Most people know the obvious migraine triggers: too little sleep, a glass of red wine, a stressful day at work. But some of the most common hidden migraine triggers are much harder to spot.
Some hit after the stress has passed. One even comes from the medication used to treat migraine in the first place. Here are five triggers worth knowing about, and how to plan around them.
1. The 'let-down' effect after stress eases off
Many people assume migraine strikes during the most stressful stretch of the week. But for some, the attack arrives once the pressure lifts, like on a Saturday morning after a demanding week or the first day of a holiday. This is sometimes called a "let-down" headache.
In one small study, the risk of a migraine attack rose nearly five-fold in the six hours after a drop in stress.1 One theory is falling cortisol. This hormone rises during stressful periods and helps dampen pain, so when it drops, that protection drops with it.
Wind down in stages. A short walk or an easy evening at the end of a busy week can soften the drop.
It isn't just the working week, either. The same pattern has been reported after exams, at the end of a big project and on the first relaxed day of a holiday abroad. Anywhere stress falls away quickly, rather than tapering off gradually.
Because the trigger is the change, not the stress itself, a few things can help take the edge off. Ease into downtime gradually rather than switching off all at once, keep a consistent bedtime through the weekend, and have your migraine treatment on hand.
2. Your migraine medication itself
It sounds counterintuitive. But taking painkillers or migraine medicines too often can become a trigger in its own right. This is known as medication overuse headache (MOH).
MOH is usually diagnosed when simple painkillers are taken on 15 or more days a month, or triptans such as sumatriptan and rizatriptan on 10 or more days a month, for three months or longer.2
A useful warning sign is a dull, background headache most days, often worst first thing in the morning. It sits underneath the more severe migraine attacks you already recognise. Your usual treatment may also start to feel less effective, or wear off sooner than it used to.
Waking up with a headache most mornings is worth raising with a GP, even if your migraine attacks feel under control.
Reaching for migraine medication on 10 or more days a month? Speak to a pharmacist or GP about preventive options. Do not increase your dose to try to get on top of it.
3. Skipping meals
Missing breakfast, delaying lunch or cutting carbohydrates sharply can all trigger a migraine attack if you're prone to them. This is thought to be linked to a drop in blood sugar.3
It's one reason migraine can flare up during busy periods, when meals get pushed back. It can also happen while you adjust to a new eating pattern, such as a calorie-restricted diet or the reduced appetite some weight loss medicines cause. When you're less hungry, it's easier to go longer between meals without noticing.
Not feeling hungry? Small, regular snacks still count, and they're easier to manage than a full meal.
Eating at regular intervals is one of the simplest ways to reduce this risk. Try not to go longer than four or five hours without food during the day.
4. Not drinking enough water
Mild dehydration is an easy trigger to miss, because thirst usually isn't the first sign.
Aim for around six to eight glasses of fluid a day. Water, lower-fat milk and sugar-free drinks, including tea and coffee, all count. For most people, that's enough to help reduce the risk of a dehydration-related migraine.4
Keep a water bottle within reach. Sipping through the day is easier than playing catch-up later.
Dehydration rarely acts alone. Long trips are a good example. Disrupted sleep, delayed meals and drinking less can all stack up at once, which may be part of why travel is so often reported as a migraine trigger.5
It matters even more in hot weather, after alcohol or during a stomach bug. At those times, top up your fluids rather than waiting until you feel thirsty.
5. Sudden changes in the weather
Some people notice a link between their migraine attacks and the weather. In particular, a change in barometric pressure, which is the weight of the air around you.
The evidence here is mixed. One UK study found no clear link between weather and migraine. A separate Scottish study found that rising barometric pressure was linked to more migraine days.5
Suspect the weather plays a part for you? Keep a simple migraine diary noting the date, time and symptoms, alongside that day's weather. It can help show whether the pattern is real or just coincidence.4
Many weather apps show air pressure. Note it in your diary alongside your symptoms to spot a pattern faster.
You can't control the weather. So if your diary does point to it, the most useful step is accepting it as one of your triggers, rather than assuming you've done something wrong. It also helps to keep a treatment such as Vydura on hand for the days you know a change is coming.
Frequently asked questions
What is the most common migraine trigger?
Stress is the most frequently reported migraine trigger, though it usually works alongside other factors like poor sleep, skipped meals, or dehydration rather than acting alone.
Can medication actually cause migraines?
Yes. Taking painkillers or triptans too often can lead to medication overuse headache, where the treatment itself starts triggering more headaches - usually linked to painkillers taken 15+ days a month, or triptans 10+ days a month.
Does the weather really affect migraine?
The evidence is mixed. Some studies link rising barometric pressure to more migraine days, while others find no clear effect. It may be a genuine trigger for some people and not others.
How much water should I drink to help prevent migraine?
Aiming for six to eight glasses of fluid a day is generally recommended, though needs vary with activity level, weather, and individual health.
Can skipping meals trigger a migraine even if I'm not dieting?
Yes, missing meals can trigger migraine in susceptible people regardless of intent, because of the drop in blood sugar. Worth bearing in mind if you're taking an appetite-reducing medication too.
References
- American Migraine Foundation. Migraine "Let Down" Headache. americanmigrainefoundation.org
- The Migraine Trust. Medication overuse headache. migrainetrust.org
- The Migraine Trust. Migraine and diet. migrainetrust.org
- The Migraine Trust. Migraine attack triggers. migrainetrust.org
- National Migraine Centre. Migraine triggers. nationalmigrainecentre.org.uk
This article is intended for informational purposes only and does not replace professional medical advice. Always read the patient information leaflet supplied with your medication and speak to a healthcare professional if you have specific concerns.