Migraine Management Essential 3: Trigger ID & Management
Trigger identification and management is an essential element of effective Migraine management. Some triggers can be avoided, which allows us to avoid some Migraines. Not all triggers can be avoided, but knowing what our triggers are is still helpful in our efforts to have fewer Migraines.
Another interesting aspect of Migraine triggers is that they can be “stackable” or “cumulative.” Some triggers might not be strong enough to bring on a Migraine if we counter just one, but “stack” two or more together, and they bring on a Migraine.
Triggers vary from one person to another. What triggers a Migraine for one may not be a trigger for another. Here are some of the most common potential Migraine triggers:
- Changes in barometric pressure / weather. This is a very common trigger and, unfortunately, one that can’t really be avoided. Many people find, however, that Migraine preventive treatment can help reduce their sensitivity to this trigger.
- Crying. It’s not the emotion leading up to crying that’s the trigger, and for most, a few gentle tears won’t trigger a Migraine. Full-out sobbing crying, however, is a strong trigger for some of us.
- Dehydration. Some of us are more prone to dehydration than others, and it’s something we often overlook as a potential Migraine trigger. Alcohol and caffeine can be dehydrating, so we need to be careful to consume enough liquids that don’t contain them.
- Flickering or bright lights. Various issues with light can be Migraine triggers. Sunglasses can help. Adding a cap or sun visor to block the light that comes in above sunglasses can also help. If fluorescent lighting at work is an issue, your employer is required by law to make “reasonable accommodations” for you. Light-related triggers include:
- flickering light such as strobe lights or fluorescent bulbs,
- bright light — natural or artificial,
- older computer monitors that have a flicker rate,
- sun flickering through trees along the road.
- Fluctuations in hormone levels. Hormonal fluctuations associated with a woman’s menstrual cycle, pregnancy, and menopause can be strong triggers. Hormone supplementation or oral contraceptives can help some women, but they can also make Migraines worse or make no difference at all. Keep in mind that reproductive hormones aren’t the only ones that can be involved in Migraine. Thyroid problems can also be a strong Migraine trigger. Thyroid issues can also be Migraine triggers.
- Foods and beverages. For some of us there are some foods and beverages that are Migraine triggers. These triggers can be hard to identify since the Migraine can occur up to 48 hours after eating a trigger food. The easiest and most effective way to see if any foods are a Migraine trigger for you is through an elimination diet where you eliminate common food triggers from your diet, then add them back, one at a time.
- Heat. Hot, stuffy rooms, hot days, and becoming overheated are very common Migraine triggers.
- Missed meals or irregular eating schedule. For some Migraineurs, missing meals or not eating on time can trigger Migraines.
- Noise. Loud noises can be a trigger for some people.
- Sleep. Waking with a Migraine is often an indication that a sleep issue is the trigger. It’s recommended that Migraineurs get up and go to bed at the same time every day, including weekends and holidays. Even when we think we’re sleeping well, we may not be. Various sleep issues can be Migraine triggers:
- too much sleep,
- too little sleep,
- interrupted sleep,
- irregular sleep schedules, and
- otherwise poor quality.
- Perfumes, fragrances, chemical fumes, odors. Many odors can be Migraine triggers for some people, especially if encountered in a small space – perfumes, scented lotions and other products, room fresheners, fumes from cleaning products, and other odors. This trigger can cause many problems for Migraineurs. Many have had problems with coworkers wearing fragrance at work. Employers should be willing to enact and enforce an office policy to prevent this problem in the workplace. There has been, in fact, at least one court case where a court ruled that it was the employer’s responsibility to ensure that employees refrain from wearing fragrance to work because it’s a trigger for an employee. (See Diana Lee’s article, ADA Accommodations & Migraine Triggers: Making the Workplace Work for You, for more on the ADA and workplace accommodations.)
- Physical exertion including sexual activity. Exercise, sports, orgasm, and other physical exertion can be Migraine triggers. It’s important that Migraine triggered by physical exertion be checked out by a doctor when they first occur to be sure that they are Migraine and not a physical issue such as aneurysm. Depending on how frequently you participate in exertional activities, doctors can usually prescribe a medication to prevent these Migraines, either on days you exert yourself or every day. Checking with your doctor is important here to be sure you’re experiencing Migraine triggered by exertion as opposed to primary exertional headache or orgasmic or preorgasmic headache.
- Stress? This one is somewhat controversial. Some experts say that stress itself is a trigger; others say it’s not. Still, I hate to see anyone accept that stress is a trigger without carefully eliminating other triggers they may encounter during stressful times. The International Headache Society has removed stress from their list of Migraine triggers and put it on their list of exacerbating factors — things that make us more susceptible to our triggers. I’d have sworn stress was a trigger for me until I kept a very detailed diary for a few months. I found that stress itself is not a trigger for me, but things I do or don’t do during stressful times are — missing meals, not drinking enough and becoming dehydrated, consuming excess caffeine, crying, not sleeping well. I hope you’ll thoroughly investigate this as I think we do ourselves a real disservice by thinking stress itself is a trigger for us and not looking closely for other triggers during stressful times.
- Tension-type headaches. Tension-type headache (TTH) is the most common headache disorder. According to the World Health Organization and International Headache Society, up to 78% of the population experiences TTH, and 60% of TTH sufferers experience reductions in social activity and work capacity. For many Migraineurs, these headaches, if not treated quickly and successfully, can trigger a Migraine attack.
One of the most effective ways to identify Migraine triggers is by maintaining a Migraine diary. You may think that Migraine diaries are just for days when you have a Migraine, but there are other uses for them too.
Migraine triggers vary greatly from one Migraineur to the next. Nothing is a trigger for all Migraineurs. I’ve described the most common Migraine triggers, but you may have triggers that are not on this list. If you’re having trouble identifying your triggers, ask your doctor to help you. While not all triggers are avoidable, it’s helpful to identify and eliminate those that are. Even if your triggers aren’t avoidable, it’s helpful to know what they are so you can work on more effective Migraine management.
For more detailed information on some of these triggers, a video about sleep and Migraines, and downloadable diaries, see More Information about Migraine Triggers.
Migraine Management Essentials Series
- Migraine Diagnosis
- Migraine Education
- Migraine Preventative Treatment
- Migraine Abortive Treatment
- Migraine Rescue Treatment
- Migraine Support
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