Although much about the cause of migraines isn't understood, genetics and environmental factors seem to both play a role.
Migraines may be caused by changes in the brainstem and its interactions
with the trigeminal nerve, a major pain pathway. Imbalances in brain
chemicals, including serotonin — which helps regulate pain in your
nervous system — also may be involved.
Serotonin levels drop during migraine attacks. This may trigger your
trigeminal system to release substances called neuropeptides, which
travel to your brain's outer covering (meninges). The result is headache
pain.
Migraine headache triggers
Whatever the exact mechanism of the headaches, a number of things may trigger them. Common migraine triggers include:
- Hormonal changes in women. Fluctuations in estrogen
seem to trigger headaches in many women with known migraines. Women
with a history of migraines often report headaches immediately before or
during their periods, when they have a major drop in estrogen. Others
have an increased tendency to develop migraines during pregnancy or
menopause. Hormonal medications — such as oral contraceptives and
hormone replacement therapy — also may worsen migraines, though some
women find it's beneficial to take them.
- Foods. Some migraines appear to be triggered by
certain foods. Common offenders include alcohol, especially beer and red
wine; aged cheeses; chocolate; aspartame; overuse of caffeine;
monosodium glutamate — a key ingredient in some Asian foods; salty
foods; and processed foods. Skipping meals or fasting also can trigger
migraine attacks.
- Stress. Stress at work or home can instigate migraines.
- Sensory stimuli. Bright lights and sun glare can
induce migraines, as can loud sounds. Unusual smells — including
pleasant scents, such as perfume, and unpleasant odors, such as paint
thinner and secondhand smoke — can also trigger migraines.
- Changes in wake-sleep pattern. Either missing sleep or getting too much sleep may serve as a trigger for migraines in some individuals, as can jet lag.
- Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
- Changes in the environment. A change of weather or barometric pressure can prompt a migraine.
- Medications. Certain medications can aggravate migraines, especially oral contraceptives and vasodilators, such as nitroglycerin.