In addition to severe pain from headache, migraine can cause a number of debilitating symptoms that range from nausea and vomiting to sensitivity to light and sound.¹ These symptoms can make it significantly harder for patients to work or perform basic tasks, and can negatively affect their overall quality of life.

Patients experiencing chronic migraine may not be fully aware of the factors that can trigger a migraine or increase its severity and frequency. As a result, they may not know that certain lifestyle factors could be contributing to their migraine progression.

Educating patients on what factors can mitigate or exacerbate migraine can be helpful to those with migraine and those with loved ones who experience migraine. It has been estimated that over 10% of people worldwide are affected by migraine.¹ With such a significant number of people experiencing the debilitating effects of chronic migraine, it is beneficial to understand some of the factors, in a patient’s control or otherwise, that can affect migraine progression and what they can consider doing to mitigate the effects. When discussing migraine with patients, what are some risk factors for progression you should mention?

Dehydration

Dehydration can affect migraine progression, frequency, and severity in a number of ways. In a 2021 study published in Current Pain and Headache Reports, researchers examined associations between dehydration and headache, finding that women who drank more water (and overall fluids) had reduced severity and frequency of migraine attacks.² While not necessarily a cause of migraine, dehydration also has the potential to both worsen migraine effects and be caused by migraine symptoms such as nausea and vomiting.

The researchers noted that while intravenous fluid use during a migraine attack is unclear in terms of efficacy, fluid intake as part of a long-term migraine management plan could be beneficial. Other studies have found similar results; researchers of a 2023 study in the Journal of Neurology concluded that hydration was among the possible risk factors for migraine progression and that less water intake was associated with more migraine disability and longer headache duration.³

Certain migraine triggers for patients are also associated with dehydration. For example, alcohol and coffee are common triggers that are also known to cause dehydration.⁴ For patients with these triggers, hydration should be a large component of long-term management.

Tobacco

Tobacco use is commonly considered a risk factor for migraine progression and severity, and recent research has identified demonstrable evidence in support of that claim. A 2023 study in Current Pain and Headache Reports examined existing data about migraine and tobacco, finding that current smokers tended to have more headaches than those who formerly or have never smoked.⁵

The researchers also found a number of tobaccos can be particularly dangerous for patients with migraine, noting that smoking and migraine are independent risk factors for stroke that can become amplified when combined. Smoking is often used as a coping mechanism for stress, another common migraine trigger. In addition, the stress induced by migraine symptoms may make it more difficult for patients to actively work on smoking cessation.

While they acknowledged that more data was needed to determine if there is a strong correlation between smoking cessation and improved migraine symptoms, it is still beneficial to overall patient health. The researchers of the aforementioned Journal of Neurology study similarly concluded that smoking tobacco was a migraine progression risk factor, and that cessation should be considered as part of migraine management.³

Sex

A patient’s sex may determine if they are more likely to experience migraine and how severe it is. Women are more likely to experience migraine attacks and migraine-related disability than men.³ Part of this may be hormonal; hormone changes during menstruation or pregnancy have shown to be migraine triggers for some.⁴ It may be helpful to discuss documenting migraine frequency with female patients to determine if this is a potential trigger.

Obesity

Research has suggested that being overweight and obesity may be correlated with an increased risk of chronic migraine.³ A 2022 study on the neurobiology of migraine progression in Neurobiology of Pain claimed there was a nearly two-fold increase in risk for developing chronic migraine in patients who are obese.⁶ The researchers, though, acknowledged that the underlying pathophysiology that may explain this is not firmly established.

Health care professionals working with obese patients who have migraine may want to mention diet as a way to help manage migraine. Many foods, like processed and cured meats, have been shown to trigger migraine attacks in certain patients, while inconsistent meal schedules may also be triggers.⁴ Putting a stronger effort into dietary health may not just benefit patients wanting to work on their obesity, but could be helpful in identifying their migraine triggers.

Medication Overuse

Overusing medication, even migraine medications, can cause significant migraine progression. Acute medication in particular, such as simple analgesic and opiates, can put patients at risk of medication overuse headache.⁶ This can be tricky for patients and health care professionals alike, as medication overuse can be both a cause and consequence of medication overuse headaches. As a result, it has been suggested that acute medication in patients with migraine should be taken under 10 days a month with patients being mindful of whether they need an increase in their medication.³

Patient education – regarding medication overuse and other risk factors – is crucial in helping to limit migraine attacks and progression. Health care providers treating patients experiencing migraine should encourage open communication about triggers and whether migraine attacks are worsening to best determine if an outside factor is exacerbating the progression.