Migraine Triggers

Cara Jakob, MD

What causes a migraine is still a mystery, but doctors are aware of a variety of factors that have been shown to initiate migraines. These factors are called triggers, and for people with migraines, avoiding them may be the only way to avoid a migraine. Each person’s triggers will be different. For some migraine sufferers, only one trigger sets off a headache. For others, the trigger responsible for the headache may change from migraine to migraine. Here, the many factors that are known to make migraines more likely to occur.

 

The Most Common Triggers

The most common triggers for migraines include:

• Sleep changes: Getting too much or too little sleep may trigger a migraine.
• Stress and anxiety: Emotional or mental stress and anxiety can trigger migraines.
• Medications: Certain medications may increase your chance for a migraine. These include oral contraceptives and vasodilators.
• Bright lights/photophobia
• Loud noises/phonophobia
• Strong odors: Such as perfumes or secondhand cigarette smoke
• Foods: The most common food offenders include aspartame, an artificial sugar substitute; foods that contain tyramine (a substance that forms as foods age), such as aged cheeses, hard sausages, and Chianti wine; foods that contain monosodium glutamate or MSG, a key ingredient in many broths, Asian foods, and processed foods; caffeinated or alcohol drinks, particularly beer and red wine; and foods that contain nitrates, such as hot dogs, bacon, and salami. Skipping a meal or fasting may also increase your likelihood for a migraine.
• Changes in the weather and barometric pressure
• Hormonal changes: This is a particularly troublesome trigger for many women—fluctuations in estrogen, caused by menstruation, pregnancy, or menopause, may cause a migraine. Hormone medications, including oral contraceptives and hormone replacement therapy, can trigger or even worsen migraines, too.
• Physical activity: Physically exerting yourself—whether through exercise, sexual activity, or physical labor—may cause a migraine.

Other Risk Factors

• Genes: Research suggests your genetics may play a role in who is likely to suffer from migraines. After all, 90 percent of people with migraines have a family history of the severe headaches. If your parents, siblings, or children have migraines, you’re more likely to have them.
• Gender: Seventy percent of migraine sufferers are women. However, in childhood, boys are more often affected than girls. The gender switch begins around the time of puberty.
• Age: Most people will experience their first migraine in adolescence, but they can occur at any age.
• Weight: Women who are mildly obese or obese have a greater risk for migraine headaches than women with a lower BMI.

How You Can Find Your Triggers

Pinpoint your migraine triggers by keeping a headache diary. Each time you have a migraine headache, record it. Also, be sure to record the time of day your headache started; what you ate or drank in the 24 hours preceding the migraine; where you were and what you were doing when the symptoms of the migraine began; and finally, if you had any other conditions that might have triggered the migraine. For example, if you’re a woman, write down if you have your period. If you take any medications to ease symptoms, record what and how much you took. Also note if that medication helped and how quickly. If your doctor has prescribed a medication to treat your migraines, having a record of its effect on your headache will be especially helpful for him or her to determine if you’re taking the right medicine for your condition.
Take this journal with you to your next doctor’s appointment. Having your doctor review your headache journal may help him or her pinpoint possible triggers. Start by avoiding those triggers as best you can to avoid another migraine. If one occurs anyway, record that information and share it with your doctor. If you find that avoiding the triggers helps your headache, it is possible you’ve found the triggers for your headaches, and avoiding them from now on will help you avoid migraines.

Avoiding Triggers

You can’t always avoid what causes your migraines, but for those risk factors where you do have control, avoiding them may help you prevent migraines and live a pain-free life. Keep away from any food or drinks that make headaches worse. If you know a particular perfume or scent brings on a migraine, avoid that. If possible, establish a daily routine and environments (at home and at work) that are less likely to initiate a migraine headache for you.