What a Trigger Does

“Migraine attacks start when a trigger flips a switch in your brain,” says Stephen F. Knox, M.D., a neurologist with Sutter Medical Group who treats patients with migraines. “The switch turns on a cascade of brain activity that ends in pain. The trick is to avoid the triggers you can and find strategies to deal with the rest.”

Common Triggers

Scientists have discovered at least a dozen genes related to migraine. Despite the different genetics, most people with migraine share the same or similar triggers. “And they’re almost always related to physical, environmental or emotional stress,” Dr. Knox says.

That’s surprising to people used to hearing about foods, food additives and drinks that trigger attacks. “Food triggers are real, but people quickly figure out what to avoid,” Dr. Knox says. “Most people start having migraine attacks as children or teens, so by the time they’ve reached their mid 20s, they know to avoid aged cheese or red wine, for example. It’s the stress-related triggers that are harder to avoid.”

Physical Stressors

People with migraines have highly sensitive nervous systems that react strongly to internal and external stress. “Anything that stresses the body can bring on a migraine attack.” Dr. Knox says. Sleep problems, hunger, dehydration and hormones are the common physical stressors.  

Hormones

The most common physical-stress trigger for women is the drop in estrogen and progesterone that happens with every menstrual cycle. Women often have their first migraine attacks during puberty, and some have an attack with every period. Many women find relief during pregnancy when hormone levels remain high. They may also experience more migraine attacks during perimenopause, the period just before menopause when hormone levels shift erratically. The good news is that menopause dramatically reduces hormone-related migraine attacks for most women.

Maybe because the hormone connection is so strong in women, there’s a myth circulating on the Internet that low testosterone levels cause migraine attacks in men. A search of peer-reviewed medical journals, however, doesn’t show any research supporting that idea.

“Less than 10 percent of men have migraine attacks,” Dr. Knox says. “And those who do are less likely than women to see a doctor until the attacks become severe. A man might think the migraine attacks are something new, but I think every man I’ve diagnosed with migraine can remember having headaches in his teens or younger. They just didn’t call them migraines. They’re sometimes amazed to find out that having frequent headaches isn’t normal and that most people rarely get headaches.”

Sleep Quantity and Quality

Sleep is another common physical stress trigger. “Not getting enough sleep, getting too much sleep, or not sleeping well can all bring on migraine attacks,” Dr. Knox says. “It’s easy to see how not getting enough sleep could cause a headache, but many people don’t realize that too much sleep can also trigger an attack.”

It’s actually common for people to experience migraine headaches after catching a few extra hours of sleep on the weekend or while on vacation. Like estrogen and progesterone, adrenalin is a hormone. And just as hormone drops trigger migraine attacks in many women, the drop in adrenalin during sleep and relaxation is thought to cause attacks.

Having a sleep disorder, such as insomnia, can also bring on migraine attacks. And people with sleep-related breathing disorders are more than twice as likely to experience migraine attacks as people without.

If you suspect you have a sleep disorder, talk to your doctor about sleep testing to find and fix the problem. If you sleep fine, but get too little or too much sleep, putting yourself on a regular schedule of eight hours' sleep each night can make a big difference.

Food and Drink

If you rush out the door without breakfast or skip lunch, you could be inviting a migraine.  As with sleep, sticking to a regular eating schedule helps keep attacks at bay.

“People focus too often on the type of food, rather than the amount of food and timing,” Dr. Knox says, “but skipping meals or eating at unpredictable times stresses the body and can bring on headaches.” 

And while alcohol, especially red wine and certain beers, trigger attacks in many people, alcohol also causes dehydration. Like hunger, dehydration can stress the body and trigger attacks.

For more information, see “Do Foods and Drinks Trigger Migraine Attacks? Yes, No and Maybe".

Environmental Stressors

Outside conditions also put stress on the body. Weather changes are a prime example. While you can’t stop barometric pressure from rising or falling, it’s helpful to know if certain weather changes trigger attacks so that you can take preventive action. “A storm front moving in or a windy spring day can lead to a migraine,” Dr. Knox says. “Bright sunlight and extreme heat or cold also affect some people. Airplane travel, with its changing pressures, can also trigger an attack.”

Smoke is another trigger. That includes smoking cigarettes and being exposed to secondhand cigarette smoke. It also includes smoke from wildfires.

“Air pollution is a surprisingly common trigger,” Dr. Knox says. “You might need to check the air-quality index given with the daily forecast and stay inside during ‘Spare the Air’ days.”

Emotional Stressors

Any emotional stress – school, work, family, life events – can flip the migraine switch. Adopting good stress-reduction habits can help—such as regular exercise, yoga or other activities you know will remove you from the cycle of stressful thoughts and resulting emotions. Mindfulness-based stress reduction classes can be helpful, especially if you’re dealing with chronic pain and stress.

Use a Headache Diary to Spot Triggers

Tracking your daily activities is the surest way to spot your triggers. There are online migraine diary trackers, downloadable cell phone apps, printable diaries and other tools that make it easy. Many doctors recommend a simple app or a small month-at-a-glance calendar that you can carry with you. “Keeping it simple helps your doctor work with you to spot triggers and trends,” Dr. Knox says. “Recording too much information can work against you by burying what’s important and making it hard for your doctor to analyze.”

Take Action

Spotting and avoiding your triggers may help you avoid frequent migraines, but it doesn’t guarantee freedom from attacks. You can make lifestyle changes—such as getting eight hours of sleep every night, not skipping meals and staying inside when the air quality index moves into the unhealthy range. But you may need to see a doctor who specializes in treating migraines to deal with the unavoidable triggers—such as hormone dips and weather-pressure changes.

Relief is available. “There are preventive medications that work well for most people,” Dr. Knox says. “And with good care, you can spend much more of your life headache-free.”