I don't really know what triggers my migraines

Photo of man with a migraine on a sofa

Stephen, 43 years old

“My migraine attacks have varied in their frequency over the last few years. For a while I had them exactly once a week – they were like clockwork. Then my symptoms got a bit worse and the phases between individual attacks got longer, and then settled at about every 14 days.”

I’m 43 years old and I had my first migraine symptoms about 20 years ago. That was when I was at university. The symptoms I had weren’t very typical of a migraine, though: For example, I had chills, and they often came in sudden episodes about once a week.

Later on they turned into migraines with the same regularity but with more typical symptoms: a headache on one side, nausea, sensitivity to light, sensitivity to certain smells, sound and touch. Back then I tried both medication and home remedies, but neither helped much.

I didn't know what migraines were back then

I went to see a neurologist. When I described my symptoms to him, he said that I had just described the textbook symptoms of a migraine.

I didn’t really know what “migraines” were back then. The doctor explained it to me. Back then, there weren’t many medications for migraines. The only things you could do was take painkillers and medicine for nausea, make changes to your own lifestyle, and try to relax a lot.

I tried different treatments

The doctor treating me was an expert in autogenic training and taught me how to do it. I still have the skills today – it’s a bit like learning to ride a bike, so I won’t forget it anytime soon. It does me a lot of good and it helps me to relax. But unfortunately autogenic training didn’t reduce the frequency or severity of my attacks. I also gave a shot, but without success.

So I went through a couple of rough years. Whenever a migraine came, I had to go to a dark room that was as cool and as quiet as possible.

The breakthrough for me was the development of triptans. I still take them nowadays. It goes like this: When I get a migraine, it’s almost always at night or in the early morning hours, around four o’clock. I wake up and realize that the migraine is starting. Then I take one of the triptan tablets and the pain usually goes away pretty quickly. I can then go to work as usual and feel fit as a fiddle.

Sometimes I get up and do some exercise or take a hot shower in the hope that I can stop the migraine. But if that doesn’t work, I take my medication and hope that it will help – which it does, mostly.

There are a wide range of different triptans – it helps to find a good doctor and try them out one by one. I tried about five different products and have now been using one of them for some time – that’s the one that worked best. Sometimes it’s not that effective, but it usually is.

Sometimes the migraines even last three days

The only side effect that I feel is that I get tired earlier in the evening. But that’s not really a big problem for me. It’s tougher to deal with when the migraine doesn’t go away, but instead comes back the next day, and ends up being a multi-day migraine. The next day I take a tablet again and I feel more and more tired. Sometimes the migraines can even last for three days, unfortunately. Then the tiredness is so extreme that I have to leave work in the afternoon to go home.

Then it’s like I’ve taken a sleeping pill and I just can’t fight it. The only thing that helps is lying down and going to sleep. But that’s nothing compared with the migraine symptoms, and I’ll gladly take being tired over the pain. I can live just fine with that.

My migraine attacks have varied in their frequency over the last few years. For a while I had them exactly once a week – they were like clockwork. Then my symptoms got a bit worse and the phases between individual attacks got longer, and then settled at about every 14 days. I still go in to work and usually no one around me even notices that I’m having a migraine attack.

I don’t have a classical migraine accompanied by an aura, in which you can feel certain telltale signs. But my mood changes a bit. The evening before a migraine, I get grumpier and more dissatisfied. I often don’t even realize it myself, but my wife notices it. She has experienced it often enough over the years. So I do in fact have a warning sign.

Intense dreams are a typical sign

I don’t really know what triggers my migraines. There are periods where I suspect there’s a link to weather conditions, or sometimes I think it might have been triggered by particular things like alcohol or coffee, but that hasn’t proven to be the case. But normal headaches from a cold or a hangover after too much alcohol, for example, often trigger a migraine.

One thing I’ve noticed: I have intense dreams immediately before an attack. That’s a typical sign that a migraine is coming on in my case. When I feel that a migraine is starting, I take a tablet and stay in bed another half hour – that’s about it.

I can’t prevent the attacks: I’ve tried taking medication as a precaution and have tested each and every kind of preventive treatment offered by conventional medicine. And none of it actually had any effects – apart from the side effects of the drugs. The best thing I can do for myself is to get movement outdoors and go running. I feel that that reduces the frequency of the migraines a little. But you can never say for sure.

Migraines aren’t the same as normal headaches

I can tell that it’s a migraine because it feels different. It’s hard to describe. It’s not necessarily just a headache, my stomach also feels a bit queasy. But it feels different from having an upset stomach. I can already sense that it’s something else – that it’s actually a migraine and not a headache brought on by a cold or an upset stomach. I can tell them apart quite well. And my senses are affected. It’s very difficult to explain, but over the years you kind of get to know the signs. I can always tell it’s a migraine pretty quickly.

I’ve now been having migraine attacks for 20 years. At first I used to feel nervous before social events, worried that I might have a migraine attack there. The fear was that I wouldn’t be at home when an attack starts. Having to deal with a migraine attack in your usual surroundings is bad enough, but being somewhere else makes it much worse.

That really had an impact on my daily life. Nowadays I only worry about not having enough tablets on me. I never travel without my medicine. It helps me so much that my migraines no longer affect my daily life that much.

Migraines run in our family

My mother also had migraines before I was born, but not afterwards. And my older sister had migraine attacks too – not as often as I do, but I think they were just as bad. My mother quite often asks how I’m coping with my migraines. Knowing that I also suffer from migraines is hard for her. She knows what it’s like and feels sorry for me.

I joined a self-help group and find it really helpful. It simply does me a lot of good to be with other people who have similar problems, and to talk about common experiences and also to console each other if needed.

I think it’s important to get diagnosed as fast as possible and to try to find the right medication with minimal side effects together with your doctor. I also think it’s crucial not to give in to the suffering and to think that you just have to bear the pain.

I believe life’s too short for that. If you ask me, you should take the medicine as soon as you start feeling the very first signs of a migraine attack, and not wait or hesitate. I try to accept my migraines and make the best of my situation.


Our real-life stories summarize interviews with people who are affected by the medical condition. Our interview partners have given us permission to publish their stories. We would like to express our sincere thanks to them.

The real-life stories give an insight into how other people cope and live with a medical condition. Their opinions and comments are not recommendations by IQWiG.

Please note: The names of our interview partners have been changed to protect their identity. The photos are of models.

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Updated on August 4, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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