Migraine and attack triggers

Skipped meals and fasting among the strongest links

Hunger and late meals are among the most commonly reported triggers, and the link is clearer than for any single food. Low blood sugar and caffeine withdrawal can arrive together.

During Ramadan, many people find it helps not to skip suhoor and to cut down coffee gradually in the week or two before, rather than stopping suddenly. If you take preventive medicines or have frequent attacks, discuss medicine timing with your doctor before Ramadan.

Caffeine a two-way relationship

A small amount of caffeine can ease an attack, which is why it is part of some painkillers. But large daily amounts raise headache risk, and a sudden drop causes withdrawal headache, as on a weekend when you drink less, or when fasting.

What matters more than “how much” is “how steady”: a moderate, consistent daily amount is better than big swings. There’s no single number that suits everyone. If you drink a lot and want to cut down, do it slowly.

Alcohol one of the most consistent dietary triggers

Often reported, especially red wine; an attack may come within hours or the next day. Not everyone with migraine is affected.

Processed meats limited evidence

They contain nitrites, which have been linked to headache in a small number of people. No need to cut them out unless you see a repeated link yourself.

Aged cheese conflicting evidence

It contains tyramine and has been blamed for decades on the basis of old studies. Controlled studies haven’t consistently confirmed it.

MSG (monosodium glutamate) conflicting evidence

Controlled trials haven’t shown a consistent effect. Where an effect appeared, it was usually with large amounts taken without food, which isn’t how people normally eat.

Artificial sweeteners little and conflicting evidence

Some people name aspartame in particular. Studies are few and small, with inconsistent results. Avoiding them is only worthwhile if the link to your attacks is clear and repeated.

Chocolate and citrus not confirmed in trials

In a controlled trial, chocolate didn’t cause more headaches than a look-alike placebo. And, as above, craving it may be an early sign of a coming attack. The evidence for citrus is weaker still.

Water sensible, but direct effect uncertain

Some people notice thirst or dehydration before attacks, and drinking enough is a sensible habit for everyone. That drinking more reduces attacks hasn’t been clearly shown in the few small trials available.

Sleep among the most consistent triggers

Too little sleep is linked to attacks, and so are too much and irregular sleep, like sleeping until noon at the weekend. What helps most: a steady wake-up time, even on days off.

Stress, and what comes after clearly linked

Stress is one of the most commonly reported triggers. Strikingly, the attack may come after the stress ends rather than during it: on the first day of a holiday, or after a deadline. A sudden drop in tension is a change, and the migraine brain is sensitive to change.

Hormonal changes clearly linked for many women

For many women attacks cluster around the period, from two days before to the first three days, linked to falling oestrogen. These attacks can be longer, and they have specific treatment options worth discussing with a doctor.

In pregnancy, migraine improves for many, especially after the first months. If you have migraine with aura, pills and patches that contain oestrogen are generally not advised, because together they raise the risk of stroke. Progestogen-only methods and non-hormonal options are usually fine; check with your doctor.

Light, smells and noise common, and overlap with the attack itself

Bright or flickering light and strong perfumes are widely reported. But sensitivity to light and smell is also part of the attack, so being bothered by them may be a sign the attack has begun, not its cause.

Weather and travel real for some people

Some people notice changes in air pressure and temperature; you can’t control these, so they’re not worth worrying over. Travel bundles several triggers together: broken sleep, late meals and tiredness.

Physical exertion sudden exertion only

Sudden hard exertion can set off attacks in some people. Regular moderate exercise, on the other hand, may help reduce them. A new headache that starts with exertion for the first time needs a medical check.

Painkiller overuse defined in the international classification

The painkiller that eases an attack can make headaches more frequent if taken on many days a month for months. The international classification sets an approximate threshold: 15 or more days a month for simple painkillers like paracetamol and ibuprofen, and 10 or more days for triptans and combination painkillers, for more than three months.

This isn’t addiction or weak willpower, and painkillers aren’t forbidden. It means it’s time for a plan with your doctor, often including preventive treatment. Don’t stop your medicines suddenly without advice.