This is reported mostly in women who smoke, take birth control pills, and have a history of migraine with aura. Many things can trigger this chemical imbalance. In women, hormone changes, natural or through birth control pills, are the most common culprit. This may be why migraine is 3 times more frequent in females. Food sensitivity, especially to chocolate, cheeses, red wine, and MSG is worth investigating with a food diary of what was consumed in the 24 hours preceding a headache.
Some sinus headaches are migraine in disguise.
If a patient presents with a headache on one side, changing sides in different attacks, with a throbbing pain, it may be migraine. There is often sensitivity to light and sound and relief with sleep. Nausea and vomiting are frequent companions of migraine. A family history and trigger pattern help make the diagnosis. Any pain that is always in the same location, awakens the patient from sleep, is caused by bending, coughing, straining at a bowel movement, or with other exertions, including sex, warrants a medical opinion.