As a neurologist at a major heachache center, I see a lot of really tough headache and migraine cases. The hard part in treating them? A lot about migraines is still not fully understood by science.
They're believed to involve the trigeminovascular system, which is different for "migraineurs" (people prone to migraines) from those who cannot have migraines. So the bad news is if you have the circuitry in your brainstem for migraines to be triggered, you'll probably never fully get rid of your migraines.
The good news is you can get migraine relief and a change in their frequency by identifying the common factors that may be triggering them.
Here are the migraine triggers I see most often in my patients, along with tips on how to avoid them. Following these guidelines won’t cure you from the migraine cascade completely — but it will help you manage them and minimize their onset.
Stress itself may not be the trigger but rather our reaction to stress. Anxiety, worry, psychological tension, emotion changes, anger, depression, and neck muscle tension are all responses to stress and can trigger a migraine.
What to Do: Take a break, even a brief pause, and look upward. When we're stressed, we oftentimes focus on those things just in front of us. Since our brains process a negative thought faster than a positive one, we focus on the negative and assume the posture of fear (hunched shoulders, frown, internally rotated arms and shoulders, and tension in our neck and shoulders).
Instead, if you look upward, you force yourself to consider a more global view and "get outside of yourself." Pausing and averting the eyes upward will help you manage your reaction to the stress.
People prone to migraines are more sensitive to all kinds of stimuli about the head, like hot or cold air and sunlight causing heating of the scalp. Weather changes, primarily the drop and fluctuation of barometric pressure before and during a wind-, rain-, or snowstorm are also a well-known trigger. Unfortunately, the reason for this is still not fully clear, making it a tricky thing to deal with.
What to Do: Since you can’t control or avoid changes in weather and we don’t fully know why it leads to a migraine onset, all you can do is try to minimize its effect. Stay indoors to avoid extreme temperatures. Drink a lot of water to avoid dehydration during hot or dry weather. And most importantly, if a big storm or extreme heat is predicted in the forecast, work to limit all other migraine triggers (which you can control) to optimize your migraine prevention.
There's a known correlation between hormone changes in women and headaches. For example, during menstruation, the drop in estrogen levels will often trigger headaches, as does beginning to take birth control or another hormone replacement therapy.
Conversely, pregnancy causes a huge increase in estrogen levels. So when a woman who has migraines becomes pregnant, her migraines are likely to do one of two things: vastly improve or stop altogether. After the pregnancy is over, the headaches often will return.
What to Do: How to fix this? Speak to your OB-GYN about what might work best for you. Low-estrogen birth control can sometimes help, as can estrogen patches worn only just before and during menstruation.
4. Change of routine
"Weekend migraine" or "vacation migraine" are well-known phenomena. They come about with the change of routine and increased relaxation after a week of stress and hard work. Not getting enough sleep or sleeping in both act as powerful triggers of the weekend headache.
Plus, any type of travel — including the jostling of a train, changes in airplane cabin pressure, and excitement — can all be triggers, so many patients suffer on their vacations.
What to Do: The body likes comfortable routine. Try to keep one — even on vacation.
5. Bright lights and sun glare
Bright lights, such as the strobing effects of video games or the lights of a TV or computer screens, can trigger migraines.
What to Do: Simple steps such as taking regular breaks from screens, using an anti-glare screen, and setting good lighting can help minimize the effects of lights on your headaches.
6. Air conditioning
Some people with migraines cannot tolerate air conditioning for various reasons. For example, dehydration, muscle contraction, the circulation of allergens are all things caused by the cold air that could trigger migraines.
What to Do: If you already suffer from migraines and headaches, the best thing to do is avoid highly air-conditioned places.
When you're prone to headaches, all kinds of noise can trigger it to be worse. Excessive bass in a car, lawn mowing and office machines, knitting needles, or even someone chewing celery next to you can be a killer when you have a headache.
What to Do: Ear protection, headsets for telephone conversations, and keeping noise at a moderate level can help.
8. Low blood sugar
Low blood sugar can be a headache trigger. This has more to do with not eating regularly. Whether that results in low blood sugar or not, skipping meals or fasting can be a powerful trigger for individuals prone to migraines.
What to Do: The best avoidance is to make sure you eat regularly throughout the day.
9. The wrong eyeglass prescription
Wearing the wrong prescription for your eyes can trigger a headache.
What to Do: Get your vision checked regularly to make sure your prescription is correct. Just remember, your eyes dilate during a headache, so they're out of focus. Because of this, you don’t want to be examined by an eye doctor just before, during, or after a headache.
The Bottom Line: Remember that these triggers aren’t the cause of your migraines, but merely the "straw that breaks the camel's back" in patients who have the circuitry to have migraines. So, while these tips can help you curtail your migraines, consider seeing a headache specialist if your migraines are getting worse no matter what you do.
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