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

Millions of people live with migraine headaches-not just bad headaches, but debilitating neurological events that can knock you out for hours or even days. If you’ve ever been trapped in a dark room, wincing at the sound of a ticking clock or the flicker of a lightbulb, you know this isn’t ordinary head pain. Migraines are a real medical condition, not just stress or fatigue. And while there’s no cure, understanding your triggers, knowing what medications can help, and having a clear plan for when an attack hits can change everything.

What Really Causes a Migraine?

A migraine isn’t just a headache. It’s a neurological storm. Research shows it starts with unusual electrical activity in the brain that spreads across the cortex, then triggers inflammation around the nerves and blood vessels in your head. That’s what causes the pounding pain, nausea, and sensitivity to light and sound. It’s not in your head-it’s in your brain, and it’s real.

One big myth is that migraines are caused by emotional weakness or poor lifestyle choices. That’s not true. While triggers can set off an attack, the root cause is biological. Your brain is wired to react more strongly than others to certain stimuli. That’s why two people can eat the same cheese, sleep the same amount, and one gets a migraine while the other doesn’t.

The Top Triggers (And How They Work Together)

There’s no universal list of migraine triggers. What sets off your migraine might do nothing to someone else’s. But research shows some triggers appear again and again. The most common ones are:

• Stress - It affects up to 80% of people with migraines. Not just being under pressure, but also the crash afterward. Ever notice a migraine hitting right after a big project ends, or on a Sunday morning when you finally relax? That’s a “let-down” migraine. Your body’s stress hormones drop suddenly, and your brain interprets that as a signal to trigger pain.
• Sleep changes - Both too little and too much sleep can trigger attacks. Nearly half of all migraines happen between 4 a.m. and 9 a.m., which suggests your body’s internal clock plays a big role. Skipping sleep, sleeping in on weekends, or even jet lag can be enough to set off an attack.
• Hormonal shifts - For women, this is huge. Fluctuations in estrogen-before your period, during ovulation, or after menopause-are linked to more than 60% of migraine episodes. Many women notice their migraines follow their cycle like clockwork.
• Dietary factors - Not everyone reacts the same way. Common offenders include aged cheeses, processed meats with nitrates, MSG, artificial sweeteners like aspartame, and alcohol (especially red wine). But here’s the twist: caffeine can go both ways. For some, a cup of coffee stops a migraine in its tracks. For others, even a small amount triggers one. The key is consistency. If you drink coffee daily, suddenly skipping it might cause withdrawal headaches. If you rarely drink it, suddenly having two cups might overload your system.
• Weather and environment - Changes in barometric pressure, humidity, or altitude can set off migraines. Flying, storms, or even just a sudden drop in temperature can be enough. Bright lights, flickering screens, fluorescent bulbs, and loud noises are also major triggers. Even smells-perfume, cigarette smoke, strong cooking odors-can be enough to push you over the edge.

Here’s the thing most people miss: it’s rarely just one trigger. It’s the combination. Maybe you slept poorly, had a stressful day, and ate a slice of pizza with extra cheese. Individually, none of those might have done much. Together? They cross your personal threshold. Think of it like filling a glass. One drop at a time doesn’t spill it. But when the glass is already half-full, one more drop-your favorite scent, a loud noise, a skipped meal-and it overflows.

Preventive Medications: Stopping Attacks Before They Start

If you’re having more than four migraines a month, or if your attacks are so bad they disrupt your life for days, preventive medication might be worth considering. 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 - Drugs like propranolol and timolol were originally developed for high blood pressure, but they’re now commonly prescribed for migraines. They work by calming overactive nerve signals in the brain.
• Anticonvulsants - Topiramate and valproate were made for seizures, but they also stabilize brain activity in people prone to migraines. Topiramate can cause side effects like tingling in fingers or weight loss, which some people actually welcome.
• Antidepressants - Amitriptyline, a tricyclic, is often used even if you’re not depressed. It helps regulate pain signals and improve sleep, both of which reduce migraine frequency.
• CGRP inhibitors - These are the newest class, designed specifically for migraines. Drugs like erenumab and fremanezumab block a protein called CGRP that’s involved in pain signaling. They’re given as monthly injections and have fewer side effects than older meds. Many people report cutting their migraine days in half.

Choosing the right one isn’t a guessing game. Your doctor will consider your overall health, other conditions you have, side effect risks, and how often you get migraines. For example, if you have asthma, beta-blockers might not be safe. If you’re trying to get pregnant, some anticonvulsants are off the table. It’s a personalized decision.

Acute Treatment: What to Do When a Migraine Hits

When the pain starts, you need fast relief-not just to feel better, but to stop the attack from getting worse. Delaying treatment often makes migraines harder to control.

Here’s what works:

• NSAIDs - Over-the-counter pain relievers like ibuprofen or naproxen can help, especially if taken early. They’re good for mild to moderate attacks.
• Triptans - These are the gold standard for moderate to severe migraines. Sumatriptan, rizatriptan, and others work by narrowing blood vessels and blocking pain pathways. They come as pills, nasal sprays, or injections. If one doesn’t work, try another-each has a slightly different effect.
• Gepants - Newer drugs like ubrogepant and rimegepant are taken as pills and don’t constrict blood vessels. That makes them safer for people with heart disease or high blood pressure. They’re also effective for nausea and can be used more than once a month.
• Anti-nausea meds - If vomiting is part of your attack, drugs like metoclopramide or prochlorperazine can help. They don’t just treat nausea-they also help with head pain.

Some people find that caffeine helps. If you normally drink coffee, having a small amount at the first sign of pain might stop the attack. But don’t start drinking caffeine just to treat migraines-it can backfire if you become dependent.

Important: Never take painkillers more than 10 days a month. Overuse can lead to rebound headaches, which are harder to treat than the original migraines.

Tracking Your Triggers: The Most Powerful Tool You Have

No medication works unless you know what’s triggering your attacks. That’s why keeping a migraine diary is the single most effective thing you can do.

Write down every day:

• What time the headache started
• How bad it was (1-10 scale)
• What you ate and drank
• How much sleep you got
• Stress levels (high, medium, low)
• Weather changes or travel
• Any medications taken

Use a simple notebook or a free app. Look for patterns over time. Maybe every time you skip breakfast, you get a headache by noon. Or maybe your migraines always happen after a bad night’s sleep during your period. Once you see the pattern, you can adjust.

Consistency matters more than perfection. You don’t need to track every single thing forever. Just for a few months. Then you’ll start seeing what’s really behind your attacks.

When to See a Doctor

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

• Your migraines are getting worse or more frequent
• Over-the-counter meds don’t help anymore
• You have new symptoms like vision loss, confusion, or weakness on one side
• You’re using painkillers more than 10 days a month

A neurologist who specializes in headaches can help you find the right combo of lifestyle changes and medication. Don’t wait until it’s unbearable. Migraines are treatable. You just need the right plan.

What Doesn’t Work (And Why)

There’s a lot of noise out there. Don’t waste time on things that won’t help:

• Just avoiding “trigger foods” - Cutting out chocolate or cheese won’t help if stress and sleep are your real triggers.
• Only using painkillers - They mask the pain, but don’t stop the brain activity causing the migraine.
• Waiting until it’s too late - If you wait until the pain is at a 9/10, it’s harder to stop. Treat early.
• Believing it’s “all in your head” - Migraines are a biological condition. You’re not weak. You’re not imagining it.

Living with migraines doesn’t mean living in fear. You have more control than you think. Start by tracking your patterns. Talk to your doctor about options. And remember-this isn’t something you have to endure. With the right approach, you can take back your days.