Working out the causes of your migraines can be difficult. Lets be honest, its really difficult.
Because you can experience different causes or triggers at different times. Furthermore, its usually a combination of them.
Having a combination of different triggers at different times means there are many different scenarios when you might be at risk of an attack.
If you have for example, 7 triggers (which in my experience is less than average), then you may have over 2,500 attacks and not one of them being caused by the same combination of triggers or circumstances.
That calculation is made using two variables: 1) number of triggers and 2) combinations of them. But there is also a third variable in migraine attacks. It's often explained as your 'migraine threshold'.
Triggers and the 'migraine threshold'
Dr Anne MacGregor (author of Understanding Migraine and Other Headaches) provides a good explanation:
Imagine a migraine ‘threshold’ that is determined by your genetic makeup. This threshold is also raised or lowered by external factors, as well as internal changes in your brain. Varying triggers occur over a period of time. If a sufficient number of different internal and environmental triggers build up to cross the current threshold a migraine attack is initiated. This explains why you do not always get a migraine attack in similar situations – perhaps your threshold fluctuates or the number or importance of triggers varies. Consequently, missing a meal and less obvious triggers such as flickering sunlight or a lack of sleep do not always bring on an attack. However, if any or all of these are combined with a period of stress at work or hormone changes an attack may occur.
This is why finding out your migraine triggers is so tricky. There are literally thousands of different scenarios that can trigger an attack when you consider all the variables. Some days they might occur predictably, other times when you sure your safe, one can arrive out of nowhere.
If you're anything like I was, you might be able to name 5-10 of your triggers. But how many you correctly name is not what really matters.
What really counts, is how many of your triggers you miss.
Unfortunately with migraines, what you don't know, can hurt you.
If the penny has just dropped then your next question is probably "how do I know if I'm missing something?"
Fortunately, the answer is simple.
You are likely to be missing a key trigger if any of the below signs are true:
- your attacks appear random,
- if they come out of nowhere and surprise you,
- if your attacks are becoming more frequent,
- if you have little control over your condition.
Please note: this assumes you have been diagnosed with migraines by a medical professional and have ruled out the possibility other complications with your doctor (often via MRI or CT scan).
If you have ruled out other conditions and relate to any of the above signs - then take comfort in the fact that you still have a great opportunity to improve your condition. How to improve your condition is not covered in this list. You can read more about improving your condition here.
For those who know their key triggers, they on the other hand:
- are rarely surprised by a migraine attack,
- find that attacks usually occur because they were complacent or caught out,
- feel a greater sense of control over their condition- they are in charge,
- are much more likely to be managing their key triggers and improving their condition.
I was a slow learner
It took me 14 years to really understand this. It was only recently I began an investigative journey to uncover what my key triggers were.
It's never too late to start.
If you're concerned that this list is all problem and no solution then here is an equally long list of migraine treatments. :)
This list should help provide you with a reference to work from. It's not exhaustive, it doesn't include absolutely everything that causes a migraine (that list would be almost infinite). But it should provide a good starting point, some great clues and most importantly, hope!
Here it is, in no particular order:
- Too much sleep/ too little sleep, 30 mins difference can sometimes be enough to trigger an attack.
- Inconsistent sleep or changing your sleep/wake cycle including staying up late on weekends, jet lag etc.
- Poor quality of sleep including frequent interruptions from new borns, or the loud dog next door waking you up throughout the night.
- Read more about sleep triggers.
- Strong emotions that are either positive or negative may trigger an attack eg. birthdays, weddings, funerals, crying etc.
- Anxiety or depression may lower your migraine threshold.
- Stressful job, relationships or children.
- Being overly busy and juggling multiple things at once.
- Changes in stress levels eg. weekends, post-exam periods, holidays.
- Few us of really drink as much pure water as recommended - are you really getting your 8 glasses a day?
- Read more about dehydration.
4) Visual agitation
- Visual strain from staring at the computer, phone or TV for too long.
- Reading or squinting. Watch-out when reading whilst your lying in the lounge chair position.
- Bright lights including car lights in your eyes whilst driving at night.
- Fluroscent lights.
- Flickering lights.
- Glare of any kind.
- Cinemas, movies including 3D movies/TVs.
- Read more about tinted lenses designed for migraine sufferers.
5) Neck/back discomfort
- Tension in your upper back or neck area.
- Poor posture whilst sitting, sleeping, reading or standing.
- Physical trauma, strain or injury to neck
- Physical trauma, strain or injury to back
- Physical trauma, strain or injury to shoulders
- Physical trauma, strain or injury to head
- Misalignments or other injuries.
- Odours, incense, perfume, deodorants, chemical smells, cleaning products, cigarette smoke, air pollution, vehicle exhaust etc.
- Odours in enclosed spaces.
- Read more about odours and migraines.
- Any form of alcohol can be a trigger, but not all may have equal impact.
8) Weather/temperature related
- Changes in barometric pressure (often due to an incoming storm).
- Changes in temperature from hot-to-cold or cold-to-hot.
- Changes in humidity.
- High altitudes.
- Read more about weather triggers.
- Inconsistent caffeine use.
- Caffeine withdrawals.
- Caffeine in some medications (causing rebound migraines).
- Skipping meals.
- Low blood sugar levels, hypoglycaemia.
- Hunger pangs.
- Menstruation: sometimes an over-reactive response to natural fluctuations in hormones throughout the month.
- Hormone imbalances
- Oral contraceptives
- Thyroid issues (more detail here)
- Acne (near the jaw line or temple).
- Read more about hormones and migraines here.
- Loud noise.
- Constant noise.
- Piercing or ringing sounds.
This is a limited diet list, make sure you read the food labels and look for alternative names of ingredients you suspect eg. Soy is sometimes listed as Textured Vegetable Protein (TVP). The product may also contain soy from other listed ingredients such as Natural flavourings, Hydrolyzed Plant Protein, or Vegetable Gum.
- Artificial sweeteners e.g. Aspartame.
- Chilli peppers or capsicum.
- Citrus fruits e.g. pineapple, oranges, lemons.
- Dairy e.g. milk, cheese.
- Food colouring
- Gluten products e.g. breads, cereals, biscuits, cakes, pastas, potato chips and other wheat or flour based products.
- MSG (monosodium glutamate)
- Nitrates e.g. processed meats such as bacon, hot dogs, sausages, cured ham, other cold cuts and other products.
- Salty foods
- Sodas including diet sodas which often contain artificial sweetners.
- Soy which is often included in breads, crackers, cakes, rolls, processed cereals, soy sauce, soy lattes, tofu, miso, canned soups, ice cream, frozen desserts, margarines, butters, some salad dressings, sauces, soybeans and breakfast bars amongst other things.
- Sulphites/Sulphates included in many processed or canned foods, condiments, relishes, jams, jellies, pudding, filings, alcoholic beverages, dried fruits, some baked goods like pie or pizza crust, crackers and cookies etc.
- Tannins often found in chocolate and beans e.g. string beans, navy beans, kidney beans etc.
- Tyramine contained red or balsamic vinegar, aged cheeses, smoked fish, bacon, sausages, hot dogs, avocado, red plums, bananas, citrus fruits, olives, processed meats and some types of alcohol.
- Yeast found in beer, yeast breads, pizza, soft pretzels.
14) Head related triggers
- A tight pair of glasses.
- Heavy or tight hair accessories such as hair clips.
- "Hairdo headaches" for example a tight ponytail.
- Tight fitting hats or caps.
- Long wet hair.
- Muscle tension, strain or stiffness anywhere on or near the head area.
- Often exercise thats too intense - especially if sudden and extreme.
- Too much or too little exercise.
- Sexual activity (see tips on how to avoid this).
- See how to avoid exercise-related migraines.
- TMJ or TMD (Temporomandibular Joint Disorders) Teeth grinding, clenching often whilst sleeping.
- Chewing gum.
17) Medications or treatments
- Medication overuse is a complication of migraines which can lead to dependency, withdrawals and daily chronic migraines.
- Rebound migraines can be caused by medication withdrawals, particularly those with caffeine.
- If certain treatments are not administered professionally, cautiously and appropriately they can lead to attacks e.g. chiropractic treatment, physiotherapy, massage etc.
There's good news
You might be looking at triggers like 'Diet' and thinking "what's left to eat? I can't starve myself because apparently that's a trigger too!"
It is a long list. But I've never met anyone with every single trigger listed above.
The good news is that surprising things happen as you begin to uncover triggers. You become more likely to manage them. With more triggers under control, your migraine threshold increases which makes you more resistant to other triggers.
This can spark a virtuous cycle of trigger discovery, management and raising your migraine threshold. It's how I reduced my attacks from 6 per week to once every 3 months.
If you're at your wits end then get a diary and make a start.
Are there any missing triggers? Do you have any questions about any of them?
Let me know in the comments below and I'll respond!
- MacGregor, A Understanding Migraine and Other Headaches. Dorset: Family Doctor Publications Ltd, 2005
- Dowson, AJ. Migraine and Other Headaches Your Questions Answered. Edinburgh: Churchill Livingstone 2003
- Hot Topics in Headache. London: The Migraine Trust 2002
- WebMD Migraine Triggers: Your Personal Checklist . Accessed 10 Mar 2014. http://www.webmd.com/migraines-headaches/migraine-triggers-your-personal-checklist
- Healthcentral Common Migraine Triggers. Authored by Terri Robert. Accessed 10 Mar 2014. http://www.healthcentral.com/migraine/triggers-22175-5.html