The exact cause of migraine isn’t fully understood. However, doctors and healthcare providers do know that many factors can induce a migraine.
Possible migraine triggers include:
- lack of sleep or jet lag
- hunger or dehydration
- medication overuse
- lights and sounds
- female hormones
- physical activity
A dramatic increase or decrease in physical or psychological stress can trigger migraine.
Danish researchers found that a majority of people with migraine report that their attacks are linked to stress.
Other researchers have reported that between 50 and 80 percent of people with migraine say stress triggers their migraine headaches. Some people experienced migraine in the aftermath of a stressful event, while others experienced a new attack in the midst of a stressful event.
Sleep disturbance is one of the most common factors linked to migraine. Insufficient sleep is often cited as a trigger for acute migraine attacks. Excessive sleep is a frequently reported trigger as well.
Jet lag and changes in your work schedule can also be linked to the onset of migraine. Insomnia is the most common sleep disorder associated with chronic migraine. People who have chronic migraine as well as insomnia are at increased risk for anxiety or depression.
These conditions have one thing in common: sleep disturbance. However, many people report that sleep often relieves their migraine headaches.
People with migraines would do well to avoid skipping meals. Research consistently shows that skipping meals is frequently linked to the onset of migraine. It remains uncertain how this happens. It’s probably related to falling blood glucose levels.
Dehydration has also been suggested as a possible migraine trigger. Failure to drink enough water has been linked to the onset of headache.
A small survey of people with migraines revealed that “insufficient fluid intake” was linked to headache onset in about 40 percent of responders.
Certain foods, or the lack of food (fasting), are frequently reported as possible triggers for migraine attack. Twelve percent to 60 percent of people say that certain foods trigger migraine headaches.
A 2008 Brazilian study found that most people with migraines reported having at least one trigger. Diet was one of the most frequently reported triggers. Fasting was the most common diet-related trigger reported.
- fermented, cured, and pickled foods, which contain large amounts of the amino acid tyramine
Experiments with aspartame have yielded conflicting results. The issue of its possible effects among people with migraine remains unresolved. Some evidence suggests that people with clinical depression may experience worsened symptoms after consuming aspartame.
MSG is used to impart a savory flavor to various foods. Many people in the general public believe MSG can trigger headaches.
Most controlled research has failed to identify a link between the consumption of MSG and headache, or any other condition, in normal individuals. However, a small 2009 study concluded that MSG could trigger headache and pain in the face and head. It may be wise to avoid MSG.
Alcohol is one of the most commonly reported triggers for migraine. Alcohol triggered migraine in about one-third of people in a 2008 Brazilian study.
Red wine appears to be somewhat more likely to trigger migraine than other sources of alcohol, especially among women. In the study, red wine triggered migraine in 19.5 percent of men and women. White wine triggered migraine in just 10.5 percent of people.
A closer look at the study’s numbers shows that red wine disproportionately affects women. Red wine triggered migraine in just eight percent of men, but among women the number jumped to 22 percent.
Some experts have reported that excessive caffeine consumption can trigger migraine. That’s why it’s wise to monitor your intake of caffeine from coffee, tea, soft drinks, and energy drinks. Energy drinks can have surprisingly high levels of caffeine.
Keep in mind that many over-the-counter (OTC) headache preparations contain significant amounts of caffeine.
One controlled study concluded that a drug combining acetaminophen (Tylenol), aspirin (Bayer), and caffeine was better at relieving the symptoms of migraine headache than ibuprofen (Advil, Aleve) alone.
Overuse of medications is one of the most common factors in migraine.
People who overuse common analgesics, or painkillers, in particular can be more likely to progress from occasional migraines to chronic migraine. People with migraine often overuse medications such as opioids and butalbital.
Overuse of these and other pain-relieving medications, such as OTC nonsteroidal anti-inflammatory drugs (NSAIDs), may actually cause more frequent headaches. It may lead to greater pain as well.
Drugs in the opioid class are especially likely to be associated with the development of chronic migraine.
It’s unclear why taking too many analgesics may actually make migraine symptoms worse. But, it’s evident that so-called analgesic rebound headaches need to be addressed when treating migraine.
Discontinuing offensive medications may be necessary before it’s possible to gain control over migraine symptoms.
People with migraine frequently report that strong or unusual smells trigger their headaches. They often cite perfume, in particular, as a trigger.
Additionally, about half of people with migraine report an intolerance for smells during attacks. This phenomenon is known as osmophobia and is unique to people with migraine headache.
During migraine episodes, cigarette smoke, food odors, and scents such as perfume were found to be the most frequently offending smells.
One study concluded that people with migraine and osmophobia were more likely to exhibit symptoms of anxiety and depression.
Some people report that bright, flickering, or pulsating lights, or loud sounds, may serve as a migraine trigger.
A small study in European Neurology found that even brief exposure to sunlight may trigger migraine. Study participants reported getting some relief by:
- wearing a hat
- wearing sunglasses
- avoiding sunny places
- getting more sleep
However, in a letter to the editor regarding that study, one neurologist noted that sunlight may not be a primary trigger for migraines. He stated that sunlight only triggered his own migraines if he’d drunk wine the previous night.
He also mentioned that sunlight triggered migraines if he was already sleep deprived, stressed, dehydrated, or experiencing low blood sugar due to skipping a meal. His conclusion was that bright light may be a sort of secondary trigger.
People whose migraine attacks appear to be triggered by bright light should consider whether these other factors may also be triggers for them.
Various weather changes have been tentatively linked to the onset of migraine headache. In a study of Brazilian adolescents with migraine, weather patterns most likely to trigger headache included sunny and clear, hot, cold, and changing weather.
Another small study, featuring mostly women from Ohio and Missouri, concluded that thunderstorms with lightning were significantly linked to the onset of headache.
Specifically, investigators concluded that lightning was the precipitating factor, although they were uncertain how lightning might trigger migraine.
Women are three times more likely to experience migraine headache than men, according to the Migraine Research Foundation. Evidence suggests that female sex hormone fluctuations may play a role in headache onset and severity.
More than half of female respondents in a 2012 study said they were likely to get severe migraine headaches during menstruation. A small subset of these women experienced migraine solely during menstruation.
The use of oral contraceptives may make symptoms worse, while pregnancy may offer relief for certain women with migraine. However, pregnancy was linked to worsening symptoms for some women. Post-menopause may provide some limited relief from headache severity.
Intense exercise may trigger migraines. A 2013 study found that 38 percent of people with migraine experience exercise-triggered migraine attacks at some point.
Many people with exercise-induced migraine reported that their headaches begin with neck pain. More than half abandoned a favorite sport or form of exercise in an effort to avoid triggering migraine attacks.
Some people reported that they’d been able to substitute low-intensity exercises for high-intensity activities that might trigger an attack.
If you’re one of the millions of people who deal with frequent or occasional migraines, it’s important to understand your personal migraine triggers and do your best to avoid them. It’s also important to remember that overuse of migraine medications can aggravate your symptoms.
Consider keeping a journal of personal migraine triggers. It may prove beneficial in helping you avoid future migraine attacks.