Migraine Symptoms and Triggers

Recognizing the signs of migraine

Migraine symptoms can be different from person to person — everyone’s experience is unique. The length, frequency and intensity of migraines can vary. However, most of the time, migraines include more than just a headache. Not everyone will have all of these symptoms, but with a migraine, you may notice:

• Early signs up to 24 hours before a migraine: About 60% of people with migraines notice signs like mood changes, trouble concentrating, yawning, food cravings, constipation, muscle stiffness, feeling bloated or having to pee frequently. This period is called the prodrome.
• A moderate to severe headache: Migraine headaches usually pulse or throb and often strike one side of the head. The pain can be so intense that it’s hard to do your daily activities. It usually gets worse when you move, and it can last from four to 72 hours.
• Sensitivity to light (photophobia): When you have a migraine, bright lights or even normal lighting can feel uncomfortable and make the headache worse.
• Sensitivity to sound (phonophobia): Loud noises or even normal sounds may worsen the headache or cause distress.
• Other sensory changes: Some people with migraines may also have heightened sensitivity to smells (osmophobia) or touch, while others may experience numbness or tingling sensations in the face, arms or legs.
• Nausea and vomiting: Many people feel sick before, during or after the migraine headache.
• Aura: Some people have these visual disturbances before or during a migraine attack. You may notice flashing lights, zigzag lines, blind spots or temporary vision loss. You could also have numbness, tingling or trouble speaking. Auras come on gradually and usually last less than an hour, but they don’t always occur with migraines. Only about 15 to 20% of people who get migraines experience auras.
• Dizziness or vertigo: Migraines can cause dizziness, unsteadiness or a spinning or whirling sensation.
• Cognitive symptoms: Migraines can lead to difficulties with concentration, memory and mental clarity. This is also known as “brain fog.”
• Feeling tired, weak or confused afterward: You can feel “off” for a day or so after a migraine. This period is called postdrome, and it affects about 80% of people who get migraines.

Causes and triggers of migraines

Experts don’t know exactly what causes migraines, but genetic, neurological and environmental factors all seem to play a role. Changes in the brainstem, interactions with pain pathways and chemical imbalances in the brain may lead to migraines. Most people who have migraines also have at least one family member with migraines.

We do know that certain experiences are likely to trigger migraines in some people. Not everyone has the same triggers or responds the same way to them, but some of the most common triggers include:

• Hormonal changes such as changes in estrogen levels that happen during menstrual cycles, pregnancy or menopause.
• Certain foods and drinks, including aged cheeses, chocolate, caffeine, alcohol (especially red wine), some fruits and nuts, pickled or fermented foods, yeast, aspartame, cured or processed foods and possibly foods that contain monosodium glutamate (MSG). Skipping meals could also lead to migraines.
• Environmental factors including bright lights, loud noises, strong smells such as perfumes or chemicals, changes in the weather or barometric pressure and exposure to smoke or allergens.
• Stress, anxiety, tension and other emotional factors: Stress management techniques like mindful breathing, gentle movement and meditation can help reduce the number of migraines you have and how severe they are.
• Medications: Some people find that birth control pills and vasodilators (medicines that open blood vessels) like nitroglycerin cause migraines.
• Sleep disturbances: Getting either too little or too much sleep can trigger migraines. You can reduce the risk of migraines with a regular sleep schedule.
• Physical exertion, such as sudden intense exercise or hard physical activities, can trigger migraines – especially if you’re not used to it. Though, regular exercise and a healthy overall lifestyle can help prevent migraines.
• Sensory stimuli, such as flickering lights, strong smells or repetitive patterns.

It can be helpful to keep a migraine diary or journal. In it, you can log how often you have migraines, how long they last and what other symptoms come with them. You can also track possible triggers and see if there is a pattern as to what might be bringing on your migraines. That way, you can avoid them as much as possible. Sharing your suspected triggers with a health care provider can also help guide your prevention and treatment options.