Migraine triggers: Categories and symptoms

Nothing ruins your day quite like a migraine. Some people get them a few times a year, while others experience them more than once a week. Learning your migraine triggers can help to reduce their frequency.

Migraine trigger categories

According to Dr. Muhammad Ubaidulhaq, pain management physician at Marshfield Clinic Health System, potential migraine triggers can be classified in six categories: Weather/atmosphere, nutrition, stress, hormonal, lifestyle and pharmacological.

Within those categories, the most common triggers include: Alcohol, artificial sweeteners, caffeine, exercise, certain foods such as chocolate and soft cheese, light, odors, oral contraceptives, smoking and menstruation.

Migraine symptoms

“Migraine headaches have four phases including prodromal phase, aura, headache phase and postdromal phase,” said Dr. Ubaidulhaq.

1. Prodromal phase of migraine starts hours or days prior to the headache and can include yawning, mood swings, trouble focusing, neck pain, exhaustion, thirst and increased frequency of urination.
2. A migraine headache can occur with or without aura. This stage is also referred as ‘warning stage’ and most often affects a person’s vision. Some people can experience confusion, disorientation and dizziness. Uncommon symptoms of aura can be tinnitus, vertigo and even difficulty in speaking clearly. This condition can appear 30-60 minutes before a migraine attack. Identifying an aura is paramount in management of the migraine headaches. Taking medication as the aura starts can prevent a person from experiencing a severe migraine headache episode.
3. Headache phase is also known as attack phase, which can persist for hours. The pattern of the headache can be variable but usually starts around the eyebrows and then radiates to one side of the head. Some people also complain of pain in the cervical region in the neck. Pulsating or throbbing pain is characteristic of migraine.
4. Postdrome phase is also known as a post-migraine phase. This stage of the migraine is frequently compared by migraine sufferers to a hangover from alcohol intoxication. It could be as terrible as migraine attack itself. The person feels worn out, exhausted and drained. They may have ongoing neck pain, trouble focusing, intestinal problems, mild headache, dehydration and mood swings.

How to avoid triggers

One of the most successful ways to avoid a migraine is to make certain lifestyle changes.

“This includes maintaining a stable daily schedule that includes healthy sleep hygiene, eating regular meals, exercise and establishing lower daily stress,” Dr. Ubaidulhaq said.

You can learn more about how to adjust your lifestyle by identifying your triggers as migraines occur.

“Maintain a daily headache diary to analyze migraine frequency, treatment patterns and potential triggers,” Dr. Ubaidulhaq said.

In general, avoid or work to diminish well-known risk factors for developing more frequent migraines including obesity, sleep disorders, excessive caffeine intake and high amounts of stress.

When to seek help from a medical professional

“It is important to recognize the pattern of the headache and if this headache meets the criteria for migraine, then it is the time to see a medical professional to discuss management,” said Dr. Ubaidulhaq.

If you are experiencing the following symptoms, then it is advisable to see a medical professional.

Migraine without aura phase:

1. At least five attacks that include numbers 2, 3 and 4
2. Headache lasting 4-72 hours (untreated or unsuccessfully treated)
3. At least two of these characteristics:
   1. Aggravation by or causing avoidance of routine physical activity
   2. Moderate or severe pain intensity
   3. Pulsating quality
   4. Unilateral location
4. At least one of these conditions:
   1. Nausea and/or vomiting
   2. Phonophobia (noise avoidance)
   3. Photophobia (light avoidance)

Migraine with aura phase:

1. At least two attacks that include numbers 2 and 3
2. At least two of these characteristics:
   1. Symptom spreading gradually over at least 5 minutes and/or 2 or more symptoms occur in succession
   2. Each symptom lasting 5-60 minutes
   3. One of the symptoms is unilateral
   4. Aura is accompanied or followed within 60 minutes by headache

3. At least one of these conditions:
   1. Visual disturbances
   2. Numbness or tingling
   3. Weakness in any part of body
   4. Difficulty speaking
   5. Abnormal smell perception
   6. Nausea and/or vomiting
   7. Photophobia
   8. Phonophobia

For help with migraines, talk to a Marshfield Clinic Health System provider.

Schedule appointment Message your provider

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