Triggering factors of Headache

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Family and family tree indicating hereditary factors

Inherited. Around 80% of patients with migraine have parents or siblings with migraine. Although the hereditary form is not fully established, in some particular forms of migraine (familial hemiplegic migraine), the gene located in chromosome 9 that transmits it has already been identified.

Woman growing older from childhood to old age

Age. Children can have migraine, although it is less common. At these ages the majority of migraines are in males. From puberty onwards, due to hormonal changes, the incidence of migraine increases in females. Migraine frequency peaks at around 20 years-old, those of trigeminal-autonomous at 30 years-old, and trigeminal neuralgia from 40 years-old onwards.

Person with symbols on the head representing stress, anxiety, confusion, disorientation, headache or migraine.

Stress. It is independent of the type of stress and the factors that trigger it. It is markedly influenced by tension headache, migraine, and cluster headaches. It is associated with changes in sleep pattern, which is also a triggering factor of cephalalgia.

Food pyramid

Diet. Migraine has possibly been associated with the previous ingestion of certain foods (about 3 hours before) such as chocolate, cocoa, vanilla, banana, dried fruits, citruses, fast food additives, sausages, fermented cheese, spicy foods (foods that contain substances with tyramine, monosodium glutamate). It is known that 50% of the patients recognise some of them, although it is under debate, since, during the prodrome phase, an appetite for certain foods appears. In any case, not all of them should be restricted, just avoid those that have been identified in a particular patient.

Beer mug and wine glass

Alcohol. It depends on the type of alcoholic drink, but, for example, tannins, which are contained in red wines, can often trigger a migraine. In cluster headaches, the consumption of alcohol is inadvisable during the symptomatic period, since it can trigger an attack.

Symbol of the woman and a clock representing the hormonal cycle

Hormonal changes. The incidence of migraine is disparate in females after the appearance of the first period (menarche). The migraine usually gets worse with ovulation and menstruation, as well as with taking oral contraceptives. Pregnancy usually improves the migraine temporarily, and many women improve extraordinarily after menopause.

Sun, wind, rain and waves as environmental factors

Climate changes. There is no climate pattern for migraine.

Woman asleep in the office

Lack or excess of sleep.

Green, blue and white striped tablets

Drugs (vasodilators, nitrites, etcetera).

Besides these general causes, there are other specific ones associated with the type of cephalalgia it may be. Thus, in the case of tension headache, and according to recent studies, the causes could lie in the trigeminal-cervical region of the head and, more specifically, in the hyperactivity of the muscles that are found in this region. In the case of cluster headaches, the origin possibly points to the hypothalamus, which at cerebral level regulates the endogenous rhythms as a source of pain.

Factors that can lead to the pain becoming chronic

There are some circumstances that make a headache persist in time, particularly, in migraine. Every year, around 2.5% of migraine patients go from an episodic form to chronic, and vice-versa, the same percentage of patients a year go from chronic to episodic migraine. It is important to take this factor into account as it has a bearing on the favourable progression of the illness.

In the case of migraine, they are dived into two large groups.

Non-modifiable factors

Elderly man and woman with cane

Advanced age. Cephalalgia is more frequent in adults than in children. It is of interest to highlight an arteritis of the temporal artery in these patients.

Man and woman

Gender. Some types of headache are more frequent in women (migraine, tension, hemicranial, and others in men (cluster headache).

Family and family tree indicating hereditary factors

Genetic factors.


Low socioeconomic status. Generally a low socioeconomic level can be a major source of problems or stressful situations that could produce cephalalgia.

Modifiable factors

Person with symbols on the head representing stress, anxiety, confusion, disorientation, headache or migraine.

Anxietydepression or stress. Anxiety or stress can be reduced by means of physical activity or relaxation techniques.

Woman asleep in the office

Sleep disorders. Its diagnosis is important, since there is effective treatment in most cases.

Medicines, pills

Abuse of medications. According to the International Headache Society, it is considered abusive to take more than 15 doses a month of triptans (drugs specific for migraine, which have some variations between them as regards intensity, tolerability and duration of the effect), or more than 10 doses a month of analgesics.

Mug with hot drink crossed out

Caffeine abuse. Occasionally, coffee can help prevent a migraine or help the absorption of analgesics. On the other hand, coffee can be harmful if taken in excess, since it can lead to dependency or interfere with sleeping patterns.


Elevated frequency of attacks. If the frequency of the attacks is more than three a month, it is important to consult with the doctor in order to identify and correct any harmful life habits, and to consider introducing a suitable preventive and individualised treatment for the patient.

Substantiated information by:

Neus Fabregat i Fabra
Víctor Obach Baurier

Published: 16 May 2018
Updated: 16 May 2018


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