If you suffer from migraines, you know there’s no perfect science to prevent one from striking.
A migraine is not just a bad headache, but an intense, throbbing pain in the head, typically behind the eyes, ears, or temples, that can also cause nausea, vomiting, sensitivity to light and sound, and even visual phenomena like flashing lights, tunnel vision, and temporary loss of sight. It can last for a few hours, or even a few days, and can seriously interfere with daily life.
The exact cause of a migraine isn’t fully understood, though research suggests the most likely scenario is that abnormal changes in the brain’s biochemistry lead to inflammation, which causes blood vessels to swell and press on nerves. There also seems to be a genetic connection, making you more prone migraines if you have a family history. Women are three times more likely to have migraines than men, according to the Mayo Clinic, and most people have their first in adolescence, but it’s also possible to have one for the first time in your 20s or 30s.
Unfortunately, as much as it’s been studied, no one’s totally sure about what will and will not trigger a migraine, so a lot of finding out what will help comes down to trial and error.
While everyone can have different personal triggers, a handful of migraine triggers are extremely common among sufferers. To get the lowdown on the biggest ones to look out for, SELF talked to Mia Minen, M.D., neurologist and director of headache services at NYU Langone Medical Center.
Loading up on booze can give anyone a headache the next day, but for some people, even a small amount of alcohol can trigger a migraine. Ethanol is a vasodilator, meaning it expands blood vessels and raises blood pressure. Some people are more sensitive to its effects than others. It’s also dehydrating, and contains various other chemicals that impact the body and can cause chemical imbalances in the brain.
“Red wine is the most likely alcoholic trigger,” Minen says, according to what patients report. One 1988 study concluded that vodka didn’t have the same effects as red wine, suggesting that there’s an ingredient specific to red wine that causes migraines, and not alcohol itself. But there are other studies that have been done since then that show beer, spirits, and white and sparkling wines all have an impact, too. Other contents like sulfites, histamines, and flavonoid phenols and tannins have been called out as potential triggers, according to the American Headache Society, but the science to support one in particular just isn’t there.
This is a big one, Minen says, because the connection is complicated. Prevailing wisdom says caffeine is a migraine trigger. There’s no clear explanation as to why, but all the advice out there says to avoid caffeine because anecdotally it’s associated with migraines, and many people find relief from cutting it out.
However, caffeine is well known to relieve headaches—that’s why its in Excedrin and other headache or migraine medications—which leads some experts, like Minen, to consider the possibility that it’s not the caffeine itself but withdrawal from caffeine that’s the real culprit.
She suggests tapering off caffeine—all, caffeine. That means not just coffee, but caffeinated tea, chocolate and, yes, those OTC headache meds with caffeine in them. (They might not be helping, but actually causing more headaches by leading to withdrawal after they wear off.)
3. Inconsistent sleep
Bad sleep habits and an inconsistent schedule, aka sleeping four or five hours some nights and 10 or 11 other nights, “can really change the homeostasis in the body and affect cortisol levels and other hormones, which can potentially trigger a migraine,” Minen says. It’s more so the fluctuation in sleep patterns that can throw hormones off balance, versus not getting enough sleep.
Hormonal changes in the brain, caused by the “fight or flight” stress response, can also press all the right migraine-causing buttons. For some people, it’s the aftermath of stress that sparks a migraine. “During very stressful times, they may not get headaches, but rather at the end of the stressful period. Once the big project is handed in, then they develop the headache,” Minen says. Again, this seems to be related to the sharp fluctuations in hormone levels, specifically cortisol.
Menstrual migraines are common. In fact, two-thirds of female migraine sufferers who are menstruating report migraines hit regularly around their monthly period, suggesting an association between migraines and the hormonal fluctuations that take place during that time of the month. “Women often first develop migraines when they’re menstruating,” Minen says. “Migraines can also change with pregnancy and at the onset of peri-menopause and menopause,” she adds, when estrogen levels are changing drastically.
6. Anxiety or other mood disorders
Migraines are common in people suffering from anxiety disorders. Studies have found that those with generalized anxiety disorder (GAD) and panic disorder tend to suffer from migraines most, according to the Anxiety and Depression Association of America. While the exact reason for this connection is not known, Minen explains that there’s most likely some common thread in the brain’s biochemistry that predisposes someone to both. Some medications used to treat migraines were initially designed to treat depression or anxiety, Minen explains, which leads experts to believe that certain neurotransmitters connected to depression, like serotonin, norepinephrine, and dopamine, may also play a role in migraines. While the jury’s out on which comes first, the migraines or anxiety, it’s clear that chronic migraines can make coping with an anxiety disorder even more daunting.
7. Certain foods
This is a tricky one. “There’s a lot of media attention on different foods,” Minen explains. For example, some studies have suggested that histamines in some foods, like aged cheese and certain meats, can be triggers. But while these may affect some individuals, population studies don’t show strong evidence that any particular foods are triggers for wide swaths of people.
Many of the studies done on the subject don’t provide great data, Minen adds, so it’s hard to make specific food recommendations across the board. “I really don’t focus on the food triggers as much because it’s so hard to identify.” If you think a food may be triggering your migraines, keep a food diary, or use a tool like Curelator, that helps you catalogue potential triggers and determine what’s truly setting you off. Once you figure it out, you’ll know exactly what to avoid to (hopefully) get many more migraine-free days.