Causes & Triggers
Migraine triggers can be anything that causes or contributes to a migraine.
- can be different for each migraine attack
- are not the same for everyone
- often combine to cause a migraine
Uncovering your triggers
Lets say its Thursday night. Its been a long and stressful day at the office. The work was so intense that you had two extra coffees to keep you going through the afternoon and late into the evening. By the time you get home it’s past your usual bedtime and you’re too exhausted to cook dinner. Instead you go straight to bed.
In the morning you wake up with a migraine. What were your triggers? What would you select from the below?
- Skipping meals
- Lack of sleep or changing sleeping pattern
- All of the above
- Not enough information
The last option 6. is the correct answer because we don’t have enough information from just the one migraine attack. All those factors may have played a role. Certainly one of them did. But we are not sure if all of them did. Caffeine for instance may not be an issue, or it could be the biggest issue for the migraine sufferer.
Triggers can be misleading
Working out what triggers to your migraine attacks can be very difficult. This is perhaps where people are the most unique in their condition. Different triggers cause migraine attacks in different people. Sometimes the same trigger affects you, sometimes it doesn’t. Sometimes you get a migraine apparently out of nowhere. Other times, it’s no surprise.
Often it’s a combination of triggers which cause a migraine attack to occur.
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 100 attacks and not one of them being caused by the same combination of triggers or circumstances.
That calculation is made using two variables:
- number of triggers and
- 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'
Migraine author Dr Anne MacGregor provides a good explanation (1) :
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 potential variables. Some days they might occur predictably, other times when you were confident you were safe, one can arrive out of nowhere.
Keeping a migraine journal
You won’t really know until you monitor your migraines in some kind of journal or diary. This helps you record your potential triggers each time you get a migraine. After you get a migraine, record as much information in the last 2 days about your:
- sleeping habits
- what you did
- what you ate & drank
- when you ate & drank
- medications and
- anything else that may contribute to your migraine
While keeping a journal or diary won’t eliminate your migraines entirely, it will help you bring your migraines under control.
Top migraine triggers
So what are the big triggers to watch out for? They are different for different people. This is not a comprehensive list, it is just a starting point for some of the more common triggers.
- Stress This trigger may be in the form of a stressful job or relationship. Anxiety causes stress, strong emotions, too many events occurring in a single day, occurring in a row, or almost at the same time. These all contribute and could potentially come under “stress”.
- Sleep factors If you’re not getting enough sleep, experiencing disrupted sleep, changing your sleeping habits (i.e. with travel) or waking up still feeling tired then you may not be getting enough sleep and it could be a trigger. Not enough sleep is a very common trigger for migraine sufferers.
- Dehydration Are you getting enough water every day? Do you know how much you need? This is another contributing factor for migraine sufferers. Surprised? When you learn that water is the body’s principal chemical component, that it makes up 60% of your body weight and that every system of your body depends on water, then it starts to make more sense why it could be a trigger for many people.
- Visual agitation This could also be called “visual stress” and it is caused by a number of factors: bright sunlight, eyes not protected from sunlight, staring at the computer screen for too long, fluorescent lights, flashing lights or going to the movies.
- Neck/back Pain Discomfort or pain in your neck or upper back area. Poor posture for those who work desk jobs may contribute to neck complaints that can lead to migraines.
- Odour Strong odours, incense, perfume, chemical smells from strong cleaning products, cigarette smoke, vehicle exhaust, air pollution etc.
- Alcohol By all means have a good time, after all we deserve some down time. But certain beers, wine and spirits are known to have a negative impact on many migraine sufferers. If in doubt monitor your body’s response to alcohol (noting what kind of alcohol you had – beer, wine, spirits etc).
- Weather related This has to do with a drop or change in barometric pressure, often just before a storm arrives. It may also be due to heat or a rapid change in temperature.
- Caffeine How much coffee or tea do you have each day? Do you keep it consistent or do you change habits on the weekends? This could be playing around with your caffeine levels. Some medications also have caffeine in them to help “activate” the medicine. Watch out for energy drinks, soft drinks like Coke and other medications which contain caffeine.
- Hunger Skipping meals, low blood sugar levels, hypoglycaemia or getting too hungry may trigger migraines.
- Menstrual related Hormone imbalance, typically experienced in women during menstruation.
- Noise Loud and/or constant noise.
- Diet This is a tricky area as there are many potential triggers within the diet that haven’t yet been discussed. If you suspect items that you eat are triggers, but don’t know where to start, then getting tested for food allergies or sensitivities may be an option. Other common food triggers to be aware of are food additives such as nitrites and MSG (monosodium glutamate), soy, food colouring, chocolate, aged cheese, red wine, beer, caffeine, citrus fruits, cured meats such as bacon, hot dogs, aspartame and ice cream. This is individual, so for best results consult an expert (like a nutritionist/dietician) or speak with your MD or GP about next steps.
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- The Migraine Trust, United Kingdom
- MacGregor EA. ‘Menstrual’ migraine: towards a definition. Cephalalgia 1996
- Levy D, Strassman AM, Burstein R. A critical view on the role of migraine triggers in the genesis of migraine pain. Headache. June 2009.
- Martin, PR. Behavioral Management of Migraine Triggers: Learning to Cope with Triggers. Current Pain and Headache Reports. June 2010.
- Lipton, R. Fair Winds and Foul Headaches: Risk Factors and Triggers of Migraine. Neurology. Jan, 2000.
- Kelman L. The Triggers Or Precipitants Of The Acute Migraine Attack. Cephalalgia. May, 2007.
- Spierings EL, Ranke AH, Honkoop PC. Precipitating And Aggravating Factors Of Migraine Vs Tension-Type Headache. Headache: The Journal of Head and Face Pain. Dec, 2001
- Moskowitz MA. Defining A Pathway To Discovery From Bench To Bedside: The Trigeminovascular System And Sensitization. Headache: The Journal of Head and Face Pain. May, 2008.
- Prince PB, et.al. The Effect Of Weather On Headache. Headache: The Journal of Head and Face Pain. Jun, 2004.
- Martin, PR. Behavioral Management Of Migraine Headache Triggers: Learning To Cope With Triggers. Headache Report. June 2010.
- Rockett, FC; et.al. Dietary Aspects Of Migraine Trigger Factors. Nutrition Reviews. Jun, 2012.