Chronic or High-Frequency Migraines: What Are the Triggers?

Medically Reviewed by Melinda Ratini, MS, DO on April 23, 2024
7 min read

Migraine is a nervous system disorder that most commonly causes a throbbing headache on one side of your head that can last from hours to days. It can also make you more sensitive to light, smells, and sound. If you have symptoms at least 8 days out of the month, you may have either chronic migraine or high-frequency migraine.

Chronic migraine means you have headaches on more than 15 days of the month for at least 3 months and 8 of those days have migraine features. High-frequency episodic migraine means you get 8 to 14 headache days per month and are more likely to develop chronic migraine.

It’s not always clear what causes a migraine, but there are certain things that seem to “trigger” an attack.

One way to try to manage migraines is to figure out your triggers. This becomes particularly important when you get migraines more often, as happens in people with chronic or high-frequency migraine. Triggers can be different for each person, but there are a number that are more common.

A migraine trigger is something that happens or something you do that leads to a migraine attack. A trigger can cause a migraine anywhere from 6 hours to 2 days after the fact.

It’s not always easy to identify your own triggers or even to tell a migraine trigger from a symptom. For example, say you notice that you get a headache (or other migraine symptom) when you skip a meal. That doesn’t mean the skipped meal necessarily caused the headache.

So did the skipped meal cause your migraine attack? Or was it simply an early symptom of the migraine attack? It depends. It could even be a bit of both. And in some cases it may be that a certain combination of factors -- say a stressful day plus a skipped meal -- turns out to be a trigger.

Unmanaged health and lifestyle issues that persist over time, like stressful work or home life, regular lack of sleep, and migraine linked to menstruation, may be more likely to lead to chronic or high-frequency episodic migraine. But scientists need more research to be sure.

One of the best ways to try to figure out what triggers your migraine is by keeping track of your symptoms in a journal. That means not just the nature of your symptoms, but also when they happen and how serious they are, and what may have triggered each attack. You can do this in a simple notebook or using digital applications like writing software and apps. There are even apps designed specifically for keeping track of migraine symptoms. Regarding the migraine itself, it may help to keep track of:

  • Specific symptoms: nausea, light sensitivity, headache, etc.
  • Time and date of migraine onset, divided into aura, headache, postdrome, etc.
  • Length of particular stages of migraine
  • Level of pain on a scale from 1 to 10
  • Location of pain

Regarding possible triggers, it helps to keep track of:

  • Amount of sleep the night before migraine
  • Stress leading up to migraine and cause of stress
  • Weather (e.g. barometric pressure changes) leading up to migraine
  • Diet leading up to migraine: What did you eat? When did you eat? Did you skip any meals?
  • All medications you take: Prescriptions, OTC pain meds, and even supplements
  • Timing and amount of all meds in relation to migraine
  • Women should note the timing of their period in relation to a migraine attack

Bring your migraine journal with you to consult with your doctor about treatment and lifestyle changes that might improve your symptoms.

Stress: It’s one of the most common triggers. Scientists think it may have something to do with the chemicals your body releases in the stress response (“fight or flight”). Stress can also raise muscle tension and stretch blood vessels in a way that can trigger or worsen migraine attacks.

What to do: Make a list of things that cause unnecessary stress in your life (a certain amount of stress is necessary and even healthy) and try to address them on your own or with a mental health therapist. Breathing exercises, yoga, meditation, and regular exercise can all help reduce your body's response to stress. A regular sleep schedule helps too.

Hormone changes: Migraines are often worse if you’re a woman around the time you get your monthly period. The drop in estrogen can be a trigger as can the hormones in birth control pills or hormone replacement therapy.

What to do: If you’re a woman and you notice more migraine attacks (or worse symptoms) around your period, talk to your health care provider. They may be able to suggest helpful changes to your lifestyle or diet or make changes to your birth control or hormone therapy that may help lessen the number or intensity of migraine attacks. They may also suggest medications to take to help prevent or abort a menstrual migraine,

Caffeine: Caffeine withdrawal is a well-known trigger for migraine. In fact, many OTC headache and migraine medications contain caffeine. So if you normally take in a certain amount of caffeine from coffee, tea, or other sources each day, it’s best to maintain those levels. If you want to lessen your caffeine intake, do it gradually so that your body can get used to it. Too much caffeine may also be a trigger for migraines or worsen symptoms in some people.

What to do: Pay attention to what happens when you skip your normal caffeine intake. What happens when you have an extra coffee or caffeinated energy drink? If you think there’s a connection to migraine attacks, consider tracking your intake in a journal, and adjusting your intake to keep attacks down.

Sensory stimuli: Loud noises, strong smells like perfume and tobacco smoke, or even bright, flashing lights seem to trigger migraines in some people.

What to do: Think ahead to when you might run into these types of triggers. Sunglasses can help with bright or flashing lights and ear plugs or hearing protection can help if you know you’re going to be somewhere loud. If strong smells are the problem, avoid them when possible. You can also tell co-workers or family members about your condition and ask them not to wear strong perfume or cologne.

Food: Some people feel that certain foods and preservatives -- tyramine (a natural compound found in aged cheeses, certain alcohols, cured or processed meats, fermented veggies, and tropical fruits), nitrates, MSG -- lead to migraine attacks. But the science on this is not yet clear. In some cases, it may be that you crave certain foods at the beginning of a migraine and after you eat them, you mistake them for the cause.

What does seem clear is that skipping meals or eating an unbalanced diet can trigger migraines and worsen symptoms in some people.

What to do: Don’t skip meals. Regular mealtimes and a healthy well-balanced diet can go a long way in preventing migraine attacks for many people. You can also try to avoid specific foods that seem to trigger your attacks. But consider using a detailed journal to try and figure out whether the food in question is a trigger or simply a craving you get at the onset of a migraine. Some people also adopt a special diet to eliminate foods thought to trigger migraines. Ask your doctor about specific diets that might be right for you.

Sleep problems: Lack of sleep seems to be a common trigger for migraines. But too much sleep can have the same effect. Pay attention to how your sleep patterns seem to affect the timing and intensity of your migraine attacks.

What to do: Aim for a bedtime that is as consistent as possible. Most adults should shoot for between 7 and 9 hours of sleep a night, but there might be slight variations depending on the person. Start a calming routine leading up to bedtime in which you avoid caffeine, fatty foods, and alcohol, and shut off electronic devices. You can try a bath or some breathing exercises to help set the tone. Talk to your doctor about other possible treatments if your sleep problems won’t go away with these strategies.

Weather changes: There’s some evidence that changes in the weather can be a trigger for migraines. In particular, changes in barometric pressure may lead to a higher frequency of attacks. Storms and very hot weather may also play a role.

What to do: You can’t control the weather. But you can watch it. When you see migraine trigger conditions on the horizon, plan accordingly. If hot days seem to be a trigger, try to adjust your schedule so that you can stay inside in the air conditioning during the heat of the day. Talk to your doctor about how to use your medication to head off a migraine attack when you know a weather trigger is on the way.