Everything You Need to Know About Migraine Triggers

Migraine is a headache disorder characterized by recurrent attacks of headaches.

These headaches can range from moderately to severely painful and can cause additional symptoms, including nausea, vomiting, sensitivity to light and sound, and worsened pain while moving. 

Unfortunately, scientists have yet to determine the exact causes of migraine.

Many experts believe there is a genetic component and research is underway to identify which gene mutations may be responsible for causing the condition.

However, several factors are known to trigger migraine headaches in some people.  

Identifying the exact triggers of your migraine headaches help you to avoid said triggers to prevent migraine attacks when possible.

In this article, I’ll explain the most common migraine triggers and when you may want to reach out to your healthcare provider or neurologist to discuss your treatment options.

Stress

Stress is a common trigger for many types of headaches, including tension headaches and migraine headaches.

In fact, according to migraine specialists, the brain of those who get migraine is particularly vulnerable to changes in both sleep and stress. 

One reason why stress may be a common trigger for people with migraine is the feedback loop that chronic pain and stress can have on one another.

Migraine headaches can cause chronic pain, which can then cause emotional and physical stress, which can trigger additional migraine headaches.

For people who experience stress-related migraine headaches, stress management can play an important role in prevention and symptom management. 

Caffeine or Alcohol

Alcohol is another common cause of both migraine headaches and cluster headaches.

Keep in mind that the amount of alcohol needed to trigger a migraine headache can vary from person-to-person.

For some, one glass of red wine may be enough to trigger symptoms, while others may not experience the effects until a few alcoholic drinks are consumed.

Caffeine’s effects on the migraine brain can also vary from person-to-person.

Some people find that drinking caffeine can trigger a migraine attack while others report that drinking a cup of coffee or taking a migraine medication containing caffeine, like Excedrin or Midol, can stop their attacks from coming on.

For others, experiencing caffeine withdrawal will trigger migraine symptoms. 

If you suspect caffeine or alcohol to be a trigger for your migraine attacks, keeping a diary of your migraine attacks and your timing and quantity of alcohol and caffeine consumption can help to identify if these triggers hurt or help your symptoms. 

Sleep Issues

Poor sleep and insomnia have long been associated with increased frequency and intensity of migraine headaches and other symptoms.

If you suspect poor sleep to be a trigger for your symptoms, following a consistent sleep schedule can help you to prevent attacks.

Avoiding blue light from the television and other electronics, limiting food and beverage intake before bed, and going to bed around the same time every night are key strategies to help you develop a healthy sleep schedule.

Hormones

Hormonal changes are another common migraine trigger for people born female.

Specifically, changes in estrogen levels during the menstrual period, perimenopause, and estrogen replacement therapy have been known to trigger migraine attacks for some people.

However, entering menopause (when estrogen levels decline significantly) can bring an end to migraine attacks.

Diet

The quality of diet may also impact the onset of migraine headache symptoms.

one large analysis of 3,069 people born female in the National Health and Nutrition Examination Study found that those who experienced migraine had a significantly lower diet quality index as defined by the Healthy Eating Index.

Other common food triggers of migraines include: chocolate, aged cheeses, some fruits and nuts, fermented or pickled foods, yeast, and cured or processed meats.

Food Additives

Though there is limited research demonstrating the direct impact of food on migraine attacks, some data show that there is a possible link between the consumption of food additives and increased migraine headache frequency and severity.

These additives include monosodium glutamate (MSG) and nitrates (used in some preserved meats). 

Light

Several types of visual stimuli can trigger a migraine attack, including changes in light.

These changes can include direct sunlight, bright light, and striped light patterns.

Changes in Weather

Changes in weather during seasonal and other environmental transitions can also trigger migraine symptoms, including changes in temperature, humidity, and precipitation.

Air pollution may also be a trigger in some people.  

Dehydration

Non-migraine and migraine headaches can be triggered by mild dehydration, sometimes referred to as a “dehydration headache.”

Data suggests that increasing your regular water intake throughout the day can help to prevent migraine headaches.

Smells

Several odors that can trigger migraine headaches, include certain perfumes, paints, gasoline, and rancid food products.

Medications 

Though many people don’t realize it, some medications can cause headaches, including migraine headaches.

Some examples of medications that may trigger migraine headaches include birth control, hormone replacement therapy, medications for erectile dysfunction (ED), medications including caffeine, some heart and blood pressure medications, and certain vitamins and supplements.

Additionally, overusing pain medication can cause something called a rebound headache, a headache that returns when the effects of the medication wear off.

Medications that can lead to rebound headaches when overused include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are often used to treat migraine headaches, but overusing them can cause rebound headaches. These may include acetylsalicylic acid (Aspirin), diclofenac, ibuprofen (Advil), and naproxen (Aleve).

• Combination pain relieving medications: Over-the-counter (OTC) examples include Excedrin, and Anacin. Some prescription combination medications can cause rebound headaches too, including Fiorinal.

• Migraine medications: These include triptans, antiemetics, ditans, and more.

• Opioids: Butorphanol, codeine, tramadol, meperidine (Demerol), and other opioid painkillers used to treat migraine have a high risk of causing medication overuse headaches.

Physical Activity 

Lack of physical activity may trigger migraine headaches in some people. However, intense physical activity can also cause migraine headaches.

In fact, one Dutch study found that exercise-induced migraine may be fairly common.

For people who experience exercise-triggered attacks, the symptom that most frequently appeared at the onset of attacks was neck pain.

When to See a Doctor

If your migraine symptoms are having a debilitating impact on your quality of life, it’s important to speak with your provider or neurologist to discuss treatment options.

Before recommending a personalized treatment plan, they may ask you to keep a migraine diary to gather all of the data possible in regard to when you experience symptoms and which factors, if any, may be triggering them.

If identifying and avoiding triggers doesn’t help to curb your migraine attacks, you can reach out to your provider to learn more about the available medications.

Some of the most common medications used to treat migraine include:

• Triptans: These are the first-line treatment for people who experience moderate to severe migraine headaches. Triptan options include: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig). 
• Dihydroergotamine: This second-line therapy can also be effective at treating symptoms, but your provider may not recommend it due to an increased risk of side effects, like nausea.
• Antiemetics: Antiemetics are medicines that target pathways that mediate nausea and vomiting.   Examples of these medication options include chlorpromazine, droperidol, metoclopramide, and prochlorperazine.
• Ditans: Ditans are a new group of migraine medications that work to block the processes that lead to the development of severe migraine headache. Lasmiditan (Reyvow) is the first to be approved by the FDA for short-term treatment in people with and without migraine aura.

It’s also important to seek medical attention if you’re experiencing a headache that is not a sign of migraine. In rare but serious cases, a severe headache may be a sign of something else.

If you experience any of the below symptoms, be sure to seek immediate medical attention: 

• Fever
• Nausea
• Shortness of breath
• Weakness in the body
• Confusion
• Double vision
• Stiff neck
• A feeling you’re experiencing the “worst” headache of your life
• A headache prompted by a head injury
• A severe and sudden headache if you never, or rarely, experience headaches

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