Finding your migraine triggersLast Updated:
I promised you more details about migraine triggers. So, after a little break to spend some time with my family, I’m back and ready to go.
Migraine attacks actually begin several hours (if not days) before the headache phase starts. Many people mistake prodrome symptoms for triggers. It’s an easy mistake to make. For example, I sometimes hear people say, “Every time I eat chocolate, I get a migraine [attack] within minutes.”
Most “triggers” are actually prodrome symptoms
There’s actually very little evidence to support the idea of chocolate as a trigger. In fact, the evidence for food triggers is getting weaker every year. Because an attack begins many hours before we feel its effects, it’s pretty unlikely that something we ate would trigger a migraine within minutes. A more likely explanation is that cravings for chocolate (or anything else!) are part of the prodrome, during which time the attack is already underway and the headache phase is inevitable*.
A 2015 study3 attempted to determine the difference between prodrome symptoms and true triggers. They identified prodrome symptoms as those occurring within a 2-hour window prior to the onset of pain. A total of 24 different symptoms were identified:
- red or pale face
- cold hands or feet
- body chills
- osmophobia (painful sensitivity to smells)
- phonophobia (painful sensitivity to sound)
- photophobia (painful sensitivity to light)
- back pain
- other aches & pains
- neck tension
- sleep disturbances
- bad mood
- depressed mood
- difficulty speaking
- difficulty concentrating
- lack of appetite
- excessive thirst
- food cravings
That same study examined these possible triggers:
- relief from stress
- weather changes
- bright sunlight
- flickering light
- sexual activity
- skipping/irregular meals
- lack of or excessive sleep
- strong odors
- hormonal changes
How do you tell the difference?
There is some overlap on those two lists. Sometimes it’s no so easy to know if something is a trigger or just part of the prodrome. Through trial and error, I have discovered that my prodrome phase can last more than a day. So, any symptom I experience 24 hours prior to the start of the headache phase, I count as prodrome. That’s how I discovered that most foods I thought were triggers were actually just prodrome food cravings. There was one exception: salty foods. Because they have the potential to cause dehydration, I now make sure to drink plenty of water when I eat salty foods. The trigger wasn’t the food, but dehydration.
Your triggers and prodrome symptoms will be different than mine. The best way to identify your triggers is to keep a detailed record of your attack frequency, duration in connection with possible triggers. Over time, you will begin to see a pattern emerge. From that information, you will be able to predict the likelihood of your next attack. There will be some triggers that are easier to avoid than others. Eliminating a trigger may require you to change some bad habits — like skipping meals or staying up late. You may need to educate loved ones, too.
A free gift
To help you discover your unique pattern of prodrome symptoms and triggers, I have created a Migraine Tracker. Feel free to download either version and use as needed. What you discover can help you and your doctor adjust your treatment plan to minimize the number of attacks you experience.
The documents are copyrighted, so please do not publish it online or reuse for commercial purposes. Feel free to link directly to the downloads as long as you give proper credit.
*Assuming that the attack includes a headache phase, which may or may not occur.
For more information…
- Becker, Werner J, The permonitory phase of migraine and migraine management, Cephalagia. 2012 January. 33(13) 1117-1121. doi: 10.1177/0333102412437390.
- Borkum, Johnathan M, PhD, Migraine triggers and oxidative stress: a narrative review and synthesis, Headache. January 2016. 56: 12-35, doi: 10.1111/head.12728.
- Schulte, Laura H, Jurgens, Tim P, May, Arne, Photo-, osmo- and phonophobia in the premonitory phase of migaine: mistaking symptoms for triggers, The Journal of Headache and Pain. 2015. 16:14, doi: 10.1186/s10194-015-0495-7.
- Schwedt, Todd J, Krauss, Melissa J, Frey, Karen, and Gereau, Robert W, IV, Episodic and chronic migraineurs are hypersensitive to thermal stimuli between migraine attacks, Cephalalgia. 2011 January; 31(1): 6-12. doi: 10.1177/0333102410365108.
- Schwedt, Todd J, Zuniga, Leslie, and Chong, Catherine D, Low heat pain thresholds in migraineurs between attacks, Cephalalgia. 2014. 0(0) 1-7, doi: 10.1177/0333102414550417.
This article is part of the July 2016 Ultimate Blog Challenge