A migraine is a “perfect storm” of combined triggers.
Treating migraines has come a long way, and doctors have discovered many tips to deal with a migraine attack. But ultimately, the best line of defense is preventing a migraine altogether.
In many cases, migraines are genetically based, and some people are predisposed to getting migraines. These people may find themselves more vulnerable to migraines when exposed to certain triggers—or multiple triggers at once.
“A bad migraine attack is a perfect storm,” says Mark Green, MD, neurologist at Mount Sinai Hospital. “For example, I’ll see a woman who says, ‘I can have a glass of wine. I can’t have two because I’ll get a migraine, but around my period, I can’t have any.”
Here are the common migraine triggers that researchers (and patients) have identified, according to Dr. Green.
Menstrual cycles. “Many women develop headaches just as their periods are beginning or a couple of days into it,” says Dr. Green. Known as catamenial migraines, they are likely caused by the fluctuation in estrogen levels, according to researchers at Harvard Medical School.
Skipping meals. Following regular and consistent habits can be a powerful weapon against migraine, and that’s true for your meal times, too. “I think we were meant to be grazers, like animals, [eating] multiple small meals a day,” says Dr. Green. “Missing a meal can become a migraine trigger.”
Dehydration. Around a third of migraine sufferers cite dehydration as one of their triggers, according to the American Migraine Foundation (AMF). Drinking enough water can help stave off migraines and other types of headaches.
Certains foods and drinks. Common food triggers include chocolate, dairy, caffeine, cured meats, and potent-smelling foods, according to AMF. Although the list of foods that are linked to migraines looks lengthy, individuals may be able to tolerate some on the list and not others. Keeping a food journal can help track which foods trigger a migraine.
Artificial sweeteners. Another food trigger is “fake sugars,” such as aspartame. Even if you don’t dump packets of zero-calorie sweetener into your coffee or tea, you might not be off the hook: These artificial sweeteners appear in a variety of “diet” foods, such as sugar-free gum and candy, low-calorie yogurt and ice cream, and even some medications.
Certain additives in food. Some people report processed foods containing the additives monosodium glutamate (MSG) or nitrate can trigger a migraine. MSG is a flavor enhancer found in a variety of processed and canned foods, and nitrate is found in processed meats, like bacon, sausages, and hot dogs.
Fermented foods. “The most common foods that people also talk about as migraine triggers are things that are fermented; things that have tyramine,” says Dr. Green. Tyramine is not an additive, but instead is naturally produced in foods when they are aged or fermented, according to the National Headache Foundation. “Besides wine, it can include yogurt, sour cream, pickles, sauerkraut, [and] things like that.”
Stress. Headaches and stress are infamous companions, but it might be even more complicated with migraines. People with migraines also report that any change in stress levels—up or down—can trigger an attack. “Stress can be a migraine trigger, [but] relaxation following that stress is often an even more potent migraine trigger,” says Dr. Green.
Too much or too little sleep. Once again, consistency helps. Following a regular sleep schedule improves your sleep, which may reduce the risk of a migraine attack. Sleep helps restore your body and repair cells and organs, according to AMF. Without enough of it, your brain might take a hit and be more vulnerable to migraines.
Certain medications. For example, some medications used to treat depression and blood pressure have been linked to migraines. Ironically, taking too many medications for your migraines can also trigger more migraines, a condition known as a medication overuse headache.
Although common triggers have been identified, your migraine triggers are personal to you. If you’re struggling to pinpoint what’s bringing on the attacks, consult your doctor. They can both help you identify your triggers and support you with migraine treatment options and home remedies for migraine.
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I think an important way to think a bad
migrane attack is a perfect storm.
00:00:08,151 --> 00:00:13,311
For example, I'll see a woman who says,
I can have a glass of wine.
00:00:13,311 --> 00:00:17,151
I can't have two, cuz I'll get a migraine,
but around my period, I can't have any.
00:00:17,151 --> 00:00:22,651
00:00:22,651 --> 00:00:27,287
There are a variety of things that make it
likely to develop migraine in a person,
00:00:27,287 --> 00:00:29,375
for example a menstrual cycle.
00:00:29,375 --> 00:00:33,490
Many women develop headaches just
as their periods are beginning, or
00:00:33,490 --> 00:00:34,820
a couple of days into it.
00:00:34,820 --> 00:00:39,670
I think we were meant to be grazers like
animals, multiple small meals a day.
00:00:39,670 --> 00:00:43,000
So missing a meal can
become a migraine trigger.
00:00:43,000 --> 00:00:46,270
Dehydration is a very,
very common migraine trigger.
00:00:46,270 --> 00:00:48,030
Many foods can be migraine triggers.
00:00:48,030 --> 00:00:52,700
Some people are sensitive to some
of the artificial sweeteners.
00:00:52,700 --> 00:00:57,154
Some people are sensitive to MSG, which
is seen in not just in Chinese food, but
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in a lot of other processed foods.
00:00:59,091 --> 00:01:03,170
Some people are sensitive to nitrites,
like in hotdogs.
00:01:03,170 --> 00:01:06,990
The most common foods that people
also talk about as migraine triggers
00:01:06,990 --> 00:01:08,700
are things that are fermented.
00:01:08,700 --> 00:01:13,020
Things that have tyramine,
it can include yogurt,
00:01:13,020 --> 00:01:16,690
sour cream, pickles,
sauerkraut, things like that.
00:01:16,690 --> 00:01:19,500
Stress and anxiety can be
an important migraine trigger,
00:01:19,500 --> 00:01:21,270
often a change from that state.
00:01:21,270 --> 00:01:23,540
So stress can be a migraine trigger,
00:01:23,540 --> 00:01:28,840
relaxation following that stress is often
an even more potent migraine trigger.
00:01:28,840 --> 00:01:31,210
Things should be regular in a migrainer.
00:01:31,210 --> 00:01:36,440
So being sleep deprived, or sleeping
too long can be migraine triggers.
00:01:36,440 --> 00:01:39,416
There are a lot of medications
that can trigger migraines,
00:01:39,416 --> 00:01:44,040
in a person who presumably is genetically
predisposed to the problem of migraine.
00:01:44,040 --> 00:01:47,870
Some of the drugs that we use for
depression can be migraine triggers,
00:01:47,870 --> 00:01:51,703
some of the older blood pressure
drugs can be migraine triggers.
00:01:51,703 --> 00:01:54,910
We wanna keep diaries to
see if we can identify
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the most important triggers in them,
and see if there's a strategy for
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minimizing those particular triggers.
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Many of the triggers of migraine can't
be avoided, they're part of life.
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Others may be important on occasion.
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Low-tyramine diet for migraine. Chicago, IL: National Headache Foundation, 2007. (Accessed on August 16, 2018 at https://headaches.org/2007/10/25/low-tyramine-diet-for-migraine/.)
Mathew PG, Dun EC, Luo JJ. A cyclic pain: the pathophysiology and treatment of menstrual migraine. Obstet Gynecol Surv. 2013 Feb;68(2):130-40.
Migraine. Washington, DC: U.S. National Library of Medicine. (Accessed on August 16, 2018 at https://medlineplus.gov/migraine.html.)
Top 10 migraine triggers and how to deal with them. Mount Royal, NJ: American Migraine Foundation, 2017. (Accessed on August 16, 2018 at https://americanmigrainefoundation.org/understanding-migraine/top-10-migraine-triggers-and-how-to-deal-with-them/.)
Wober C, Wober-Bingol C. Triggers of migraine and tension-type headache. Handb Clin Neurol. 2010;97:161-72.