What Causes Migraines? 9 Common Triggers & How To Address Them Naturally
Having a headache might seem like a minor issue in the grand scheme of things, but for migraine sufferers, headaches are a serious, sometimes life-impairing problem. Often, we think of a migraine as just being a really intense headache, but there's actually more to it than that. And, since an estimated 20 percent of women and 10 percent of men will experience migraines at some point in their lives, it's important to familiarize yourself with this condition.
Here, learn everything you need to know about how migraines differ from regular headaches, what causes migraines, migraine symptoms, and how to prevent and treat migraines.
What are migraines?
Considering migraines "just bad headaches" is an oversimplification, but it's not entirely inaccurate. Migraines are headaches, after all, but they're a very specific type of headache with specific symptoms and traits. First, migraines are a recurring type of headache—meaning that, like Pringles, most people won't have just one. In addition to being recurring, migraine headaches are also characterized by causing moderate to severe pulsing or throbbing pain that is often limited to one side of the head. Beyond these basics, there are other symptoms shared by many people who suffer from migraines, which we will address in the next section.
It's also important to know that there are two main types of migraines—migraines with auras and migraines without auras. Migraines with auras are accompanied by visual and sensory symptoms, which can include:
- Scotomas (blind spots)
- Zigzag lines floating across the field of vision
- Shimmering spots or stars
- Changes in vision or vision loss
- Flashes of light
- Feelings of numbness, typically felt as tingling in one hand or in your face
- Difficulty with speech or language
- Muscle weakness
- Chronic migraine: Migraines that trigger symptoms at least 15 days of the month
- Hemiplegic migraine: Migraines that temporarily cause weakness on one side of the body
- Abdominal migraine: Migraines that are connected to irregular function in the gut and abdomen (this kind is most common among kids 14 and younger)
- Migraine with brainstem aura: Migraines that can trigger severe neurological symptoms—these are very rare
- Menstrual migraine: Migraines that are triggered by or connected to a woman's menstrual cycle
What are the symptoms of a migraine?
Before we dig into what causes migraines, we should take some time to address migraine symptoms, which can vary a bit from person to person but do present as clear patterns when you look at migraine sufferers as a whole.
Among the most common migraine symptoms are nausea, vomiting, and dizziness. Many people suffering from migraines also experience sensitivity to light and sound. In order for a headache to qualify as a migraine, the incident must meet certain criteria, which includes experiencing some combination of the most common symptoms of migraines.
The International Classification of Headache Disorders diagnostic criteria for migraine are as follows:
- At least five attacks per month fulfilling criteria 2 through 4
- Headache attacks lasting 4 to 72 hours (if untreated or unsuccessfully treated)
- Headache has at least two of the following four characteristics: unilateral location, pulsating quality, moderate or severe pain intensity, aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)
- During headache at least one of the following: nausea and/or vomiting, light sensitivity and sound sensitivity
The International Headache Society summarizes this complicated diagnostic tool in plain English as the "5, 4, 3, 2, 1" criteria, meaning:
- 5 or more attacks per month that last between 4 hours and 3 days
- At least 2 of the following qualities: The headache occurs on one side of the head, the headache is a pulsing sensation, the headache results moderate-to-severe pain, and the headache is made worse by regular, day-to-day physical activity.
- And, at least 1 additional symptom, most often nausea, vomiting, sensitivity to light, or sensitivity to sound
What causes or triggers migraines?
So what causes migraines? Well, the unfortunate truth is, scientists don't yet know for sure precisely what causes migraines. There are, however, some solid leads and theories out there.
Even though there aren't definitive answers to the question of what causes migraines, experts agree that both genetics and environmental factors appear to play a role in determining who will be afflicted by the condition. Possible root causes of migraines include:
- Inflammation of blood vessels in the brain
- Extreme stress or tension
- Changes in the brainstem and the way it interacts with the trigeminal nerve, a major pain pathway
- Imbalances in brain chemicals, such as serotonin, which helps regulate pain in the nervous system
- Abnormalities with neurotransmitters
While what causes migraines might not be known yet, scientists have pinpointed several things that frequently trigger migraines. Confused? Basically, we don't know what causes someone to be one of the 12 percent of Americans affected by migraines, but we do know things that tend to set off specific attacks for those individuals. These migraine triggers include:
- Irregular sleep patterns
- Hormonal imbalances
- Certain foods and drinks
- Skipping meals and fasting
- Too much stress
- Sensory stimuli
- Extreme physical activity
- Certain medications (e.g. birth control, vasodilators)
- Changes in weather or barometric pressure
How to prevent and treat migraines by countering common triggers.
1. Prioritize your sleep.
While everyone on the planet should make a point to prioritize getting a healthy amount of quality sleep, this is especially true for anyone who suffers from migraines. This means not sleeping too little but also not sleeping too much, as that can also trigger a migraine. Many migraine sufferers find that maintaining strict consistency when it comes to scheduling sleep is a key component in managing migraines.
"I go to sleep around the same time each night and wake the same time each morning. Yes, even on the weekends. Getting the same number of hours of sleep each night is important, but just as important is that those hours are on the same schedule," says Ilene Ruhoy, M.D., a neurologist who suffers from migraines herself. "So eight hours of sleep between 10 p.m. and 6 a.m. is not the same as eight hours of sleep between 1 a.m. and 9 a.m."
2. Get your hormones in check.
Changes in hormone levels can trigger migraines. This is especially a problem for women, some of whom experience migraines in connection with their menstrual cycles, usually between two days before and three days after their periods. Medications that affect hormones play a role, too. "As I explain in my book Beyond the Pill, it isn't uncommon for women to develop migraines when they begin hormonal birth control or as part of post-birth control syndrome (PBCS)," says Jolene Brighten, N.D., functional medicine naturopathic doctor and mbg Collective member. "Starting a headache journal and tracking your cycle is a great way to identify if hormone imbalance is your root cause."
But what should you do if hormones are the trigger? For some women, going off birth control may be the answer. Other women, like those with PBCS who experience migraines after they go off the pill, may need to take a variety of steps to get their symptoms in check. "It often requires addressing multiple factors including gut health, detoxifying, nutrients, and balancing hormones," says Dr. Brighten, who recommends following these tips and finding a functional practitioner to guide you through the process.
Other periods of hormonal upheaval that may trigger migraines are perimenopause (the period before menopause) and menopause. For some women, making dietary changes and lifestyle changes are enough to balance hormones, while others may want to consider taking bioidentical hormones, so always talk to your doctor about your options. On the bright side, after menopause is over, many women find their migraines improve.
3. Try these two supplements.
Painkillers often come with a host of side effects, especially when taken in the dosage required to manage migraine pain (more about this later). So natural solutions are key. Two options Dr. Brighten frequently uses to help her patients get lasting relief and sometimes even eliminate migraines altogether: magnesium and turmeric.
"Magnesium at a dose of 600 mg with the onset of a migraine can help prevent it from progressing," she says. Magnesium may be particularly beneficial for women experiencing migraines around their menstrual cycle.
"Turmeric specifically effects the NFkB pathway that is responsible for the inflammatory component of migraines." Unlike magnesium, which may help ease migraine symptoms right away, you may need to take turmeric supplements consistently (i.e., every day) to reap their anti-inflammatory, migraine-reducing benefits.
4. Eliminate your migraine trigger foods.
People who suffer from migraines have to be careful when it comes to diet. There are no specific foods or drinks that trigger migraines for all sufferers, but there are certain foods and drinks that many people who deal with migraines find trigger headaches.
Alcohol and caffeine are both common culprits in triggering migraines. When it comes to food, aged cheeses, salty foods, chocolate, some fruits and nuts, and processed foods may trigger migraines, as can some food additives, like aspartame and the preservative monosodium glutamate (MSG).
"I ran some tests on myself and learned that I am sensitive to tyramines found in soy, aged cheeses, and fermented or pickled foods. I removed these foods completely from my diet," Ruhoy says. "Find out what foods work best for your individual body with an elimination diet and/or food sensitivity testing."
If you have a history of migraines, experts recommend keeping a migraine diary and making notes of foods and drinks consumed before the onset of an attack. If certain foods and drinks do tend to trigger migraines, eliminating them from your diet is key to preventing (at least a percentage) of your future migraines.
5. Keep healthy snacks at the ready.
Skipping meals and fasting are both common migraine triggers. If you suffer from migraines, you should consult your doctor before considering any kind of fasting or intermittent fasting program. If you know that going too long between meals triggers your migraines, always keep a few healthy snacks on hand such as almonds, roasted chickpeas, veggie slices, and fruit.
6. Tamp down the stress with meditation.
Stress makes just about everything worse, including migraines. This isn't to be confused with regular stress-induced headaches, also known as tension headaches (which, for the record, are the most common type of headache of all).
If stress is a trigger for you, Ruhoy recommends meditation. "Meditation has been shown to reduce nervous system tension and response to internal or external stimuli," she says. "Deep breathing helps improve oxygen delivery everywhere, including the brain."
In addition to meditation, any activity that gets you moving and/or brings you joy will help reduce the stress levels in your life that may be contributing to your migraines. This could mean finally decluttering your office, listening to your favorite podcast while you walk around the block, adopting a regular yoga practice, or taking a couple minutes every hour to practice this deep breathing exercise.
7. Keep noise-canceling headphones on hand.
Migraines can also be triggered by anything that overwhelms the senses. This includes everything from extremely bright lights and loud sounds to strong smells. These can be hard to avoid if you can't control your environment, but consider limiting your use of products that contain synthetic fragrances (or even strong natural ones), and always having a pair of sunglasses and noise-canceling headphones in your bag.
8. Exercise, but not too much.
Extreme physical exertion, like high intensity interval training (HIIT), can trigger migraines for some people. However, others report that regular exercise is key to managing the condition. So you'll need to do some experimentation to find a level and type of physical activity that works for you. While burpees and sprint intervals may trigger migraines, things like yoga, walking, and slow jogging may be perfectly tolerable.
"I am super busy with family and work and used to use that as an excuse to exercise less often. But facing frequent migraines taught me that it cannot be an excuse," Ruhoy explains. "I wake up a little earlier four to five days a week to run or take a yoga class. It starts my day on a really positive note and keeps my headache frequency way down."
9. Have more sex (or masturbate!)
If you needed more motivation to hit the sheets, here it is: "Many of my patients are surprised to learn that research has shown orgasms can help reduce the pain of a migraine and that regular orgasms may also prevent migraines," says Dr. Brighten. "Some research has shown that an orgasm can provide complete relief in about 47% of people." Got migraines? Aim to orgasm at least once a week—doctors' orders. A very small percentage of the population can have an increase in pain with orgasm, however, so be sure to evaluate if orgasms help you.
What to consider when natural migraine treatments don't work.
When preventative measures and natural treatment options fail, you should always consult with your doctor who may help you determine an underlying cause. Sometimes pain-relief medications may be necessary to treat migraines, at least until you discover what's triggering them. These include everything from OTC staples like Advil and Tylenol to triptans.
If natural prevention tactics and pain relievers don't help, and you suffer from more than four debilitating migraines a month, your doctor might recommend preventive medications as well. These are usually medications for other ailments that are prescribed off-label, including antidepressants, cardiovascular drugs, and anti-seizure medications. Botox is also an FDA-approved treatment option for migraines occurring 15 or more days a month; and recently, the FDA approved a the transcutaneous supraorbital nerve stimulation (t-SNS) device, which is a headband with electrodes that has been shown to reduce the occurrence of migraines.
Complications associated with migraines.
In case you need more inspiration to get your migraines under control naturally, we're going to give it to you. Surprisingly, many of the most common (and sometimes, the most serious) side effects and complications associated with migraine headaches are, sadly, a result of attempts to treat them. Some of these complications include:
- Abdominal problems: People who suffer from migraines tend to take a lot of over-the-counter painkillers to combat their symptoms. Taken in particularly large doses or too regularly for an extended period of time, for example, ibuprofen (the key ingredient in Advil, Motrin IB, and other popular OTC pain relievers) can cause abdominal pain, bleeding, and even ulcers.
- Medication-overuse headaches: If you take OTC or prescription headache medicines for more than 10 days a month for three straight months (or just in really high doses, even over a shorter period of time), you can actually trigger additional headaches on top of your migraine attacks. Oftentimes, people will respond to these overuse headaches by taking more medicine—which just perpetuates the cycle.
- Serotonin syndrome: Serotonin syndrome is potentially life-threatening but very rare. The condition occurs when your body has too much serotonin, which can be raised by migraine medications, particularly when taken in conjunction with antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Again the risk of developing this complication is low, but it is there.
- Chronic migraines: Some people who suffer from migraines develop chronic migraines, which are migraines occurring on 15 or more days a month for more than three months.
- Status migrainosus: This complication causes severe migraines that last for longer than three days straight.
- Migrainous infarction: People who experience migraines with auras should stay mindful of how long the aura symptoms last—if they extend longer than an hour, it can be a sign of a stroke. If this happens to you, see a doctor immediately.
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