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 work in less obvious ways, hitting after the stress has passed, or coming from the very 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 - on a Saturday morning after a demanding week, or on the first day of a holiday. This is sometimes called a "let-down" headache.
Research has found that the risk of a migraine attack rises by around five times in the six hours after a sharp drop in stress, likely linked to falling cortisol levels, the hormone that helps dampen pain during stressful periods.1
It isn't limited to the working week. The same pattern has been reported after finishing exams, wrapping up a big project, or reaching the first relaxed day of a holiday abroad - anywhere stress falls away quickly rather than tapering off gradually.
Because the trigger is the change rather than the stress itself, easing into downtime gradually rather than switching off all at once, keeping a consistent bedtime through the weekend, and having your migraine treatment on hand can help take the edge off.
2. Your migraine medication itself
It sounds counterintuitive, but taking painkillers or migraine-specific medicines too often can itself become a trigger, medically 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 are taken on 10 or more days a month, for three months or longer.2
A useful warning sign is a dull, background headache that's present most days, often most noticeable first thing in the morning, sitting underneath the more severe migraine attacks you already recognise. Your usual treatment may also start feeling less effective, or wearing off sooner than it used to.
The result is that treatment can become less effective over time. If you're reaching for migraine medication more than 10 days a month, it's worth speaking to a pharmacist or GP about preventive options rather than increasing the dose.
3. Skipping meals
Missing breakfast, delaying lunch, or cutting carbohydrates sharply can all trigger a migraine attack in people who are prone to them.
This is thought to be linked to a drop in blood sugar, and the same pattern has been reported in people taking weight loss medications that reduce appetite, since eating less overall makes it easier to go longer between meals without noticing.3
This is one reason migraine can flare up unexpectedly during busy periods when meals get pushed back, or while adjusting to a new eating pattern, including calorie-restricted diets or the reduced appetite some weight-loss medications cause.
Eating at regular intervals, and not going longer than four or five hours without food during the day, is one of the simplest ways to reduce this risk.
4. Not drinking enough water
Mild dehydration is an easy trigger to miss, because thirst usually isn't the first sign.
Aiming for around six to eight glasses of fluid a day, on top of tea, coffee or other drinks, is generally enough to reduce migraine risk linked to dehydration.4
Dehydration rarely acts alone. Long journeys are a good example - disrupted sleep, delayed meals and reduced fluid intake can all stack up at once, which may be part of why travel is so commonly reported as a migraine trigger.5
This matters more than usual in hot weather, after alcohol, or during a stomach bug, so it's worth topping up fluids at those times rather than waiting until you feel thirsty.
5. Sudden changes in the weather
Some people notice a pattern between their migraine attacks and the weather, particularly a change in barometric pressure — the weight of the air around you.
The evidence here is mixed: one UK study found no clear link between weather and migraine, while a separate Scottish study found that rising barometric pressure was associated with more migraine days.5
If you suspect weather is a factor for you, a simple migraine diary noting the date, time and symptoms alongside that day's weather can help confirm whether the pattern is real rather than a coincidence.4
Because you can't control the weather, the most useful step is recognising it as a genuine trigger rather than assuming you've done something wrong, and having a fast-acting treatment such as Vydura ready 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.