What to Know About Migraine Triggers

A migraine is a throbbing headache often associated with nausea, vomiting, and light and sound sensitivity. Depending on the migraine type, an aura (a reversible neurological symptom) may precede the headache.

Triggering factors like daily stress, specific dietary products (e.g., alcohol or chocolate), and sleep deprivation are reported in up to 76% of people with migraines.

This article reviews common migraine triggers and how to recognize personal triggers to help reduce the number and severity of migraine attacks. Strategies to combat a migraine headache promptly and effectively are also discussed.

Migraine

What Are Migraine Triggers?

The activation of the trigeminovascular system causes migraines. This complex pathway connects the trigeminal nerve (or fifth cranial nerve) to blood vessels within the outer membranes of the brain (meninges).

Though a person's genetic makeup influences migraine development, experts believe various environmental factors trigger migraine attacks (perhaps directly or indirectly) by activating the trigeminovascular system.

Potential migraine triggers include stress, consuming certain foods and drinks, sleep disturbances, and hormonal fluctuations. Weather-related factors and sensory stimuli like strong smells, bright lights, or loud noises have also been reported as migraine triggers.

Learning Your Migraine Triggers

Migraine triggers vary significantly among individuals and do not precipitate an attack 100% of the time. Also, multiple triggers may need to be present in some cases for a migraine to occur.

Identifying and learning how to cope with (or avoid) personal triggers is a challenging but powerful task in optimizing migraine care.

One valuable tool for learning your migraine triggers is to start a migraine diary, whether that's through a handwritten notebook, computer spreadsheet, or smartphone app.

You can improve your chances of pinpointing personal triggers by recording your daily routine (e.g., meals and sleep schedule), migraine symptoms, and the remedies or medications you're taking to relieve attacks.

Stress Triggers

Stress, especially exposure to daily stressors like working long hours, paying bills, and caring for children, may trigger migraine attacks and contribute to the development of chronic migraines (15 or more migraine attacks per month).

In addition, migraine attacks are also often considered stressors themselves, creating a vicious and exhausting cycle of pain and stress.

Though a link between the stress response and migraines exists, the precise connection remains unknown. Experts suspect that a complex interplay of factors like the timing and type of stressor and phenomena like central sensitization (increased responsiveness of pain-sensing nerve cells) are involved.

Migraine Food Triggers

Several types of foods and drinks may provoke a migraine attack. Interestingly, the amount of them required to trigger a migraine and the timing of a person's exposure to them appear to influence whether they develop a migraine.

Commonly reported migraine food/drink triggers include:

  • Alcohol, especially red wine and beer
  • Chocolate
  • Caffeinated beverages, such as coffee, black tea, energy drinks, or soda
  • Certain dairy products, such as aged cheeses (e.g., cheddar, gouda, and parmesan)
  • Food containing nitrates and nitrites, especially cured and processed meats such as bacon, sausage, hot dogs, and deli meats
  • Monosodium glutamate (MSG), which occurs naturally in tomatoes and cheeses and is a common additive in fast foods, soy sauce, and canned vegetables and soups.
  • Artificial sweeteners, especially aspartame

Sleep

Nearly 75% of people with migraines identify sleep deprivation as a trigger. In addition to sleep deprivation, altered sleep schedules (e.g., as a result of jet lag) and excessive sleep can also trigger migraines.

Several sleep disorders are also associated with migraines, namely restless leg syndrome, insomnia, shift work disorder, and narcolepsy.

Interestingly, the relationship between poor sleep quality and migraine attacks is bidirectional, meaning sleep problems can trigger migraines, while migraine attacks can promote sleep disturbances.

The fact that similar brain structures and chemicals are involved in sleep and headaches may explain this two-way connection.

Medication Overuse

Frequent and excessive use of pain-relieving migraine medications is another common trigger. Medication overuse entails taking headache painkillers for 10–15 or more days per month for over three months.

The good news is that rebound headaches generally improve after a person stops taking the pain medication. Responsiveness to any preventive treatments for migraines also tends to improve upon discontinuation of the drug.

Precaution

Speaking with a healthcare provider or headache specialist before discontinuing any pain medication is essential. Depending on the drug, you may need to stop taking it gradually to avoid harmful withdrawal symptoms.

Strong Smells

Strong smells may trigger a migraine, typically within minutes and even in low concentrations.

Commonly reported migraine-triggering odors include:

  • Perfume
  • Cigarette smoke
  • Gasoline and motor vehicle exhaust
  • Home or clothing cleaning products like bleach, fabric softener, or laundry detergent
  • Foul odors like sewer, garbage, and sweat
  • Beauty products, such as nail polish or shampoo
  • Cooking smells, such as those of fried food, grilled fish or meat, garlic, mint, cheese, and curry
  • Insect repellent

Bright Lights and Loud Sounds

Bright light, including sunlight or fluorescent light, can trigger a migraine, as can flickering lights or the glare of a phone or computer screen.

Moreover, loud everyday noises, such as the sirens of ambulances, fire trucks, police cars, and railroad crossing bells, have been identified as capable of triggering migraines.

Sensory stimuli like bright lights and loud sounds are not only migraine-triggering but can also aggravate the pain of an already occurring migraine headache. This is why people with migraines often prefer to rest in a dark, quiet room until the pain subsides.

Weather Changes

The following weather changes may trigger a migraine attack:

  • A decrease in barometric pressure (the weight or force of the air on Earth), such as the kind that occurs because of an approaching thunderstorm
  • High humidity in warm months (April through September)
  • A decrease or increase in temperature

That said, compared to other migraine triggers, the scientific evidence backing up weather-related factors is limited and mixed.

This controversy may reflect that only a subset of people are genetically vulnerable to weather effects. Alternatively, specific weather conditions may need to combine with other environmental factors to incite a migraine attack.

Hormones

Migraines are three times more common in females (people born with ovaries) than males (people born with testes). This sex discrepancy is attributed mainly to the natural fluctuation of the sex hormone estrogen. 

Specifically, estrogen changes during puberty, the menstrual cycle, pregnancy, and perimenopause can trigger an attack in migraine-prone individuals.

Birth control pills and hormone replacement therapy (HRT) also influence estrogen levels and, thereby, migraine manifestation.

It's unclear exactly how estrogen levels provoke a migraine attack. Experts suspect estrogen's interaction with serotonin, calcitonin gene-related peptides (CGRPs), and the cells that line blood vessels within the brain likely play a role.

Other Hormones and Migraine

Two other hormones linked to migraines include:

  • Cortisol, which is released from the adrenal glands (small glands that sit upon your two kidneys) when a person experiences anxiety, fatigue, stress, or pain.
  • Insulin is released by the pancreas and helps blood sugar (glucose) enter the body's cells for energy. Insulin resistance (which is when cells don't respond well to insulin) is associated with chronic migraines.

How to Avoid Migraine Triggers

Though it's certainly possible to avoid some migraine triggers—for example, a specific dietary product or overuse of pain medication—other triggers, like the everyday stresses of life, cannot be so easily evaded.

If you cannot avoid a given trigger, learning how to cope with it is your best bet for preventing future migraine attacks. For instance, to minimize stress, consider cognitive behavioral therapy, progressive muscle relaxation, or biofeedback.

Likewise, if caffeine triggers your migraine headaches, but you feel like you need your morning coffee to function, try aiming for a lower daily caffeine intake—less than 200 milligrams per day (mg/day), which is equivalent to 1 to 2 cups of brewed coffee.

The following healthy lifestyle behaviors can also help optimize your migraine care:

  • Exercising 30–60 minutes three to five times a week (under the guidance of a healthcare provider if you have any other chronic conditions or movement restrictions)
  • Eating regular, well-balanced meals at least three times a day
  • Ensuring adequate hydration (seven to eight 8-ounce glasses of water per day is generally considered sufficient)
  • Maintaining a regular sleep schedule (same bedtime and wake-up time).

How to Get Rid of a Migraine

Getting rid of a migraine often involves a combination of home remedies and medication.

The two main home remedies that can help alleviate a migraine headache are napping in a dark, quiet room (or with an eye mask and earplugs) and placing an ice pack on your neck.

Depending on migraine severity, a healthcare provider or headache specialist may recommend a non-prescription or prescription drug.

Non-prescription drugs for migraine include:

Precaution

Due to potential harm, only take medication, including OTC drugs like Tylenol or Advil, under the guidance of a healthcare provider. They may not be appropriate for your care or cause harmful drug interactions.

Prescription drugs are often reserved for moderate-to-severe migraine headaches. They include:

Summary

Migraines are a debilitating neurological condition caused by a complex interplay of genetic and environmental factors. These environmental factors, called triggers, include daily stressors, specific dietary products, sleep problems, weather and hormone changes, and sensory stimuli such as strong odors, bright lights, and unpleasant noises.

Recognizing and avoiding or coping with personal migraine triggers can help reduce the number and severity of migraine attacks. Home remedies, medication, and healthy lifestyle behaviors are also critical to migraine management.

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Colleen Doherty, MD

By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.