Beyond Migraine Podcast — Episode 4: Understanding Migraine Triggers

This article is part of a sponsored series linked to each Beyond Migraine podcast episode brought to you by the Migraine Association of Ireland and Teva Pharmaceuticals Ireland. Please tune in to hear more on these topics and encourage people you are treating for migraine to listen in.

According to Dr Sinead Beirne, GP at Dublin City GP practice, GP Lead at St Vincent’s University Hospital Headache Clinic and TV and Radio medical expert, ‘the most common migraine triggers include stress, hormones, exercise, diet, sleep changes and sensory stimulation’. Dr Beirne was speaking on the latest Beyond Migraine podcast episode where she was in conversation with host, Debbie Hutchinson, and former Miss Ireland and social media influencer, Aoife Walsh, about what can trigger an attack, and how sufferers can manage these triggers.

Migraine triggers are rarely standalone causes for migraines, but they can help to bring about a migraine attack. Triggers are highly individual, and a person can build up a battalion of possible triggers throughout the day, leading them over their migraine threshold and thus triggering a migraine.

Dr Beirne advised that people with common migraine triggers should follow a routine. “They should go to bed at the same time every night, get up at the same time every morning, ensure they have a good diet, and keep hydrated during the day, take a mild to moderate amount of exercise to help keep migraines at bay and help cope with stress, and people living with migraine should also consider practising mindfulness.”

Aoife can relate to this as her migraines started when she was completely out of routine. “I was travelling a lot, over and back between Dublin and New York. My sleep pattern was all over the place. I was either getting too little sleep or too much sleep or I was jet-lagged all the time. That’s when I really started to experience migraine. I remember the first time I got a migraine, I was in Dublin, after returning from New York, it was the middle of the night. I couldn’t sleep because I didn’t know what time of day it was. My body-clock was all over the place and I got hit by this excruciating pain in my head. And when you haven’t experienced a migraine before, you’re like, what is going on when my head is about to explode?”

“A bad sleep routine or stress are the main migraine triggers for me. If I’ve had a bad night’s sleep or a restless night’s sleep, I’d wake up and the beginning of the migraine would already be there, lingering and lurking, and by the afternoon, I would be out for the day. I’d have to close the curtains, have my eye mask on and ear plugs in. It would completely disrupt my whole day due to the lack of sleep”, continued Aoife.

Keeping a migraine diary helped her identify her triggers and solidified the fact that her migraines were very much related to sleep patterns. They also related to general anxiety and day-to-day worries and everything that then comes with that.

Dr Beirne confirmed that a headache diary is important in trying to identify your triggers. They can help identify if the cause is stress or diet or exercise. She also said that dietary triggers are really interesting. “I think it was very much the old thinking that cheese or chocolate might trigger a migraine and for some people they certainly do. There can be a little bit of confusion around this. Twenty-four hours before somebody gets a migraine, they can often have a prodrome, which is where they can crave certain foods. Typical signs of prodrome would be yawning or maybe craving carbohydrates, and sometimes the person can think that the food that they craved caused the migraine. But, in fact, they were having a prodrome that was about to lead into a migraine. So, we can falsely accuse some foods of causing migraine when this might not be the case.”

That’s where the migraine threshold plays a part. A stressful day at work could mean you are not hydrating properly, eating irregularly and the glass of red wine you had to unwind when you got home could have sent you over your ‘migraine threshold’ and trigger an attack. Reassessing your work-life balance, adopting a healthier lifestyle, implementing stress-reduction techniques and regular exercise could have better outcomes in terms of reducing your migraines in the long run.1

“I hate saying it, but you’ve got to have a boring life when you’ve got a migraine. However, there are times in life when a person will have busier periods, and at those times you need to make sure if you’re not getting enough sleep, that your blood sugars are okay by eating regularly. You need to try to mitigate other triggering factors, as a build up of triggers can be what leads to a migraine”, advised Dr Beirne.

Aoife said that going to her GP was very beneficial to her. “My GP told me to keep a headache diary to help narrow down and identify my triggers. He also suggested that I list out all my medications, any vitamins or supplements I was taking, and write down my diet. He also told me to write down if had family history of it, which I do, because my Mum gets migraines as well, so that was all very helpful in learning about the migraines, and what was going to be triggering them.”

Dr Beirne added: “It’s amazing how long people can suffer unnecessarily, so I really encourage people to empower themselves, and go and see your GP if you are someone who suffers from migraine.”

You can listen to the Beyond Migraine episode featuring Dr Sinead Beirne and Aoife Walsh here.

The series can be streamed via the Migraine Association of Ireland website, as well as wherever you listen to your podcasts.

For more information on migraine, you can visit Neurologybytes. This is an online news and education platform dedicated to neurology, where healthcare professionals working in neurology can discover bite-sized content on the latest developments, with a particular focus on migraine and MS. Read more about migraine on www.neurologybytes.ie.

The Beyond Migraine podcast is supported by funding from Teva Pharmaceuticals Ireland. Speakers have received an honorarium for their contribution to the podcast.