Migraine triggers

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There are a number of migraine triggers, including:

  • Hormonal changes in women. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women.

    Hormonal medications, such as oral contraceptives, also can worsen migraines. Some women, however, find that their migraines occur less often when taking these medications.

  • Drinks. These include alcohol, especially wine, and too much caffeine, such as coffee.
  • Stress. Stress at work or home can cause migraines.
  • Sensory stimuli. Bright or flashing lights can induce migraines, as can loud sounds. Strong smells — such as perfume, paint thinner, secondhand smoke and others — trigger migraines in some people.
  • Sleep changes. Missing sleep or getting too much sleep can trigger migraines in some people.
  • Physical factors. Intense physical exertion, including sexual activity, might provoke migraines.
  • Weather changes. A change of weather or barometric pressure can prompt a migraine.
  • Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.
  • Foods. Aged cheeses and salty and processed foods might trigger migraines. So might skipping meals.
  • Food additives. These include the sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods.

    Risk factors

    Several factors make you more prone to having migraines, including:

    • Family history. If you have a family member with migraines, then you have a good chance of developing them too.
    • Age. Migraines can begin at any age, though the first often occurs during adolescence. Migraines tend to peak during your 30s, and gradually become less severe and less frequent in the following decades.
    • Sex. Women are three times more likely than men to have migraines.
    • Hormonal changes. For women who have migraines, headaches might begin just before or shortly after onset of menstruation. They might also change during pregnancy or menopause. Migraines generally improve after menopause.

    Complications

    Taking painkillers too often can trigger serious medication-overuse headaches. The risk seems to be highest with aspirin, acetaminophen and caffeine combinations. Overuse headaches may also occur if you take aspirin or ibuprofen (Advil, Motrin IB, others) for more than 14 days a month or triptans, sumatriptan (Imitrex, Tosymra) or rizatriptan (Maxalt, Maxalt-MLT) for more than nine days a month.

    Medication-overuse headaches occur when medications stop relieving pain and begin to cause headaches. You then use more pain medication, which continues the cycle.

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