What are migraine triggers and
Why do I have migraine headaches?
As a headache specialist I get asked this all the time. Migraine unfortunately is all too common. The lasted estimates are that there are over 36 million people who suffer from migraines in the United States. Not only is it very common, but also migraine headaches are also very disabling. Migraine headaches are listed as the 4th leading cause of disability in women and the 7th leading cause overall.
The pathophysiology of migraine is not completely known. What is known is that some ‘triggers’ activate the neurons in the brain these neurons release neurochemical, CGRP, Substance P, and Kinins. These neurochemical then cause a localized neurogenic inflammation and localized vasodilation. If the trigger remains or if more neurons become activated eventually the abnormal electrical sign will propagate up into the cerebral cortex and you will start to feel the pain of a migraine.
If the conditions are just right, any one probably can have a migraine that is if they have enough ‘triggers’. However the people who suffer from regular migraine headaches have a genetically induced hypersensitive brain. What does hypersensitivity mean? Basically the way I like to describe it is, that in these genetically predisposed individual it does not take as many of the triggers to trigger a migraine. Another way to think about it is that the migrainour’s brain does not like change, and any change in the external or internal environment may just be enough to trigger a migraine.
What are triggers?
Triggers can be either internal or external factors that can initiation the process of a migraine. Not everyone has the same triggers and the same triggers do not always ‘trigger’ a migraine. Here are some of the more common triggers reported.
- Change in routine – the brain does not like change, so any change your regular routine can trigger migraine.
- This includes changes in sleeping patterns. Both lack of sleep and too much sleep may be a trigger.
- Skipping meals, or fasting
- Changes in external environment temperatures – i.e. going from a hot outdoor temperature to a cold air-conditioned room.
- Changes in hormones: Both around the time of their menstrual cycle and being premenopausal are often times that women are more prone to migraine headaches.
- Changes in weather specifically; barometric pressure changes are often reported as times when migraines become more frequent.
- Certain foods and additives
- Red Wines
- Artificial Sweeteners
- Processed foods
- Stress: but not only can stress it self trigger a migraine, but frequently people experience a migraine after a “let- down” of stress. So often see increase in migraines after school finals are over, or after that completely that big project at work.
- Strong smells such as perfumes or certain scented cleaning products can trigger migraines in some people.
As you might notice not all the triggers are avoidable but I always encourage my patients to do the best that they can to get in a regular pattern/routine and do the best to stick to it. Then also eliminating the triggers that they can control. I also stress the importance of starting/continuing a regular exercise program. As discussed in prior blog post, this can also help prevent migraines.