Why Me? The contributing factors to migraine are highly complex, in part because what causes migraine is different for everyone.

Unfortunately for those of us living with migraine, any number of factors can trigger an attack. From genetic makeup to hormones to food choices to other medical conditions, if you aren’t carefully dialed-in to what causes your own migraine, then preventing them becomes a lot more challenging. Dr. Laine Green, a neurologist at Dalhousie University in Halifax, Nova Scotia, reveals the factors that contribute to triggering a migraine attack, and shares tips for how to address those factors that are within our control.

“Contributing factors for migraine should not be underestimated,” Green said. “Addressing those alone can be very powerful in making someone’s migraine disorder better for them. But also, neglecting them can be a significant barrier to allowing people to get better.”

What determines when someone gets a migraine attack?

Migraine has a threshold, and how close a person is to that threshold at any given time determines how frequent, severe, and debilitating the headache and other symptoms of the attack will be. The key is to understand your individual migraine triggers and how close you are to your attack threshold, and avoiding triggers during vulnerable times. Let’s say one person’s trigger is red wine. If he or she drinks a few sips of red wine, they may not reach the threshold to get a migraine. But if they drink a full glass of red wine and missed a meal that day, the chances of reaching that threshold are higher.

Understanding your individual thresholds allow doctors to develop an ideal treatment plan, comprising acute and preventive treatment, as well as non-drug treatments such as a healthy diet and stress management.

Lifestyle Factors

A person’s everyday behaviors could be key contributors to frequency, duration, and severity of migraine attacks. Key lifestyle factors that can impact migraine are sleep routines, exercise, diet, hydration, stress management and avoiding individual migraine triggers. From there, it’s easier to develop a plan to manage relevant factors that will, in turn, minimize the impact on migraine. As a headache specialist, Green analyzes each patient for specific lifestyle aspects that might contribute to migraine—which sometimes means answering tough questions about your day to day life.

Medical Factors

Lifestyle elements are not the only things that contribute to migraine attacks. According to Green, there are also a number of medical factors that can trigger an attack, which is why it’s important that headache specialists evaluate all aspects of a patient’s health. Certain psychiatric conditions such as mood and anxiety disorders may play a role in migraine, as well as obstructive sleep apnea.

“In its own right, obstructive sleep apnea can be a trigger,” Green said, “and it contributes to poor sleep routines with people.” Also a contributor to poor sleep routines: teeth grinding or jaw clenching. “It’s important for a person with migraine to talk to their dentist to see if there are these signs on their teeth,” Green said, noting that jaw joint disorders could have negative effects on a person’s migraine.

Tools to Manage Your Migraine

A comprehensive migraine treatment plan includes more than acute and preventive treatments. “You also have to consider the non-drug treatments: lifestyle modifications,” says Green. “We’re looking at all of these contributing factors and taking those into account in the overall comprehensive management plan for the patient. These comprehensive plans addressing all of these issues are important to give us our best chance of success in making people better going forward.”

The American Migraine Foundation offers some tools to help with some of these lifestyle modifications. Our Meal Planning Toolkit helps you maintain a balanced diet and identify certain migraine triggers to avoid. And starting a headache diary can help track headache days and symptoms, and identify potential triggers that can provide insight into new ways to manage and treat your migraine.