Migraine Headaches: Common Triggers, Preventive Medications, and How to Treat an Attack

What Migraines Really Feel Like

A migraine isn’t just a bad headache. It’s a full-body neurological event that can leave you curled up in a dark room for hours-or even days. The pain is often pounding, one-sided, and gets worse with movement. But it’s not just the head pain. Nausea, vomiting, sensitivity to light, sound, and even smells are common. Some people see flashing lights or blind spots before the headache hits. Others feel dizzy, numb, or have trouble speaking. This isn’t something you can just "push through." For 12% of Americans, migraines are a regular, disruptive part of life-and women are three times more likely to get them than men.

What Actually Triggers a Migraine?

There’s no single cause of migraines. Instead, your brain has a threshold. When too many triggers pile up, it crosses that line and launches an attack. The triggers vary wildly from person to person. One person’s migraine starter is another person’s harmless habit.

• Stress is the #1 trigger, affecting up to 80% of people with migraines. But here’s the twist: it’s often not the stress itself-it’s the letdown. You’ve been running on adrenaline all week, and the moment you finally relax-Saturday morning, on vacation-that’s when the migraine hits. Your brain misreads the drop in stress as a threat.
• Sleep changes are just as powerful. Too little? Too much? Waking up at a different time? All of these can trigger an attack. Nearly half of all migraines happen between 4 a.m. and 9 a.m., which shows how closely they’re tied to your body’s internal clock.
• Hormones play a big role, especially for women. Many report migraines right before or during their period, during ovulation, or while pregnant. Birth control and menopause can also shift your migraine pattern.
• Diet is tricky. Some people swear chocolate or cheese sets off their migraines. Others drink coffee daily and never have an issue. But certain substances are common culprits: alcohol (especially red wine), MSG, artificial sweeteners like aspartame, aged cheeses, cured meats, and caffeine-both too much and sudden withdrawal.
• Weather changes are real. A drop in barometric pressure before a storm, high humidity, extreme heat, or even flying in an airplane can trigger attacks in over half of migraine sufferers.
• Sensory overload is another big one. Bright or flickering lights (sunlight on water, fluorescent bulbs, strobe lights), loud noises (construction, sirens, even a crying baby), and strong smells (perfume, cigarette smoke, cooking odors) can push you over the edge.

Here’s the key: it’s rarely just one trigger. Two or three small ones-like skipping lunch, getting less sleep than usual, and walking into a smoky room-can combine to spark an attack. That’s why keeping track matters more than guessing.

How to Find Your Personal Triggers

You can’t avoid every possible trigger. And you don’t need to. You need to know which ones are yours.

Start with a simple headache diary. Write down:

1. When the migraine started and ended
2. How bad it was (on a scale of 1 to 10)
3. What you ate or drank in the 24 hours before
4. How much sleep you got
5. Any major stressors or emotional events
6. Weather changes or travel
7. Any unusual lights, sounds, or smells

Do this for at least 6 to 8 weeks. Look for patterns. Do your migraines always happen after Friday night wine? After a night of poor sleep? Around your period? Once you spot your top 3 triggers, you can start making smart, realistic changes.

Don’t obsess over every bite of food or every hour of sleep. The goal isn’t perfection-it’s control. If you know your trigger is skipping meals, make sure you have a snack ready. If bright lights bother you, keep sunglasses handy-even indoors.

Preventive Medications: When Daily Pills Make Sense

If you’re having more than four migraines a month, or if your attacks are severe enough to miss work or family time, preventive medication might help. These aren’t painkillers. They’re taken daily to reduce how often and how badly migraines hit.

There are several classes of drugs used for prevention:

• Beta-blockers like propranolol and timolol were originally for high blood pressure but are now common migraine preventives. They help calm overactive nerves in the brain.
• Anticonvulsants like topiramate and valproate stabilize electrical activity in the brain. Topiramate can cause weight loss and tingling in fingers and toes-side effects that help some people but bother others.
• Antidepressants like amitriptyline aren’t for depression here. They help regulate pain signals and improve sleep, which can reduce migraine frequency.
• CGRP inhibitors are the newest class. Drugs like erenumab and fremanezumab are monthly injections that block a protein involved in migraine pain. They’re often used when older drugs don’t work or cause too many side effects.

Choosing the right one isn’t a one-size-fits-all decision. It depends on your other health conditions, side effect tolerance, and how your body responds. It can take weeks to months to see results. And you might need to try a few before finding the right fit.

Preventive meds aren’t magic. They won’t stop every migraine. But they can cut the number of attacks in half for many people. That’s life-changing.

What to Do When a Migraine Hits

When the pain starts, you need fast, targeted relief-not just any painkiller.

For mild to moderate attacks:

• Over-the-counter NSAIDs like ibuprofen or naproxen can help if taken early.
• Combination meds like Excedrin Migraine (which includes caffeine) work well for some people.

For moderate to severe attacks:

• Triptans like sumatriptan or rizatriptan are the gold standard. They target the brain’s pain pathways and can stop a migraine in its tracks-if taken at the first sign of pain. They come as pills, nasal sprays, or injections.
• Gepants like ubrogepant and rimegepant are newer options. They work like triptans but are safer for people with heart disease or who can’t take triptans.
• Anti-nausea meds like metoclopramide or prochlorperazine are often given alongside pain meds because nausea makes everything worse.

Timing matters. The sooner you take your acute medication, the better it works. Waiting until the pain is at its peak makes it much harder to stop.

Also, avoid lying in a bright, noisy room. Go dark. Go quiet. Put a cold cloth on your forehead or neck. Even small environmental changes can help your brain calm down.

Why Consistency Is Your Secret Weapon

Migraines hate routine. Your brain thrives on predictability. That means:

• Going to bed and waking up at the same time-even on weekends.
• Eating meals at regular times. Skipping meals is a top trigger.
• Staying hydrated. Dehydration can set off an attack.
• Managing stress with daily habits: walks, breathing exercises, yoga-not just when you feel overwhelmed.

It’s not about being perfect. It’s about being steady. Even small, consistent habits lower your overall sensitivity to triggers. Over time, your threshold rises. You become less reactive.

Think of it like building a buffer. The more stable your daily life, the more room you have before a trigger pushes you over the edge.

When to See a Doctor

You don’t have to suffer in silence. See a doctor if:

• You’re having more than four migraines a month.
• Your headaches are getting worse or changing in pattern.
• Over-the-counter meds aren’t helping.
• You’re relying on painkillers more than twice a week.
• You have new symptoms like vision loss, weakness, or confusion.

A neurologist who specializes in headaches can help you build a full plan: trigger tracking, preventive meds, acute treatments, and lifestyle support. You don’t have to figure it out alone.

Final Thought: You’re Not Broken

Migraines aren’t a sign you’re weak, lazy, or stressed out too much. They’re a neurological condition-with real biology behind them. You’re not imagining the pain. You’re not overreacting. You’re not failing at life because you need to avoid cheese or wear sunglasses indoors.

What you need is a plan. Not a cure, but a way to take back control. Start with your diary. Identify your top three triggers. Talk to a doctor about options. Build small, steady habits. You don’t need to eliminate every risk. You just need to tip the balance in your favor.

One less migraine a month is progress. Two is a win. And over time, those wins add up to a life that’s no longer ruled by pain.