Have We Been Blaming the Wrong Thing?
Why stress, sleep, and food are not the true drivers of headache and migraine.
Watson stands by the clinic window, watching as a patient leaves holding a neatly printed “migraine trigger list.” His colleague comes in and glances at the paper.
“Another patient leaving with the so-called holy grail of headache management?” the colleague asks.
Watson sighs. “You mean the ‘avoid everything that makes life worth living’ list?”
His colleague laughs. “Come on, triggers are important. Everyone says so.”
Watson turns with a raised eyebrow. “Are they important? Yes. Are they the answer? Not really.”
The Trigger Hunt
His colleague pulls up a chair. “But isn’t identifying triggers basic migraine advice? Stress, sleep, hormones, food, weather. If patients avoid them, they should have fewer attacks, right?”
Watson crosses his arms. “That’s the theory, but real life is more complicated.”
“How so?”
“Well,” Watson says, “patients often have many triggers. Some can’t be avoided, like hormonal changes. Others are just part of daily life: work stress, screens, bright lights, social meals. Trying to avoid them all can make life feel smaller.”
His colleague nods slowly. “I’ve seen that. People plan their lives around what might cause a headache.”
“And even with all that effort,” Watson adds, “the headache usually still happen.”
What Even Is a Trigger?
“So what’s going wrong?” the colleague asks.
Watson picks up a marker and writes on the whiteboard:
Trigger ≠ Cause
“A trigger,” he explains, “is just something that happens right before an attack. But that doesn’t mean it’s the real cause.”
His colleague tilts their head. “Isn’t that just semantics?”
Watson smiles and draws a small speaker.
“Imagine the brainstem as a sound system,” he says. “It usually adjusts the volume of signals like light, sound, smell, stress, and input from the neck and head. Most of the time, you don’t even notice it working.”
He draws a dial turned all the way up.
“But for people with frequent headache or migraine, that volume control can get stuck on high. Normal things start to feel overwhelming. Light seems too bright, smells are too strong, and everyday stress feels like too much. The system turns everything up.”
His colleague nods slowly. “So the trigger…”
“…is just another sound in a system that’s already too loud,” Watson says. “It’s not causing the problem. It just shows how sensitive the system already is.”
He taps the drawing.
“If you turn the volume back down and reduce the underlying sensitivity, many of those ‘triggers’ stop being a problem.”
The Loaded System
Watson underlines a new phrase on the board:
Pre-existing sensitisation
“In people with recurrent headache and migraine,” he says, “the nervous system, specifically the trigemino cervical complex is sensitised – more sensitive than it should be. It’s like the volume control on sensory processing is turned up too high.”
His colleague leans in.
“Normally, the brain quietly balances incoming information like light, sound, smells, stress, and signals from the neck and head. Most of the time, we’re not even aware it’s happening.”
Watson draws a small speaker and turns the dial all the way up.
“But when the system is sensitised, those same normal signals get amplified. Light feels too bright. Noise too loud. Everyday stress feels overwhelming. Even routine physical input can feel threatening. The system isn’t broken; it’s just turned up.”
“So the trigger…” his colleague begins.
“…is just one more sound in a system that’s already too loud,” Watson finishes. “It doesn’t create the problem. It exposes how sensitive the system already is.”
He pauses, then adds another image.
“It’s also like a smoke alarm that’s become overly sensitive. It doesn’t just react to a real fire. Burnt toast or a bit of steam can set it off. The toast isn’t the danger. The alarm threshold is simply too low.”
His colleague nods slowly. “So the system is both louder and quicker to react.”
“Exactly,” Watson says. “When sensitivity is high, ordinary life events start to look like triggers. But they’re really just normal inputs meeting an over-responsive system.”
He steps back from the board.
“Turn the volume down, restore balance in the system, and many of those same triggers lose their power.”
Why Triggers Get the Blame
“But people are so convinced their triggers are the cause,” the colleague says. “Chocolate. Red wine. Weather.”
“Because the timing makes it seem true,” Watson replies. “If a headache comes after stress or poor sleep, the brain connects them. It just feels logical.”
He pauses. “But if stress caused migraine, everyone under stress would have one-sided, throbbing head pain with nausea and light sensitivity.”
“Fair point.”
“And weather doesn’t pick one side of the head,” Watson adds with a hint of humor.
The Real Problem with Avoidance
“So should we just ignore triggers?” the colleague asks.
“Not completely,” Watson says. “Triggers can give us clues about how sensitive the system is at the moment. But if you focus only on avoiding them, it’s like tiptoeing around a smoke alarm instead of fixing the wiring that’s causing the problem.”
His colleague laughs. “That’s… uncomfortably accurate.”
“When the system is very sensitive,” Watson continues, “almost anything can seem like a trigger. As the sensitivity goes down, many of those triggers quietly stop causing problems. Triggers Don’t Cause Migraine. It’s nervous system sensitivity, not modern life, that determines who gets headache and why.”
The Shift in Focus
His colleague leans forward. “So instead of obsessing over every possible trigger…”
“…we start asking a different question,” Watson says. “Why is the system’s volume turned up in the first place?”
There’s a pause as that lands.
“When the nervous system is sensitive,” Watson continues, “normal sensory input gets turned up. Stress feels worse, light is brighter, and neck tension feels more serious. Almost anything can seem like a trigger when the system is on high alert.”
His colleague nods. “So, it’s less about removing every sound from the room…”
“…and more about turning the volume down,” Watson says.
“Exactly. As the underlying sensitivity goes down, the system becomes more tolerant. The same light, the same busy day, or even the same glass of wine might not cause problems anymore – not because the world changed, but because the nervous system did.”
He caps the marker and steps back from the board.
“The goal isn’t to live a smaller, more limited life by avoiding every possible trigger,” he says softly. “It’s about restoring resilience. When the system is less sensitive, triggers become what they were always meant to be – just normal parts of life.”
