The American Migraine Foundation’s Guide to Triggers & How to Manage Them
The sudden onset of migraine means a dark room, bed, and a cool towel for most of us. While these seem to come out of nowhere, many will find that there are usually some signs that a migraine attack is on its way. These signs can reveal a pattern in your symptoms, and even provide you with preventative tools for managing migraine. Everyone has different triggers, but there are a few common culprits that affect a large number of people living with migraine. When you can identify your triggers, you are one step closer to effectively managing your migraine and avoiding future attacks.
Tips for managing the 10 most common migraine triggers
Perhaps the biggest culprit of all, stress is a trigger for almost 70% of people with migraine, and one study revealed that 50-70% of people had a significant association between their daily stress level and their daily migraine activity. When you add the perpetual worry of when the next attack will strike, it can start to feel like a never-ending, exhausting cycle.
How to cope: Start by making a list of the things known to cause you undue stress and tension, and then work towards reducing these triggers in your life. Biofeedback, relaxation therapy, meditation, exercise, and maintaining a consistent sleep schedule can be extremely helpful in managing stress. These strategies will not eliminate all stress from your life, but they can change your body’s physiological response to stress and thus reduce the ability for stress to trigger a migraine attack.
2. Changes in or an irregular sleep schedule
The connection between migraine and sleep is undeniable. Sleep renews and repairs all parts of the body—including the brain—so it makes sense that when your sleep schedule becomes irregular, you are more prone to migraine attacks. Something else to note when it comes to sleep: Nearly half of all migraine attacks occur between 4:00am and 9:00am, putting people at a greater risk for developing a sleep disorder.
How to cope: Try to go to bed at the same time every night, and aim to get at least 7-8 hours of sleep. Eliminate TV, texting, reading, and listening to music while in bed, and try your best not to nap during the day. This article from the AMF Resource Library has great information and tips on how to make a sleep plan that works with your lifestyle.
Women are three times more likely to have migraine than men, and up to 75% of women find that they experience attacks around the time of their menstrual period. This is called “menstrual migraine,” occurring only during a women’s period due to the change in estrogen and progesterone levels.
How to cope: Besides changes in lifestyle and diet, there are some methods of birth control that can stabilize hormone levels and therefore prevent future migraine attacks. Make sure to meet with a headache specialist and/or your gynecologist so you can find the right treatment plan.
4. Caffeine and Alcohol
Many people find their migraine symptoms are heightened after consuming caffeine or alcohol. Conversely, other people say that a cup of coffee can stop their migraine symptoms, and some medications designed to fight migraine pain may contain a dose of caffeine. Although migraine patients consider red wine the principal alcoholic migraine trigger, studies show that other types of alcohol are just as likely—and sometimes even more frequently—the culprit.
How to cope: Limit and know your limits when it comes to alcohol consumption. If you are experiencing the warning signs and symptoms of a migraine attack after drinking alcohol, take your acute (as needed) medication immediately.
5. Changes in the weather
Storms, excessive heat and changes in barometric pressure are common weather-related migraine triggers that can lead to a migraine attack. High humidity and heat can easily lead to dehydration, another common trigger.
How to cope: We can’t control the weather, so if the current conditions are not favorable for your migraine, stay inside or adjust your schedule accordingly. If there’s an errand you need to run and it’s the middle of July in Arizona, take care of it in the morning before it gets too hot!
There’s a laundry list of foods known to trigger a migraine attack, the most common ones being foods that contain histamine and MSG, chocolate, cheese and other dairy products, artificial sweeteners (e.g. aspartame), caffeine, cured meats, and anything with a strong smell.
How to cope: If you can identify specific food triggers, be sure to avoid them as much as possible. Many people also adopt a migraine diet that eliminates foods and ingredients known to trigger a migraine. You can read more about how to make this lifestyle change in our resource library.
About 1/3 of people with migraine say dehydration is a trigger, and for some, even the slightest hint of dehydration can be the fast track to debilitating head pain. Dehydration affects the body on all levels and can cause dizziness, confusion, and can even become a medical emergency.
How to cope: Always carry a water bottle and keep track of your fluid intake (daily recommendation is two liters), and limit your consumption of diuretics. Sometimes an attack can be stopped in its tracks by simply drinking a glass of water.
For many migraine patients, natural light is the enemy. This condition is called Photophobia, and it is actually one of the criteria used to diagnose migraine. Both natural, bright light and fluorescent or flickering bulbs are problematic, making it difficult to spend time outside or be in an office environment.
How to cope: Wearing sunglasses is helpful when you’re outside, and it’s a good idea to carry a pair with you at all times. When faced with artificial light, sit closer to windows and avoid flickering lights or sources of glare. Greenlight is the only band of light that has been shown to not aggravate migraine –finding bulbs that emit green light or sunglasses that deflect all but green light could be helpful.
Some odors may activate certain nerve receptors in the nasal passages that may trigger a migraine attack or make worse one that already started. Osmophobia (aversion to odors) is a common symptom of migraine.
How to cope: Avoid perfumes, strong food smells, chemicals or gasoline. If you work in an office environment, make your condition known among your coworkers, and don’t be afraid to ask that they refrain from wearing perfume or cologne.
10. Medication Overuse
Ironically, if you have regular migraine headaches and take acute medication prescribed by your doctor more than 10 days out of a month, it can in itself cause more migraine attacks—a phenomenon known as Medication Overuse Headache (MOH).
How to cope: If you have MOH, you must first stop taking the medication and clear it out of your system before you can stop the cycle of pain. You should work with your doctor to learn how to come off certain medications, such as opioids or butalbital-containing medications, safely. If you need help finding a doctor, use the American Migraine Foundation’s doctor database.
Remember, everyone’s experience with migraine and migraine triggers is different. Don’t feel embarrassed when talking to your doctor or headache specialist about your triggers—it will help them give you a proper diagnosis and start the best treatment plan for your symptoms. For more information on the various migraine triggers and how to manage them, visit the American Migraine Foundation resource library, or contact us directly.
Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.