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Headache Trigger Factors

There are a number of factors which may trigger (set off) your headache attacks more frequently. Isolating the triggers that affect you requires much patience, but you will have the very worthwhile prospect of reducing the frequency of your headaches.

It is important to bear in mind that migraines are very individualistic conditions and that the triggers which act with sure fire regularity with one person, may not affect another. Even members of the same family are seldom affected by the same triggers. Also keep in mind that your particular trigger may not be on the attached list, as it is only a partial listing of the most common ones reported. In most cases, people with migraines are usually affected by more than one trigger and it often takes a combination of two or more triggers to set off the chemical chain reaction that results in a migraine attack.

One of the biggest problems in identifying migraine triggers is that the body's reaction to foods consumed or events experienced can be delayed for 24 hours or more. This means that the only reliable way to isolate your triggers is to compile a list looking backward at least 24 hours from the start of each migraine attack. A headache diary should include only relevant information about foods consumed, weather conditions, position in menstrual cycle, and physical and emotional stresses. Also include the time of onset, duration, severity and location of the headache.

After your headache diary is completed, a thorough examination of the diary will often reveal a pattern in which one or more trigger factors stand out quite clearly. Once a pattern is observed, each suspected trigger must be isolated and avoided to determine whether the headache persists in its absence. Of course some triggers, such as hormonal changes and fluctuations in the weather are impossible to avoid. However, it may be that the "unavoidable" trigger factors are effective only when acting in concert with other trigger mechanisms.

The following are five major divisions of headache triggers which commonly increase the incidence of migraine attacks.

Environmental Factors:

  • Sensitivity to strong sensory stimuli
  • Bright lights, strong sunshine, or glare from snow or computers
  • Loud noises
  • Strong odors from cigarette smoke or perfume
  • High altitudes of the atmosphere of pressurized cabins in commercial airlines
  • Weather changes—extremes of cold and hot with high humidity, and low barometric pressure, often when the mercury falls below thirty

Potential Dietary Trigger Factors:
Certain people have a chemical sensitivity to particular foods that contain vasoactive substances, such as:

  • Ripened cheeses (cheddar, emmantalar, gruyere, stilton, brie and camembert)*
  • Permissible cheeses: American, cottage, cream and Velveeta
  • Chocolate*
  • Vinegar (except white vinegar)
  • Anything fermented, pickled or marinated
  • Sour cream and yogurt
  • Hot fresh breads, raised coffee cakes and doughnuts (due to inadequate yeast rising time)
  • Pods of broad beans (lima, navy and pea pods)
  • Any foods containing large amounts of monosodium glutamate (Chinese food)*
  • Onions
  • Citrus fruits (oranges, lemons, limes, grapefruit)
  • Bananas
  • Pizza
  • Pork
  • Excessive tea, coffee, cola beverages*
  • Fermented sausages (bologna, salami, pepperoni, summer sausage and hot dogs)
  • Alcoholic beverages*
  • Products containing Nutrasweet*
  • Seafood (shrimp, crab, lobster) and herring

* denotes most common dietary triggers

Psychological or Emotional Factors:
Stress: Although it is more often the cause of tension headaches than migraines, emotional stresses are direct trigger factors in many cases. Moreover, migraines are frequently triggered by tension headaches which result from stress. It should be kept in mind that stress arises not only out of unhappy or painful experiences, but also out of joy, excitement and surprises as well.

Many people find that it is not stress, but the release from it that triggers their migraines. This so-called "weekend migraine syndrome" has been well documented for years. No one knows why the transition from stress to relaxation should trigger migraines, but it is known that the attacks can often be avoided by making the switch a gradual one. For instance, "sleeping in" should be avoided.

Physical Factors:

  • Severe fatigue
  • Physical illness
  • Strenuous exercise ("overdoing it") or lack of physical conditioning
  • Oversleeping or lack of sleep
  • Prolonged fasting—going without food for a long period of time can lower the blood sugar to a point where a migraine can be triggered. Eating three meals per day can alleviate this problem
  • Hormonal changes during a female's menstrual cycle—most attacks usually occur just before or during the menstrual flow. Others experience attacks at mid-cycle during ovulation. It is important to keep a record of your cycle in relationship to your headaches, as up to 70% of migraines in females are hormone related
  • Muscle tightening in neck and shoulder from physical or emotional stress
  • Poor posture
  • Tobacco use—cigarette smoking

Pharmacological (medication) Factors:

  • Estrogen—used for hormone replacement in post-menopausal women
  • Birth Control Pills - Some contain hormones which upset the body's natural balance
  • Let your current health care provider know all the medications that you are currently taking
  • Do not stop taking medications without your doctor's approval

Minnesota Headache Center
A service of Noran Neurology
612.879.1000