Migraine Triggers Part 1: Figuring Out the Trigger Riddle!
Do you know your migraine triggers? There are a lot of questions that those of us with migraine are asked by our doctors, friends, family, and those we know online. Questions about our symptoms and treatments we’ve tried. Questions about what “causes” migraine and why it affects our lives so much. Questions about why we’re always sick and whether we’ve tried specific miraculous “cures.” However, none of these are asked as frequently as questions about triggers!
- Do you know what triggers your migraine attacks?
- How did you find that out?
- Why don’t you stop eating or drinking X, Y & Z?
- Are you really doing everything you can?
...the list of questions goes on and on!
A one-size-fits-all list doesn't work
For many with migraine, one of the things our doctor did when first diagnosing us was to present a huge list of potential triggers. Triggers that you are informed, “must be avoided.” The list is often given as a one-size-fits-all, as though we all have exactly the same triggers. It may even be presented as though it is our “fault” we have migraine attacks. That perhaps we’re not doing everything we can to help ourselves!
Unfortunately, unless you are seeing a certified headache specialist, there is frequently a lack of understanding of this disease's complexity. In truth, the list of potential migraine triggers is pretty exhaustive. It is often enough to make the most courageous of us throw our hands up in defeat. Having said that, knowing and understanding our triggers is an important part of disease management. So let’s revisit the question: Do you know your triggers, and how should you go about figuring that out?
Migraine trigger "stacking"
Migraine triggers are as varied and complex as the people who live with migraine. They can be challenging to figure out, can change like the wind, and are often “stackable.” Consider those rare online stores which allow us to stack multiple coupons, one on top of the other. This allows us to get the absolute best deal possible. Sadly, migraine triggers are the same. They can stack one on top of each other to increase the severity, frequency, and even range of symptoms. As we start to figure all this out, this theory of “stacking” is really important. Understanding it helps us make wise decisions.
So, let’s look at some examples of common migraine triggers (note: this is not an exhaustive list):
- Weather-related: Barometric pressure changes, humidity, bright sun, strong wind, extreme levels of heat or cold, even earthquakes.
- Fragrances: Perfume, cologne, scented personal care products, cigarette smoke, vape smoke, food scents.
- Lighting and noise: Fluorescent lights, flashing or flickering lights, bright lights, bright colors on images, moving GIFs, movies, blue light, loud noises, sudden noises.
- Sleep: Too little, too much, irregular sleep.
- Food and drink: Alcohol (especially red wine), dehydration, MSG, matured cheeses, chocolate, caffeine (either too much or too little), additives, histamine, cured meats, to name just a few.
- Lifestyle: Stressful situations, lack of relaxation, exercise (either lack of or too much), travel.
- Medical conditions: Sinusitis, neck and shoulder pain, sleep disorders, vitamin deficiencies, medication overuse, TMJ, traumatic brain injury.
- Hormones: Oral contraceptives (can help or trigger), puberty, menstrual cycle, pregnancy, perimenopause, menopause.
The complexity of migraine triggers
Hopefully, at this point, you haven’t thrown up your hands and given up on this whole topic! It can be overwhelming, for sure, but hold onto your seat because we’ve only just begun! Not only is the list of potential triggers huge, but it is so much more complex than just knowing possible factors. Let’s look at five things that add to the complexity of it all:
We’re not all the same
What might be a trigger for you could have no impact on me at all. In some cases, your trigger could even be a protector for me (something that helps prevent migraine attacks). Two great examples of this are exercise and caffeine.
Triggers are a moving target
Something that may be a trigger now may not be in the future, and vice versa. Migraine has an annoying habit of changing just when we least expect it. We are constantly kept on our toes!
Not every trigger is the same
Some triggers may be much stronger than others and cause a migraine by themselves. Others may be weaker and only trigger an attack when stacked with other factors. Weaker triggers may easily be missed by us, while stronger triggers may be given all the credit!
There can be a delay in cause and effect
Some triggers may bring on an attack immediately, which can help us easily identify them. However, others may take hours or even longer to take effect. These can be easily missed if we aren’t tracking what we do, where we go, what we eat, weather changes, and more.
Sometimes we get our triggers wrong
We now understand that the first stage of a migraine attack is prodrome which can be hard to know when it starts. This often complicates our understanding of triggers. It’s not unusual for a migraine attack to start before we are aware of it, and sometimes we can crave certain things during that time. For example, we might crave chocolate during the prodrome and not realize that we’re already in an attack, so we could blame the chocolate on the pain and nausea that quickly follows. In the same way, we might have an unusual burst of energy during the prodrome and then incorrectly blame “doing too much” for the reason that pain and nausea quickly follow.
So where do we go from here?
Hopefully, you’re still with me at this point! Don’t give up because there really is light at the end of the “trigger tunnel,” I promise you! In part 2 of this article, we’re going to look at how to figure out our triggers, what happens once we’ve figured them out, and why it’s not all about triggers.
But in the meantime, we’d love to hear from you. Were you ever given a list by a doctor and told to avoid everything on it? How did that make you feel, and was it helpful? Do you already know what your triggers are, and if so, how did you find out? And finally, what do you think is the most frustrating part of migraine triggers?
How much has your migraine disease changed or evolved over time?