoms and personal food triggers. For occasional headaches, it is possible to take OTC drugs like Excedrin Migraine to ease the pain. Some people have an intolerance to histamine that triggers a Migraine attack when histamine levels increase. Certain foods, drinks, and additives may trigger migraines, and tracking them in a headache diary with one elimination per month may be helpful. It’s a little more complicated than just feeling thirsty. “So they identify chocolate as the trigger when it’s actually the chocolate craving that’s the indication that they’ve already started their headache,” Dr. Charles explains. The histaminergic system may be a goal for novel migraine drug,” concluded one study on histamine and Migraine (18). Tyramine, typically found in aged or fermented food, is a widely reported Migraine food trigger. Food additives and processed foods are widely considered to be common migraine triggers. This Migraine Again article is based on scientific evidence from reputable sources including scientific and academic institutions and medical journals. Migraine sufferers would do anything to get relief from this throbbing headache. It is also available under various brand names as a tabletop sweetener. According to the Migraine Trust, a drop in blood sugar after skipping meals, fasting or dieting, or eating food with high sugar content may trigger a Migraine attack (9). Focusing on a few important points can help you prevent Migraine symptoms and relieve the stress of so many choices. \"Many people with migraines have increased appetite and food cravings just before their headaches start.\" Reaching for a chocolate bar may be the result of a migrain… Foods high in histamine to be avoided include (19): Some people with Migraine can benefit from an elimination diet although they remain controversial. A low histamine diet can offer relief in individuals sensitive to it. Living with unpredictable Migraine attacks is frustrating enough. And alcoholic drinks with higher sulfite content may increase your chances of getting a migraine. The best diet for you is based on your individual food triggers. Foods high in Omega-3s include (21): Sometimes it’s easier to focus on what you can eat rather than what you can’t. Consistency is the name of the game with Migraine prevention. Do you have any Migraine food triggers? Ham, bacon, sausage, and pepperoni commonly contain nitrates or nitrites.8, Monosodium glutamate (MSG) is thought to trigger migraines in 10 to 15% of people who suffer from this condition.9 It is a salt of the amino acid glutamic acid and is naturally present in foods like cheese, tomato, soy extracts, and yeast extract. Not everyone has the same Migraine food triggers. Take it one day, one snack at a time. Adding supplements or foods high in Omega-3 fatty acids to your Migraine diet can also help reduce inflammation. There are no clinical studies at this time supporting the use of this headache diet, and it can be a difficult diet to stick to. Then various migraine trigger foods are introduced one at a time to determine what foods might cause a headache or dizziness attack. This comprehensive guide is designed to take some of the stress out of figuring out Migraine triggers and making healthy food choices. Do check in with a doctor if you have severe headaches that come on suddenly or if your headache occurs along with other symptoms like fever, a stiff neck, loss of consciousness, pain in your ear or eye, or confusion.19. Despite the lack of science, the most common foods and drinks reported to be potential headache triggers include: Aged cheese (blue cheese, brie, cheddar, English stilton, feta, gorgonzola, mozzarella, muenster, parmesan, swiss) Alcohol (red wine, beer, whiskey, Scotch, and champagne are the most commonly identified headache triggers) 2 (1989): 90-92. Chocolate, alcohol, monosodium glutamate, cold foods, and avocados can all cause headaches. One study which looked at about 170 patients from the headache unit of a medical center found that it was reported as a trigger by 8.2% of the subjects.15, Fermentation increases tyramine in foods. Fermented sausages, meats that are improperly stored or not-fresh, processed meats and tofu/tempeh. A portion of the book outlines an aggressive elimination diet, based on 30 years of Dr. Buccholz’s clinical experience. High salt meals can trigger Migraine attacks in some people. What Is An Elimination Diet and Should I Try One? The science behind food sensitivity and IgG testing is promising but it’s still new, says Amy Sutton from Harvard University (12). One study reported that headaches and moodiness were reported in women when they lost 1.4% of their body weight in fluid (10). \"Chocolate may be getting a bad rap as a migraine trigger,\" says Dr. Rosen. But 22 percent of headache sufferers identify chocolate on the list of foods that trigger migraines or headaches. Despite little proof of efficacy, the American Migraine Foundation explains that an elimination diet can be considered to reduce Migraine triggers. Food should be nourishing and enjoyable, not anxiety-inducing. For her, it wasn’t one of her personal migraine food triggers. (See: Will Chocolate Trigger a Migraine? It’s a naturally occurring chemical that tends to increase as food ripens or ages. Here's an article about foods that trigger migraines which should be avoided to prevent migraine attacks. Few migraine food triggers are proven by scientifically-accepted studies. Preliminary studies on the keto diet have shown positive results in lowering the frequency of Migraine, but we’re still waiting for conclusive results. 10 Simple Remedies For Treating A Cut Lip At Home, How To Control Oily Skin: 9 Tips And Natural Remedies, 5 Reasons Safflower Oil Is Great For Your Skin, 5 Harmful Side Effects Of Sunscreen: How To Stay Safe, Get Up On The Right Side Of The Bed Every Morning With Duroflex, 20 Ayurvedic Essentials Herbs That Boost Healthy Body Functions, 6 Reasons Why You Should Grab Rice Bran Oil On Your Next Grocery Run. This article may contain scientific references, including links to peer-reviewed scientific papers and studies. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836999/, https://www.ncbi.nlm.nih.gov/pubmed/27699780, https://www.ncbi.nlm.nih.gov/pubmed/23126519, https://www.migrainetrust.org/about-migraine/trigger-factors/hypoglycaemia/, https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201, https://americanmigrainefoundation.org/resource-library/migraine-and-diet/, https://headaches.org/2007/10/25/low-tyramine-diet-for-migraine/, https://www.huffpost.com/entry/less-carbs-more-fat-ketog_b_12672220, https://onlinelibrary.wiley.com/doi/full/10.1111/head.12293, https://www.ncbi.nlm.nih.gov/pubmed/17490952/, https://www.histamineintolerance.org.uk/about/the-food-diary/the-food-list/, https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/the-truth-behind-the-most-popular-diet-trends-of-the-moment/art-20390062. If you are prone to sugar crashes or have them regularly, there may be something you can do about it. Foods that trigger migraines should avoid. Fermented, aged or overripe foods. Aged cheeses, wine, and certain meats are all possible migraine triggers for some people. Lori holds a Bachelor of Science in Nursing from Wilkes University and a Master of Science in Nursing from the University of Pennsylvania. “Aspartame as a dietary trigger of headache.” Headache: The Journal of head and face pain 29, no. 5 Health Benefits Of Lemon Verbena That Might Surprise You! Many doctors recommend adding nutritional supplements to your Migraine diet. Written by Lori Smith | Jul 23, 2019 | Medical Review by: Jessica Kiarashi, MD. Remedy for migraines may demand a combination of over-the-counter and prescription (OTC) drugs and other treatments. But they should be done under medical guidance so that medical and nutritional support is provided (13). To understanding how gluten affects you and your Migraine, you may need to undergo IgG antibody testing (8). A headache diary or app can highlight the connection between certain food cravings and the start of a Migraine attack. Magnesium for Migraine. Triggers can also be additive, meaning: a specific food may push you over the threshold into an attack only when you’re exposed to other triggers at the same time, like poor sleep or extra stress.

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