Migraines can be triggered by a number of factors. By identifying and avoiding these triggers, you can help manage your headaches. Keeping a headache journal that tracks the date, time and onset of your headache, a list of medications, and other external factors can help you and your doctor track patterns and plan treatment.
Common trigger factors include:
- Diet — For some people, certain foods trigger migraines, although this is rarely the only cause. Alcohol, especially red wine, the sugar substitute aspartame, caffeine, the food seasoning monosodium glutamate (MSG), foods such as aged cheese that contain tyramine, and nitrites in foods such as preserved meats may cause migraines.
- Environmental Factors — Migraine headaches can be triggered by environmental conditions including weather or temperature changes, glaring or fluorescent lights, computer screens, strong odors and high altitude.
- Hormones — Many women have migraine attacks just prior to or during the first few days of their menstrual period. Fluctuating estrogen may play a role. Menstrual migraines can be more debilitating, difficult to treat and longer lasting than other migraines. They may worsen in early pregnancy and improve in late pregnancy. They typically subside as women age, particularly after menopause. Oral contraceptives or estrogen-replacement therapy can provoke or worsen migraines.
- Sleep — Too much or too little sleep can trigger a migraine in some people.
- Stress and Anxiety — People who suffer from migraines tend to be sensitive to stress. Emotional stress or daily pressure can trigger a migraine attack in some people. Managing stress can help alleviate migraines. For example, it might help to complete large jobs in small increments over time instead of all at once. Learning to relax and "let go" of events beyond your control also may help. Practicing stress-relieving techniques, such as yoga, transcendental meditation, hypnosis and biofeedback may be helpful.
Typically, pain relievers such as aspirin, acetaminophen and ibuprofen are recommended as initial treatments. If they don't relieve the pain, your doctor may prescribe other drugs or drug combinations. Your doctor will work with you to determine the drugs best for you, based on the severity of your attacks. Drugs, however, don't cure the condition.
Some medications used to treat other conditions — such as beta-blockers for hypertension and tricyclic for depression — are effective in treating migraines. The benefits and dosages of these drugs when used for migraines, however, are different than those in the treatment of other conditions.
- Tricyclic Antidepressants — Antidepressant drugs have analgesic or pain-relief qualities. Although you may not be depressed, your doctor may prescribe drugs such as amitriptyline or doxepin to help reduce the frequency and severity of your headaches.
- Beta-blockers — A drug such as propranolol may be combined with an antidepressant, such as amitriptyline, to prevent chronic daily headaches.
- Anti-seizure Medications — Most recently a number of medicines used in epilepsy (seizures) have been found to be very effective in migraine and may be used to prevent attacks.
- Combination Therapy — Each symptom of a migraine headache may have a separate cause or mechanism. A new fixed-dose tablet combining the medications sumatriptan and naproxen targets more than one of these mechanisms. Some doctors have been combining the two drugs. Two studies assessing the effectiveness and safety of the combination drug suggest that the combination provides more effective headache relief than either drug alone. The combination did have some minor side effects including dizziness, drowsiness and paresthesias or abnormal body sensations.
Many drugs for acute migraine attacks work best when taken as soon as you feel a migraine coming on. It's important that you take the medications as prescribed, not more often or in higher doses.
If you experience frequent attacks, medication to prevent migraines may be prescribed so that headaches will strike less often and last for shorter periods of time. Be sure to continue taking your preventive medications even while being treated for an acute attack.
If your doctor prescribes medication, be sure to ask:
- How often to take the medication
- Should the medication be taken with meals or on an empty stomach
- What to do if pain or other symptoms persist
Reviewed by health care specialists at UCSF Medical Center.