Are migraine triggers and causes the same thing? No.
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
Migraine causes are the reason why an individual experiences migraine in the first place.
- Are often genetic. The susceptibility of migraine is passed from parent(s) to child.
- They are also environmental.
- For example, significant head injury, concussion or whiplash can bring on migraine.
- Other environmental or lifestyle factors may also contribute to the presence of migraine.
- Poor diet, chronic lack of sleep, lack of exercise, high stress, and physical abuse for example may be factors in the cause of migraine.
- 1 Multiple Choice Question: Which Trigger Is It?
- 2 How Triggers Can Be Misleading
- 3 The ‘Migraine Threshold’
- 4 Hidden Triggers Can Lead To More Attacks
- 5 Keeping A Migraine Journal
- 6 Top Migraine Triggers
- 6.1 1) Sleep
- 6.2 2) Stress
- 6.3 3) Dehydration
- 6.4 4) Visual agitation
- 6.5 5) Neck/back discomfort
- 6.6 6) Odors
- 6.7 7) Alcohol
- 6.8 8) Weather/temperature related
- 6.9 9) Caffeine
- 6.10 10) Hunger
- 6.11 11) Hormonal
- 6.12 12) Noise
- 6.13 13) Diet
- 6.14 14) Head related triggers
- 6.15 15) Exercise
- 6.16 16) Jaw
- 6.17 17) Medications or treatments
- 7 There’s good news
Multiple Choice Question: Which Trigger Is It?
Lets say it’s 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.
How 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’.
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 2,500 attacks and not one of them being caused by the same combination of triggers or circumstances.
That calculation is made using two variables: 1) number of triggers and 2) combinations of them. But there is also a third variable in migraine attacks. It’s often explained as your ‘migraine threshold’.
The ‘Migraine Threshold’
Dr. Anne MacGregor (author of Understanding Migraine and Other Headaches) provides a good explanation:
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 uncovering migraine triggers is so tricky. There are literally thousands of different scenarios that can trigger an attack when you consider all the variables. Some days they might occur predictably, other times when you sure your safe, one can arrive out of nowhere.
You might be able to name 5-10 of your triggers. But how many you correctly name is not what really matters.
What really counts, is how many of your triggers you miss.
Hidden Triggers Can Lead To More Attacks
If the penny has just dropped then your next question is probably “how do I know if I’m missing something?”
Fortunately, the answer is simple.
You are likely to be missing a key trigger if any of the below are true:
- your attacks appear random,
- if they come out of nowhere and surprise you,
- if your attacks are becoming more frequent,
- if you have little control over your condition.
Please note: this assumes you have been diagnosed with migraines by a medical professional and have ruled out the possibility of other complications with your doctor (often via MRI or CT scan).
If you have ruled out other conditions and relate to any of the above signs – then take comfort in the fact that you still have a great opportunity to improve your migraine condition. How to improve your condition is not covered in this list. You can read more about improving your condition here.
For those who know their key triggers, they on the other hand:
- are rarely surprised by a migraine attack,
- find that attacks usually occur because they were complacent or caught out,
- feel a greater sense of control over their condition- they are in charge,
- are much more likely to be managing their key triggers and improving their condition.
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.
It often takes many years of suffering, frustration, and disappointment to eventually try keeping a regular diary.
It’s never too late to start.
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.
- Too much sleep/ too little sleep, 30 mins difference can sometimes be enough to trigger an attack.
- Inconsistent sleep or changing your sleep/wake cycle including staying up late on weekends, jet lag etc.
- Poor quality of sleep including frequent interruptions from new borns, or the loud dog next door waking you up throughout the night.
- Strong emotions that are either positive or negative may trigger an attack eg. birthdays, weddings, funerals, crying etc.
- Anxiety or depression may lower your migraine threshold.
- Stressful job, relationships or children.
- Being overly busy and juggling multiple things at once.
- Changes in stress levels eg. weekends, post-exam periods, holidays.
- Few us of really drink as much pure water as recommended – are you really getting your 8 glasses a day?
4) Visual agitation
- Visual strain from staring at the computer, phone or TV for too long.
- Reading or squinting. Watch-out when reading whilst your lying in the lounge chair position.
- Bright lights including car lights in your eyes whilst driving at night.
- Fluorescent lights.
- Flickering lights.
- Glare of any kind.
- Cinemas, movies including 3D movies/TVs.
- Read more about tinted lenses designed for migraine patients.
5) Neck/back discomfort
- Tension in your upper back or neck area.
- Poor posture whilst sitting, sleeping, reading or standing.
- Physical trauma, strain or injury to neck
- Physical trauma, strain or injury to back
- Physical trauma, strain or injury to shoulders
- Physical trauma, strain or injury to head
- Misalignments or other injuries.
- Odors, incense, perfume, deodorants, chemical smells, cleaning products, cigarette smoke, air pollution, vehicle exhaust etc.
- Odors in enclosed spaces.
- Any form of alcohol can be a trigger, but not all may have equal impact.
- Changes in barometric pressure (often due to an incoming storm).
- Changes in temperature from hot-to-cold or cold-to-hot.
- Changes in humidity.
- High altitudes.
- Inconsistent caffeine use.
- Caffeine withdrawals.
- Caffeine in some medications (causing rebound migraines).
- Skipping meals.
- Low blood sugar levels, hypoglycemia.
- Hunger pangs.
- Menstruation: sometimes an over-reactive response to natural fluctuations in hormones throughout the month.
- Hormone imbalances
- Oral contraceptives
- Thyroid issues
- Acne (near the jaw line or temple)
- Read more about hormones and migraines here
- Loud noise.
- Constant noise.
- Piercing or ringing sounds.
This is a limited diet list, make sure you read the food labels and look for alternative names of ingredients you suspect eg. Soy is sometimes listed as Textured Vegetable Protein (TVP). The product may also contain soy from other listed ingredients such as Natural flavorings, Hydrolyzed Plant Protein, or Vegetable Gum.
- Artificial sweeteners e.g. Aspartame.
- Chilli peppers or capsicum.
- Citrus fruits e.g. pineapple, oranges, lemons.
- Dairy e.g. milk, cheese.
- Food coloring
- Gluten products e.g. breads, cereals, biscuits, cakes, pastas, potato chips and other wheat or flour based products.
- MSG (monosodium glutamate)
- Nitrates e.g. processed meats such as bacon, hot dogs, sausages, cured ham, other cold cuts and other products.
- Salty foods
- Sodas including diet sodas which often contain artificial sweeteners.
- Soy which is often included in breads, crackers, cakes, rolls, processed cereals, soy sauce, soy lattes, tofu, miso, canned soups, ice cream, frozen desserts, margarines, butters, some salad dressings, sauces, soybeans and breakfast bars amongst other things.
- Sulfites/Sulfates included in many processed or canned foods, condiments, relishes, jams, jellies, pudding, filings, alcoholic beverages, dried fruits, some baked goods like pie or pizza crust, crackers and cookies etc.
- Tannins often found in chocolate and beans e.g. string beans, navy beans, kidney beans etc.
- Tyramine contained red or balsamic vinegar, aged cheeses, smoked fish, bacon, sausages, hot dogs, avocado, red plums, bananas, citrus fruits, olives, processed meats and some types of alcohol.
- Yeast found in beer, yeast breads, pizza, soft pretzels.
- Uncover your best migraine diet here.
- A tight pair of glasses.
- Heavy or tight hair accessories such as hair clips.
- “Hairdo headaches” for example a tight ponytail.
- Tight fitting hats or caps.
- Long wet hair.
- Muscle tension, strain or stiffness anywhere on or near the head area.
- Often exercise that’s too intense – especially if sudden and extreme
- Too much or too little exercise
- Sexual activity
- TMJ or TMD (Temporomandibular Joint Disorders) Teeth grinding, clenching often whilst sleeping
- Chewing gum
17) Medications or treatments
- Medication overuse is a complication of migraine which can lead to dependency, withdrawals, and daily chronic migraines
- Rebound migraines can be caused by medication withdrawals, particularly those with caffeine
- If certain treatments are not administered professionally, cautiously and appropriately they can lead to attacks e.g. chiropractic treatment, physiotherapy, massage etc.
There’s good news
You might be looking at triggers like ‘Diet’ and thinking “what’s left to eat? I can’t starve myself because apparently that’s a trigger too!”
It is a long list. But I’ve never met anyone with every single trigger listed above.
The good news is that surprising things happen as you begin to uncover triggers. You become more likely to manage them. With more triggers under control, your migraine threshold increases which makes you more resistant to other triggers.
This can spark a virtuous cycle of trigger discovery, management and raising your migraine threshold. It’s how I reduced my attacks from 6 per week to once every 3 months.
If you’re at your wits end then use a diary and make a start.
Let me know in the comments your triggers and if you manage them in the comments below.
- The Migraine Trust, United Kingdom
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- Lipton, R. Fair Winds and Foul Headaches: Risk Factors and Triggers of Migraine. Neurology. Jan, 2000.
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- Prince PB, et.al. The Effect Of Weather On Headache. Headache: The Journal of Head and Face Pain. Jun, 2004.
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- Rockett, FC; et.al. Dietary Aspects Of Migraine Trigger Factors. Nutrition Reviews. Jun, 2012.