Migraines: Triggers and diagnosis

Migraines are a type of headache disorder that can cause severe, throbbing pain, often accompanied by nausea, sensitivity to light and sound, and visual disturbances. Unlike ordinary headaches, migraines are a complex neurological condition with a variety of underlying causes and triggers. Understanding why migraines happen and what can bring them on is an important step in managing them effectively.

Why do I experience migraines?

Migraines are thought to arise from changes in brain activity that affect nerve signals, blood vessels and chemical messengers. While the exact cause is not fully understood, several underlying factors contribute:

Genetics: Migraines often run in families, suggesting a hereditary component.
Brain chemistry: Fluctuations in neurotransmitters, such as serotonin, are linked to migraine attacks.
Vascular changes: Alterations in blood flow in the brain may play a role in triggering pain.
Hormonal influences: Many women experience migraines around menstruation, pregnancy or menopause due to changes in oestrogen levels.

These underlying pathologies mean that some people are more predisposed to migraines than others, but external triggers often determine when an attack occurs.

What triggers migraines?

Migraine triggers vary widely between individuals, but common ones include:

Stress: Emotional tension or sudden relaxation after stress can bring on migraines.
Hormonal changes: Menstrual cycles, contraceptives or hormone therapy may influence migraine frequency.
Dietary factors: Skipping meals, dehydration, caffeine withdrawal, or foods such as aged cheese, chocolate and processed meats.
Alcohol: Particularly red wine, which is a frequent trigger.
Sleep patterns: Too little, too much, or disrupted sleep.
Sensory stimuli: Bright lights, loud noises, or strong smells.
Weather changes: Shifts in barometric pressure or temperature can affect some people.
Medications: Certain drugs, including some used for blood pressure or hormone therapy, may provoke migraines.

Keeping a diary of episodes can help identify personal triggers.

How are migraines diagnosed?

Migraines are usually diagnosed based on symptoms and medical history. A doctor may ask about the pattern, duration and severity of headaches, as well as associated features such as aura, nausea or sensitivity to light. Scans or blood tests are rarely needed unless another cause is suspected.

What treatment options are available?

Treatment is tailored to each person’s needs and may include:

Acute medicines: Painkillers, anti-sickness drugs, or triptans to stop an attack.
Preventive medicines: Beta blockers, anti-seizure medicines, or newer monoclonal antibody injections (CGRP inhibitors) for frequent or severe migraines.
Lifestyle adjustments: Regular sleep, stress management, and identifying and avoiding triggers.

When should you see a doctor?

If headaches are severe, frequent, or interfere with daily life, medical assessment is essential. Some migraine symptoms overlap with more serious conditions, so urgent advice should be sought if headaches are sudden, very severe, or associated with weakness, speech problems or vision loss.

Migraines are a neurological condition with both internal and external influences. By understanding the underlying factors and recognising triggers, patients can work with specialists to reduce the frequency and severity of attacks and regain control over daily life.