What Causes Migraines? Yale Doctor Reveals Hidden Triggers and Remedies That Ease Head Pain Fast
Plus learn the red flags that can show up days before a migraine attack
Key Takeaways
- Hormonal shifts and stress are the two most common migraine triggers in women.
- Early warning signs like yawning and irritability can appear days before head pain hits.
- Tracking triggers and finding the right treatments can help prevent and ease migraine attacks.
If you deal with chronic migraines, you’re all too familiar with the debilitating pain, sensitivity to bright lights and queasiness that come with them. But what actually causes migraines in the first place? Knowing the culprit behind your head pain is the first step toward preventing migraine attacks in the future. Pinpointing the underlying cause helps you and your doctor figure out the best treatment options, whether it’s migraine self-care remedies you can try at home, prescription pain relievers or a combination of both. Here, a neurologist reveals the most common triggers you need to know.
What are migraines?
Migraines are moderate to severe throbbing headaches that typically occur on one side of the head. Often, they’re accompanied by sensitivity to light and sound as well as nausea and/or vomiting, explains Nicholas Tzikas, MD, a neurologist with Yale Medicine and an assistant professor of clinical neurology at Yale School of Medicine in New Haven, CT. “The pain can also switch sides, migrate or involve the entire head,” he notes. “Left untreated, migraines can last anywhere between four to 72 hours.”
If you’re prone to migraines, you’ve got plenty of company. In fact, 40 million Americans suffer through these debilitating headaches, according to the American Migraine Foundation. And while you might think of a migraine as a more severe headache, they’re actually a type of neurological disorder and a disruption of the nervous system. The pain and sensory sensitivity happens when there’s an external or internal trigger that causes brain neurons to fire abnormally.
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Migraine symptoms to watch for
A migraine can send you specific warning signs it’s on its way. “Migraines have various phases, but the two which typically precede a migraine are the prodromal phase and aura,” says Dr. Tzikas. “The prodromal phase can kick in hours or days prior to a migraine, warning of an impending attack.” Signs and symptoms of the prodromal phase include:
- Excessive yawning
- Concentration difficulties
- Irritability
- Gastrointestinal disturbances
The aura phase, on the other hand, can temporarily cause symptoms such as:
- Visual disruptions, including seeing “stars”, zig-zags or sparks in your vision
- Numbness or tingling in the body
This phase typically lasts five to 60 minutes, the American Migraine Foundation reports.
Types of migraines
It’s important to know you can experience a migraine headache following the prodromal or aura phase, or you can get migraine and aura symptoms simultaneously. When the two occur at the same time, it’s known as a migraine with aura, or a “classic migraine.”
The most common type of migraines, however, are those that occur without symptoms of aura. This migraine is known as a migraine without aura, or a “common migraine”. About 75 percent of people with migraines don’t experience aura, reports the National Institutes of Health.
Finally, though uncommon, you can also experience an aura without a migraine headache. This affects only about four percent of people who get migraines.
What causes migraines?
There are many different things that can bring on a migraine, but the two most common causes in women are hormonal changes and stress, explains headache specialist Susan Hutchinson, MD, a board-certified family practice physician, director of the Orange County Migraine and Headache Center in Irvine, CA, and author of The Women’s Guide to Managing Migraine. Here we take a look at those top migraine causes, plus other sneaky triggers.
Hormone changes
Estrogen changes throughout a woman’s lifetime, whether during menstruation or perimenopause (when your body begins to transition into menopause), can increase the risk of having a migraine and make them more severe. “During perimenopause, there’s an increase in migraines due to widely fluctuating estrogen levels,” Dr. Hutchinson explains. “But once a woman is post-menopausal, there can be improvement, since hormones are no longer fluctuating. Studies have shown that keeping estrogen (estradiol) levels steady can help prevent hormonally triggered migraines.”
Dr. Tzikas agrees there’s a strong connection between hormones and migraines. “Many women will note they get migraines around the time of their menstrual cycle as estrogen levels drop. In line with that connection, many women have noted an improvement in their migraines during pregnancy when estrogen levels rise,” he says.
The fix: If you noticed your migraines began or worsened during perimenopause, ask your doctor if menopause hormone therapy (previously called hormone replacement therapy, or HRT) might be right for you. It helps regulate your estrogen levels, which could help stave off the underlying cause of your migraine attacks.
Stress
The American Migraine Foundation found that everyday stress is a trigger for up to 70 percent of migraines. “There are multiple reasons stress can aggravate or trigger a migraine, including anxiety, insomnia, poor eating habits and other factors that often co-exist with stress,” says Dr. Hutchinson.
One way stress may bring on migraine pain is by spurring the release of certain hormones. When you’re experiencing a stressful event, your body releases the stress hormone cortisol as well as adrenaline, responsible for your “fight or flight” response. In increased amounts, these hormones can spark vascular changes (such as constricting blood vessels in the brain) to bring on a migraine headache. Worry, anxiety, and fear can also create muscle tension, potentially making a migraine more severe.
The fix: Work on bringing your cortisol levels down. We know it’s easier said than done, but these smart tips to lower your cortisol naturally—like simple relaxation techniques, sipping holy basil tea and socializing with friends—can help.
Lifestyle changes
Dr. Hutchinson says other migraine triggers can come from food, lifestyle factors and our environment. She notes that foods with certain preservatives, artificial sweeteners or monosodium glutamate (MSG), alcoholic beverages and drinking too much caffeine can all bring on a migraine. Inadequate sleep as well as changes in barometric pressure can also contribute to a migraine attack.
The fix: Start a migraine journal. Each time you feel a migraine coming on, log what you ate or did in the days leading up to it. This can help you pinpoint triggers so you know what to scale back on or cut out of your diet. And of course, prioritizing sound sleep helps too.
Genetics
If you suffer from migraines, you may have your genes to blame, too. “Migraines have a tendency to run in families,” says Dr. Tzikas. “Heredity can count for up to 50 percent of a person’s susceptibility to migraine. And one study found the risk of migraine in patients who had relatives with migraine was three times greater than that of people who didn’t have a family history of migraine.”
The fix: You can’t change your genes. But there are prescription medications that help reduce both the frequency and severity of migraine attacks. They include triptans (a sumatriptan like Imitrex), ergotamines (Ergomar) and calcitonin gene-related peptide (CGRP) inhibitors (Ubrelvy). Ask your doctor what might be right for you based on the underlying cause of your migraines.
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