By Michele Bloomquist
Medically reviewed by Holly G. Atkinson, MD
Migraines may appear to strike out of the blue, but there are actually many known triggers that cause these debilitating headaches. If you can identify your migraine triggers, you may also be able to avoid them, or at least reduce their severity. Some triggers come in the form of food and drinks that you can cut down on or eliminate from your diet; others, such as a change in season or barometric pressure, are unavoidable.
Pay attention to what you eat and drink, what's going on in your environment and daily life, and how you feel each day. Soon, you may begin to see a connection between your headaches and one or more of the most common triggers.
Alcohol: Drinking alcoholic beverages, especially red wine and beer, can lead to migraines. If you don't want to avoid alcohol altogether, vodka, scotch, and Riesling wine seem to be the safest choices, but you should limit yourself to no more than two drinks in one day, if you are a man, and one drink a day if you're a woman.
Caffeine: An increase or decrease in the usual amount of caffeine you consume per day can lead to a migraine. Aim to have no more than two caffeinated beverages each day.
Environmental Influences: Changes in season, weather, altitude, and the barometric pressure can trigger migraines. While there is little you can do to control these factors, you can anticipate them and take as many other steps as possible to avoid a migraine.
Sleep patterns: Missed sleep or too much sleep can set off a migraine. Do your best to maintain a consistent sleep schedule. Going to bed and getting up at roughly the same time every day may also reduce your susceptibility.
Foods: Certain foods have been linked to more frequent migraines, including chocolate; ripened cheeses like cheddar, Stilton, Brie, and Camembert; fermented, pickled, or marinated foods; nuts; peanut butter; sourdough bread; sour cream; pickled or dried herring; citrus fruits; bananas; figs; raisins; papayas; red plums; pizza; aspartame (NutraSweet); chicken liver; sausage; bologna; hot dogs; salami; summer sausage; snow peas; broad beans; lima beans; fava beans; and foods containing monosodium glutamate, like soy sauce, meat tenderizer, and seasoned salt.
Lights: Bright lights, glare from the sun, and flickering lights from electronic equipment such as computer screens and televisions can trigger a migraine for some people. Carry sunglasses with you on bright days and avoid flashing or bright lights when possible.
Medications: Some prescription and over-the-counter medications, including antihistamines, decongestants, vasodilators, and herbal supplements, can trigger migraines. Speak with your doctor about possible alternatives if you suspect that certain medications are causing your headaches.
Motion: Travel or symptoms of motion sickness can trigger a migraine. Medications taken to prevent motion sickness might help.
Noise: Sudden or prolonged loud noises can set off a migraine. Avoid these when possible. If you must be in a noisy environment (at work, for example), use earplugs.
Physical activity: Physical exertion — exercise, sex, physical labor — can trigger migraines. If you notice this connection, avoid physical activity when other risk factors for a migraine are high, or limit the intensity of physical exertion when you can.
Smells: Some people report sensitivity to powerful odors like paint thinner, perfumes, flowers, pollution, and secondhand smoke. Do your best to avoid strong odors. Ask others to be sensitive to your needs (you may request for your co-workers not to wear perfume in the office or your friends not to smoke near you).
Skipping meals: Fasting, dieting, or skipping meals can lead to migraines. Aim to eat a balanced diet of regular meals spaced evenly throughout the day.
Stress: Some people report a connection between stress and migraines, either during a stressful situation or immediately following. Do what you can to avoid stress at work and at home, taking steps to anticipate and minimize stress when you can, and practicing stress-management techniques like deep breathing or meditation when you can't.
Tobacco: Cigarette and cigar smoke has been linked to migraines and may interfere with migraine treatments. If you smoke, talk to your doctor about how to quit.
Migraine With Aura
By Debra-Lynn B. HookMedically reviewed by Kevin O. Hwang, MD, MPH
Up to 30 percent of people with migraines have what doctors call “migraine with aura” — they will experience a visual or other sensory disturbance, like seeing flashes of light, anywhere from 5 to 60 minutes before the headache pain of migraine begins. While auras can be unnerving, seeing an aura is like hearing a fire alarm; it's telling you to take medication right away and possibly stop the migraine before it begins.
The aura that precedes a migraine can take different forms. You might see:
- Wavy or jagged lines in a zig-zag pattern.
- Flashing lights and colors.
- Blind spots or partial loss of vision.
- Distortions of the size, shape and location of fixed objects.
- Your face might feel numb.
- Your speech could get slurred.
- You might feel like you’re about to fall.
- You feel like pins and needles are moving slowly down your arm.
Some researchers don’t think so. Scientists who have looked at brain images of people experiencing an aura think aura is an electrical phenomenon involving nerves in the brain. Whether one person with migraine has auras and another doesn’t will depend on which patient has the more sensitive nerve cells.
When particularly sensitive nerve cells are repeatedly stimulated by flashing lights, for example, that stimulation builds up over time. So when the nerve cells suddenly begin firing off, they trigger activity that leads to those visual and other disturbances.
In that way, an aura helps warn you that a migraine is coming. Talk to your doctor about using this warning sign to take migraine medication right away.
Migraine Aura and Risk of Stroke
If migraine with aura symptoms sound familiar, they are: They are similar to symptoms that people who have had a transient ischemic attack, or a mini-stroke, feel. A TIA occurs when your blood vessels are temporarily blocked, usually causing no lasting damage.
“This is very disturbing, and many people think they are having a stroke,” says Seymour Diamond, executive chairman of the National Headache Foundation, and director of the Diamond Headache Clinic and the inpatient headache unit at Saint Joseph Hospital in Chicago. The way you tell the difference, Dr. Diamond says, is that with an aura, the feeling will travel down the arm. If the person is having a stroke, the sensation would affect the whole arm, at once.
Research conducted over the past 15 years suggests that there may, in fact, be a connection between migraine aura and stroke:
- A recent University of Maryland study found that women who had a stroke were 1.5 times more likely to have had a migraine with visual auras in the past, compared to women without stroke.
- The link between stroke and migraines with visual auras was even stronger in women who smoked and used oral contraceptives.
- A Harvard Medical School study that looked at cardiovascular disease and cancer in 27,000 women at least 45 years of age also found increased risk of stroke among women who had migraines with auras.
People with visual auras who suffer mild, infrequent attacks are at minimal risk, while those who have suffered severe, lengthy attacks for several years are at greatest risk, as are those who smoke and take oral contraceptives.
However, the number of people with visual aura who suffer stroke is still relatively low, and more research is needed before a more definite answer is found about the connection between strokes and auras.
Monitoring Migraine Auras
Some doctors will closely monitor their patients with visual aura who have a long history of severe, lengthy attacks, because of their risk of stroke. K. Michael Welch, MD, president of the Rosalind Franklin University of Medicine and Science in Chicago, says he will prescribe a daily baby aspirin for a patient with severe visual migraine aura — not to ward off migraines, but to reduce the stroke risk.
If you have migraines with aura, don’t be surprised if the aura comes and goes; don’t even be surprised if they appear and a headache doesn’t follow.
What you should pay attention to: An older person who’s never had a migraine and who starts having migraine aura-like symptoms. Make sure that person sees his or her doctor to rule out problems such as TIA and other brain conditions.
Women and Migraines
By Katherine Lee
Medically reviewed by Lindsey Marcellin MD, MPH
It may not be fair, but it is a fact: Of the nearly 30 million people in the United States who suffer from migraines, about 75 percent are women.
And to add a bit of irony, many women who experience these often-debilitating headaches are the ones who can least afford to be sidelined. Most women who have migraines are between the ages of 20 and 45, which means that they are likely to be juggling responsibilities at home and at work. Women in this age group are often mothers of young children or busy with their careers or both. For these women, severe migraine symptoms that interfere with day-to-day activities can throw a big monkey wrench into their lives.
Compared to men, women also tend to have more painful and longer-lasting headaches that include other symptoms, such as nausea and vomiting. Migraine attacks may also be more severe around their menstrual periods.
How Hormones May Trigger Migraines
Doctors believe that hormones, especially estrogen, may play a role in migraine headaches. While experts aren’t exactly sure how hormones affect migraines, they do know that a woman’s estrogen and progesterone levels drop sharply just before a menstrual cycle begins. They also know that estrogen controls chemicals in the brain affect sensitivity to pain. That’s why shortly before a woman gets her period, falling estrogen levels may make her more vulnerable to feeling the pain of cramps, muscle aches — and headaches.
Some of the evidence that supports a link between hormones and migraines:
- In children, girls and boys tend to get migraine headaches at about the same rate until they hit puberty, at which point there is a sharp increase in migraine headaches among girls who begin menstruating.
- An estimated 60 percent of women experience migraine headaches several days before or during their menstrual cycle (though most will also experience attacks when they are not having their periods).
- Women are also more likely to have migraine attacks around the middle of their menstrual cycles, when they are ovulating.
- Pregnancy also seems to affect migraines. Many women report that their symptoms occur less frequently, are less severe, or even disappear completely during pregnancy. Others say the opposite, that pregnancy makes their migraine attacks worse.
- As women near menopause, there is often an increase in migraine attacks.
Since women are more vulnerable to migraine attacks shortly before or during their period, they should be particularly careful to avoid common migraine headache triggers around that time. Avoiding triggers is a good idea anytime, but it is especially important to be vigilant when the body is experiencing changes in hormone levels.
Some smart moves to keep migraines at bay:
- Eat right. About a week before your period, try to stay away from carb-heavy foods, especially sweets and chocolate; these affect blood-sugar levels and can trigger migraine attacks. Other foods to avoid include alcohol and aged cheeses such as Brie and cheddar.
- Don’t skip meals. Not eating can lower your blood sugar levels and make you hungry, which are common triggers for migraines.
- Get enough rest. Sticking to a regular sleep schedule and getting about the same amount of sleep each night is important for reducing the risk of migraine attacks.
- Exercise regularly. Working out for at least 30 minutes a day can help relieve stress, a common migraine trigger.
- Try relaxation exercises and techniques. These include meditation and yoga, and have been shown to be effective in reducing stress.
- Consider medications. If nothing else is working to prevent migraine attacks, talk to your doctor about taking medications a day or two before you expect migraine symptoms to strike. Some common drugs women can take to prevent migraine attacks include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen; an older class of drugs called ergot drugs; or one of the triptan drugs, a newer class of medications that has shown great results.
Is It Time to See a Neurologist?
By Madeline Vann, MPH
Medically reviewed by Lindsey Marcellin, MD, MPH
The average headache doesn’t require a call to a neurologist or even your family doctor. However, experiencing frequent headaches, and taking medication for them on a regular basis, may become a concern. Taking an over-the-counter (OTC) pain reliever for headaches can become a mindless habit. If you’re taking OTC headache medication 10 days or more out of the month, it’s time to call a doctor, as this puts you at risk of getting a rebound headache, a low-grade headache that’s caused by taking too much pain-relieving medication.
Signs You Need to Find a Neurologist
Warning signs that you need specialized medical attention for your headache or migraine include:
- You are over 50 and having chronic headaches or a new type of headache.
- Your headache is accompanied by nausea, vomiting, dizziness, confusion, loss of consciousness, or blurry vision.
- Your headache is accompanied by weakness or loss of control of part of your body, speech, or vision.
- You have two or more headaches in a week.
- Your headaches are getting worse, not better, with time and treatment.
- Your headaches are not responding to recommended OTC treatment or prescription drugs.
- Your headache is sudden and severe and is accompanied by a stiff neck or fever.
- You have a new headache and a history of cancer or HIV/AIDS.
- Your headache begins after you hurt your head.
- Your headache is making it hard for you to carry out your daily life.
Diagnosing Your Headache
According to headache expert Peter Goadsby, MD, director of the Headache Center at the University of California San Francisco, a valuable tool in diagnosis is your headache history. A thorough history, aided by your detailed notes, can help pinpoint causes, triggers, and even potential solutions. Make careful notes about your headache experiences before you go to the doctor and include:
- When the headaches occur
- What, if anything, makes them feel better or go away
- Whether sound, light, or noise bothered you during the headache
- Whether there were any changes in your vision before or during the headache, such as blurriness, black spots, or flashes of light
- How well you slept the night before
- If you are a woman, where you are in your menstrual cycle
- Unusual weather at the time
- Food or drink that you have consumed in the 24 hours before the headache
- Activities you were engaging in when the headache began or just prior to it
- Previous headache diagnoses and treatments you’ve tried
The tests your doctor orders will depend in part on what she suspects could be causing your headaches and whether it’s a primary headache, such as a migraine, or a secondary headache, which means that it’s a symptom of another health concern. The process of diagnosis may include:
- Medical history. Your doctor will want to know about other health conditions you have as well as medications, supplements, and herbal treatments or teas that you rely on.
- Family history. You will provide details of any family members who have headaches or migraines, at what age the headaches started, and other health diagnoses. Goadsby notes, “Very often family members won’t know they’ve got migraines, but they will know they are prone to headaches.” This helps to indicate that migraine is the problem.
- Physical exam. Your doctor will examine you, paying close attention to your head, neck, and shoulders, which can all contribute to headache pain.
- Neurological exam. A neurological exam may include vision, hearing, nerves, reaction time, and mobility tests.
- Blood tests. Blood tests may be ordered to help rule out infection and other health conditions of which headaches are a symptom.
- Spinal fluid test. This may be necessary if your doctor suspects that your headaches are caused by certain types of infection or by bleeding in your brain.
- Urinalysis. A urine sample may be ordered to help rule out infection and other health conditions of which headaches are a symptom.
- Imaging tests. Computed tomography (CT) or magnetic resonance imaging (MRI) may be ordered. These imaging tests can show changes in bones and blood vessels as well as the presence of cysts and growths that may be causing your headaches.
- Neuroimaging. Imaging tests may be given during a headache episode to get a clearer picture of what is going on during an actual headache.
- Electroencephalogram (EEG). This test can show your doctor whether there are changes in brain wave activity. It can help diagnose brain tumors, seizures, head injury, and swelling in the brain.
By Madeline Vann, MPH
Medically reviewed by Lindsey Marcellin, MD, MPH
The medications you rely on to help manage your headache, sinus headache, or migraine could actually create another type of headache, known as a rebound headache. This may also be referred to as a “medication overuse headache” or an “analgesic rebound,” as analgesic is the medical name for pain-relieving medications that you can get over-the-counter or by prescription for headache treatment.
Rebound headaches feel like a dull, chronic, tension headache. They are thought to occur because ongoing use of pain relievers “rewires” the pain pathways in your brain.
The Rebound Headache: Who Is at Risk?
There are some factors that increase your risk of a rebound headache, including:
- Taking pain medication for headache or migraine daily or almost every day
- Taking pain medications containing caffeine or butalbital
- Having a previous history of rebound headaches
The Rebound Headache: Think Prevention
If you have migraines or frequent headaches, there are some steps you can take to prevent a rebound headache:
- Talk to your doctor about medication that prevents migraines or headaches, rather than relying on pain relievers after the headache has already started.
- Ask your doctor about trying other treatment approaches, such as antidepressants, which have been shown to help ease chronic tension headaches.
- Limit your use of pain relievers:
- Over-the-counter pain medications should be used 15 days or fewer per month.
- Prescription headache relievers containing ergots, triptans, opioids, and barbiturates should be used 10 days or fewer per month. Check with your doctor or pharmacist to see if these ingredients are in your prescription headache medicine.
If you have a rebound headache or suspect that medication is causing a headache or migraine-type headache, talk to your doctor. Taking more pain medication won’t ease a rebound headache. Your best bet is to stop taking the medications you have been taking, but ask your doctor to outline how to do so safely before you begin. Your headache may get worse for a few days — and you may experience nausea or vomiting during this time — but then the symptoms should subside. If they don’t, check back in with your doctor.
If you have had a rebound headache, you are more likely to have them again if you use analgesics later on. Instead, your doctor may recommend that you take prescription medication to prevent headache or migraine pain. You should also explore options for headache management without pain relievers, such as addressing underlying problems such as insomnia, or with stress management techniques.
Dealing with a rebound headache is frustrating. But working closely with your doctor and remaining open to other options for treatment can ultimately give you relief from both your primary headache and your rebound headache.
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