Migraine Triggers: Common Triggers List and How to Find Yours

Most people with migraine have a list of things they suspect set off their attacks. Some of those suspicions are right. Others are coincidences that stuck. This guide covers the triggers people report most often, what research says about how reliable trigger reports are, and a practical way to find out which ones matter for you.

Not medical advice. This article is general information. It is not a diagnosis or treatment plan. Talk to a doctor before making significant changes to your diet, sleep or medication, and seek urgent care for any warning signs listed at the end.

What is a migraine trigger?

A trigger is something that makes a migraine attack more likely to start in someone who already has migraine. Triggers don't cause the condition itself. Mayo Clinic notes that migraine causes aren't fully understood, but that genetics and environmental factors appear to play a role (Mayo Clinic).

Triggers are also personal. NINDS lists common triggers but stresses that they "differ from person to person" (NINDS). Something that reliably sets off one person's attacks may do nothing for someone else.

The most commonly reported triggers

One of the largest studies of migraine triggers surveyed 1,207 people with migraine at a US headache centre. About three quarters (75.9%) reported having triggers. The most frequently reported were (Kelman, 2007):

Trigger	Share of people reporting it
Stress	79.7%
Hormones (women)	65.1%
Not eating	57.3%
Weather	53.2%
Sleep disturbance	49.8%
Perfume or odour	43.7%
Neck pain	38.4%
Light	38.1%
Alcohol	37.8%
Smoke	35.7%
Sleeping late	32.0%
Heat	30.3%
Food	26.9%
Exercise	22.1%

These figures are what patients reported in a clinic population. They are not proof that each factor causes attacks, and they may not match the wider population.

Major health organisations list a similar set. Here is what they say about each group.

Stress

Stress tops most lists. The NHS includes stress and tiredness, as well as anxiety and depression, among the triggers some people notice (NHS). The American Migraine Foundation also lists stress as a leading trigger (American Migraine Foundation). NINDS notes that some people get attacks at predictable times, such as on weekends after a stressful week (NINDS). So the drop in stress can matter as well as the stress itself.

Hormonal changes

Mayo Clinic says that changes in estrogen levels seem to trigger headaches in many people, before or during periods, in pregnancy and around menopause (Mayo Clinic). The NHS describes attacks just before or during a period as menstrual migraine, noting they are often longer and more severe (NHS).

Sleep

Both too little and too much sleep appear on these lists (Mayo Clinic; NINDS). An irregular schedule, such as a late weekend lie-in, is worth watching as much as total hours.

Skipped meals, food and drink

Skipping meals or not eating regularly is listed by the NHS, Mayo Clinic and NINDS. Too much caffeine is listed by the NHS and Mayo Clinic, and alcohol by Mayo Clinic and NINDS. Mayo Clinic also lists aged cheeses, salty and processed foods, and the additives aspartame and MSG as possible triggers for some people (Mayo Clinic). Food was reported by a smaller share of people than stress, hormones or missed meals in Kelman's study.

Weather and environment

Changes in weather or barometric pressure, bright or flashing lights, loud sounds and strong smells all appear on Mayo Clinic's and NINDS's lists (Mayo Clinic; NINDS). You can't control the weather, but knowing it affects you can help you plan. Our guide to barometric pressure headaches covers what the research on weather actually shows and how to check whether pressure changes affect you.

Physical strain

Mayo Clinic notes that intense physical exertion can provoke migraine in some people. In Kelman's study, 22.1% reported exercise as a trigger (Kelman, 2007).

Frequent use of painkillers

This one is different. Taking acute headache medication too often can itself lead to more frequent headaches. The International Headache Society describes this as medication-overuse headache: headache on 15 or more days a month linked to regular overuse of acute medication for more than three months (ICHD-3). It is a good reason to log every dose, and to talk to your doctor if your medication days are climbing.

Why suspected triggers are often wrong

Here is the important caveat: what people believe triggers their attacks doesn't always hold up when tested.

In a study at the Danish Headache Center, 27 people with migraine with aura who said bright or flickering light or strenuous exercise triggered their attacks were deliberately exposed to those triggers. Only 3 (11%) had a migraine with aura afterwards, and another 3 had a migraine without aura. Nobody developed an attack after light exposure alone (Hougaard et al., 2013). The authors concluded that self-reported triggers caused attacks only in a small subgroup, and that triggers need prospective confirmation.

There are a few reasons a suspected trigger can be misleading:

• Coincidence. If you have frequent attacks, something will always have happened just beforehand.
• Early warning signs mistaken for causes. Many attacks start with a prodrome hours or days before the pain. One survey of 461 patients found 86.9% reported at least one such symptom, most often fatigue, sensitivity to sound and yawning (Schoonman et al., 2006). Food cravings are another recognised prodrome symptom (Mayo Clinic). If you eat chocolate because of a craving that was already part of the attack, the chocolate can look like the cause.
• Combinations. A single factor may not be enough on its own, but may matter alongside others, such as poor sleep plus a missed meal plus a period.

Research also suggests trigger profiles are very individual. When researchers analysed 90 days of paper diaries from 326 people tracking 33 possible factors, they found an average of four factors associated with attacks per person. Those profiles were unique in 85% of the people with at least one association (Peris et al., 2017). A review of the field concluded that prospective electronic diaries give the most reliable information (Pavlovic et al., 2014).

The practical takeaway is to gather evidence before cutting things out of your life.

How to find your own triggers: a step-by-step approach

1. Track every day, not just attack days

To tell whether something is a trigger, you need to know how often it happens on days when you don't get an attack too. Log sleep, meals, stress, caffeine, alcohol and your cycle daily, even on good days. Our free headache diary covers the core fields.

2. Log possible warning signs separately

Record yawning, cravings, neck stiffness and mood changes as their own entries with a time. That keeps them apart from your suspected triggers.

3. Give it time

A single month will show little. Aim for at least two to three months, and longer if you are looking for a link to your menstrual cycle, so the pattern can repeat.

4. Compare, don't just count

For each suspected trigger, look at both sides. How often was it followed by an attack within a day or so? How often was it not? Something that shows up before 8 of your 10 attacks but is also present on most attack-free days is weak evidence.

5. Change one thing at a time, with your doctor

If a pattern looks strong, discuss it with your doctor before making big changes, especially to diet or medication. Changing several things at once makes it impossible to tell which one helped. The American Migraine Foundation encourages talking openly with your doctor about triggers (American Migraine Foundation).

Using an app to spot patterns

Comparing trigger days with attack days by hand is tedious, which is where an app helps. Mira, a free migraine tracker for iPhone and iPad, lets you log triggers, symptoms, medication and your cycle with each attack. Its insights then review how often each trigger comes up and how attacks line up with your menstrual cycle and ovulation. Everything stays on your device and in your private iCloud.

An app can show you a pattern, but it can't confirm that a pattern is a cause. Treat what it finds as a question to take to your doctor.

When to get help

See a GP if your attacks are severe, getting worse or happening more than once a week (NHS). Call emergency services for a sudden, extremely painful headache, problems speaking, vision loss, weakness on one side of the body, confusion, a seizure, or a headache after a recent head injury (NHS).

FAQ

What are the most common migraine triggers?

In Kelman's 2007 study of 1,207 patients, the most commonly reported were stress, hormonal changes in women, not eating, weather and sleep disturbance. The NHS, Mayo Clinic and NINDS list similar triggers.

Can a trigger cause a migraine every time?

Usually not. In a controlled study, most people exposed to their self-reported light or exercise triggers didn't develop migraine with aura. Triggers often seem to raise the chance of an attack, rather than cause one every time.

How long does it take to find migraine triggers?

There's no fixed answer. Tracking daily for at least two to three months gives patterns a chance to repeat, and longer may be needed for cycle-related patterns.

Should I cut out all foods on trigger lists?

Lists of common triggers aren't personal advice. Avoiding many foods without evidence can be restrictive. Track first, and speak to your doctor or a dietitian before making major diet changes.

Is weather really a migraine trigger?

Weather changes and barometric pressure appear on Mayo Clinic's and NINDS's trigger lists, and 53.2% of patients in Kelman's study reported weather as a trigger. Whether it affects you personally is something your own diary can help you see. See our guide to barometric pressure headaches for how to log attacks against local pressure.

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This article is for general information only and is not medical advice. It does not replace a consultation with a qualified health professional.