There’s a common perception that weather systems, or changes in barometric pressure, are a strong migraine trigger.
In this episode, learn the 3 key things to know when it comes to the weather and migraine connection.
MIGRAI-NEVERLAND, our premier resource for those who want to find their pill free path to migraine freedom (including the Beast Slayer Training Academy): mymigrainemiracle.com/endofmigraine
The 9 Primary Migraine Miracle RESOURCES: mymigrainemiracle.com/how-we-can-help/
The Keto Blast Challenge: ketoformigraine.com
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The book that started it all – The Migraine Miracle: https://www.amazon.com/Migraine-Miracle-Sugar-Free-Gluten-Free-Inflammation/dp/1608828751
Studies on the Weather & Migraines:
Bolay, Hayrunnisa, and Alan Rapoport. 2011. “Does Low Atmospheric Pressure Independently Trigger Migraine?” Headache 51 (9): 1426–30.
Elcik, Christopher, Christopher M. Fuhrmann, Andrew E. Mercer, and Robert E. Davis. 2017. “Relationship between Air Mass Type and Emergency Department Visits for Migraine Headache across the Triangle Region of North Carolina.” International Journal of Biometeorology 61 (12): 2245–54.
Hoffmann, Jan, Hendra Lo, Lars Neeb, Peter Martus, and Uwe Reuter. 2011. “Weather Sensitivity in Migraineurs.” Journal of Neurology 258 (4): 596–602.
Kimoto, Kazuhito, Saiko Aiba, Ryotaro Takashima, Keisuke Suzuki, Hidehiro Takekawa, Yuka Watanabe, Muneto Tatsumoto, and Koichi Hirata. 2011. “Influence of Barometric Pressure in Patients with Migraine Headache.” Internal Medicine 50 (18): 1923–28.
Marmura, Michael J., and Pablo Bandres Hernandez. 2015. “High-Altitude Headache.” Current Pain and Headache Reports 19 (5): 483.
Mukamal, Kenneth J., Gregory A. Wellenius, Helen H. Suh, and Murray A. Mittleman. 2009. “Weather and Air Pollution as Triggers of Severe Headaches.” Neurology 72 (10): 922–27.
Prince, Patricia B., Alan M. Rapoport, Fred D. Sheftell, Stewart J. Tepper, and Marcelo E. Bigal. 2004. “The Effect of Weather on Headache.” Headache 44 (6): 596–602.
Szyszkowicz, Mieczysław, Gilaad G. Kaplan, Eric Grafstein, and Brian H. Rowe. 2009. “Emergency Department Visits for Migraine and Headache: A Multi-City Study.” International Journal of Occupational Medicine and Environmental Health 22 (3): 235–42.
Zebenholzer, Karin, Ernest Rudel, Sophie Frantal, Werner Brannath, Karin Schmidt, Ciçek Wöber-Bingöl, and Christian Wöber. 2011. “Migraine and Weather: A Prospective Diary-Based Analysis.” Cephalalgia: An International Journal of Headache 31 (4): 391–400.
Hey folks. In this episode, I’m going to be talking about something that comes up quite a lot in the migraine community. That is the topic of the connection between changes in the weather, or specifically, barometric pressure, and migraines.
In the migraine community at large, there’s definitely a prevailing perception that changes in the weather … particularly a strong weather system … is a migraine trigger. For some people, they would say a very strong trigger.
Oftentimes, that is attributed to the changes specifically in barometric pressure, because strong weather systems generally occur when there are large pressure changes, as any Weather Channel junkie will tell you.
We’ve certainly received a number of questions on this topic over the years, including a lot of people who ask, what they should do specifically for migraines that are brought about by changes in the weather.
That’s the topic for the day. In this episode, what I’m going to do is break things down, and give you what I think are the three most important things to understand, and take away when it comes to this particular topic.
Before I get into the meat of that topic, I’m just going to do a little bit of housekeeping. As of the time of this recording, we’ve recently kicked off our latest Ketoblast, which is our 30-day keto challenge for migrainers. There’s still time to hop on board and be part of it if you want to.
We’ve got a great influx of new folks who are with us for the first time in MigraiNeverland, and taking part in this challenge. As a reminder, the Ketoblast and all of our 30-day challenges are available as one of the many benefits of being a member of MigraiNeverland. You can have access to all of our 30-day challenges and you can pitch us [inaudible 00:02:05] in as many as you would like.
In fact, I did a poll at the start of this keto challenge. About half of the people who where there have already done it before, and are doing it again for the second, third, or more time. It’s something that you can do as many times as you’d like. And it comes with the extra support of a community around you to do it with, which always helps with the accountability, and just it’s more fun to do things as part of a group.
So there’s that resource for you. If you want to see the full schedule of challenges for the remainder of the year, you can head over to mymigrainemiracle.com/schedule. We just wrapped up our first-ever Sleep Challenge, which I really enjoyed, and I’m sure we’re going to repeat that one again. Probably in 2020.
If you want to learn more about becoming a member, and all the many things that are included with membership, just head over to mymigrainemiracle.com, and click on the Resources tab at the top menu. You’ll see the nine ways that we can help, including MigraiNeverland membership.
I know I say this a lot, but I’m consistently amazed by the incredible people in our MigraiNeverland community. We recently recorded several more interviews to share with you on this podcast with our members, and I’m just consistently blown away at what an amazing group of people we have. I can’t wait to share those episodes with you. If you’re one of our members and you’re listening right now, thank you so much for being so awesome.
Okay, back to the topic of the day, which is the connection between migraines and changes in the weather. [inaudible 00:03:35] specifically also changes in barometric pressure. I think the first place to start, if we’re going to be doing a deep dive into this, is to ask, is this actually true?
There are a number of things that are commonly bandied about in the migraine world that are taken as established truths. Many of which have either have not been shown to be true, or have been demonstrated to be false.
The first thing we want to do in the name of advancing human knowledge and truth … and not barking down wrong trees and blind alleys … is to first see what the research has to say on this topic. I think many people are going to be surprised to learn that the research here isn’t at all clear.
Given the prevailing perception that changes in the weather, and changes in pressure, are a major trigger, I think many would think that the research on this topic would be a slam dunk. But that’s certainly not the case.
It’s a question that’s been studied by various researchers around the world over the past couple of decades or so. One of the challenges here is designing a study that can actually get you closer to an answer to this question. I’ll talk a little bit more in a minute about why this can be particularly challenging for an issue like this.
But I’m going to review a few of the published studies on this topic. I won’t go into too much detail about the specifics of the methodology or the statistical analyses, as that’s beyond the scope of this discussion. However, I think even after this bird’s-eye view of the published data, some very useful themes will emerge, and conclusions that we can make.
If you want to take a look at these studies for yourself, I will provide the links on the Show Notes page on the Web site, which you can go to by going to mymigrainemiracle.com/moment, and there you have a menu of all of the prior podcast episodes, including this one.
Let’s take one study, which was published in 2011 in the Journal of Neurology. In this one, they retrospectively analyzed the headache diary of 20 migrainers, and correlated at four-hour intervals their diary to atmospheric pressure, temperature, and relative air humidity. They did this for a period of 12 consecutive months; this actually took place in Berlin, Germany.
Now, one interesting note here, just as an aside, was that they found that migraines were most likely to occur at four a.m. That’s probably a pretty consistently recognized finding. We talk a lot about how critical it is to prevent these middle-of-the-night attacks, which is a subject we’ve covered a lot in MigraiNeverland and the Beastslayer Academy, as well as in clinic chats. It may be worthy of an episode topic in the future.
But suffice to say, there’s a lot that we can do to prevent those middle-of-the-night attacks which really moves the needle forward, since those are the time when they are most likely to occur … and the worst attacks tend to occur.
Anyways, back to the topic at hand. What they found in this study was that there was an association between temperature and higher humidity in six people. Their conclusions from this study was that there was a subgroup of migraine patients who were weather sensitive.
Now, this was a retrospective study with small numbers … only 20 people … and making correlations amongst multiple variables. All of these things which introduce a significant amount of noise into the data. So, this kind of study should be taken with a big grain of salt. But, at least there’s a suggestion of a connection in a subset of the patients in this study.
Another study was published in the International Journal of Biometeorology. Who knew that biometeorology was a thing? In that study, they looked at the link between air mass types … I’ll explain what that is in a second … and ER visits for migraines over a seven-year period. This was in North Carolina.
What they found was that there were more ER visits on tropical air mass days, and fewer ER visits … and these are ER visits for migraines … on polar air mass days. So, warm tropical air, more migraines. Cooler polar air, fewer.
The effect here was not big. Also, this is just correlational data, remember. And it’s retrospective, meaning looking backwards. You can’t conclude at all that these things are causally linked. But again, there’s a correlation.
Now interestingly, in this same study, they found no correlations between ER visits for migraine and the magnitude of change in barometric pressure. That means even if there was a direct relationship between these meteorological changes … specifically, these changes in air mass and migraine … which again, we can’t conclude a direct relationship. But if that’s true, we can say that even if that is a direct connection, it’s not being mediated by changes in barometric pressure. So that’s that study.
In a study in 2004, in the journal Headache, they looked at the diaries of 77 migrainers for a period of two to 24 months. At the onset of the study, each subject had to fill out a questionnaire on their beliefs about the influence of weather on their migraines.
Then, using the diaries, they looked at the association between three factors: one was temperature and humidity; another was changing weather pattern; and the third was barometric pressure. What they found was that there were correlations with theses weather variables in about half of the subjects. The most significant correlation was, again, between temperature and humidity.
Now, there were also some significant methodological limitations with this study. Again, you could only say there are correlation between these variables. These do not demonstrate causation. But, thus far, in the studies that do show an association between the weather and migraines, most of that association is being found between temperature and humidity … and not barometric pressure changes.
Also, in this study they found that there are a number of patients who in that initial questionnaire, believed that the weather and specifically barometric pressure changes, were a major trigger. But after doing the analysis, found no association in those patients.
Now, in general, prospective studies … where you track subjects over the course of a study … yield superior information, or more reliable information than retrospective studies, where you look at subject data after the fact. All other things being equal.
In 2011, probably the largest prospective study on this topic that I’ve seen … This one was published in the Journal of Cephalgia … and it involved 238 migrainers who were living within 25 kilometers of the Vienna Meteorological Station. They were able to collect really good weather data for these folks that they knew was applicable, because folks lived so close to where the data was being collected.
They maintained a diary for 90 days. And they analyzed 11 meteorological parameters and 17 different weather situations. Ultimately, they found no statistically significant association between migraines and any of the weather parameters … leading the authors of that study to conclude that “The influence of weather factors on migraine and headaches is small and questionable.”
Those are four studies that I think give you a pretty representative picture of at least what the published data on this topic says right now. Because of that, there are plenty of migraine researchers who would say that really, there’s no convincing link between weather changes and barometric pressure. Or if there is, it’s questionable or mild.
Now that we’ve reviewed some of the published research, trying to answer this question, what conclusions can we draw from it? First, I think we can draw that heat and humidity is the most significant weather factor. That actually doesn’t come as any surprise. That’s a link that has been pretty well established. But don’t make the mistake of thinking that means you should avoid the heat altogether. On the contrary, avoiding heat altogether would be one of the worst reactions to that data. Now, why is that?
Well, our ability to regulate body temperature and keep ourselves cool when it’s hot outside, requires all sorts of physiological processes, which are dependent on specific proteins. The genes for those proteins are turned on when you’re exposing yourself to heat. So you are adapted to different climates, depending on how long you’ve been exposed to that climate.
If we take someone who’s going outdoors every day as they transition from winter to summer, gradually those genes are being turned on, and the body is continually adapting to the heat.
Now, imagine someone else who’s not going outside at all during the transition from winter to summer. Or avoids it as much as possible, and then one day, during the summer, they go outside and are out in the heat for several hours for whatever reason.
The first individual’s going to be well adapted, and the body’s mechanisms for regulating body temperature and protecting itself from the heat, will be fully online. Whereas the second person’s going to have none of that. And the heat is going to be at a huge homeostatic stressor. Guess which one of these people is going to be far more likely to be visited by the Beast?
In this instance, avoiding the heat altogether makes you far more prone to heat-induced migraines. This same principle applies to so many things. By avoiding something altogether, we continue to lower our resilience to that thing … thereby creating self-fulfilling prophecies.
Because guess what happens when our heat avoider goes out in the heat, and is visited by the Beast in the summer? That only further reinforces the notion that they’re heat sensitive. So they end up avoiding it even more, and becoming even less resilient. And more sensitive, and so on. These kind of vicious cycles happen all the time.
This topic of the connections between heat and migraine probably deserve its own episode. So I’ll get back to our primary topic of the day. But just to summarize, the first thing that we can conclude from the data on the connection between weather and migraines is that heat and humidity are the most significant factors. There’s much that we can do to make ourselves more resilient in the face of that.
The next thing we can say is that if changes in barometric pressure or weather fronts are a trigger, they’re likely a weak one. If that wasn’t the case, then it wouldn’t be so challenging to find a signal for this correlation in the data. So if it were a strong trigger, then it would jump right out of the data, which it’s not doing. You wouldn’t be having to comb through it so hard and figure out all these different ways to assess it, to even find that there is any type of connection.
Then the data also says that if it is a trigger, it’s likely only relevant for a subset of folks. Furthermore, that migrainers weren’t particularly good at identifying whether or not they were part of that subset.
So I think that without a doubt, the prevailing belief here in the broader migraine community is much greeter than the reality. As the Nobel Prize–winning physicist Richard Feynman famously said, “The first principle is that you must not fool yourself. And you are the easiest person to fool.” That’s certainly true in the realm of migraines.
But, for the sake of argument, let’s say that there is a subset of migrainers who have at least some degree of sensitivity to weather fronts. If you’re in that category, or at least think you are, what should you do about those?
The first and key point that I want to make here is that there’s nothing fundamentally different about a migraine that’s brought on by this factor, than one that’s brought on by anything else. Once that migraine switch is flipped, migraines are migraines. We see this confusion a lot in the migraine world. And I’ve talked about it on prior episodes, with respect to hormonal versus vestibular migraines and so on.
The good news is that what we do in response doesn’t really change, depending on what the triggering or associating factors were. The bedrock foundation of how to protect ourselves is always the same, and that’s the three Pillars of Protection that you’ve heard me talk about before.
Additionally, once the Beast has come to visit, how you handle it is also the same. Talked about our drug-free strategies here in the past, including my favorite one … which I did two episodes on, which is the Starve and Sink.
In fact, you’ve heard this from many people in our community, including several people who’ve been on the podcast, that one of the great joys of implementing the plan is that they no longer have these issues with weather systems. They used to be very afraid when strong storms would come through, and now they aren’t.
The ultimate strategy is to prevent them in the first place. To build up the three Pillars of Protection to the point where, even if some weather system comes through, it still can’t bring you near the threshold for triggering the Beast.
As far as what to do when a system comes through, one that we believe based on experience could raise our vulnerability … Or if we started feeling a little bit headachy … I would generally handle this exactly the same way I’d handle any other scenario where something beyond my control has raised my vulnerability like traveling across time zones, or eating a “cheat” meal.
That includes things like fasting, or reducing my carbs to nearly zero. Increasing the interval from my last meal to bedtime. And lots of low-intensity physical activity. The best thing there is lots of walking.
The point here being that if indeed changes in air pressure are a factor in raising our vulnerability to an attack, there’s not really anything we can do about that factor specifically. But what we can do is focus on the things that we know help us, and just go all in on those things.
The second thing here is that, again, if this is a factor, it’s not likely as significant as we might think. Changes in the weather or barometric pressure have likely been the falsely accused scapegoat far more often than it’s been the actual culprit. Even when it does contribute, it’s only going to be one of many factors. Remember the balloons and weight analogy. It’s only one of many balloons that is contributed to bringing us over the migraine threshold.
I think its actual contribution towards bringing us closer is probably going to be less than many folks believe. I think the perception is amongst many is that if there’s some kind of weather system rolling in, then a migraine is inevitable. But were that the case, we would not have such a hard time demonstrating it to be true in the research. The signal should be plenty large enough to see it through the noise.
For example, when we took at the association between smoking cigarettes and lung cancer, we find a huge signal. It’s clear as day. We know that smoking is significantly associated with lung cancer risk. This is not true of the research on barometric pressure and migraines.
So even though I think it is likely an issue for some folks, the signal is still very weak, which means it’s not nearly as big a factor as I think most folks believe.
Then lastly, given the research I’ve described, which shows that if indeed weather systems are a trigger, their contribution isn’t likely as significant as we think. I think it’s really important to not let our expectations work against us. As I said earlier, studies have shown that some folks who report barometric pressure changes as being a major trigger, show no association at all when this is actually studied prospectively.
That begs the question of what’s actually leading those folks to believe that this is true; that there is an association? One big reason why, and one big reason why this is a really tough issue to study and answer this question, is confirmation bias.
Imagine you’ve heard that there’s a connection between weather systems, or changes in barometric pressure, and migraines. On the days when there’s a weather system and you get a migraine, you’re going to notice that association, and you’re going to be likely to blame the migraine on that weather phenomenon. That’s precisely because we’ve been primed to think that the weather system causes migraines.
Even if you’re no more likely than chance to be visited by the Beast on a day when there’s a weather front rolling in, confirmation bias alone is going to make you believe that association exists.
It’s only when you look prospectively as these studies have tried to do, and track it with weather data, to see whether you’re actually more likely to experience a migraine when there’s a weather system, that you can answer this particular question. That’s one way in which our expectations can mislead us, and lead us to believe there’s a connection where none exists.
Then there’s another even more insidious and sinister way in which our expectations can undermine us. It’s quite possible that given the relatively weak signal linking migraines and weather systems, that the expectation alone of migraines occurring more likely with weather systems has actually led to more migraines than the systems themselves.
We know the impact of anxiety on migraine, and we’ve talked about the Nocebo Effect in the past, which is the expectation that something is going to have a negative impact on you, makes that negative impact more likely. That’s purely a result of your thoughts or expectations, and not the thing itself.
You could make a very good argument that the single best strategy for dealing with weather system–related migraines is to at least believe that there’s no connection between them whatsoever. Since believing that there is a connection can only do more harm than good. You can’t control the weather, but you can control your expectations.
I think it’s definitely safe to say that not only has this issue received far more attention than it deserves, but it would be really great for everyone if it received less attention than it deserved, because the attention itself may be fueling the problem.
All right, that’s all I’ve got for this episode. Remember, you can find the Show Notes and episode transcripts for all of these episodes of the Miracle Moment by going to mymigrainemiracle.com/moment. The Show Notes for this episode will include links to all the studies that I mentioned, including a few more on the topic of weather and migraines.
If you enjoy this podcast and you want to help other people to discover it, it’d be awesome if you left a rating and review in iTunes. It really helps, and it really means a lot.
All right, hopefully you found this to be a thought-provoking and actionable episode. Now it’s time to take that knowledge, go out and Slay the Beast.