As a neurologist at one of the major headache centers in my region, I see a lot of really tough headache and migraine cases. The tough part in treating them is that a lot about migraines is still not fully understood. They are believed to involve the “trigeminovascular” system, which is different for migraineurs (people prone to migraines) from those who cannot have migraines.
The bad news is if you have the circuitry in your brainstem for migraines to be triggered, it’s something you’re stuck with and you will never fully get rid of your migraines. The good news is you CAN get migraine relief and markedly change their frequency by identifying and isolating the common predisposing factors that may be triggering them.
To help you begin managing your headaches today, I have compiled a list of the 11 migraine triggers that I see most often, along with tips on how to avoid them. Following these guidelines won’t cure you from the migraine cascade completely, but it will help you take control of your migraine headaches and minimize their onset.
- Stress. Stress itself may not be the trigger, but rather our reaction to stress. Anxiety, worry, psychological tension, emotion changes, anger, depression, and neck muscle tension are all responses to stress and can trigger a migraine. So, take a break, even a brief pause, and look upwards. When we are stressed, we often times focus on those things just in front of us. Since our brains process a negative thought a hundred times faster than a positive one, we focus on the negative and assume the posture of fear (hunched shoulders, frown, internally rotated arms and shoulders, and tension in our neck and shoulders). Instead, if you look upwards, you force yourself to consider a more global view and “get outside of yourself”. Creating an effect similar to that which comes from meditation, pausing and averting the eyes upward will help you manage your reaction to the stress you are feeling in that moment.
- Weather. People prone to migraines are more sensitive to all kinds of stimuli about the head, like hot or cold air, sunlight causing localized heating of the scalp, and photosensitivity as the migraine cascade occurs. Weather changes, primarily the drop and fluctuation of barometric pressure before and during a wind, rain, or snow storm is a well-known effect. But, the reason why this triggers a migraine is still not fully certain, making it a tricky thing to deal with. Since you can’t control or avoid changes in weather and we don’t fully know why it leads to a migraine onset, all you can do is try to minimize it’s effect. Stay indoors to avoid extreme temperatures. Drink a lot of water to avoid dehydration during hot or dry weather. And most importantly, limit other triggers. If a big storm or extreme heat is predicted in the forecast, work to limit all other migraine triggers (which you can control) to optimize your migraine prevention.
- Hormones. There is a known correlation between hormone changes in women and headaches. For example, during menstruation, the drop in estrogen levels will often trigger headaches as does beginning to take birth control or another hormone replacement therapy. Conversely, pregnancy causes a huge increase in estrogen levels. So when a woman who has migraines becomes pregnant, her migraines are likely to do one of two things: vastly improve or stop altogether. After the pregnancy is over, the headaches often will return. How to fix this? Low estrogen birth control can sometimes help, as can estrogen patches worn only just before and during menses. Speak to your ob-gyn for suggestions on both of these.
- Change of routine. Weekend migraine or vacation migraine are well-known phenomena. They come about with the change of routine and increased relaxation after a week or period of time of hard work. Not getting enough sleep or sleeping in, both acts as powerful triggers of the weekend headache. Any type of travel including the jostling of a train, changes in airplane cabin pressure, and excitement can all be triggers, so many patients suffer on their vacations. The body likes comfortable routine. Try to keep one, even on vacation.
- Bright Lights and Sun Glare. Bright lights such as the strobing effects of video games or the lights of TV/computer screens can trigger migraines. Simple steps such as taking regular breaks from video games, computers, or TV, using an anti-glare screen, and setting good lighting can help minimize the effects of lights on your headaches.
- Air conditioning. Some people with migraines cannot tolerate air conditioning for various reasons. Dehydration, muscle contraction, the circulation of allergens – all things caused by the cold air and can trigger migraines. If you already suffer from migraines and headaches, the best thing is to avoid highly air conditioned places.
- Noise. When you are prone to headaches, all kinds of noise can trigger it to be worse. Excessive bass in a car, lawn mowing and office machines, knitting needles, or even someone chewing celery next to you can be a killer when you have a headache. Ear protection, head-sets for telephone conversations, and keeping noise at a moderate level can help.
- Low blood sugar. Low blood sugar can be a headache trigger. This has more to do with not eating regularly. Whether that results in low blood sugar or not, skipping meals or fasting can be a powerful trigger for individuals prone to migraines. The best avoidance is to eat regularly throughout the day.
- Eyeglasses. Wearing the wrong prescription can trigger a headache, so get your vision checked regularly to make sure your prescription is correct. Just remember, your eyes dilate during a headache, so they are out of focus. Because of this, you don’t want to be examined by an eye doctor just before, during, or after a headache.
- Anesthesia. Many people will wake up after surgery with a blasting headache. Let your anesthesiologist know if you have headaches and they can give you different products to put you to sleep that may not have as high a chance of resulting in a headache.
- High blood pressure. Sometimes, headaches can be a sign of something much more serious going on. Extremely high blood pressure, the kind that puts you into the emergency room, can cause headaches. Have your blood pressure checked on a regular basis by a competent health professional. Remember- one of the most common causes of hypertension in the United States is sleep apnea – so consider seeing a specialist to have your sleep assessed.
The thing to always remember is that these triggers aren’t the cause of your migraines, but merely the “straw that breaks the camel’s back” in patients who have the circuitry to have migraines. What enables them to trigger the cascade is frequently predisposing factors of neck problems, and sleep and sleep position problems, which increase the vulnerability and sensitivity to those triggers, and thus allow them to act as accelerants.
So, use my tips to help you curtail your migraines, but if your migraines are getting worse no matter what you do, don’t be afraid to see a headache specialist about them. There are many approved medications that can be used for migraine that will help you “put out the fire,” as you and your headache specialist investigate predisposing factors important for you.