Follow Sharron on Twitter

Sharron's book is now available at Amazon, Barnes and Noble, and wherever books are sold. The book can be purchased in print form or ebook format.

Conari Press, an imprint of Red Wheel/Weiser, LLC  is the publisher of Sharron's book, Migraine: Identify Your Triggers, Break your Dependence on Medication, Take Back Your Life -  An Integrative Self-Care Plan for Wellness," released June, 2013. Follow Sharron on Twitter @murraysharron, and her page Sharron Murray, MS, RN on Facebook, for tips to help you battle your migraines and achieve wellness.



Puzzled by migraine triggers? 7 things to know to help manage attacks 

Migraine is believed to be a genetic neurological disease. As persons with migraine, we are thought to have an inherited sensitivity of the nervous system, which makes our brains hyperexcitable. This hyperexcitiability gives us a predisposition to migraine attacks.

Once we have been diagnosed with migraine, we need to know about triggers. Although much is written about triggers and scientific evidence is often insufficient, inconclusive, and debatable, seven important things we should be aware of are:


Triggers are internal and external stimuli that "set off" (provoke, initiate) migraine attacks in those of us who have the disease. In other words, migraine disease makes us vulnerable to triggers. 


It is important for us to know that triggers do not cause our symptoms. "During a migraine attack, a storm of electrical and chemical activity 'switches on' different areas in the brain and surrounding nerves to cause migraine symptoms" (Dr. Andrew Charles, AHS14AZ).


 Triggers thought to be associated with an increased probability of an attack over a brief period of time include: 

  • Altered  sleep patterns (poor sleep, interrupted sleep, oversleeping).
  • Hormonal changes like estrogen withdrawal.
  • Hypoglycemia (missed and skipped meals, fasting).
  • Dehydration.
  • Stress, including perceived emotional stress and "let-down" stress.  As well, stress can make us more susceptible to other triggers. For example, perceived emotional stress may interrupt our sleep or make it difficult for us to fall aseep.
  • Environmental factors like weather changes, bright or flickering lights, loud noises, and strong odors.
  • *Dietary factors including magnesium deficiency and chemicals and additives in foods, such as tyramine (e.g., aged cheeses, bananas, avocados, fava beans, garbanzo beans, lima beans, organ meats like liver, pickled foods, canned soup, nuts, peanut butter, tomatoes, and soy sauce), tannin (e.g., chocolate, cheeses, ice cream, nuts, bananas, smoked foods, and cigarette smoke), aspartame (e.g., diet sodas), phenylethylamine (e.g., chocolate), sulfites (e.g., fermented foods and beverages), nitrites (bacon, ham, pepperoni, and other processed meats), gluten (e.g., wheat, barley, rye, and may be added to number processed foods as thickener,stabilizer, emulsifier, starch, or hydrolyzed plant protein), MSG (e.g., sauces, gravies, processed meas, packaged foods, and canned soups and vegetables).
  • Alcohol.
  • Exposure to, or withdrawal from, certain medications, caffeine.    

*Food cravings (hunger) in the premonitory phase may be mistakenly identified as triggers. For example, declining estrogen levels that occur at the time of menstruation as well as low levels that are encountered during the menopausal transition, are triggers for some women. Low estrogen levels are associated with low serotonin levels. Low serotonin levels may promote food cravings for starches and sugars, including chocolate. If we mistakenly identify a food craving as a trigger, we may unnecessarily avoid something we enjoy.  


While specific triggers may be controversial, in a study where respondents were presented with a list to choose from (Kelman, 2007, cited in Pavlovic et al, 2014), the most commonly occurring triggers were:

  • Stress.
  • Hormones.
  • Missed meals.
  • Weather.
  • Sleep disturbances.
  • Odors.
  • Alcohol.
  • Heat.
  • Foods.


While a single trigger may initiate an attack, a single trigger (apart from menstruation) may not be powerful enough to consistently initiate an attack by itself. In other words, we need to know if a specific trigger is always followed by an attack. Since it may take a combination, or loading of triggers (additive effect, stacking, cumulative) to provoke an attack, it is helpful for us to know which triggers occur either singly or in combination with others. For example, high stress plus poor quality sleep or oversleeping, is associated with an increased chance of an attack. (Spierings et al, (2014)


Perhaps, the most important thing to know about triggers is they are unique to the individual.  Keeping a diary can help us identify our personal triggers and make associations between these triggers and our attacks. An advantage of electronic diaries is they can capture data on the same day and eliminate the inaccuracy of recall, along with the frustration of flipping through pages to try and figure everything out. 


Once we identify our unique triggers, we can avoid or learn to manage them. For example, we can avoid triggers that are not consistent with a healthy lifestyle such as toxic smells; chemicals and additives in foods and beverages; fasting and skipped meals, dehydration; and, lack of sleep or oversleeping.  We can learn to manage others like stress. 


Murray, S. "Can we use associations between migraine triggers, premonitory symptoms, and migraine attacks, to predict our attacks and decrease their frequency?" Sharron Murray's Articles, December, 2014.

Murray, S. , MS, RN. Migraine: Identify Your Triggers, Break Your Dependence On Medication, Take Back Your Life.  San Francisco:Conari Press, 2013.

Sharron Murray MS, RN is an author and coauthor CaMEO Study, "Life With Migraine". Currently, Sharron is active in the migraine community as a writer, advocate, American Migraine Foundation Partner, moderator for the American Migraine Foundation "Move Against Migraine" Facebook Group, and member of the National Headache Foundation Patient Leadership Council. 

Follow Sharron on twitter @murraysharron, her Facebook page: Sharron Murray MS, RN 

This article is not intended as a substitute for medical advice. If you have any specific concerns about your health or nutrition, please consult a qualified health care professional.

Updated November, 2018

Copyright September, 2015, Sharron E, Murray


PrintView Printer Friendly Version

EmailEmail Article to Friend

References (2)

References allow you to track sources for this article, as well as articles that were written in response to this article.

Reader Comments

There are no comments for this journal entry. To create a new comment, use the form below.

PostPost a New Comment

Enter your information below to add a new comment.

My response is on my own website »
Author Email (optional):
Author URL (optional):
Some HTML allowed: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <code> <em> <i> <strike> <strong>
« The influence of regular lifestyle behaviors in migraine | Main | Recalled maltreatment, migraine, and tension-type headache »