Migraine attack triggers
Factors that can be involved in triggering migraine attacks
What is a trigger?
A trigger is something that happens to you, or something that you do, which seems to result in you having a migraine attack.
The migraine attack may start anywhere between six hours and two days after the trigger happens.
How to identify triggers
If you have migraine, almost anything can be a trigger. This means it can be very difficult to identify your potential triggers. It may also be a combination of a few things that seems to lead to a migraine attack. And a trigger may not lead to a migraine attack every time, which can confuse things even more.
Here is an example of how combinations of triggers can work: A young woman has identified that her migraine attacks appear to be triggered when she skips meals, is feeling stressed and when she is about to have her period. If she comes home late from a very stressful day at work, her period is just about to start, and she goes straight to bed without eating a proper meal, she will almost certainly have a migraine attack. However, if she skips dinner another time, when the other triggers did not happen, she will probably not have migraine attack.
Many people find that they sometimes go a long time without having a migraine attack. During this time, your body may seem to be less sensitive to triggers and you may find that even the combination of your usual triggers doesn’t result in a migraine attack.
Is it a trigger or a warning?
We know that the brain of someone with migraine likes balance, like regular sleep and meal patterns. We also know that migraine can be triggered by alcohol and the menstrual cycle. The evidence for other triggers, such as exercise, eating chocolate and bright light, is less certain.
It can sometimes be difficult to tell if something is really a trigger, or if what you’re experiencing is an early symptom of a migraine attack.
Studies have found that sometimes what you may think is a trigger is actually to do with the ‘premonitory’ or ‘warning’ stage of a migraine attack.
During this stage, you may get symptoms such as changes in your mood or emotions, cravings for certain foods, and being more sensitive to light, sound or smells.
These symptoms can lead to you think that something is triggering your migraine attack. For example, at the beginning of a migraine attack, you may start to crave sweet foods. You may then eat some chocolate to satisfy the craving. When you then get a headache, you may think that eating chocolate was the trigger. But actually you were starting to have a migraine attack when the cravings started – and the cravings were the warning sign.
The same could be true for other triggers. If you are more sensitive to light in the warning stage, you might think bright lights are a trigger. If you are more sensitive to smells, you might think certain scents are a trigger.
If you are able to identify what your warning signs are, it can help you to understand what is happening during your migraine attacks. This could help you to spot an attack early and get the treatment you need sooner.
Keeping a diary
Keeping a migraine diary may help you to find out what might be triggering your migraine attacks, or may make you more alert to warning signs. You may notice a pattern of things that happen in the two days before a migraine attack.
You should try to keep a record of things like:
- what time you wake up and what time you go to sleep
- the things you do (going to work, watching TV)
- where you are (the environment around you may contain triggers such as lighting or the temperature of a room)
- what you eat and drink
- when you eat and drink
- when you have bowel movements
- what exercise or travel you do
- what your mood is like
- what the weather is like
- your menstrual cycle (for women)
- when a migraine attack or other headache starts, how painful it is and what other symptoms you have
- what medicines you take to try and ease the pain, and how much you take
- anything else you can think of that might be a change to your lifestyle
The timing of when you have migraine attacks may help you to identify your triggers. For example, if you tend to get migraine attacks at the weekend, it could be that caffeine withdrawal is a trigger, as you may drink fewer cups of tea or coffee at home than at work. Winding down at the weekend after a stressful week at work can also be a trigger for some people. And some people find that having more sleep at the weekend can be a trigger.
Avoiding triggers
If the trigger of your migraine attacks is a single thing, it can be simple to avoid. However, it may be harder to avoid attacks that are triggered by a combination of things.
It can be difficult to avoid your triggers if this means changing your lifestyle. This is because:
- routines can be hard to break
- other people may be involved, so changes are more difficult to make
- major changes may be needed, which take time, effort and support
- it may have a negative impact on other parts of your life.
It is also important to be realistic about what impact identifying and avoiding triggers will have. If you avoid your triggers, you may be able to reduce how often you have headaches, but you may not be able to stop having them altogether. Many people need to use additional methods to control their condition.
General improvements in your lifestyle can mean that you are more able to cope with migraine attacks, as you are healthier and fitter. You should aim to exercise regularly and eat a well-balanced diet.
You may continue to have very painful headaches even after looking at all the issues talked about here. If this is the case, talk to a doctor about the possibility of using medication to try and stop the headaches happening.
Common triggers
Common triggers of migraine attacks include being hungry or thirsty, feeling stressed or changes to your usual routine. As there are many things that could be triggers, keeping a migraine diary can help you to identify your triggers.
Some people find that if their usual routine changes, this can lead to a migraine attack. For example, if the time when you go to sleep and wake up changes, or you get more or less sleep than usual. Going on a long journey can also be a trigger. Even if the changes are nice, such as going on holiday, they can be triggers.
A lot of people with migraine find they have migraine attacks at the weekend. This may be because you change your daily routine at the weekend, such as eating at different times, and drinking less tea or coffee than you do during the week. Some people find that having a lie in after a busy week can be a trigger. Also see stress, sleep and caffeine below.
If you are stressed, this can trigger a migraine attack. Other heightened emotions such as anxiety, excitement, tension and shock can also cause migraine attacks. Some people find that their migraine attacks start when they stop feeling stressed. This could be why they may have migraine attacks at a weekend, when they relax after a busy week at work.
Both having too much or too little sleep can trigger a migraine attack. Some people find that if they have sleepless nights or a few late nights, which means they are very tired, this can trigger a migraine attack. Other people find that if they get more sleep than usual, for example if they have a lie in on a weekend, this can lead to a migraine attack.
Having too much caffeine can lead to a migraine attack for some people. However, cutting out caffeine suddenly can also trigger migraine attacks. If you think caffeine may be a trigger, it is best to try and gradually cut down the amount you have, rather than stopping suddenly. Some people find that changes in how much caffeine they have at a weekend can impact whether they have a migraine attack or not. Caffeine is in tea, coffee and cola, as well as chocolate and some over-the-counter painkillers.
Migraine is linked with female hormones. This may be why more women than men have migraine.
Many women with migraine have their first migraine attack during their teens, often around the time that their periods start. Some women find that their migraine attacks are linked to their menstrual cycle, so they may have attacks around the start of their period.
When women go through the menopause, they may find it difficult to manage their migraine attacks as they are more unpredictable.
If you have migraine, you can take the contraceptive pill, but it is important to choose the right one for you and your condition.
Triggers may be in the environment around you, for example if you are somewhere that is at a high altitude, if there are changes in the weather, or if there is high humidity. Loud noises, bright lights and flickering lights can also be triggers. Although it is not clear whether the light and sound are the triggers, or if you are being more sensitive to them because you are in the early stages of a migraine attack.
Sitting in front of a computer for a long time can trigger a migraine attack. It is important to take regular breaks from the screen. It might also help if you use an anti-glare screen and have good lighting.
It is important to sit comfortably when you use a computer. If you are in an uncomfortable position, it can cause the muscles in your head, neck and shoulders to tense up, which can contribute to migraine attacks.
Many people with migraine find that what they eat has an impact on their migraine attacks.
At the beginning of a migraine attack, you may start to crave sweet foods. You may then eat some chocolate to satisfy the craving. When you then get a headache, you may think that eating chocolate was the trigger. But actually you were starting to have a migraine attack when the cravings started – and the cravings were the warning sign.
You may find that if you miss meals or eat sugary snacks instead of a proper meal, this can result in a migraine attack. Not having enough food is one of the most common food-related causes of migraine attacks. It is therefore important that you eat regularly. Having small nutritious snacks regularly may help to control your migraine attacks.
Some foods contain chemicals or additives which some people find contribute to their migraine attacks. For example:
- Tyramine, which is found in red wine and foods such as soft cheeses like camembert and brie. Some people with migraine avoid red wine as they find tyramine can trigger migraine attacks.
- Monosodium glutamate (MSG), a flavour enhancer that is added to some foods, in particular Chinese food and processed meats.
- Nitrates, which occur naturally in some foods such as vegetables, and are also added to foods such as processed meats.
- Aspartame, an artificial sweetener that is found in some foods and fizzy drinks.
Although some people may be sensitive to certain foods, there isn’t any scientific evidence that additives such as tyramine actually cause migraine attacks.
Special diets
There have been some studies into whether following a special diet or cutting out certain foods can have an impact on migraine. However, these studies have not produced clear evidence of an impact.
Many people with migraine find that if they miss a meal, this can trigger a migraine attack. It is important that you eat a healthy diet and stick to regular mealtimes.
Chocolate
Many people crave sweet food such as chocolate before they have a migraine attack. They may then eat chocolate to satisfy the craving. When they then get a headache, they may think that eating chocolate was the trigger. But actually they were starting to have a migraine attack when the cravings started – the cravings were the warning sign.
Caffeine
Having too much caffeine can lead to a migraine attack for some people. However, cutting out caffeine suddenly can also trigger a migraine attack. If you think caffeine may be a trigger for your migraine attacks, it is best to try and gradually cut down the amount you have, rather than stopping suddenly.
Some people find that they have migraine attacks at the weekend, as they have less caffeine than during the week.
Caffeine is in tea, coffee and cola, as well as chocolate and some over-the-counter painkillers.
Alcohol
Drinking large amounts of alcohol can give many people a headache, which is one of the most common symptoms of a hangover.
Alcohol can also trigger migraine and cluster headache for people who are prone to having either. It often doesn’t have to be a large amount of alcohol to have this effect.
Alcohol is not a trigger for everyone who gets migraine and cluster headache, and some people find that certain types of alcohol have this effect while other types don’t.
Keeping a diary
If you think that a certain food or drink is playing a role in your migraine attacks it can help to keep a headache diary.
This can show when you’re having attacks and what you’ve had to eat or drink. If you think there is a link and want to cut out certain foods or drinks the diary can help you track what impact it has. It may also help to cut one thing out at a time rather than lots of things all at once, otherwise it can be hard to know what had had an impact.
Blood sugar levels
If you skip meals, go on a diet, or exercise without eating enough food beforehand, your blood sugar levels can drop (this is called hypoglycaemia). People with migraine can find this leads to them having a migraine attack.
Migraine is not caused by low blood sugar, but it can make migraine attacks more likely or the symptoms more painful.
If your migraine attacks appear to be triggered or made worse by having low blood sugar levels, make sure you have small, frequent, low-sugar meals. Try not to miss breakfast or skip meals. Have a proper meal instead of a sandwich for lunch, and if you have an early lunch, have an afternoon snack to make sure you don’t get too hungry.
If you find you have headache when you wake up, it may help to have a healthy snack before bed.
To keep blood sugar levels stable, eat a healthy, balanced diet with lots of fruit and vegetables, cut down on cakes, biscuits and ice cream, and avoid processed foods and ready meals.
If you are dieting, aim to lose weight gradually over a longer period of time. This will also make it easier to keep the weight off in the long term.
Coeliac disease and gluten sensitivity
Coeliac disease is a serious condition where a person’s immune system reacts when they eat gluten and causes damage to the lining of their gut. When this happens, they have symptoms such as diarrhoea, bloating, vomiting and stomach cramps. There can also be serious complications if it is not treated, such as anaemia. There is no cure for coeliac disease and people with it need to avoid gluten all their life.
There have been studies into the link between coeliac disease and migraine. There is no evidence to suggest that coeliac disease causes migraine. It is thought that if people with coeliac disease and migraine follow a gluten-free diet, this may help with both of their conditions.
Gluten sensitivity is when a person has a bad reaction if they eat gluten. They may have similar symptoms to coeliac disease, but there is no damage to the lining of their gut or the risk of serious complications that can happen with coeliac disease.
Gluten is found in foods that contain wheat, barley or rye. These include pasta, bread, cakes, some sauces and most ready meals.
One of the symptoms of gluten sensitivity is headache. But there is no evidence that gluten sensitivity causes migraine. However, if you are sensitive to gluten, you may find that if you eat food containing gluten, it makes migraine attacks more likely or the symptoms more painful.
There is no evidence to suggest that a gluten-free diet can help people with migraine who are not gluten sensitive or who don’t have coeliac disease.
If you don’t drink enough water, you can get mild dehydration. This can impact people with migraine. You should drink at least eight glasses of water a day. This is on top of any other drinks you may have.
Taking cocaine can trigger a migraine attack. If you regularly take cocaine and are trying to stop, this can also trigger migraine attacks. Using cannabis can make it more difficult for your migraine attacks to be treated.
Taking regular exercise can help to prevent migraine attacks as it stimulates the body the release natural painkillers. It also improves your general health, which means you may be more able to cope with migraine attacks.
For some people, sudden vigorous exercise can trigger a migraine attack. This is particularly in people who don’t normally do much exercise.
Some people grind their teeth when they are asleep and find they wake with head pain. If this happens to you, you can see a dentist who may be able to advise on whether you could have a special mouth plate (called occlusal splints), which can reduce the teeth grinding.
Some head injuries can result in headaches and migraine attacks.
Coughing a lot can lead to a migraine attack in some people.
Having tense muscles in your neck and shoulder can cause headaches and may be a sign that a migraine attack is starting.
Sunlight and artificial lights can trigger migraine attacks. Flashing lights such as car head lights, glare from the sun, Christmas lights etc can all trigger and exacerbate migraine symptoms. The types of artificial light that can trigger or exacerbate migraine include fluorescent light, sunlight, and LED/LCD lights. We also know that the brightness of the light can play a role. Someone that has migraine may also be sensitive to light as well, this is called photophobia.
Prolonged or sudden loud noises, such as busy areas or sirens, can trigger migraine attacks. Someone that has migraine may also be more sensitive to noise during a migraine attack and they may find it difficult to be in a noisy environment. They may choose to wear ear defenders or rest in a quiet room when a migraine attack has been triggered by noise.
