Sydney Headache & Migraine Centre

Understanding Triggers

Headaches and Migraines are complicated. Each person’s case is different and what triggers an episode can differ. Whilst Sydney Headache and Migraine Centre practitioners focus on desensitising the brainstem, using manual therapy neck treatment, we also understand the multitude of other triggers that can impact headaches and migraines. 

The diagram below shows the ‘big picture’ and how triggers don’t occur in isolation. It’s often a combination of triggers that pushes you above the headache/migraine threshold, where a migraine episode occurs. Minimising as many triggers as possible will help keep your headache issue better controlled and under the threshold.


There are the classics of cheese, wine and chocolate, but there are others such as citrus and MSG that are also quite common. Sometimes food triggers can be something quite subtle, such as onion or garlic, both of which can take some effort to figure out. Either way, if there is a type of food or drink that triggers your migraine/headache episodes a good start would be to simply avoid those types of food. With treatment to desensitise the brainstem, we have found some patients can return to eating their “trigger foods” …but always in moderation!


Hormonal changes are common triggers for women and can be traced back to the drop in estrogen levels. This occurs, quite substantially, around day one of the cycle and again, moderately, at ovulation. The drop in estrogen will also cause a drop in serotonin levels which is the main driver for increasing the sensitivity level within the brainstem. Whilst hormonal change, for the most part, is going to happen, treatment can be effective in decreasing other factors affecting brainstem sensitivity so the drop in estrogen does not have the same impact in triggering a migraine. 


The upper neck joints are our main area of focus. Nerves from the top three spinal levels connect directly into the brainstem. Consequently, they have a very significant impact on brainstem sensitivity levels and your migraine threshold. In today’s ‘screen-driven’ world, we are often overloading our upper neck joints or we have injured them with a whiplash or concussion-type injury, even a mild one.  We recommend all migraineurs have an assessment of their upper neck to determine if there is an issue that can be effectively dealt with.


Another common problem in our present-day existence is the presence of stress. It may not seem ‘bad’ stress, it could be just ‘busyness’. We just don’t have much down time to unwind and relax. This can lead to us being ‘wired up’, sometimes in a constant state of ‘fight or flight’. The control centre for this action, the hypothalamus, sits just above the brainstem and can contribute to increasing brainstem sensitivity. You can do lots of things to help this issue. Paradoxically, it usually involves doing less, or at least slowing down. Mindfulness and meditation are gaining recognition as things that help us ‘de-stress’. Yoga or Pilates are also useful ‘me’ time activities.
It’s good to have a life full of activity but remember slowing down is also important when it comes to headaches and migraine.

Lack of Sleep 

Sleep is important in living a healthy lifestyle. It allows the nervous system to reset and get ready for the next day. Lack of sleep or poor sleeping patterns can lead to a headache/migraine episode. This is not always easy, especially for parents with young children. If you know that you are not getting enough sleep hours or are susceptible to a poor night’s sleep, working on your sleep hygiene can further reduce the likelihood of headache/migraine attack.

Mental Health

Conditions such as anxiety and depression are common in long term headache and migraine patients as they can contribute to brainstem sensitivity. Likewise, more serious mental health conditions can also increase brain stem sensitivity thus being involved in triggering the migraine process. With appropriate treatment to settle the brainstem and reduce headache/migraine episodes, patients will quite often experience an improvement in their mental health simply because you feel better when you aren’t experiencing as many headaches. In some cases, it can be beneficial to seek professional help to learn better ways to manage mental health. This can also lead to improvements in headaches and migraines.