The last few years have been undeniably stressful. So, if you’ve noticed an uptick in migraine attacks, stress could be the culprit.  But, the complete list of migraine triggers is long and very much based on your unique makeup. One thing is for sure, migraine attacks often happen when you deviate from your routine, says Nada Hindiyeh, MD, a headache specialist and clinical assistant professor of neurology at Stanford University.

“By far the most common trigger that we see is stress and about 70 percent of people with migraine are going to report that,” says Dr. Hindiyeh. “But so many other things can be triggers. One of the most important things I actually recommend to people with migraine or headaches is a really routine lifestyle because when you get thrown off or your brain gets thrown off, that’s when a lot of migraines can happen.”

It’s safe to say that from the start of the COVID-19 pandemic until now has been a pretty rocky ride. Routines have come and gone and changed multiple times over the last few years, and that’s had an effect on people with migraine.

“Because people have been, throughout this pandemic, thrown off of their routine, a lot of these things start to come into play,” says Dr. Hindiyeh. “You’re no longer going to the office at the same time, waking up at the same time, eating at the same time.” She explains that these changes in routine trigger hormonal changes and neuropeptide changes in the brain. “When you get triggered down that neuronal pathway, one of the pathways that get triggered is pain, because the brain senses something is off or different.”

Let’s back up, what exactly is migraine?

Before diving into the long list of migraine triggers, it’s important to know the textbook definition of migraine, says Stephen Silberstein, MD, director of the Headache Center at Thomas Jefferson University in Philadelphia.

“A migraine is a headache, but it has certain characteristics; a Picasso and a Rembrandt are both paintings, but they have different characteristics,” says Dr. Silberstein. “If you have a severe headache that comes and goes, that interferes with your life it’s more than likely migraine. The characteristics are moderate to severe, often throbbing. You don’t feel like moving about, it’s often one-sided, you’re often sick to your stomach, [and] you may have a sensitivity to light or sound.”

Adelene Jann, MD, migraine specialist and clinical assistant professor in the Department of Neurology at NYU Langone Health, says migraines typically last anywhere from four hours up to three days. Genetics also play a role. Dr. Jann says women are more likely to experience migraine than men. Dr. Hindiyeh adds that migraine is hereditary. “It’s a genetic disease, it’s hereditary, so people are born with a predisposition to having a hyperexcitable or hypersensitive brain,” says Dr. Hindiyeh.

With that said, to prevent migraine attacks, it’s important to understand your triggers. Explore the list of migraine triggers, below.

Here’s a list of potential migraine triggers related to changes in routine

1. Dehydration

“Dehydration is a big one, especially in the summer when it’s hot,” says Dr. Hindiyeh. To make sure you’re getting enough water, consider setting reminders or investing in a big water bottle.

2. Changes in weather

Many feel that they can predict the weather with their migraines. Dr. Hindiyeh says that for a lot of people, changes in weather, hot weather specifically for some and cold weather for others, can cause a migraine.

3. Skipping a meal

“Skipping a meal can be a big trigger as well,” says Dr. Hindiyeh. “We have people really routinely eat their meals at the same time every day.”

4. Changes in sleep

“Changes in sleep are another very, very big trigger,” says Dr. Hindiyeh. “It’s really about consistency.” You’ll want to make sure you’re going to bed at the same time every day, waking up at the same time every day, and not napping.

5. Hormonal changes

Menstrual cycles can also play a huge role. “We oftentimes see migraine first start in girls right around puberty around the time of their menarche,” says Dr. Hindiyeh.  She says many experience more frequent migraines around their period. “For two-thirds of women, after menopause is when things actually get a lot better.”

6. Certain medications

“If you’re overusing certain medications, certain over-the-counter medications, or even migraine prescription medications, they can cause worsening or increased frequency of migraines,” says Dr. Hindiyeh. “Think about Advil or Tylenol. You think ‘Oh yeah, I can use that every once in a while.’ But when you start to use any of these more than 10 days a month, they can trigger more and more and more migraines.”

7. Extended screen time

“During this time people are on their screens—on their computers, on their iPad, on their phones—more than ever before,” says Dr. Hindiyeh. “Life has really shifted to a model where we have to use those constantly. And so the bright light from the screen or that constant need to be in front of it and trying to focus, that can be a huge trigger. I really recommend that people take breaks from it at least once every hour. Getting up and moving away from your screens.”

8. Skipping workouts

“One of my favorite things actually to help prevent migraine, and I can’t recommend this enough, is daily aerobic exercise,” says Dr. Hindiyeh. “So we know that daily aerobic exercise will help prevent migraines. But [for] people [who] aren’t able to go to the gym and maybe for them, a home workout isn’t as successful. Being thrown off that routine can be a big, big trigger as well.”

How to identify your triggers and get help

Migraine attacks can often have more than one trigger. Dr. Jann recommends tracking your migraines to try to pinpoint triggers.

“Keeping a headache diary can help track the frequency of your migraines and whether or not they are associated with common triggers, like menstruation, the weather, or certain foods,” says Dr. Jann. “The diary can be done on paper or on app on your phone. Be sure to bring your headache diary to your doctor’s appointment so that the doctor can review it and come up with treatment options.”

If the thought of tracking your migraines stresses you out, Dr. Hindiyeh says just being self-aware can help. “If you know that you’re on a very strict routine, you haven’t changed your sleeping schedule, you haven’t skipped any meals, you haven’t done this, but maybe you realize ‘okay, well I’m spending so much more time on the screen, something feels different,’ then that certainly can be playing a big role.”

Unfortunately, many people with migraine go untreated, but Dr. Silberstein explains that there are a lot of treatments available. “There are things like yoga, biofeedback, and meditation,” says Dr. Silberstien. “They enable you to stabilize your brain, they can actually relieve and prevent migraine. And there are new devices that are noninvasive which can be applied to your arm, your head, or your neck, and actually prevent and turn off a migraine attack.” Be sure to check in with your doctor and explore all of your options.