While there are many useful medications available for the treatment of migraines, there are also an abundance of prescription medications, over-the-counter remedies, and illegal drugs that affect the brain and vascular system and act as potential migraine triggers. Perhaps the most common among adults is alcohol, a central nervous system depressant, covered earlier in this chapter.

With an estimated 45 million adult American smokers, cigarettes are also one of the more common migraine triggers. Cigarette smoke — both firsthand and secondhand — may trigger a migraine attack, and the full health effects of the over 4,000 chemicals found in cigarette smoke are not fully understood.

Aside from increasing the frequency of migraines and the risk of heart disease and lung cancer, studies have shown that smoking increases risk of stroke sevenfold in women who have migraine with aura. If you smoke and have migraines, talk to your doctor about a plan for quitting. Nicotine replacement therapies such as patches and gum can be a useful aid for smoking cessation. However, their use should be carefully supervised, as sudden withdrawal from nicotine can also be a migraine trigger.

Because prescription and over-the-counter medications must undergo extensive clinical trials and scientific scrutiny before they are approved for market, including full disclosure on all statistically significant side effects, they are perhaps the most well-studied triggers. The following drugs have been associated with migraine attacks: