Common triggers

Commonly reported migraine trigger factors include hunger, dehydration, stress and changes in routine

Introduction

Here we look at some common migraine trigger factors. You can learn more about what trigger factors are here.

If you are prone to getting migraine, it is wise to suspect everything until you have identified or eliminated a particular factor by using your trigger diary.

Common triggers

Changes in routine

Some people find that changes in their routine can contribute to a migraine. For example changing sleep patterns or changes caused by long journeys can precede an attack. Even pleasant changes such as a holiday can be implicated.

Weekend headaches

Many people complain that they suffer migraines at the weekend. At the weekend you may have a change in many of your daily routines such as eating times, reduced caffeine consumption which is particularly noticeable if you have a ‘lie in’ after a busy week. See also stress, sleep, and caffeine below.

Stress

Migraine and stress are strongly linked. Indeed, anxiety, excitement and any form of tension and shock may all lead to a migraine attack. However, some people report that their migraine attacks start when the stress reduces. This is sometimes experienced as “weekend headaches” when, after a busy and stressful week at work, an individual might experience a migraine at the weekend when they are more relaxed.

Sleep

The complex nature of trigger factors is illustrated by sleep. Both too much and too little sleep can be implicated in a migraine starting. Some people find that sleepless nights, a number of late nights and being over tired can trigger a migraine. Other people find that sleeping in or dozing in the mornings has the same effect.

Caffeine

Excessive consumption of caffeine may contribute to the onset of a migraine attack. You could try not having more than 4 or 5 cups of tea, coffee or cola in a day. Some people find that suddenly stopping caffeine altogether can also be a trigger factor. If you suspect this, you may wish to cut down on caffeine more gradually. Some people find that consuming less caffeine at the weekend can have an impact on migraine attacks, but you should also note that caffeine can be found in many products including chocolate and over the counter painkillers.

Hormonal changes in women

Migraine is closely associated with female hormones. Some women find their migraines start at puberty, and are linked to their menstrual cycle. The additional hormonal trigger for women may explain why more women than men experience migraine during their reproductive years. The menopause is often the most difficult time for women with migraine.

The environment

There are certain trigger factors which can be related to environmental issues such as high altitude, weather changes, high humidity, loud noises, exposure to glare or flickering lights. It is unclear if light and sound are themselves triggers, or if heightened sensitivity to them are early features in the attack.

Computer screens/VDUs

Sitting in front of a computer at home or work for long periods of time can cause problems if you experience migraine. Following common sense precautions such as taking regular breaks, using anti glare screens and good lighting can help prevent this sort of difficulty.

Sitting comfortably is very important when you use a computer to avoid muscle tension building up in the head, neck and shoulders. This muscle tension is implicated in the onset of migraine.

Food

Healthy eatingFood related triggers occur in about 10% of people with migraine. Many people will crave sweet food such as chocolate before the pain of the migraine is experienced which leads them to conclude that eating sweet food is a cause. However, sometimes the craving for particular food is a symptom of the beginning of the migraine.

Lack of food

Missing meals or eating sugary snacks instead of a balanced meal can all contribute to a migraine attack. Insufficient food is probably one of the most important dietary triggers. You may find that eating small nutritious snacks at regular intervals can help to control your attacks.

Additives

Some food products contain chemicals or additives which may also be implicated in an attack. Ones which are frequently mentioned by people with migraine are monosodium glutamate, nitrates and aspartame.

Alcohol and cheese

There is some evidence that red wine may trigger a migraine because it contains tyramine which has been linked to migraine. Certainly many people with migraine avoid red wine. Tyramine is also found in other food products such as soft cheeses like camembert and brie.

Mild dehydration

Mild dehydration can have an impact on people who have migraine. It is recommended that you should drink at least 8 glasses of water per day. This is in addition to any other drinks you may have. Fizzy drinks can contain the sweetener aspartame which some people link to their migraine.

Did you know?  The widespread belief that chocolate should be avoided by migraine patients lacks scientific evidence. Chocolate is more likely to be a dietary symptom of a migraine attack (people can experience food cravings before the onset of an attack), rather than a dietary cause.

(Lippi G et al. Chocolate and migraine: the history of an ambiguous association. Acta Biomed. 2014 Dec 17;85(3):216-21.)

Although some people may be sensitive or intolerant to certain foods, research has not demonstrated a consistent link with tyramine, nitrites or any other food component. A true sensitivity to a food as a migraine trigger usually causes attacks repeatedly rather than occasionally.

(Frith A. Coping with Headaches and Migraine. Sheldon Press 2009.)

Drugs

Taking cocaine and withdrawal from cocaine can trigger an attack. Using cannabis can contribute to making your attacks more difficult to treat.

Exercise

Like sleep, exercise can both help to prevent migraine and conversely can be a trigger factor for some people. Regular exercise which is built up gently can help to prevent migraine. It also stimulates the body to release its own natural painkillers, as well as increasing the individual’s sense of well-being and general health. Sudden vigorous exercise, particularly for people who do not usually take exercise, can be a trigger factor.

Oral contraceptives

The use of contraceptives which contain hormones such as the contraceptive pill can trigger migraine for some women. Medical advice should always be sought if this occurs. If you already experience migraine you should tell your GP this before you start taking hormonal contraceptives.

Teeth grinding

Some people grind their teeth during the night and find they wake with head pain. If this is the case it is worthwhile seeing a dentist as there are special mouth plates (called occlusal splints) which can reduce the teeth grinding.

Physical conditions

  • Head injury
    Specific head injuries can result in headaches and migraine.
  • Muscle tension
    Tense muscles in the neck and shoulder areas can cause headaches and may be a premonitory symptom of the migraine starting.
  • Coughing
    Repeated coughing can lead to a migraine for some people.