How Much Control Do You Really Have Over Migraine Triggers?
How Tracking Migraine Symptoms Can Reveal Your Triggers
Migraine triggers vary, from lifestyle to environmental factors. Keeping a log to spot patterns over time can help you anticipate triggers and take steps to prevent future attacks.
You’re doing everything right: Keeping a migraine diary, taking medication, and trying to avoid common triggers. Yet, you start to feel the warning signs that a migraine attack is coming on. It’s easy to get frustrated and wonder what you did (or didn’t do) to bring on another attack.
But the truth is, you may not be doing anything wrong. “It’s a common misconception that migraine is a simple cause-and-effect condition,” says Hao Huang, MD, a neurologist and migraine expert at the Neuroscience Institute at Hackensack University Medical Center in Paramus, New Jersey. “In reality, it’s a complex neurological disease.”
While it’s still important to identify your personal migraine triggers, it’s also good to recognize that not every attack can be traced back to a specific, modifiable factor, says Dr. Huang. “Sometimes, attacks occur for reasons that remain unclear.” Also, when multiple migraine triggers pile up at once, it can make you more susceptible to an attack.
So how much control do you really have over migraine triggers? Here’s what you can — and can’t — change.
8 Migraine Triggers You Can Influence
The good news is that you have control over many potential migraine triggers. “Initially, identifying the triggers that you can modify by maintaining a diary or using a headache app is very useful, because not everyone’s triggers are the same,” says Brian Gerhardstein, MD, director of headache medicine at the Neuroscience Institute at JFK University Medical Center in Edison, New Jersey. “And not everyone responds the same way to potential migraine triggers.
Some of these modifiable migraine triggers include:
1. Stress
Perhaps the most common trigger, stress contributes to attacks for 70 percent of people with migraine.
Although it’s impossible to avoid all stress, you can still practice healthy coping mechanisms and manage your response to stress by reviewing your obligations, limiting nonessential demands, and focusing on what truly matters to you, says Dr. Gerhardstein. Or try practicing a relaxing activity every day, such as engaging in a hobby, meditating, or doing yoga.
“It’s also important to reframe negative thoughts, focus on what you can control, and let go of worries about things you cannot,” he adds.
2. Dehydration
Dehydration is a known trigger for about one-third of people with migraine.
Huang suggests carrying a reusable water bottle with you throughout the day as a reminder to take regular sips. “The daily recommendation is around two liters for the average person,” he says.
Limiting drinks that contain caffeine or alcohol can also help maintain hydration, as these are diuretics, which cause you to urinate more.
3. Sleep
Both too much and too little sleep are linked to migraine.
“Managing sleep-related migraine triggers involves attaining consistency and quality in your sleep patterns without making you feel too restricted,” says Gerhardstein. For better rest, try to go to bed and get up at the same times each day, even on the weekends. And try to follow a calming bedtime routine an hour before you turn in, such as enjoying a warm bath, reading a book, or taking deep breaths. It’s also a good idea to avoid eating large meals just prior to bedtime, because this can affect digestion and sleep quality.
4. Diet and Meal Timing
Some people may find that certain foods trigger migraine attacks. “If you suspect food triggers, you can try an elimination diet under the guidance of a healthcare professional to see if your symptoms improve,” says Huang. “However, be mindful not to become overly restrictive.”
Focus on eating plenty of:
Fruits and vegetables
Healthy fats, such as avocados and olive oil
Lean proteins, such as fish and poultry
Whole grains
Fresh foods, as opposed to processed foods, give you greater control over the ingredients and potential migraine triggers.
In addition, skipping meals can bring on a migraine. To avoid this, eat regular meals and snacks around the same times each day to maintain steady blood sugar levels.
5. Caffeine and Alcohol
While some people find a little caffeine can help stave off a migraine, too much caffeine, as well as caffeine withdrawal, can bring on an attack. Alcohol — especially red wine — can also be a trigger.
“We usually recommend less than two cups of caffeine per day,” says Huang. If you consume caffeine regularly, try to keep your intake consistent. If you want to cut back, do so gradually to avoid withdrawal headaches.
“With alcohol, pay attention to how different types and amounts affect you, and consume it in moderation,” he adds.
6. Light Exposure
Bright, flickering, or glaring lights can be problematic for many people with migraine. It’s known as photophobia.
To manage photophobia, wear sunglasses when you’re outdoors, even on cloudy days. When indoors, try to position yourself near natural light, and use blinds to reduce glare. When using screens, consider lowering the brightness and wearing blue light–filtering lenses to reduce light exposure.
7. Screen Time
Although computer screens and smartphones are ubiquitous in modern life, “Screen time can be a significant migraine trigger, due to the development of eyestrain, blue light exposure, and sleep disruption,” says Gerhardstein.
Try to limit nonessential screen time. You can also use anti-glare screens and blue light filters for electronic devices. And put screens away before bedtime, so they don’t interfere with your sleep.
8. Noise
Loud noises can be a trigger for migraine attacks.
“When you anticipate being in a noisy environment, consider using earplugs or noise-canceling headphones,” says Huang. At home, eliminate unnecessary background noise, such as the radio and TV when you aren’t using them, or try using a white noise generator to mask these sounds.
Special Considerations
Taking steps to avoid these triggers can reduce risk, but it isn’t guaranteed to prevent every attack. The goal of migraine management is not to live a life of restriction, but to find a balance that allows you to participate in life as fully as possible. “If you feel like your world is shrinking due to trigger avoidance, it’s a sign that your current management plan needs to be reevaluated with a healthcare professional,” says Huang.
3 Migraine Triggers That Are Harder to Control
Some migraine triggers are difficult or impossible to control. Be aware of these three:
1. Hormone Fluctuations
Women are three times more likely than men to have migraine, and hormones — specifically, estrogen — are a big reason.
“A sharp drop in estrogen levels just before a menstrual period is a common trigger for ‘menstrual migraine’ episodes, which are typically more severe, last longer, and are often less responsive to standard acute treatments than nonmenstrual migraine attacks,” says Gerhardstein.
While migraine tends to ease during pregnancy, in the years leading up to menopause, women may have fluctuating hormone levels, which can also make migraine attacks more frequent and severe. But once menopause sets in and estrogen levels stabilize at a low level, migraine often improves — and may stop altogether for some women.
2. Weather Changes
Changes in weather, especially shifts in barometric pressure, are a common trigger that can be hard to predict and impossible to control. “These atmospheric changes act as a stressor on a brain that is already predisposed to migraine,” says Huang.
3. Genetics
Even though genetics isn’t a “trigger” in the same sense as a single event, such as eating a certain food or sleeping poorly, genetic predisposition can influence how sensitive your brain is to environmental triggers and the severity of the migraine attacks you get.
Genetics can also affect other migraine characteristics, such as certain types of aura and nonheadache symptoms, says Gerhardstein.
How Trigger Stacking Affects Migraine
Most of the time, it isn’t just one trigger that brings on a migraine attack. Instead, several triggers can build up and push you past your threshold, or personal tolerance level for triggers.
“Often, under high-stress situations, we have other factors that may occur, such as having a poor night’s sleep, not maintaining your usual routine to reduce stress, or missing regular meals,” says Gerhardstein. “This can lead to an accumulation of factors that lower your migraine threshold and trigger an attack.”
Understanding trigger stacking can help you avoid blaming yourself for an attack. It also allows you to focus on managing the triggers you can influence, especially when you know you’re facing one you can’t, such as a sudden shift in the weather.
“Recognizing when triggers are stacking up can help you decide when to take acute medication to stop an attack early,” says Huang. “If you find your threshold is consistently low and attacks are frequent, it’s a strong signal to discuss preventive treatments with your doctor to help raise that threshold.”
The Takeaway
A migraine attack is rarely the result of a single trigger but, rather, the accumulation of several triggers that stack up and push you past your threshold for migraine.
Some migraine triggers are in your control or can be managed with a consistent, healthy lifestyle, but some are outside your control.
If attacks becomes frequent or debilitating, despite proper migraine management, or you find yourself overly restricting your life to reduce the likelihood of an attack, talk to your doctor about whether you should reevaluate the treatment plan to raise your threshold for future episodes.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Shamin Masrour, DO, is the founder and medical director of the Texas Headache and Facial Pain Center. She is board-certified in neurology by the American Board of Psychiatry and Neurology and certified in headache medicine by the United Council for Neurologic Subspecialties.
She earned her medical degree at the Texas College of Osteopathic Medicine and completed residency in adult neurology at the University of Texas in Austin, where she served as chief resident. She went on to gain advanced training in headache and facial pain through a fellowship at UT Southwestern Medical Center in Dallas.
After completing her fellowship, she was recruited to join the faculty at UT Southwestern Medical Center in 2016 as an assistant professor in the department of neurology. While there, she became the clinical leader in the facial pain program and served as associate fellowship director in headache.
She has published various articles and book chapters, and has presented at various local and national conferences. She remains actively involved in medical education and currently serves as adjunct faculty at UT Southwestern Medical Center, continuing to mentor medical students and residents.
Dr. Masrour’s clinical and research interests include cranial neuralgias, particularly trigeminal neuralgia, procedural treatments for headache and facial pain, and migraine therapy.
Erica Patino is a freelance writer and editor, content strategist, and usability specialist who has worked for a variety of online health outlets, including Healthline, Sharecare, and Twill Care. She was previously a senior editor at Everyday Health. She is also the founder and editor-in-chief of Hear 2 Tell, a website that covers advances in hearing loss treatment. Patino lives in Portland, Oregon, with her husband and twin sons.
