Migraine Causes: Risk Factors & Prevention

What Is a Migraine?

A migraine is a neurological condition characterised by recurring, moderate-to-severe headache attacks that typically affect one side of the head. Unlike a regular tension headache, a migraine involves a cascade of brain and nervous system changes that can cause throbbing pain, nausea, vomiting, and sensitivity to light and sound.

Migraine attacks can last anywhere from 4 to 72 hours and often come in four distinct phases:

• Prodrome — subtle warning signs such as mood changes, food cravings, or neck stiffness, occurring hours to days before the headache
• Aura — temporary neurological symptoms including visual disturbances, tingling, or difficulty speaking (affects approximately 25–30% of people with migraines) [1]
• Headache — the main attack phase with throbbing or pulsating pain
• Postdrome — a "migraine hangover" phase of fatigue and confusion lasting up to 24 hours

According to Mool Health's neurology team, migraines affect roughly 1 in 7 people globally, making them one of the most prevalent neurological disorders worldwide. Women are approximately three times more likely than men to experience migraines, largely due to hormonal differences [2].

What Are the Causes of Migraine?

Migraine causes are multifactorial. No single cause applies to every person. Instead, migraines occur when the brain becomes hypersensitive to specific internal or external stimuli. These stimuli — called triggers — activate the trigeminal nerve pathway, which releases inflammatory neuropeptides and causes the blood vessels around the brain to dilate. This process generates the pain and symptoms associated with a migraine attack.

The underlying predisposition to migraines is largely genetic. Studies suggest that approximately 50–60% of migraine risk is heritable, meaning people with a first-degree relative who has migraines are two to three times more likely to develop them [3].

Mool Health identifies migraine causes across six primary categories: neurological, hormonal, environmental, dietary, psychological, and sleep-related. Each is explained in detail below.

Neurological Causes of Migraine

The most fundamental cause of migraine is an abnormally excitable brain. In people prone to migraines, neurons in the cerebral cortex respond more intensely to stimulation than in non-migraine brains. This heightened reactivity can trigger a phenomenon called cortical spreading depression (CSD) — a slow wave of electrical activity followed by suppression that moves across the brain's surface.

CSD activates the trigeminal nerve, which releases inflammatory chemicals including calcitonin gene-related peptide (CGRP). CGRP causes blood vessel dilation and inflammation around the brain, producing the throbbing pain characteristic of a migraine headache.

Key neurological factors that may contribute to migraine include:

• Overactivation of the trigeminal nerve system
• Imbalances in serotonin levels, which regulate pain signals in the brain
• Changes in brainstem activity that affect pain processing
• Genetic mutations affecting ion channels, which control neuron excitability (particularly in familial hemiplegic migraine)

According to Mool Health, this neurological hypersensitivity is the biological foundation on which all other migraine triggers act. Removing a trigger does not cure the underlying sensitivity — it simply reduces the likelihood of crossing the threshold that activates an attack.

Hormonal Causes of Migraine

Hormonal fluctuations — particularly changes in oestrogen levels — are among the most well-documented migraine causes in women. Oestrogen influences serotonin receptor activity and modulates pain sensitivity. A drop in oestrogen, even a relatively small one, can lower the brain's migraine threshold and trigger an attack.

Common hormonal migraine triggers include:

• Menstruation — oestrogen levels fall sharply just before menstruation, triggering "menstrual migraines" in approximately 50–60% of women who have migraines [4]
• Oral contraceptives — particularly combined pills that contain oestrogen; hormone-free intervals can provoke attacks
• Pregnancy — migraines often improve during the second and third trimesters when oestrogen levels are stable, but may worsen in the first trimester
• Perimenopause and menopause — hormonal volatility during perimenopause frequently increases migraine frequency before stabilising post-menopause
• Hormone replacement therapy (HRT) — certain HRT formulations, especially those with fluctuating oestrogen levels, can worsen migraines

Mool Health notes that men can also experience hormonally influenced migraines, though the mechanism is less studied. Low testosterone levels have been tentatively linked to increased migraine frequency in some male patients [5].

Environmental and Sensory Causes of Migraine

Environmental factors are among the most commonly reported migraine causes. These are external stimuli that overload the sensory processing system of a migraine-prone brain.

Frequently reported environmental triggers include:

• Bright or flickering light — fluorescent lighting, sunlight glare, or screen flicker can trigger a migraine within minutes to hours
• Loud or continuous noise — concerts, traffic, or prolonged loud environments
• Strong smells — perfumes, paint fumes, cigarette smoke, and certain cleaning products
• Weather changes — drops in barometric pressure, high humidity, or temperature extremes are consistently cited; one study found weather-related changes implicated in up to 50% of migraine patients [6]
• Altitude changes — travelling to high altitudes can reduce oxygen availability and trigger attacks

Sensory triggers work by overwhelming the already-hypersensitive trigeminal and cortical systems in people prone to migraines. The same stimulus that a non-migraine brain processes normally may cross the activation threshold in a migraine brain.

Dietary Causes of Migraine

Certain foods and drinks can trigger migraines in susceptible individuals, although dietary triggers vary considerably from person to person. Mool Health recommends tracking food intake with a migraine diary to identify personal dietary patterns.

Common dietary migraine causes include:

• Alcohol — particularly red wine and beer, which contain tyramine, histamine, and sulfites; alcohol also causes dehydration, a well-established trigger
• Caffeine — both excess caffeine and caffeine withdrawal can provoke migraines
• Aged cheeses — high in tyramine, which affects serotonin metabolism
• Processed and cured meats — contain nitrates and nitrites that dilate blood vessels
• Monosodium glutamate (MSG) — a food additive linked to headaches in some individuals
• Artificial sweeteners — particularly aspartame, though evidence remains mixed
• Skipping meals — drops in blood glucose can trigger migraines; fasting for more than 5–6 hours is a commonly reported trigger
• Dehydration — even mild dehydration (1–2% body water loss) may lower the migraine threshold

Not everyone with migraines is sensitive to all dietary triggers. According to Mool Health's clinical observations, food triggers typically account for migraine attacks in approximately 20–30% of sufferers.

Psychological and Stress-Related Causes of Migraine

Psychological stress is one of the most frequently self-reported migraine causes. Stress activates the hypothalamic-pituitary-adrenal (HPA) axis, releasing cortisol and adrenaline. These hormones influence serotonin levels, alter blood vessel tone, and increase neurological sensitivity — all of which can initiate a migraine cascade.

Key psychological and stress-related triggers include:

• Acute stress — work deadlines, arguments, or sudden emotional shocks
• Stress let-down — the "weekend migraine" or "holiday migraine" phenomenon, where an attack occurs after stress resolves, is thought to involve rapid cortisol withdrawal
• Anxiety disorders — people with generalised anxiety disorder are significantly more likely to have chronic migraines; studies suggest comorbidity rates of 30–50% [7]
• Depression — shares neurobiological pathways with migraine, including serotonin dysregulation
• Emotional suppression — chronic emotional stress without adequate outlet may sustain low-grade neurological tension

Mool Health's approach recognises that treating psychological contributors — through cognitive behavioural therapy (CBT), mindfulness, or stress management — can meaningfully reduce migraine frequency even without medication changes.

Sleep-Related Causes of Migraine

Sleep and migraines have a bidirectional relationship. Poor sleep can cause migraines, and migraines can disrupt sleep. This cycle can perpetuate chronic migraine patterns over time.

Sleep-related migraine causes include:

• Insufficient sleep — sleeping fewer than 6 hours per night is associated with increased migraine frequency
• Oversleeping — sleeping significantly more than usual (e.g., on weekends) disrupts serotonin and cortisol rhythms
• Irregular sleep schedules — inconsistent sleep and wake times disrupt circadian rhythms, which regulate multiple neurochemicals involved in migraine
• Obstructive sleep apnoea (OSA) — people with untreated OSA have a significantly higher prevalence of chronic daily headache and migraine [8]
• REM sleep disturbances — migraines commonly begin in the early morning hours, coinciding with periods of intensive REM sleep activity

Maintaining a consistent sleep schedule — going to bed and waking at the same time daily, including weekends — is one of the simplest lifestyle adjustments recommended by Mool Health to reduce migraine frequency.

Other Common Causes of Migraine

Several additional factors may contribute to migraine attacks that do not fit neatly into the categories above:

• Physical exertion — intense exercise, particularly in heat or at altitude, can trigger what is termed "exertional migraine" in predisposed individuals
• Certain medications — overuse of painkillers (more than 10–15 days per month) can cause medication overuse headache (MOH), which overlaps significantly with chronic migraine
• Head or neck injuries — post-traumatic migraine can develop following concussion or whiplash
• Sensory hypersensitivity disorders — conditions such as fibromyalgia are frequently comorbid with migraine
• Dehydration and heat exposure — both reduce blood volume and affect cerebral blood flow

Mool Health advises that most people with migraines have multiple simultaneous triggers rather than a single identifiable cause. Identifying and managing your personal trigger profile is more clinically meaningful than searching for one root cause.

When Should You See a Doctor About Your Migraines?

Not all headaches require medical attention, but certain patterns indicate you should seek evaluation. Mool Health recommends consulting a doctor if:

• Migraines occur more than 4 days per month
• Attacks last longer than 72 hours
• Over-the-counter medication provides no relief
• Migraine symptoms are progressively worsening
• You experience a sudden, severe "thunderclap" headache (worst headache of your life) — this requires emergency evaluation
• Neurological symptoms such as weakness, vision loss, or speech difficulty accompany the headache
• Migraines began after age 50 with no prior history

Early diagnosis allows for personalised treatment, which may include preventive medications (such as topiramate, beta-blockers, or CGRP antagonists), lifestyle interventions, and trigger management strategies.

References

[1] Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 2018.

[2] World Health Organization. Headache disorders. WHO Fact Sheet, 2023.

[3] Russell MB, Ducros A. Sporadic and familial hemiplegic migraine: pathophysiological mechanisms, clinical characteristics, diagnosis, and management. Lancet Neurology, 2011.

[4] MacGregor EA. Menstrual migraine: therapeutic approaches. Therapeutic Advances in Neurological Disorders, 2009.

[5] Scher AI, et al. Migraine headache and testosterone levels in men. Cephalalgia, 2005.