Understanding and managing migraine triggers

Experts aren’t sure what causes a migraine.

It is believed to be caused by abnormal brain activity affecting the nerve cells, blood vessels and chemicals in the brain.

There is some evidence that this abnormality is related to genetic factors. You may have a family member who struggles with migraine if you have it.

People at risk of migraines are more sensitive to certain stimuli, especially during the early stages of an attack. It could be environmental factors like light or weather or could be related to your lifestyle (e.g. your diet).

These triggers can cause a migraine attack. It can occur anywhere from 6 hours to 2 days after you encounter a trigger.

Understanding and identifying your triggers is the key to preventing migraines. So, below is a comprehensive list of triggers and how to avoid them.

The most common and troublesome triggers are the ones you can’t control. Below are some of the types of triggers that can occur around you.

Light

Light sensitivity (photophobia) is a common symptom of migraine attacks. However, light can also be a trigger.

It can be natural light or artificial light (e.g. computer screens, lamps, car headlights and Christmas lights). Pulsating or flickering lights can also trigger a flare-up in some.

If light is a trigger for you, you can try:

• wearing tinted glasses
• changing your light bulbs
• sitting in a dark room
• wearing a hat outdoors
• changing the light settings on your devices

Seeing flashes of light can also be a symptom of migraine.

Weather

Some people find that intense weather or changing weather can cause symptoms.

Studies have shown that changes in sunlight, barometric pressure (air pressure) and humidity can cause migraines. Despite the evidence, experts have yet to find a reason why weather can cause migraines.

It can be hard to prevent weather triggers. However, making sure your health is in check (e.g. having a healthy sleep schedule and staying hydrated) will help lower the risk of attacks.

Smells

Sensitivity to smells is known as osmophobia. It is common in people with migraine.

One study found that the smells most associated with migraine attacks were perfumes (56.4%) and tobacco (47.5%). Other common triggers include:

• fabric softener
• body odour
• rubbish
• hairdressing products
• car fumes
• sweat

Some people may also notice phantom smells during the early stages of an attack, such as a burning smell that no one else can smell.

Most of these scents are unavoidable. However, getting fresh air or taking medication will help prevent an attack.

Noise

Research has found that people with migraines are more sensitive to sound. Therefore, it is likely to trigger symptoms.

It is particularly associated with loud, sudden or prolonged sounds. This can include busy areas or sirens. Migraineurs also found sounds deemed as pleasant as unpleasant, like bird calls.

A lot of noise is unavoidable. However, there are things you can do to improve noise sensitivity. Wearing earplugs, ear defenders or noise-cancelling headphones are the best way to avoid triggers when out.

What you eat or when you eat can also trigger migraines. Here are some of the most common dietary triggers.

Dehydration

Lack of fluids is a very common migraine trigger. It is so common that some people have proposed that “water deprivation headache” should be a primary headache disorder.

Your body loses fluid through sweat or urine. If you don’t replace them, your body becomes dehydrated. Studies demonstrate that hydration affects the pain response in the brain. Migraineurs are more sensitive to these feelings and this is what triggers a migraine.

Hydration is extremely important. Each day, you should aim to drink 11.5 cups (2.7 litres) if you’re a woman or 15.5 cups (3.7 litres) if you’re a man.

Caffeine

Caffeine in coffee, tea or other products can trigger a migraine. Research estimates this trigger affects between 6.3 - 14.5% of migraineurs.

Experts are not sure why caffeine can trigger a flare-up. It may be because it can dehydrate you. Others believe it has to do with how it alters magnesium levels in your body.

Everyone’s caffeine tolerance is different. However, research has found that people with migraine shouldn’t consume more than 200mg of caffeine a day.

Food additives

Certain chemicals found in food may trigger migraines for some:

• monosodium glutamate (MSG) - a flavour enhancer added to some foods
• tyramine - a chemical found in red wine and soft cheeses
• nitrates - found in foods such as vegetables and processed meats
• aspartame - an artificial sweetener found in some foods and fizzy drinks

Keeping a food diary and tracking your migraines is a good way to find out what triggers your symptoms.

Missing meals

Skipping meals can affect your blood sugar levels. Research has shown that this can affect glucose metabolism in your brain and trigger a migraine. Eating regularly will help keep your blood sugar stable.

Alcohol

10% of migraineurs say that alcohol triggers them regularly.

Alcohol can cause migraines in several ways:

• It causes dehydration.
• It releases chemicals into the bloodstream that may cause migraine.
• It expands blood vessels and increases blood flow.
• Certain alcohols (darker drinks e.g. beer and wine) contain certain compounds as a result of fermentation which may cause migraine.

If you find alcohol is a trigger, it is best to avoid it completely. However, if you find that small amounts are okay, then make sure to drink in moderation.

Elements in your daily life can also be significant migraine triggers.

Change in routine

A surprising trigger for migraines is a change of routine. This may be if you get more or less sleep than usual or going on a long journey.

There can be a lot of additional factors that happen when your routine changes (e.g. you may drink more coffee if you had less sleep).

Many people with migraine also notice that they often experience attacks on weekends. For example, choosing to lie in on a weekend when you get up early each day for work may be a trigger.

Drugs

Certain recreational drugs may trigger migraines. One of the most notable is cocaine. This is because research shows that it affects blood flow. You should avoid doing recreational drugs, especially if they cause symptoms.

Smoking

Cigarettes and other tobacco products are also linked to migraines.

Nicotine is the main drug in tobacco products and e-cigarettes which affects certain brain chemicals linked to migraine. The smell of these products may also trigger a flare-up.

Quitting smoking is the best way to reduce symptoms. However, quitting all of a sudden may also trigger migraines.

Nicotine-replacement products and smoking cessation medications (e.g. Zyban & Champix) may also cause headaches. So, it’s important to quit slowly and gradually.

Stress

Stress is another common trigger.

Stress is the body’s response to pressure. It causes mental symptoms like anxiety, depression or frustration. It also causes physical symptoms such as digestion issues and breathing difficulties.

If you have migraine, your brain is more sensitive. So, it has a less adapted response to stress. This means it is more likely to worsen the stress response in the body and trigger a migraine.

Female hormones have been found to be a trigger. Specifically, drops in oestrogen levels can cause migraine. This is why women are more likely to get them.

Your oestrogen levels drop right before your period starts. So, it’s common for women to have migraines before their period. Oestrogen levels also drop during menopause as your ovaries stop producing eggs.

You can’t help hormone changes. However, taking hormonal medications may help to balance your hormones.

Women of childbearing age can take hormonal contraception like “the pill” to reduce menstrual migraines. Menopausal women can take HRT to reduce menopause symptoms.

Some triggers are unavoidable. However, there are things you can do to reduce the risk of being affected by them:

• have a good and consistent sleep schedule
• stay hydrated
• eat a balanced diet
• avoid skipping meals
• manage your stress

These factors, as well as managing individual triggers, will help keep migraines at bay. Your doctor may also suggest keeping a migraine diary to track your triggers and symptoms.

While attacks aren’t always avoidable, quick treatment will stop migraine symptoms before it gets worse.

The first-line treatment for migraines is a group of medicines called ‘triptans’ like sumatriptan. They are available as tablets and as nasal sprays.