Top migraine triggers

Top 10 Migraine Triggers, According to New Study

A new study1 has identified the top 10 migraine triggers and the frequency at which they occur. The study’s author* culled this list by examining a collection of existing migraine studies in a meta-analysis of 25 previously published studies of a wide range of migraineurs throughout the world. They found the top 10 triggers to be:

1. Stress, 58% (of 7,187 patients)
The researcher defined stress as “a specific adaptive and defensive physiological reaction by the nervous system in response to a wide variety of physiological and/or psychological stimuli.” In most studies, the increased stress coincided with increased migraine frequency, though one found that the migraine attacks occurred after the stress lifted.

2. Auditory, 56% (of 397 patients)
While noise and sounds are ranked second, they were mentioned in far fewer studies than the other triggers. The percentage may or may not scale if a larger number of patients were assessed.

3. Fatigue, 45% (of 2,577)
The article noted that fatigue and stress could be interrelated. I wonder if fatigue is the trigger or if patients notice feeling fatigued before a migraine and assume it is a trigger when it is actually a very early migraine symptom.


4. Fasting, 44% (of 3,374)
Whether intentionally fasting or unintentionally skipping a meal, doing so was a trigger in almost half of migraineurs.

5. Hormonal, 44% (of 4,461)
This applies only to women. The article noted that the “association of a migraine with specific phases of the menstrual cycle is perhaps the most commonly known and accepted migraine precipitating factor.”

6. Sleep, 43% (of 5,347)
The studies examined a variety of sleep pattern disturbances, though “sleep deprivation” and “lack of sleep” were frequently mentioned.

7. Weather, 39% (of 5,527)
Weather changes were the most commonly cited weather-related trigger, though strong winds were also mentioned. The article also notes that strong winds are indicative of a weather change.

8. Visual, 38% (of 5,176)
Lights and glare were mentioned the most, though flickering lights or contrasting patterns (like road stripes) were also cited.

9. Olfactory, 38% (of 5,251)
The odors were typically “generated by organic compounds such as perfumes, nail polish, paint, gasoline, and cleaning products,” according the study.

10. Alcohol, 27% (of 3,695)
The association between alcohol and migraine was lower than the author believed to be expected. He questioned whether alcohol in general is the trigger or if it only certain types of alcohol.

Other frequently mentioned triggers that didn’t make the top 10 include physical activity (exercise, exertion, and/or straining) for 25% of migraineurs and foods for 20%. The paper mentioned that there were many more, but none occurred in more than 20% of patients on average. Many of the triggers affected only subgroups of migraineurs.

What ties all the triggers together, according to the article, “appears to be an intrinsic difficulty in adapting to internal and external environmental changes.” They noted that this was particular apparent with a decrease in many stimuli, including barometric pressure, estrogen, and sleep. Why and how do these factors trigger migraine attacks? Those are questions for future research.

Findings were published in the August issue of the journal Current Pain and Headache Reports.

*Stephen J. Peroutka, MD, PhD, is the chief medical officer at Semnur Pharmaceuticals, a start-up known for work on non-opioid drugs for back pain. I have to admit immense curiosity about why the company’s CMO is writing about migraine triggers.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
    Peroutka, S. J. (2014). What Turns on a Migraine? A Systematic Review of Migraine Precipitating Factors. Current pain and headache reports, 18(10), 1-6.

Comments

View Comments (21)
  • Colorado4Now
    2 years ago

    Paco: An emphatic “Yes!” about the pressure changes! I also am sensitive to a small pressure change. Even 0.03 rise in pressure begins the pain of a migraine, and then if it should rise and fall rapidly, say within hours, I am in misery all day.

    So, Bluebird: I am interested in the same question you posed. How have others resolved the weather issue? RX, relocation, etc. I live in a place with sudden, frequent pressure and weather changes. They are making my life miserable.

    For those who asked: #1 trigger for me is to vary my sleep routine. #2 would be weather changes (pressure rising specifically or rising/falling rapidly). #3 alcohol of any kind (but I can control that entirely) tied with stress. #4 bright lights, loud noise, and strong smells (particularly perfumes, but only women’s; strangely men’s colognes do not bother me).

  • DebbyJ56
    3 years ago

    While I agree with most of the triggers because I suffer from most of them. Having chronic daily migraines for more than 12 yrs has no answers. When I wake up at 3am with a brutal migraine there has been no trigger, no reason at all. This has been my life. No answers from five neurologists and a well know headache center in Phila, PA. I have no quality of life and continue to suffer with no help in sight.

  • Aussie Chook
    4 years ago

    My top stressor is stress. Interestingly the neurologist I went to about 4 years ago said it wasn’t that migraineurs were a bunch of sissies who couldn’t cope with stress, rather it was that we are a bunch of people whose brains/neural pathways respond differently than the average person to stressors. And that made sense to me because I’m not a stressed person, however, when a trigger occurs (weather, stressful situation, alcohol etc.) I immediately feel a different response than say my spouse, even if we’re in the same situation. I’ve slowly learnt that I’m not weak (as my father implied) and that my response to triggers is not within my control unless I avoid them. Here in Australia the hot weather always brings on a migraine, and when it’s stormy, same thing. I can drink very small amounts of brandy and soda, but not wine. So I believe that migraineurs’ bodies are wired differently and when reading ‘stress’ in an article, we shouldn’t think it means we’re weak, but that we simply respond differently. I take Sandomigran at night and Naramig for migraines, so generally I believe they are well treated but I still average one a week. Oh, and I use a Cefaly at night too – it’s wonderful for preventing the morning fog I used to get

  • jojobaggins
    4 years ago

    Thanks for writing this, Kerrie. I found it interesting, and it’s helpful to read the comments of others, too.

    If I had to list my top three triggers, they would be:
    1. Food–I worked out that caffeine, any kind of wine, and aspartame are definite, immediate triggers for me. MSG less so, but maybe still just a mild trigger? My SIL gets triggered by onions and avocadoes. She can eat shallots, at least. But makes eating out at restaurants tricky.
    2. Hormonal changes–I usually get one either a couple days before menstruation or during it. If I am really lucky, I might also get one around the time of ovulation, too. 🙁
    3. Weather–this one doesn’t happen as much, because the weather changes need to be extreme for it to trigger me.
    3.5 Low blood sugar–this one also doesn’t happen much, because I am careful about eating when I need to, but it is a DEFINITE trigger for me. And I can’t just eat carby stuff, I have to eat balanced food regularly (carb, protein, fat)

    I have also been doing some reading about brain chemistry lately. I suspect low serotonin is a trigger for me. I have periods of mild depression, and migraines do tend to hit me when I am down. I also have periods of hyperactivity, but thankfully don’t seem to have a migraine correlation then.

    Getting motion sickness can trigger a migraine for me sometimes.

    And I live in the world’s worst air polluted city (Delhi), and can’t help but wonder if the pollution has caused the uptick in migraines for me. Maybe a weak trigger that just tips the balance with other things and migraine happens?

    My migraines usually last 18-24 hours, and then I have at least one day of the postdrome hangover. Once, the postdrome lasted a full week.

    Before I moved to Delhi 3 years ago, I was getting migraines 4-5 times per year. Now I get them at least once a month, usually 2-3. I hope this worsening is not a trend that will continue. 🙁

  • Pondrat
    4 years ago

    My quickest trigger glare, no doubt; a bright flash can touch off an instant migraine. The most common trigger is a weather change; unfortunately I live in an area where fronts come and go constantly, and my head suffers as a result. The absolute worst headaches can be brought on by food or drink; a beer with a chocolate chaser would put me in the E.R.

  • BethBlue
    4 years ago

    I have two points. (1) PHH is absolutely correct, and has eloquently pointed out the inconsistencies that exist in categorization of migraine triggers. To me, “stress” is similar to the catch-all “insubordination:” It can mean virtually anything you wish it to mean. (2) I believe that the ordering of triggers is wildly different for migraine sufferers — at least, they are for me. I am tremendously sensitive to noise, light, and especially smells. For example, flying is a major production. I can spend days in preparation (getting Botox shots, refilling medication, getting extra sleep), but one perfume-doused passenger can bring the whole house of cards tumbling down. Stepping on a plane and being bombarded with the galley’s coffee pots can ruin the entire flight for me. And if you think a crying baby annoys “normal” people, imagine what it does to a migraineur!

  • Doug
    4 years ago

    I would like to point out that there is no food on this list! I am so sick of reading migraine tips that say to eliminate various foods that are alleged migraine triggers. I once removed every potential food trigger and food allergy from my diet and still had headaches every day for weeks.

  • Doug
    4 years ago

    This is the first study I’ve seen that includes auditory triggers. That is my number 1 trigger. I have talked to many people who have the same trigger, but I have not seen one study, informational web page, or anything that has listed noise as a trigger.

  • Paco
    4 years ago

    3.FATIQUE I do find that I become run down and tired no matter how much sleep I’ve was able to get the night before; before a migraine headache. Sometimes by as much as one hour before the atmosphere pressure drops. I sometimes have other signals instead. I have found my body able to detect a pressure change of as small as .01 inches of mercury; especially if followed by a rapid rise or rapid drop in pressure.

  • bluebird
    4 years ago

    Kerrie. How did the weather trigger resolve? Luck /RX/ or moving someplace? Weather fronts take me out!
    Thank you for presenting this info.
    I agree with PHH, in that I feel I consistently bring tremendous courage, discipline, resiliency and determination to “rise to the Occasion” day after day. We cope with stress all the time. What is curious to me is how a migraineur might respond differently with different stressors or at different times. For someone with an anxiety disorder or the caretaker of several children and aging parents or poverty and worry that is appropriate..is it different for migraineurs? Are we intrinsically more sensitive? I know we have to be strong just to get by day to day. Strong enough to be gentle with one’s self and those we care about.
    I am becoming more interested in the “let down” headache issue. Ironic to have a trigger be having held it together. Feels like having survived the jungle, getting home to the cave means I can let down and accept the myriad of compromising and challenging parts of this disease which make me feel vulnerable in the world. But how Could that be a trigger? Or is it that denial is exhausting and I have been subject to migraine all the while I was coping?

  • PHH
    4 years ago

    I think I’m annoyed with the continuing statement that “stress” is a trigger without a thoughtful discussion of what stress is actually composed of.

    I think the definition of “stress” used in this analysis is rather useless. It lacks specificity – what is the stress…??

    Is it your “anxiety” about a project deadline or less sleep the night before so that you could polish the project presentation?

    Is it your “annoyance” about having to do something on short notice for a parent/child (whoever you are taking care of ) or is it that you skipped lunch to do the chore?

    Is it the “concern” one has about making all the flights for a trip or is it the long hours spent in the airport and confined space of a plane (loud noise, frequent light level change, lots of odors)

    The definition used describes what every TRIGGER creates “a specific adaptive and defensive physiological reaction by the nervous system in response to a ….” lack of sleep, lack of food, getting stuck with food choices full of known triggers, high light, etc. etc.

    The triggers are the “wide variety of physiological and/or psychological stimuli.”

    The triggers that stress is composed of are then listed as less common of a trigger than stress!

    This is not a very thoughtful conclusion. I realize the original papers may have been the source of the fuzzy thinking, but I would have liked to see the meta-analysis author take on the poor categorization of triggers in their discussion of the results. Such data review papers are a good forum for changing the paradigm 🙂 Since the categorization appears to have been done by migraineurs (though we don’t know if they were given a list of choices), I guess I’m suggesting that we think more carefully about what we DO with stress, besides the result of a migraine. This might help with management of the actual triggers.

    My experience is that the migraine physiology is not very resilient to change. The migraineur may be very capable of handling stress – hence the migraine attack occurring AFTER the stress has been “lifted”. This means the migraineur “rose” to the challenge of the stress, but at a much bigger cost than non-migraineurs. And most of us know that a price will be paid, but do what is needed anyway… I’d call that handling stress quite well, and in fact with a form of courage.

    I thank the contributors to this site (in other discussions and articles) for making me think through what “stress” means. Because of their comments I have been able to parse what happens “under stress” and have, at least at times, managed to limit the behavioral changes that occur and still meet the demand. It takes being a LOT more organized, consistent and thoughtful than many of the folks around me. But it is worth every moment of less pain and disability!

  • euse
    4 years ago

    I could not agree more with you.

    It’s also important to keep in mind that the way in which triggers are reported are not free of cultural biases (women might be more likely to report “stress” as a cause than men, amongst many other biases…)

    I have read this paper and, frankly, was less than impressed.

    The article claims to be “a systematic review”, however, it completely lacks reporting of proper statistical measures.

    Furthermore, the conclusion Peroutka offers in the final section of the article falls shamefully short in a number of ways. For example, it omits any critical discussion of methodological and conceptual issues at the basis of the reviewed data. He then proceeds to speculate about possible interventions for stress and fatigue based on the views of a single physician published in 1952(!).

    An article like this would be considered sub-par even for an undergraduate student at my institution, not to speak of a senior researcher. It certainly does not warrant a front-page post on this site.

  • rhondagrensberg
    4 years ago

    I didn’t see one of my triggers listed, it is bright light. I hate going outside when there are no clouds or going into a store that thinks you need to be able to see minutia. I did see one of mine listed but it isn’t organic smells it is chemical smells. For instance I can be in the room with real vanilla and even use it for baking, but the chemical smell of a vanilla candle or air freshener will send me to bed for days.

  • Sally
    4 years ago

    My top triggers would have to be exercise or physical exertion, weather changes and stress. Odors and heat are also factors.

  • Luna
    4 years ago

    1. Odors absolutely always cause migraine symptoms. 2. Light &/or glare 3. barometric pressure changes. 2 & 3 often. Stress only if I’ve gotten off my daily sleeping/eating/drinking routine.

  • monkeybrew
    4 years ago

    Kerrie,

    I share Nancy’s thanks for sharing this study. It is interesting to me how, on a day-to-day basis, these types of triggers may move up or down on my own personal list.

    I wonder if folks have a “top three” that remain somewhat constant? If so, might people be willing to share?

    Take Care,
    MB

  • shine4him
    4 years ago

    My top 3 are pretty consistent:

    1. Weather
    2. Hormonal
    3. Anything on the back of my neck for more than an hour (turtlenecks, heavy necklaces, etc)

    I also get lack of sleep headaches, but usually those only occur after I’ve had 4 hours of sleep or less in a night.

  • rhondagrensberg
    4 years ago

    I can almost always count on chemical smells, bright light, and loud noise to put me down for days.

  • Kerrie Smyres moderator author
    4 years ago

    Great question. I expect they remain fairly constant for most people, but don’t think there’s published research on that.

    Personally, it has changed for me as my treatments have changed. Weather used to be a huge trigger for me, but isn’t currently. Odors are a big trigger for me and I can’t imagine that changing (but I’d be thrilled if it did!).

  • Nancy Harris Bonk moderator
    4 years ago

    Hi Kerrie,

    Thank you for sharing this study with us in a clear, concise manner.

    Nancy

  • Lmcfalls
    4 years ago

    I am surprised food is not receiving any attention as has been mentioned. I have found that any “regular headache ” develops into a migraine unless aborted very early. There are medications used for pain and other conditions that begin the cycle for me. Third would be flashing lights such as driving while the sun shines thru the trees. Each causes discomfort and then a tensing of muscles. That leads to pressure on trigeminal nerve (and others). Chemicals released. Blood vessels swell increasing pressure, bringing pain. If I am already tired or dehydrated or whatever then a migraine is more likely to occur. Is this close to how others understand migraines?

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