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Triggers: avoid them or cope with them?

What are migraine triggers?

Migraine triggers [1] are things you come in contact with that your brain reacts to by starting a migraine [2] attack. These things can be inside your body, like hormones and feelings, or outside of you, like weather changes and smells. Things inside and outside of your body may interact, for example drinking alcohol to relieve anxiety. Some of them will be within your control, and others won’t. 

Which things can trigger a migraine?

Many researchers have surveyed patients about their perceived triggers. The list of potential migraine trigger is very, very long. 

CATEGORYEXAMPLELINK IN THE TREE
EmotionsStress
Letdown after a stressful event
Strong feelings such as anger, anxiety or excitement
703 [3], 704 [4], 710 [5], 711 [6]
NutritionSkipping meals
Dehydration
Alcohol, MSG (monosodium glutamate) 
Too much caffeine [7] or withdrawal from caffeine . 
Some people with migraine are sensitive to specific foods (cold cuts, cheeses, chocolate, citrus, onions, nuts…the list is endless) 
** Food triggers are often overestimated.For most people, these foods are not triggers.
701 [8], 702 [9], 707 [10], 708 [11]
SleepToo much or too little sleep
Irregular sleep schedule, jetlag
Untreated sleep apnea [12]
Some migraines start during sleep but sleep may relieve a migraine
715 [13], 716 [14]
HormonesPuberty, menstruation, pregnancy, perimenopause, birth control and hormone replacement
Breastfeeding is usually protective. 
Hormone branch
WeatherExtremes of heat or cold, strong wind, chinooks, humidity, altitude, bright sun, barometric pressure changes718 [15]
EnvironmentalLoud noise, bright lights
Smells like cigarette, fuel, fire smoke, perfumes, cleaning products
Visual stimulation like many things moving at the same time (shopping center syndrome)

MovementExercise, sexual activity, posture, muscle tightness705 [16], 706 [17], 722 [18], 723 [19]

Does this mean that I have to avoid everything on that list?

No! that would be extremely difficult. Triggers are very specific for each person. You will probably not be triggered by everything on the list, and you may find things missing from the list that do trigger migraines for you. It may take some time and effort for you to find your balance. 

 woman in storm

How can I identify my triggers?

The best thing to do is keep diaries until patterns emerge (it may take months). You might not know the answer for an individual attack, but over time your patterns will become clear to you and your doctor. If you have very frequent attacks, it is more difficult to identify single triggers. It may be better to stop the trigger chase to focus on protective behaviors and medications (See this post [20]). 

protective behaviors

Migraine Buddy [21] is a detailed App that can help you to track triggers.

See also the Curelator app [22].

The Canadian Migraine Tracker [23] is more simple, but also allows trigger monitoring and healthy practice recording. 

Is it really a trigger or is it a “premonitory” symptom?

The first phase of a migraine is the phase before the pain starts, but other symptoms are present. This is called the “premonitory” phase. Often people feel tired, stressed, or lose their appetite and yawn. Sometimes it is hard to tell if skipping a meal triggered your migraine or if you were getting a migraine so you didn’t feel like eating. Another example: are sore muscles in your neck causing a migraine, or caused by a migraine coming? Even migraine researchers find this question puzzling! 

It seems that some things are only triggers sometimes, is that possible?

Yes! Triggers stack up. Each person has a threshold for migraine and when things go over that threshold, an attack happens. You may not get an attack with every menstrual period, every stress, or every glass of wine, but when you have all three at the same time you do get an attack. 

migraine trigger theshold theory

Can I build a resistance to my triggers?

Maybe! There is a theory that if you expose yourself to a small amount of a trigger on a regular basis, you might develop a tolerance to it, but this research is still ongoing. This may apply to foods, stress, and exercise, but will not be practical for weather changes or periods. Other triggers are just better avoided, for example lack of sleep and dehydration. Once you have decided how to deal with your triggers, you can also raise your migraine threshold. 

How do I raise my threshold for migraine?

The brain of the person with migraine likes things to be consistent. To raise your threshold, it is good to keep the same sleep/wake schedule, eat regular meals, manage your stresses, and stay hydrated. Regular exercise, regular relaxation, and preventive medications can also raise your threshold so that more triggers can stack up before an attack occurs.

Is it still worth it to manage triggers?

Managing triggers can make a difference. But it is also important not to overestimate your triggers because rigid avoidance of every potential trigger will cause stress to you and the people in your life. Remember that some people with migraine lead pristine (even saintly) lives and still stuffer from chronic migraine [24]. Other approaches, including medication, may be needed. Finding your own balance is the key to success.

REFERENCES

Spierings EL, Donoghue S, Mian A, Wober C. Sufficiency and necessity in migraine: how do we figure out if triggers are absolute or partial and, if partial, additive or potentiating? Curr Pain Headache Rep. 2014;18(10):455.

Baldacci F, Vedovello M, Ulivi M, Vergallo A, Poletti M, Borelli P, et al. How aware are migraineurs of their triggers? Headache. 2013;53(5):834-7.

Andress-Rothrock D, King W, Rothrock J. An analysis of migraine triggers [1] in a clinic-based population. Headache. 2010;50(8):1366-70.

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