Up to 53% of migraineurs report weather changes as a consistent trigger making it one of the most commonly reported triggers for migraine behind stress, hormones and skipped meals1 .
A subject of interest as far back as 1974, researchers have spent decades trying to examine the question: Does weather actually trigger migraine attacks, and if so, what are the factors related to weather change that is causing attacks in people?
Theories over the years have included temperature and barometric pressure changes, high and low humidity, high winds, stormy weather, and changes in light conditions (very bright or dull light as well as changes in daylight hours).
The science however has provided contrasting and often confusing results making it difficult to understand what is happening.
In 19792 researchers in London asked 310 migraineurs about the day and time of their attacks (subject to recall bias) and found no correlation with changes in wind, barometric pressure, humidity and temperature.
Jump ahead to 2011 and Karin Zebenholzer and colleagues3 undertook a 90-day prospective diary study in Vienna. Whilst they found trends when analyzing change in temperature, wind speed, sunshine duration in isolation, analysis of multiple variables to account for attacks yielded no positive findings.
Their conclusion was ‘the influence of weather factors on migraine and headache is small and questionable.
Migraine Triggered by Thunder Storm or Lightening
In 20134 researchers studied the effect of lightening strikes on 90 migraineurs who kept diaries for 3-6 months. When they analysed the data they also accounted for rainfall, and barometric pressure.
When there was a lightening strike within 25 miles (40kms) there was a 25-30% increased risk of both new-onset headache or new-onset migraine. They are following up with further research to try and determine what it is that lightening strikes do that can cause a slight increase in migraine incidence.
The odds of having a new headache or migraine start increased on days with lightening that had a more negative charge leading researchers to suggest that something to do with the electromagnetic interaction is causing some irritation of the nervous system and triggering an episode.
Lead researcher Dr Vince Martin5 , explained that other environmental factors change in thunderstorms, in particular related to fungi and mold. Rain increases mold counts, and if lightening strikes the ground it aerosolizes the fungi. In other words we breathe in a lot of fungi and molds in the air during thunderstorms, contributing to our now famous ‘Thunderstorm Asthma’ events.
When this is coupled with the fact that migraineurs tend to have a higher incidence of non-allergic rhinitis (nasal and sinus irritation) it provides another possible mechanism for triggering an attack, but it is still interacting with a sensitized system as Dr Martin explains:
“I think that what we don’t realize is all these different things in our lives can influence that (migraine) threshold. So how much sleep you got the night before, how much stress you are under, whether you fasted for a prolonged period of time. All these things have a neurologic effect on migraine patients and can seek to lower that threshold and make people more vulnerable to migraine.”
The threshold to which he refers of course is the ‘explosiveness’ or the trigeminal nucleus. Read on for ideas on how to fix this sensitivity.
Migraine Triggered by Barometric Pressure Changes
Barometric pressure is what we see weather forecasters referring to with weather patters. Low pressure allows clouds to form and typically rain and storms. High pressure is typically associated with clear blue skies and warmer weather.
The challenge is that pressure changes ahead of the weather that comes with it, so you won’t often ‘see’ the weather that might trigger you. This might result in many migraineurs claiming to be able to ‘predict the weather’ as they might be sensitive to falling barometric pressure.
Dr Martin5 researchers studied the effect of lightening strikes on 90 migraineurs who kept diaries for 3-6 months. When they analysed explains that ‘some (migraineurs are) triggered by falling or rising barometric pressure. Interestingly if falling pressure does it then rising pressure is usually ‘protective’ and vice versa.’
Researchers in Japan6 studies the effects of changing Barometric pressure in 34 migraineurs compared to a control group of tension-type headache sufferers. On face value there appears to be a link between small decreases in barometric pressure (6-10hPa) and increased incidence of migraine compared to tension-type headache controls. Unfortunately the diary-recording period only went for 18 days. The problem is that we don’t know if the migraine group had a higher incidence of attacks and whether either incidence was different to the previous 18-days prior to recording.
Cioffi and colleagues 7 investigated the effects of changing weather in patients with temporomandibular disorders (TMD) and migraine. Their results indicate that decrease in atmospheric pressure increased the intensity of TMD pain, however increase in pressure and temperature increased the intensity of migraine symptoms. Again the study is very limited, in part by a ‘lost’ or ‘not captured’ data rate of 25% and no indication of the baseline activity in both groups – in other words we don’t know whether the pain fluctuations can be attributed to the weather or if these are normal fluctuations.
More disturbingly, the authors claim as a starting point in their introduction that:
‘The pain course of subjects suffering from migraine is influenced by weather conditions”
citing two publications to support the statement. On reviewing these two publications the conclusions the authors draw themselves are quite the opposite:
‘The influence of weather factors on migraine and headache is small and questionable8 ”
and
“In a sub-group of migraineurs, a significant weather sensitivity could not be observed9 ”
Migraine and Weather: Conclusions
So this all seems a bit confusing, and we want a simple answer – do changes in weather cause migraines or not?
The answer is a simple as does chocolate, or wine, or perfume cause a migraine. The answer is obviously yes………..and no.
That is to say migraineurs as a group are heterogeneous. Some things that may trigger one migraineurs may not trigger another, so pooling together large groups to study effects of anything, be it a trigger (or a treatment for that matter) can dilute the effect that it might have on sub-groups. The difficulty is in discerning the sub-group in a way that allows better predictions of the effects of
The results of Hoffmann’s 12-month study10 , though inconclusive, did show trends leading to the conclusion that “only a sub-group of migraineurs is sensitive to specific weather conditions, explaining why previous studies, which commonly rely on pooled analysis, show inconclusive results”.
One might expect a better result in migraineurs who report weather changes as a trigger, however Zebenholzer and colleagues looked at perceived weather changes compared to weather data and found a poor correlation3 .
Not unsurprisingly, the ability of a migraine brain to accurately detect weather may be impaired (similar to its response to noise, light, smells in some cases), leading to inaccurate forecasting, and the feeling that ‘the weather is changing and here comes my migraine’ whereas in fact the sense that the weather is changing may be a part of the migraine itself.
Another problem is that changes in weather do not influence migraineurs in isolation. What were the other factors occurring at the time of the study with regards to amount of sleep – over-sleeping, under-sleeping, dietary influences, hydration levels, stress levels etc
As with many other triggers, often in isolation or at low doses they may be ok, but when a strong dose or in conjunction with others triggers may cause problems.
At the end of the day the research has failed to show what we know and see in the clinic, and that is, without question, migraine can be triggered by changes in the weather – but as with many other things migraine, the exact mechanism’s have eluded researchers and remains an area of ongoing focus for some.
What to Do about Weather related Migraine: Treatment
What does chocolate, perfume, bright light, red wine, stress, hormones changes and weather changes have in common? Nothing apart from the fact that they can all (amongst a host of other things) be considered triggers for some peoples migraine.
Focusing on triggers can be helpful if you only have a small number. If on the other hand you have multiple triggers, then this line of migraine management often proves futile and frustrating as the next doctor pulls out yet another migraine diary for you (scream!).
The thing that ties these and every other migraine trigger together is that they all interact with a sensitized trigeminal nucleus to cause the symptoms we associate with primary headache conditions.
So aside from moving to somewhere with stable weather patterns that has just the right mix of heat, humidity, wind and small changes in pressure to prevent your weather related migraines, what else can you do.
I would urge you to ignore the triggers and focus on the sensitized brainstem.
The nerves from the top of the neck feed directly into this area making it the number one suspect in the frontline of fighting the underlying problems in migraine.
In recent years the migraine community has shifted away from the vascular theories to focus on a sensitized brainstem model. This brings the neck back into focus, and even Dr Andrew Charles has moved from: ‘this (neck pain) is just a symptom of their migraine’ in 201211 to a ‘greater appreciation of the potential role of the cervical nerves’ acknowledging the ‘frequent occurrence of neck pain could indicate a role for the upper cervical nerves in the transmission of migraine pain’ in 201812 .
Come and get the underlying problem assessed and treated with the only technique developed specifically to lower trigeminal nucleus sensitivity.
For those wanting more tips on how to minimise weather related migraine:
- Stay indoors with windows shut. This may minimise the impact of aerosolized molds and fungi.
- Monitor Weather forecasts for migraineurs. I’m not sure how they account for individual variation is triggers, but it may be of some help.
- If you know the upcoming changes that are forecast may be a trigger try to minimise your other triggers at that time – in other words be more watchful about skipping meals, careful with sleep patterns, drink plenty of fluids etc
