What are migraine triggers?

Most migraine attacks occur for no apparent reason. However, something may trigger migraine attacks in some people. Triggers can be all sorts of things, including:

• Diet and foods. For example: dieting too fast, cheese, chocolate, red wines, citrus fruits, and foods containing tyramine (a food additive).
• Environmental. For example: smoking and smoky rooms, glaring light, VDU screens or flickering TV sets, loud noises, strong smells, hot weather.
• Psychological. For example: depression, anxiety, anger, tiredness. In some people migraines occur when relaxing after periods of stress. For example, weekends or holidays.
• Medicines. For example: hormone replacement therapy (HRT), some sleeping tablets, and the contraceptive pill.
• Change in habits. For example: a change in sleep patterns (missing sleep, lying in, etc), missing meals, long-distance travel, jet lag, etc.
• Other. Periods (menstruation), shift work, the menopause.

Some notes about migraine and triggers

It may help to keep a migraine diary. A pattern may emerge, and it may be possible to avoid one or more things that may trigger your migraine attacks. (But note: too much effort trying to identify triggers may cause anxiety. In some people it may do more harm than good to search for triggers, especially if no trigger is found - which is common.)

Many people blame foods as triggers. However, foods are not thought to be common triggers. Suspect a food as a trigger if a migraine occurs within six hours of eating the suspected food and cutting out the food reduces the number of migraine attacks.

Some people need a combination of triggers to set off a migraine. For example, some women may only get a migraine if they drink red wine and are having a period. Another example is that a food trigger may only set off a migraine if you are also over-tired.

Migraine diary

An example of a migraine diary is provided below. It may help to fill it in over 3-4 months so that you and your doctor develop a better understanding of your migraines.

Firstly, fill in the calendar part. This gives an overall picture of when the migraines occur.

• Fill in the days of the week.
• Mark when you have an attack. Note: people with migraine can also have common tension-type headaches. So, in the attack column, indicate when you have a migraine, or a tension-type headache, or if you are not sure.
• If you are a woman and have periods, put a B in the period column on the days you are bleeding.

Migraine/Headache Diary

Further sources of help and information

Migraine Action

27 East Street, Leicester, LE1 6NB
Tel: 0116 275 8317 Web: www.migraine.org.uk

Migraine Trust

52-53 Russell Square, London, WC1B 4HP
Tel: 020 7631 6975 Web: www.migrainetrust.org

References

• Migraine, Clinical Knowledge Summaries (October 2010)
• Guidelines for All Healthcare Professionals in the Diagnosis and Management of Migraine, Tension-Type, Cluster and Medication-Overuse Headache, British Association for the Study of Headache - BASH (2010)