How to avoid the worst headache of your life.

By Karyn Repinski

A generous pour of a great wine. The scent of a handsome guy's cologne. A taste of some well-aged cheese. It all sounds like a great night out. But if you struggle with migraines, any of the above could spark trouble, leaving you stuck in bed for all the wrong reasons. Eighteen percent of American women experience migraines, which are like headaches on steroids. The intense, painful throbbing usually begins on one side of the head and can cause nausea, vomiting and extreme sensitivity to sound and light. Most sufferers are aware of the usual suspects (certain foods and strong odors) that can send them over what experts call the "headache threshold"—the point at which a migraine is set off. Sadly, there's a whole host of other culprits that many haven't heard of. Avoid agonizing pain and a derailed day by learning how to sidestep these lesser-known scenarios that can spark symptoms.

First Day of Vacation

"Stress is probably the number one migraine trigger," says Noah Rosen, MD, director of the Headache Center at Northwell Health Neuroscience Institute. But here's what is truly shocking (and just plain unfair): New research finds that "let-down stress," or the relaxation you

feel after particularly tough times finally come to an end, can be an even more powerful prompt. In fact, risk for an attack rises nearly five times

in the first six hours that you start feeling less tense.

Prevention prescription: Do something daily that brings you peace, like meditation, deep breathing or progressive muscle relaxation. "Making each day more enjoyable minimizes variations in day-to-day stress and makes you calmer overall," says Elizabeth Seng, PhD, a clinical psychologist and assistant professor of clinical health psychology at Yeshiva University in New York City.

Workout Mistakes

Even though getting regular exercise is a prescription for fewer headaches, many women avoid breaking a sweat because they think it will set off a migraine. Not quite. More often it's specific aspects of exercise—and not the physical activity itself—that spark symptoms, says Rosen. Some triggers include being dehydrated (which impedes blood and oxygen flow to the brain), low blood sugar (the brain relies on a steady supply of sugar for energy) and exertion (the force used when strength training, for instance, increases pressure in the brain).

Prevention prescription: Be strategic. Always warm up—a sudden demand for oxygen can spur an attack. If lifting weights seems to bring on a pounder, opt for lighter weights and more reps. Stay hydrated by drinking about nine cups of H2O a day, and prevent blood sugar from dropping by eating at least an hour and a half before exercising, which gives the body time to digest too. If you haven't worked out in a while, start slowly. "People who experience migraines are more sensitive to change of any kind, and a new exercise program is a significant change," says Seng.


Women are three times more likely to get migraines than men. "Hormones are a huge trigger," explains Susan Hutchinson, MD, founder of the Orange County Migraine and Headache Center. What's more, female migraine sufferers seem to be particularly affected by the natural dip in hormone levels that occurs right before the start of their period, possibly because their estrogen levels drop more rapidly—by 40% compared to 30% for non-sufferers, according to a new study. Lower levels of estrogen mean lower levels of serotonin, a chemical that buffers the effects of pain, making female sufferers more likely to feel the ache.

Prevention prescription: Birth control pills, patches and vaginal rings moderate estrogen fluctuations, which can reduce the frequency and severity of menstrual-related migraines, explains Hutchinson. An estrogen skin patch or gel can also help keep hormone levels steady. Talk to your doctor to see which alternative is best for you.

Bad Weather

Some people who get migraines can be particularly sensitive to cold temps, high humidity or changes in temperature and atmospheric pressure—with a drop often signaling that a "brain storm" is coming.

Prevention prescription: While you can't control the weather, you can prepare to lessen its impact. Start a diary that tracks the date and time your headaches begin along with weather specifics: Is it especially hot, humid, cold or dry? Based on your findings, you can spend more time indoors on very cold, hot or windy days.

A Rumbling Stomach

If anyone is likely to skip meals or not eat on schedule, it's busy moms. But for those prone to migraines, the resulting drop in blood sugar levels can cause a thumping head—especially in the a.m. "If you eat at 6 p.m. and don't have anything until the next morning, you could be fasting for over 12 hours," says Seng, who is also an Excedrin Migraine Experience representative. Keep in mind that what you eat is as important as when: Too much sugar, especially if you're very hungry, can cause blood sugar to spike, followed by a sharp drop.

Prevention prescription: Keep blood sugar levels on an even keel by eating five or six small, balanced meals at regular intervals throughout the day. Be sure that each meal includes complex carbs (like quinoa, brown rice or veggies), lean protein (like salmon or chicken) and healthy fat (like avocado or olive oil). Before bed, have a small snack. Hutchinson recommends a high-protein food like yogurt or peanut butter to help stabilize blood sugar and keep your head at peace.

Is It a Migraine?

More than half of migraine sufferers don't get a proper diagnosis. Learn to recognize the signs so you can get the right care.

Tension Headache

Warning signs: None

When it strikes: Most often while you're awake

Pain scale: Mild to moderate ache that feels like a too-tight headband

Where it hurts: All over your head

Other symptoms: None


Warning signs: Fatigue; irritability; flashes of light; wavy, zigzag vision; hand and face tingling

When it strikes: Any time, day or night

Pain scale: Moderate to severe throbbing pain

Where it hurts: More likely to be one-sided

Other symptoms: Nausea, vomiting, light and noise sensitivity, visual disturbances

Cluster Headache

Warning signs: Usually comes on suddenly, although may also have migraine-like signs

When it strikes: Typically in the middle of the night or during naps

Pain scale: Excruciating pain. Cluster headaches are often referred to as "suicide headaches."

Where it hurts: Generally in or around one eye, but may radiate to face, head, neck and shoulders

Other symptoms: The eye on the affected side may become red, tear and droop; a stuffy or runny nose on that side is also common. Many people experience a flushed or sweating face.