Migraine is thought to be a genetic disorder, but certain triggers can cause migraine episodes – here’s what you need to know about what causes migraines.
A neurological condition that can cause debilitating symptoms like a severe headache, nausea, and vomiting, and dizziness, migraine affects more than a billion people worldwide.
Genetics can play a role in people developing migraine, and according to Rick Godley, a general otolaryngologist in Rhode Island and president and founder of the Association of Migraine Disorders, it is generally caused by the nervous system being too sensitive and over-reactive.
But what causes a person’s individual migraine attacks — which doctors call “migraine triggers” — can vary from person to person, and may include a combination of environmental or lifestyle factors.
According to Shivang Joshi, a neurologist in Amherst, NY and an executive board member with the Association of Migraine Disorders, migraine triggers fall into several different categories, some of which people can control, and some that are uncontrollable.
These are some of the most common ones.
Sensory migraine triggers
Sensory stimuli, including vision, hearing, and smell, can often trigger migraines in people, Godley tells Allure.
According to a 2013 study, approximately 40 percent of people with migraines have attacks triggered by visual stimuli (like bright or flickering lights), more than 50 percent experience attacks triggered by noise, and half report perfumes and other smells trigger their migraines.
Hormonal triggers
According to Jan Brandes, a neurologist and board member at the National Headache Foundation, migraine affects three times as many women as men worldwide, which could be in part because migraine is linked with the menstrual cycle.
Estrogen fluctuations, Brandes says, can impact excitability in the brain, which may lead to migraine.
However, it's important to note that having (or not having) a menstrual cycle does not correlate directly with gender, nor do hormone levels.
Studies often use binary gender terms to group people together, which can make it harder for individuals to receive diagnoses because humans often fall outside of binary categories.
Joshi says it’s typically decreasing estrogen, which occurs right before a person’s period and during menopause, that triggers migraine.
Food migraine triggers
What you eat and drink can also contribute to migraine attacks, but according to Brandes, food is far less of a common factor than most people think.
Joshi agrees, and explains that foods that you think may directly cause migraines may sometimes simply be foods you craved before the migraine, so you associate them with the attack itself.
However, some specific foods actually can be culprits: For example, Joshi says foods with nitrates (anything that’s cured, such as lunch meats or bacon) and foods or drinks with aspartame (an artificial sweetener found in diet sodas).
Monosodium glutamate (MSG), a flavor enhancer sometimes found in processed food, can also trigger migraine; Joshi says glutamate acts as an excitatory amino acid in the brain.
Alcohol is another migraine trigger, and according to Brandes, it’s the most significant cause in the food and drink category – though experts aren’t totally sure why.
Some people have specific alcohol triggers, while others can’t handle any alcohol.
“Red wine is classically thought of as a migraine trigger, some patients can’t drink white wine or alcohol if it’s not clear, while others are triggered by beer,” Brandes says.
Lifestyle migraine triggers
It’s not only what you eat and drink that can cause migraine; Godley says how well people maintain an eating pattern and replenish fluids can impact migraine frequency.
For example, you can eliminate migraine-triggering foods and drinks, but if you skip meals or get dehydrated, you can still get migraines.
Even if you’re drinking water throughout the day, keep in mind too much caffeine — which is a diuretic and makes you urinate frequently — can cause dehydration, which Brandes says could lead to migraine.
“If someone gets up in the morning and drinks four cups of coffee then goes to work, they don’t eat or drink anything until afternoon, it may be that dehydration is playing an important role in triggering that migraine,” she says.
Stress is another known cause of migraines, Godley says; that can be psychological stress, or physical stress, such as poor posture or head trauma.
According to Thomas Pitts, a neurologist with Hudson Medical + Wellness in New York City, sleep deprivation — another form of stress — can also trigger individual migraines.
Brandes says people who have erratic sleep schedules, such as young parents or those who work night shifts, may get more migraines over the period of a few months.
Too much screen time could also be a factor in people’s migraines, for a few reasons. Pitts says neck pain is a known trigger, so sitting for a prolonged period with poor posture can contribute to migraine, and don’t forget — while you’re staring at screens, you’re likely to be taking in some of those sensory triggers.
Other migraine triggers
Brandes says changes in barometric pressure — whether a rise or fall — can also cause migraines. “Some people say ‘I can be the weather channel because I can feel in my head changes as the barometric pressure changes,’” she says.
Other types of environmental factors, like humidity or high altitude, are also known to trigger migraine attacks in some people.
Medication overuse, specifically medications meant to treat migraine pain, can also trigger new migraines or make them worse.
In fact, according to the American Migraine Foundation, if you have regular migraine headaches and take an acute, prescribed medication more than 10 days each month, you could get more migraine attacks.
If you think your migraine is tied to lifestyle factors, Brandes suggests addressing those behavioral causes first.
Try keeping a diary of when you get migraines and any potential causes, including the weather, your menstrual cycle, how you slept, and what you ate and drank.
If you see a pattern — for example, if drinking red wine or wearing perfume always gives you headaches — try reducing those things or eliminating them altogether.
If your migraines are caused by uncontrollable factors, like your menstrual cycle (or you just need medical support) Brandes suggests reaching out to your Ob-gyn, primary care doctor, or someone who specializes in headache, like a neurologist.
It might take some time, but a health care provider can help you find a treatment plan that helps.
“Migraine is a treatable, manageable disorder,” Brandes says. “The key is having a correct diagnosis and a clinical partner that will really work with you and listen to you.”
