Migraine Triggers You Might Be Missing and How to Spot Them

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What if a major migraine trigger is one you've never noticed? Welcome to Migraine Heroes,

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a podcast for anyone living with migraine and wondering why nothing has fully worked yet.

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I'm Diane Ducarme. Over the past seven years, I've helped hundreds of people living with migraine.

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What I've learned? No two migraine stories are exactly the same, and none of them are simple.

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That is why, in this podcast, we explore migraine from many different angles.

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Food, hormones, stress, sleep, the nervous system, emotions, and much more, through the lens of both

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modern science and traditional Chinese medicine. A quick note before we start. What we talk about

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here is educational. For anything related to diagnosis or medication, please keep working

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with your doctor. Now take a deep breath and let's dive in. Today, I'm not going to spend 20 minutes

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explaining what a migraine trigger is, and I'm not going to give you a complicated neurological

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lecture. And I definitely do not want you to finish this episode with a gigantic list of things

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you're suddenly afraid to eat, to drink, or to do. This episode is much simpler. I want to give you

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a scan, a long list of things that can be worth observing, simply so you can say,

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Oh, I never thought about that. And for the more difficult ones, I will give you a hack on how to

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know if this might be you. Now, no obsession, but sometimes it's hard to be in the mountain and to

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see the mountain. So I hope you find a small gem in this episode for you. But before we start,

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there's one very important principle I want to introduce. And to explain why I want to approach

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triggers this way, I want to tell you about Deirdre. So Deirdre was one of the very first

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people I helped. And when I met her, she had been living with migraine for around 40 years,

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40 years. She had also lived through years of depression, antidepressant treatment,

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and extremely frequent use of acute migraine medication, including Triptans. Her medication

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use had become very high, something that of course needed careful medical supervision,

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because frequent acute medication can in itself complicate migraine. So when I first welcomed

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Deirdre and told people around me that I believed I could help her, I remember feeling incredibly

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humbled. Because you have to imagine what it means to meet someone who has been carrying this

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for decades, someone who has spent such a huge part of her life in pain, someone who's been

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trying for years and years simply to function, to show up, to be a good person, to be the best

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version of herself. And Deirdre was incredibly sweet. There was something about seeing how hard

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she had fought, and it really stayed with me. I remember her saying, you know, midway into it,

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she says, thank you so much for continuing to power through with me. Most people abandon because

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I'm such a complex profile. Now, this is where the story becomes really important for today's

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episode. Because back then, I had made a very deliberate decision. I was not going to teach

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people long lists of migraine triggers. I genuinely thought, what's the point? You know, people with

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migraine are already told to avoid everything, avoid wine, avoid cheese, you know, chocolate and

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alcohol, you know, stop living all together. And I thought, I do not want Migraine Heroes to become

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another program that gives people an even longer list of things that they are no longer allowed to

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do. Because the Migraine Heroes method works differently. Our starting point is not, what can I

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remove? Our starting point is, what can we add? When we work with food, for example, we're not

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only interested in foods that may be associated with attacks, we're equally interested in discovering

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the foods that seem to help your particular body become more stable and more resilient.

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I sometimes call these your D triggers. The idea is simple. If certain combinations of sleep,

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stress, food, hormones, hydration, environment can make you move closer to an attack,

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then we also want to investigate what seems to move you in the other direction. And this is the

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way of thinking that eventually became part of the Migraine Heroes method. Now, back to Deirdre,

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because something happened with Deirdre that made me rethink that quite completely. So one day after

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Deirdre had already made really substantial progress, she suddenly had a massive migraine

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that lasted three full days, three full days bedridden. And I remember asking her, what happened?

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I was trying to understand patterns, trying to understand what helps, trying to understand

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what could make someone suddenly go backwards after making such progress. And Deirdre said

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something very simple. And she told me that she had eaten with a few friends a Thai green papaya

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salad, sometimes topped with cheese, quite a spicy Thai dish. And I remember this horrible

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sinking feeling because spicy food was something I had already identified as a possible trigger for

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one of her particular patterns. I knew it was worth watching, but she did not. And my immediate

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reaction was guilt. I thought, oh no, I knew this information and she didn't. Now, of course, I could

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never know with certainty that the spicy food caused those three days of migraine. But what

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stayed with me was something else. She had not been given the information that might have helped

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make the connection herself. And that bothered me enormously. You need to imagine me tossing and

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turning in my bed. And that's how deeply I care. Because I had been so focused on not making people

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afraid of triggers that I had gone too far in the other direction. But there had to be a middle

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ground. You don't need to obsess over triggers when you're building in the things that support

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you. You do not need to build your life around avoidance. You do not need to remove 20 foods

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because they appear on somebody else's migraine list. But if there's something that you're consuming

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or doing regularly, or even on occasions, but you don't like so much that repeatedly seem to

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coincide with your attacks, then you deserve to know that it's worth observing. And so from that

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point onward, I changed the method and I added triggers into the Migraine Heroes app. Not because

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I wanted people staring at red flags all day. Not because I wanted migraine management to become

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restrictive. But because I wanted people to be able to say, ah, I'm having this today. Let me

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simply notice what happens. And we would still lead with addition. But we would also make sure

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you had visibility on the common things that might be working against you. And I've never forgotten

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those three days with Deirdre. And it is exactly why I want to give you this list today. Not a list

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to fear. A list to scan. You might hear a whole family of triggers and recognize none of them.

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Perfect. Or one line might make you think, wait, I do that all the time. And that's the purpose of

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this episode. Not elimination. Awareness. Now back to Deirdre. Over time, her migraines did improve.

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And she experienced meaningful reduction in both frequency and intensity. And something else

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happened too. She changed. She lost weight. She was going out more. Her eyes were shining and lighting

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up her face. There was life. There was possibility. And the people around her are starting to comment

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as well. There was more of her again. Now, as you can imagine, brace yourself. This list is long. So

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instead of throwing a hundred different triggers at you one by one, I'm going to group them into

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families. Some of these have strong evidence. Others are things people report again and again.

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Both are worth knowing about. And neither means it applies to you. And I'm going to do this on a

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slightly more joyful note. Because, well, migraine triggers are not exactly a joyful topic. So I'm

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going to bring as much lightness, simplicity, and humanity to this as I possibly can. Okay?

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Let's meet the trigger families. Now, first family, of course, stress and emotional triggers. We're

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going to start with the one everybody knows about. And the twist almost nobody knows. So stress,

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anxiety, or anger, emotional distress, major life changes, mental overload, and then the surprising

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one, the letdown after stress. So tiny hack. If your attacks love to arrive on a Saturday morning,

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or the first day of a holiday, or right after a big deadline, notice that it's not stress itself,

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it's the moment your body finally lets go. So we have in this family, stress, letdown after stress,

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anxiety, anger, emotional distress, major life changes, and mental overload. Second family,

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sleep and routine. Now, this is the family that likes things predictable. Now, too little sleep,

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too much sleep, poor quality or interrupted sleep, shift work, jet lag, and changes in your schedule

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or daily routine. So tiny hack. Oversleeping is the sneaky one here. If the weekend light in you

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were looking forward tends to end with a headache, that's worth noticing that change in rhythm can

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matter as much as the amount of sleep. So in this family, we have sleep deprivation, oversleeping,

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poor quality sleep, interrupted sleep, changes in sleep schedule, shift work, jet lag, changes in

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daily routine. Third family, hormonal trigger. So this family, of course, is going to mostly concern

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women and it moves through life with you. So it can be your period, the days before, ovulation,

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pregnancy or hormonal contraception, perimenopause and menopause, and other shifts,

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mainly in estrogen. So here, the tiny hack is not to cycle day next to your attacks for two or three

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months if you can. Many women only see the pattern once it's written down. And if your migraines

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change when you started, stopped or switched contraception, that's worth really mentioning

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to your doctor. And I would even add as early as possible. So in this family, we have menstruation,

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premenstruational hormonal changes, ovulation, perimenopause, menopause related hormonal

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fluctuations, pregnancy related hormonal changes, breastfeeding related hormonal changes, hormonal

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contraception and other estrogen fluctuations. Fourth family, food and eating patterns. And now

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food, which, as you know, now we approach quite differently admiring heroes. First, when you eat.

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So skipping meals, fasting, long gaps between meals, dieting, very large meals and changes in meal

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timing. Then there's the what you eat. Aged cheeses, the processed meats, the nitrates, the MSG,

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so monosodium glutamate, the aspartame, chocolate and spicy food, well, they're very spicy Thai dish.

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And finally, foods you might be individually sensitive to, which no list in the world can name

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for you. Now, tiny hack number one, when an attack starts, ask yourself, when did I eat last? Before,

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what did I eat? And for many people, the gap matters more than the plate. Tiny hack number two,

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chocolate is a fascinating one. Sometimes the chocolate craving is not the cause. It's an early

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sign to an attack that is already on its way. So if you notice that craving, it might be your body

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sending a message rather than chocolate causing the problem in itself, or at least making the

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problem worse. So we have, I'll recap, we have skipping meals, fasting, intermittent fasting,

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long gaps between meals, dieting or calorie restriction, large meals, changes in meal timing.

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Then we have the aged cheeses, the processed meats, the monosodium glutamate, so the MSG,

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the aspartame, the nitrates and nitrates, the histamine-rich foods, the gluten for certain

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people, dairy for others, chocolates and other individual sensitive food, and of course, spicy

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food for some. Now we get to the fifth category, drinks and hydration. That's a short family, but

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a really important one. So we have things like dehydration or alcohol. Red wine in particular

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is the only anonymous migraine trigger in the world. Too much caffeine, according to science,

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too much caffeine or caffeine withdrawal and sudden changes in how much caffeine you have.

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And note that this one is highly individualistic depending on how your body processes caffeine.

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Now, tiny hack, if you get headaches on weekends or holidays, when your coffee comes later than

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usual, caffeine withdrawal might be part of the story. It's not about giving up coffee,

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it's about noticing whether your body likes consistency. So we have again, dehydration,

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alcohol, red wine, excess caffeine, caffeine withdrawal, sudden changes in caffeine intake,

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but also complex smoothies. So that's complex to understand. Search my podcast for this topic.

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Excess intake of kombucha, again, a complex one. And we'll also add a flat white of a divine

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little latte. It also can create more brain fog. Okay, then we go into weather and environment.

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Now, this is the family we cannot control at all, which is exactly why it helps to know about it.

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Changes in barometric pressure or rapid weather changes or heats or colds, high, low humidity,

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storms, altitudes, and air travel. They can all create small disasters. Now, tiny hack here,

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many weather apps will show you barometric pressure. This is actually something I'm working

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on for the Migrant Heroes app. If you check it on your attack days for a few weeks, you might see a

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pattern. Knowing a pressure drop is coming, it's not going to change the weather, but it lets you

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protect everything else that day, sleep, meals, water intake. So in this category again, thank you

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barometric pressure, rapid weather changes, heat, cold. In particular, by the way, when I say heat,

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I mean really summer heat. That can be a really nasty one with those heat waves, high humidity,

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low humidity, storms, altitude changes, and air travel. Here again, for more details on air travel.

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I'm going to put all of the links because there's many podcasts on each of these subtopics in the

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show notes. Now, seventh category, seventh family, light and visual triggers. So that's the family

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that comes in through the eyes. We're talking here about bright lights, sunlight, glare,

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flashing or flickering lights. Some people talk about their kids playing with toys that are

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flickering. Fluorescent lighting, screens, iPhones, computers, high contrast patterns,

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and fast moving images. Tiny hack. So try to compare a heavy screen day with a lighter one.

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And here too, light sensitivity can sometimes be an early sign of an attack rather than the cause.

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But in saying that, it can also what brings you over the edge, right? So if light suddenly feels

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too much, notice whether an attack follows and maybe just go for a walk. Again here, the way we

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look at things is so important because many of you work and your work is really bringing your

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financial independence. So it's a tricky one to function in society these days. So it's important

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to get to the root cause of it. But meanwhile, just trying to manage it. For example, if I'm

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completely honest, it's a very sunny day and I'm in a room that is quite white today in my son's

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room. It has the best acoustic. We just moved and it's more tiny. And with his bed, there's enough

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furniture. But I'm wearing my sunglasses therefore because there's just a lot of light and I have

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both the screen and the light of the sun. So in this family again, bright light, sunlight, glare,

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flashing or flickering light, fluorescent lighting, screens, high contrast visual patterns,

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rapidly moving visual images. Family number eight, smell and air quality triggers. Now,

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this is the ones your nose file under. Oh, very nice. And your brain files under. Oh no, not again.

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So here we have the perfume, the scented candles and the air freshener, the cleaning products,

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the paint, the gasoline fumes and strong cooking smell and cigarette smoke, including secondhand

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smoke. OK, so here we have the tiny hack. Think about cleaning day, the perfume section of a

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department store, a really stuffy, smelly hotel with the scent or a teenager store that has a

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strong scent or the colleague with the strong fragrance. Any of those come before your attacks.

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So here we have again perfume. We have cleaning products. We have paint fumes, gasoline fumes,

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cooking smell, scented candles, air fresheners, cigarette smoke, secondhand smoke. Family number

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nine, sound and sensory overload. Now, sometimes it's that one thing. It's everything at once.

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So loud noise, sort of repetitive noise, crowds and many stimuli that come at the same time.

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So a tiny hack. Notice the day after a busy event, not just the evening itself, but sometimes

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overload. It can show up later. So again, think loud noise, repetitive noise, crowded environments,

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concerts or clubs, multiple simultaneous sensory stimuli. Family number 10, physical and musculoskeletal

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triggers. Now let's talk about the body itself, the neck tension, the posture, those long periods sitting.

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Yeah, so tiny hack number one. If you wake up with a sore jaw or tired teeth, you might be grinding

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at night. A dentist can actually tell you and or maybe so can a partner. Tiny hack number two, neck

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pain is tricky. It can be a trigger, but it can also be one of the first signs of an attack. So

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notice whether the tension comes first or lingers or arrives together with the migraine. Okay, so in

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this family again, we have the neck pain or neck tension, the poor posture, the jaw clenching, the

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teeth grinding, prolonged sitting, certain neck movements such as, for example, tilting the head

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forward, heavy lifting, strenuous exercise, physical exhaustion, sexual activity. I haven't done a

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podcast on this topic yet, but I'll put it on my list because I think this is an important one.

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So keep an eye for it. Family number 11, hang in there. There are 12. Okay, it's a lot of families.

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I'll give you that. So illness and body stress. So this is when your body is already fighting

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something. It can be infections, fever, the general strain of being unwell. So no hack here, just

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kindness. If you're ill, your threshold is probably lower. That's the reason to be gentle with

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yourself, not to over-analyze. Here we have infection, we have fever, we have head trauma,

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like traumatic brain injury, TBI, also called concussion, whiplash, long COVID, and emotional

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trauma. They can be quite nasty. Some of them are short. Some of them can really put you backwards

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a long time. If this is you, all of my thoughts with you, these are really not easy. They're

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very creepy and they really need a good revamp of the body. Okay, and last but not least, medications.

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And so this is the last family. I'm not going to start listing medication classes here because this

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is really something to discuss with your doctor, but there is one important point to know. Sometimes

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a medication that is helping you can, depending on the medication and how often it is used,

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also contribute to more frequent headaches or lower your migraine threshold. So this is

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particularly well established with the frequent use of certain acute migraine and over-the-counter

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pain medications, where we have recognized condition called medication overuse headache.

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Again, I've done a podcast on this topic. In the case of Deirdre, these were the tryptons, right?

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It's a chicken and egg. Of course, this is very difficult. And also, medication taken for other

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reasons can also sometimes be associated with headache as a side effect as well. So if you

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notice that your migraine became more frequent after starting a medication, changing the dose of

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your medication, or using a particular medication more often, that is absolutely worth bringing to

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the conversation with your doctor. Not to stop it on your own, not to assume the medication is the

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cause necessarily, but simply to ask, could this medication or the way I'm using it be contributing

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to my headaches and migraines? So this is a very reasonable question to ask. So that's the scan.

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Now, if nothing else that you already know rang a bell, perfect. You've just ruled a lot of other

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things, right? And if one or two made you stop thinking, huh, that's me, don't turn your life

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tomorrow. Just notice the next time it happens, ask yourself what came before. Because a list

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tells you what's common. It can't tell you which ones are yours. And with Deirdre, it was spicy

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food. For you, it might be nothing on this list, or it might be three small things that only matter

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when they happen together. A short night, a skipped lunch, and a pressure drop on the same day. Now,

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because I've recorded close to 200 episodes, many of the things on this list have an episode on

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their own. Sleep, hormones, weather, caffeine, stress. So next to each family, you'll find the

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episodes that go deeper. And I want to end on something important because I promised you

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this wouldn't be a list of fear. In all our years of working with people, we have never told anyone

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to eliminate everything on a list like this. Never. We help people pay attention to the few

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things that seem most connected to their patterns. And at the same time, we build up the other side.

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The foods, the habits, the rhythms that help their body become more stable. They're D-triggers. And

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as that side grows, something lovely often happens. Things that used to feel risky can be enjoyed

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again, in moderation, of course. Now, I'm thinking of Amanda, based in Canada, who, after years of

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avoiding alcohol, had told her husband, I'm going to take three days off and try to have a cocktail.

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She was so sweet, and she hadn't had a migraine, and so she could finally enjoy a cocktail again

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without spending the next days in bed. So that's what we're working towards. Not a smaller life,

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a bigger one. That's all for today. I hope this episode helped you notice some new things.

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If you'd like to keep exploring your patterns, you can find us on MigraineHeroes.com.

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Your body has a story to tell. Let's keep listening. I will be back with you soon.