What is a Migraine Trigger?
Specific internal or external stimuli may provoke a migraine attack in people with migraine disease. We call these stimuli triggers. They’re not the underlying cause of migraine, but they may trigger the cascade of neurological events that leads to a migraine attack. Triggers may be factors occurring around you (environmental), changes happening in your body (physiological), or things you consume (food).
Some people with migraine disease can reduce the number of attacks they get by identifying their triggers, avoiding the triggers that can be avoided, and preparing for the triggers they can’t avoid. Although this practice doesn’t work for everyone with migraine, if it works for you, it can make a big difference in your quality of life.
How to look for triggers
A migraine symptom diary is one of the best tools to use when you have migraine disease. Keeping detailed records for a few weeks to months can help you track if there are patterns to your attacks. You can learn more about tracking your attacks here.
You can use a migraine diary to track any of the following:
- Your migraine attacks, headache days, and other symptoms
- What foods you eat
- When you eat—on a regular schedule or a changed schedule?
- What the weather is like
- Typical daily activities
- Where do your typical daily activities occur? Is the location loud? Are there fluorescent lights? Are there strong odors?
- Activities that aren’t part of your typical day
- Menstruation, ovulation or other hormonal changes
- Sleeping and waking—do you keep a regular sleep/wake schedule? Do you sleep through the night without waking? Do you feel rested when you wake up?
- Activities that aren’t part of your typical day (ex. travel, vacation)
Once you have at least several weeks of records, you might notice that specific environmental factors, physiological factors, or eating certain foods preceded some of your attacks.
The Sensitive Brain and Migraine Triggers
Dr. Michael Teixido, a neurotologist from Delaware and Vice President of the Association of Migraine Disorders, discusses how the brain of people with migraine disease is hyper-sensitive. He also talks about how the different types of migraine triggers work to cause a migraine attack.
Environmental triggers
Weather Conditions
Scientific studies about weather and migraine may have inconsistent results, but it’s clear to headache specialists that many weather-related changes can affect people with migraine.
Weather-related triggers include:
- Barometric pressure changes (such as approaching rain/snow)
- Seasonal changes
- Changes in altitude, including air travel
- Humidity
- Lightning
Sensory Stimuli
Sensory stimuli, things we feel, see, smell or hear can be difficult for people with migraine, especially during an attack. Some triggers and exacerbating factors may include:
- Bright lights - sun, glare from snow or water, or fluorescent light bulbs
- Flickering or intermittent lights—camera flashes, strobe or other special effects lighting
- Loud, harsh, or repetitive noises, especially if you can’t move away from them
- Odors—cooking odors, fragrances, smoke (from tobacco products or other environmental sources), even scents you may consider pleasant
- Sudden changes in environmental temperature (may be weather or going from warm indoor space to cold outdoor space/cool indoor space to hot outdoor space)
Some of these factors are beyond our control, therefore having a comprehensive treatment plan is crucial.
Physiological triggers
Stressors
Stressors, whether physical or psychological, can affect both your body and mind, potentially triggering migraine attacks or making you more vulnerable to other triggers:
- Life stress like illness, family/work/school challenges, financial challenges, living in situations at risk for insecurity, violence, or other trauma
- Jet lag, insomnia, inconsistent sleeping schedule
- Fasting, inconsistent eating habits, food insecurity
- Even “good” or welcome stressors and life changes may increase your vulnerability to migraine attacks
Exercise
Exercise is generally a good thing for your body, your stress levels, and your overall health. If you have migraine disease, moderate regular exercise might help to reduce the number of attacks you get. But sudden exertion or intense exercise (especially if you’re not accustomed to it) may trigger a migraine attack.
Environmental factors matter, too. If you’re sensitive to weather, exercising outdoors in a volatile climate may be challenging. Many indoor exercise facilities can be problematic if you’re sensitive to loud noises and bright/flashing lights.
Dehydration can trigger migraine attacks, so make sure you drink enough water before, during, and after exercise.
The “best exercise” is the one you can do regularly, especially if you enjoy it, appreciate the results, and can perform it safely without encountering other triggers. On days when pain and fatigue are severe, gentle stretching, yoga, and other low-intensity exercises can be helpful.
Hormones
Migraine disease can affect anyone, but people who experience estrogen fluctuations are at higher risk for migraine. Rates of migraine are equal in children until puberty when females will outnumber males from 2:1 to 3:1.
Hormone changes that can impact migraine include:
- Menstrual cycles, particularly during ovulation or menstruation
- Pregnancy—migraine often intensifies during the first trimester but may be less severe in the second and third trimesters
- Ovarian cysts
- Perimenopause, when baseline estrogen swings become unpredictable, and menopause
- Hysterectomy with removal of ovaries
- Addition of some oral contraceptives, particularly those with varying amounts of estradiol throughout the month (e.g., triphasic formulations)
People living with migraine may be able to reduce hormonal fluctuations and their impact on migraine with hormone therapy (such as birth control pills). However, some therapies are not advised for people with certain conditions (ex., migraine with aura) or specific risk factors (ex., heart disease).
Even if you learn to manage your triggers, you can still have migraine attacks —and it’s not your fault.
Food triggers
Some people with migraine will find they have specific food triggers while others won’t. Another factor to consider is your eating schedule. For some, when you eat may be more important than what you eat.
- Eat on a regular schedule whenever possible—hunger and blood sugar fluctuations can trigger a migraine attack.
- If following the “three meals a day” standard is difficult or doesn’t make you feel good, try “grazing”—splitting your food intake across several mini-meals or snacks.
- Stay hydrated—dehydration is a frequent migraine trigger.
Common Food Triggers
If you eat a particular food and get a migraine attack within 24 hours more than half the time you eat that food, there’s a strong chance it’s a trigger for you. The scientific evidence regarding food triggers is inconsistent, but experts generally agree that some foods are more likely to trigger migraine attacks than others:
- Alcohol, especially red wine
- Artificial sweeteners, especially aspartame (found in most diet sodas)
- Processed and/or cured meats, like hot dogs, bacon, and certain cold cuts— nitrites, nitrates, and tyramine typically found in these foods may be migraine triggers
- Pickled and fermented foods (including kombucha tea)
- Nuts and nut butters
- Broad beans in pods: lima, fava, string, garbanzos, lentils, snow peas
- Aged cheeses
- Dried fruit
- Monosodium glutamate (MSG) occurs naturally in some foods but is also an additive and flavor enhancer commonly found in prepared foods and condiments.
The truth about some foods once considered definite migraine triggers may be more complicated:
Caffeine is a paradox for many people with migraine. It may trigger an attack if you consume it or skip your usual dose, but it can also help stop an attack in progress.
The latest science suggests that caffeine’s ability to trigger a migraine attack depends on how much you regularly have. People who typically consume little or no caffeine or those who regularly consume a lot of caffeine are most vulnerable to post-consumption headaches, but those who consume 1-2 servings daily are less vulnerable. Caffeine withdrawal often causes headaches in people with or without migraine, even if the “withdrawal” happens to be a delay in your first cup of the day.
Over-the-counter analgesics that contain caffeine may be effective in stopping a migraine attack, but they may also increase the risk of medication adaptation headache, formerly known as medication overuse headache or rebound headache. Remember to count foods, over-the-counter medications, and beverages when you’re trying to calculate how much caffeine you consume. We have a list of caffeine amounts in common items here.
Chocolate
Current science and clinical observation suggest that chocolate isn’t a migraine trigger but that it’s likely a common craving in the prodrome phase of a migraine attack.
What About Special Diets?
If you search for information about “migraine diet” you’ll find many different recommendations: low-histamine diet, ketogenic diet, gluten-free diet, “Heal Your Headache” diet and more. Some diets are easier to follow or more accessible and affordable than others. Several clinical studies suggest that these diets may help some people, but there doesn’t appear to be any one diet that reduces or eliminates migraine attacks in large numbers of people. It’s important to discuss your health history and risk factors with your healthcare provider before implementing a major change to your eating habits.
Test Food Triggers with an Elimination Diet
An elimination diet isn’t a diet plan itself—it’s a test to see whether a suspected food triggers your attacks.
- If patterns in your migraine symptom diary point to a certain food as a possible migraine trigger, try eliminating that food for four weeks.
- Avoid eliminating several foods at once. Stick to a single food for each trial period.
- After four weeks, check your symptom diary. If you notice a reduction in attacks, you may have pinpointed a migraine trigger. Then, try reintroducing that food slowly (not every day) in small amounts. You may find that the food is a consistent trigger for you, but you may also discover that you can have it occasionally in smaller amounts without triggering an attack.
- If there wasn’t much of a change in your migraine patterns, then that food likely isn’t a trigger (or at least a trigger by itself).
Remember that triggers are highly individual. You might not react to a food that is considered a “common” migraine trigger, but may find that other foods trigger your attacks. Some people with migraine can identify food triggers, but others can’t, no matter how diligent they are.
Migraine Safe Foods Shopping List
Download The Guide to Migraine-Friendly Food Shopping
What if you don’t see a pattern? Or it seems like everything is a trigger?
- Don’t feel guilty. Migraine disease is different for everyone who has it. Some people get positive results when they can identify and avoid specific triggers while other people may not be able to identify clear-cut triggers.
- Your healthcare provider might recognize a pattern, especially if your provider specializes in headache medicine. Specialists with additional training in headache medicine often manage people with severe, frequent, and hard-to-treat attacks.
- Triggers often work in teams. Experts think of triggers as stackable, meaning that your resistance to a particular trigger might vary depending on the effects of other triggers or circumstances. If you’re exposed to a certain trigger when you’re well-rested and the weather is clear, maybe it won’t trigger a migraine attack. But if you’re exposed to that same trigger when it’s raining and you didn’t sleep well, it might trigger an attack.
- Triggers are harder to identify when you have lots of migraine days. If you have high-frequency episodic migraine (8-14 headache days/month on average) or chronic migraine (15+ headache days/month), you may have more trouble identifying specific triggers than people with very low-frequency episodic migraine (0-3 headache days/month) or low-frequency episodic migraine (4-7 headache days/month). If you have lots of symptom days, looking for triggers may be less helpful than working with your healthcare provider on preventive treatment to raise your migraine threshold.
Trigger or prodrome symptom?
Some experts now suggest that, rather than a specific trigger causing an attack, the prodrome phase of a migraine attack may have begun unnoticed. This phase can start anywhere from a few hours to two days before the headache phase, making it seem as if a particular factor triggered the attack when, in reality, the attack had already begun. For example, some people crave chocolate before a migraine attack, which may lead them to believe chocolate caused the attack, but the craving was actually a prodrome symptom.
Besides food cravings, other common prodrome symptoms include yawning, mood changes, frequent urination, neck stiffness, and more.
Tracking your symptoms and activities in a headache diary or smartphone app is one of the best things you can do to help manage your migraine attacks.
Although it remains uncertain whether triggers contribute to the onset of a migraine attack, documenting the specifics of your symptoms and activities as they occur provides you and your healthcare providers with valuable insights into the frequency and severity of your attacks, their effects on your daily life, and potential clues regarding triggers and prodrome symptoms.
This page has been medically reviewed by: Andrea D. Murphy, MSN, APRN, ANP-BC, NEA-BC, AQH.
The contents of this page are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The dosages provided are all stating what is typical for an individual but it is important to always consult with a medical professional to determine what dose is best for you. The list of side effects for each medication is not exhaustive. AMD does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.
