Almost everyone with migraine has a list of things they suspect. Red wine. Stress. Bright lights. Cheese. The list is usually assembled from bad experiences and from things read online. It may or may not reflect what is actually driving their attacks.
This is not because people are bad at recognising their triggers — it is because migraine triggers do not work the way most people expect them to.
A trigger is not a direct cause. It is a factor that, in combination with other factors, pushes the nervous system over its threshold for generating a migraine attack. The threshold itself changes depending on how rested you are, what hormonal phase you are in, how much stress you have been under, and other factors that interact in complex ways.
This explains why red wine triggers a migraine on some occasions but not others. It is not that red wine is inconsistently a trigger — it is that the same exposure has different effects when the baseline threshold is different. One glass after a poor night's sleep during a stressful week will hit very differently from one glass when you are well-rested and relaxed.
Research published in the Journal of Neurology in 2023 noted that "repeated and prolonged activation of the trigeminovascular system" through unrecognised triggers may actually lower the threshold over time, potentially contributing to an increase in attack frequency.1 The practical implication: identifying your triggers is not just about managing individual attacks — it may also affect the long-term course of the condition.
A study by Park et al., published in PLOS ONE, analysed 4,579 days of smartphone diary data from 62 migraine patients over three months. The triggers appearing most often on headache days were stress (57.7% of headache days), sleep deprivation (55.1%), fatigue (48.5%), and hormonal changes.2 Weather changes also featured prominently — consistent with the broader epidemiological literature.
These are population-level findings, though. Your personal trigger profile may look quite different. Individual variation is large, and population data is a starting point, not a diagnosis.
There is an important nuance that research published in the Journal of Neurology has highlighted: some symptoms people attribute to triggers — such as food cravings, mood changes, or yawning — may actually be early symptoms of the migraine itself (the prodrome), not causes of it.3
This matters practically. If you eat chocolate, develop a migraine twelve hours later, and conclude "chocolate is my trigger" — it is possible that the craving for chocolate was itself an early sign that the migraine was already developing. This is one reason why trigger identification based on individual episodes can be unreliable, and why systematic daily tracking over months is more accurate than drawing conclusions from single experiences.
A 2021 study at King's College London examined the agreement between self-reported trigger factors and early premonitory symptoms in migraine patients. The study found meaningful overlap, supporting the idea that some perceived triggers may actually be early-phase symptoms rather than independent causes.3
This is the most commonly skipped step and the most important one. Triggers often act with a delay of twenty-four to forty-eight hours. If you only log on headache days, you will miss the connection between poor sleep on Tuesday and the attack that arrives on Thursday morning. Consistent daily logging — even on good days — captures delayed effects.
Instead of just noting "drank coffee," note how much you slept the night before, whether you were stressed, what phase of your hormonal cycle you are in, and what the weather was doing. The interaction between these factors is what matters, and the dashboard can only reveal those interactions if you log the individual components consistently.
A trigger that appears before eight out of twelve attacks over three months is meaningful. The same trigger appearing before two out of three attacks over two weeks is not — the sample is too small to distinguish a real pattern from coincidence. Reliable conclusions require enough data.
If stress appears on every headache day but also appears on many non-headache days, it may not be a reliable trigger for you specifically — or it may be a threshold modifier rather than a direct trigger. The dashboard comparison of headache versus non-headache days helps clarify this.
For modifiable triggers — specific foods, alcohol, irregular sleep, dehydration — direct avoidance is the simplest approach. For unavoidable triggers — hormonal cycles, weather changes, occupational stress — the goal shifts to threshold management: reducing other triggers at high-risk times to reduce the overall load on the nervous system.
A detailed trigger profile is also useful clinically. It helps a neurologist understand whether preventive treatment is warranted, and whether your pattern is consistent with the mechanism of a proposed treatment. "My attacks cluster in the days before menstruation and seem worse after poor sleep" is far more actionable information than "I think stress might be a trigger."
BodyPing's migraine module includes a comprehensive trigger library and a dashboard that shows which factors appear most often before your attacks — across weeks and months of data.
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