Migraine triggers and how to manage them

Migraine is not a bad headache. It is a neurological condition with a headache as its most obvious feature, and it responds to being managed rather than endured.

Find your own triggers, not the list

Published trigger lists are long and mostly wrong for any given person. What works is a diary: date, time of onset, what you ate, how you slept, where you were in your menstrual cycle if relevant, and what you had been doing. Four to six weeks usually reveals a pattern.

The triggers that come up most often

Skipped meals and dehydration. Disrupted sleep — including too much, at weekends. Hormonal changes. Alcohol, particularly red wine. Sudden caffeine withdrawal. Bright or flickering light. Stress, and, characteristically, the let-down after stress rather than the stress itself.

What to do at the first sign

Treat early. Migraine medication works far better taken in the first twenty minutes than two hours in, once nausea has slowed your stomach down. Have it with you rather than at home.

The trap: medication-overuse headache

Taking painkillers for headache on more than ten to fifteen days a month reliably produces more headaches. It is one of the commonest reasons a migraine pattern gets worse, and it is entirely reversible — but the withdrawal is unpleasant and worth doing with support.

When prevention is the right conversation

If you are getting four or more migraine days a month, or if attacks are severe enough to cost you work or family time, preventive treatment is likely to help more than better rescue medication. There are several classes, including newer ones developed specifically for migraine.

When to be seen promptly

A headache that is the worst you have ever had and came on within seconds. A headache with fever and neck stiffness. New neurological symptoms that do not resolve. A headache that is new and persistent over the age of fifty. These need same-day assessment, not a diary.

If migraines are shaping your month, book a consultation. Bring the diary — it is the most useful thing you can bring.