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What You Need To Know About Migraine Triggers (It’s Complicated)

June 21, 2017

If you have ever had a migraine, you know that the pain can drive you to bed for a day – maybe even longer. It’s the kind of pain that a person will do anything to avoid.

But migraine is more than a headache.

“Migraine is a neurologic condition,” says neurologist Dr. Brian Grosberg, medical director of the Hartford HealthCare Headache Center. “People often have pain, but they will have other symptoms along with it: light sensitivity, sound sensitivity, maybe some nausea.”

Yet the search for what causes your migraine condition — your trigger(s) — is complicated.

Keeping a “migraine diary” can help. The typical diary asks patients to track the date, time and severity of their migraines. It often includes a list of potential triggers, including hormonal changes, sensory stimuli, medications and diet as well as changes in stress levels. Even changes in the weather can trigger a migraine.

All this can be overwhelming to the patient desperate for relief from the pain associated with migraines — so much so that they are willing to eliminate EVERYTHING on the diary’s trigger list out of an abundance of caution, even if it never triggered a headache from them previously.

Headache specialists caution, however, that doing so is not an effective strategy.

“When it comes to triggers, avoidance isn’t always the answer, especially with desirable activities, such as exercise, sex, or travel,” said psychologist Dr. Brooke Pellegrino, also from the Hartford HealthCare Headache Center. “If you always avoid your triggers, you may become more sensitive to them the next time you encounter them. Total avoidance is typically not the answer, rather learning to become more tolerant of triggers is typically more helpful and allows the patient to better function in their environment.”

“I always make sure a patient knows that not every trigger applies to every person. In fact, sometimes it takes more than one thing at a time to trigger a migraine,” Dr. Pellegrino noted.

The best place to start identifying your headache type, and any accompanying triggers is by consulting with a headache specialist.

With that in mind, here is a typical migraine trigger list, courtesy of the Hartford HealthCare Headache Center and the New England Center for Headache, with a cautionary note from Dr. Pellegrino:

“Don’t get too caught up in identifying your triggers,” Dr. Pellegrino advises. “You can almost drive yourself crazy trying to think of every little thing you came in contact with on a given day may have triggered your headache.”

Potential migraine triggers may include one or more of the following:

• Hormones
  Menses (period)
  Ovulation
  Hormone replacement therapy
  Oral contraceptives
• Diet
  Alcohol
  Chocolate
  Aged cheeses
  Monosodium glutamate (MSG)
  Artificial sweeteners
  Caffeine
  Nuts
  Nitrates and Nitrites (found in hot dogs, bologna, and other processed meats)
  Citrus fruits
• Changes
  Weather
  Seasons
  Travel (crossing a time zone)
  Altitude
  Schedule change
  Sleeping patterns (erratic or changes in normal patterns)
  Diet
  Skipping meals
• Sensory stimuli
  Strong light
  Flickering light
  Odors
  Noise
• Stress
  Let-down periods (vacations, weekends, after a major event)
  Times of intense activity
  Loss (death, separation, divorce)
  Relationship difficulties
  Job stress, loss, or change
  Crisis

Need a headache specialist? The Hartford HealthCare Headache Center can help. Learn more here.