A 100-city analysis of weather-driven migraine risk across America

Published by MigrAid · April 2026 · Revised edition (v1.1), August 2026


Correction Notice (v1.1, August 26, 2026)

This revised edition replaces the original April 2026 index. A journalist fact-checking the original ranking identified inconsistencies we confirmed on review: two of the four scoring factors in v1.0 (trigger season length and severity) were derived from written city weather profiles rather than from measured data, and the season-length factor counted only each city's primary trigger window. Cities with two distinct volatile seasons, New York and Nashville among them, were scored as if they had one short season and ranked far more favorably than their measured pressure records support.

Version 1.1 rescores every city directly from three years of hourly surface-pressure observations (April 2023 through March 2026). The text-derived trigger-diversity factor has been removed rather than kept in a corrected index, and its weight redistributed proportionally. The headline findings survive the correction: high-altitude Front Range cities remain the most challenging metros in America, and coastal California remains the most favorable region. The largest corrections are listed in the What Changed section below. The original report remains available as an archived PDF.


Executive Summary

This is the first 100-city migraine risk analysis published since Sperling's "America's Migraine Hot Spots" study in 2006. This revised edition scores each metro from three years of measured hourly atmospheric pressure rather than from climate descriptions, making it, to our knowledge, the first city migraine ranking built entirely on observed pressure behavior.

Key findings:

  • Colorado Springs, Colorado is America's highest-risk city for weather-driven migraines, scoring 91.73, roughly 2.2x the national median (42.60). Denver and Flagstaff complete an all-high-altitude top three.
  • Elevation remains the strongest single signal. The three most challenging cities all sit above 5,000 feet, where baseline pressure near 800 to 840 hPa makes every weather-driven swing proportionally larger, and where mountain wind patterns produce rapid short-window pressure movement that sea-level cities rarely experience.
  • January is America's worst migraine month in the measured record, qualifying as peak trigger season in 86 of 100 metros. The deep-winter window from December through March dominates; July qualifies in none.
  • New York City ranks 15th most challenging, correcting the most significant error in v1.0, which had placed it among the ten most favorable metros. Its measured record shows a nine-month trigger season and 94 severe-swing days per year.
  • California dominates the favorable list, holding 6 of the ten most favorable metros, and Honolulu replaces San Diego at rank 100 with the calmest measured atmosphere in the country.
  • The Northeast is the most challenging region on average, edging past the Mountain West once cities are scored on measured storm frequency rather than described weather.

Methodology (v1.1)

Each of the 100 largest U.S. metropolitan areas was scored from hourly surface-pressure observations covering April 1, 2023 through March 31, 2026 (roughly 26,000 hourly readings per city), drawn from the Open-Meteo historical weather archive. All pressure changes are scaled to sea-level equivalent (multiplied by 1013.25 divided by the city's mean surface pressure) so that a swing at altitude is compared fairly against the same relative swing at the coast.

Three-Factor Composite Score (0-100, higher = more challenging for migraine sufferers)

1. Trigger Season Length (53.3% weight). The number of calendar months in which at least 35% of days recorded a sea-level-equivalent pressure drop of 5 hPa or more within 24 hours, the change threshold most consistently associated with migraine onset in the clinical literature.

2. Swing Severity (33.3% weight). The number of days per year with a severe pressure event: a drop of 10 hPa or more within 24 hours, or a rapid drop of 5 hPa or more within 6 hours. The six-hour window captures fast events such as chinook onset and squall-line passage that a daily average conceals.

3. Baseline Pressure (13.3% weight). The city's measured mean surface pressure, reflecting elevation. Residents of high-altitude cities live at a lower baseline, so weather-driven changes represent a larger fraction of the pressure their bodies experience.

Each factor was min-max normalized across the 100-city sample and combined using the weights above. v1.0's fourth factor, a count of trigger types drawn from written city profiles, was removed in this revision because it could not be reproduced from measured data; its weight was redistributed proportionally across the three measured factors.

What this index is not

This is a weather-driven migraine risk index. It does not measure migraine prevalence, healthcare access, or non-weather triggers. In particular it does not score air quality, which is a documented migraine trigger in its own right: cities such as Bakersfield and Fresno rank favorably here on atmospheric stability while ranking among the worst in the nation for particulate pollution. Readers weighing a move should treat this index as one input among several.


What Changed from v1.0

Cityv1.0 rankv1.1 rankWhy
New York, NY9615Measured record shows a 9-month season and 93.7 severe-swing days per year, far more challenging than its v1.0 text profile scored.
Topeka, KS9227Measured record shows a 7-month season and 104.4 severe-swing days per year, far more challenging than its v1.0 text profile scored.
Lubbock, TX7919Measured record shows a 7-month season and 97.4 severe-swing days per year, far more challenging than its v1.0 text profile scored.
Tampa, FL4297Measured record shows 11.0 severe-swing days per year, calmer than its v1.0 text profile suggested.
Tallahassee, FL3282Measured record shows 24.7 severe-swing days per year, calmer than its v1.0 text profile suggested.
Wichita, KS7325Measured record shows a 7-month season and 108.7 severe-swing days per year, far more challenging than its v1.0 text profile scored.
Mobile, AL4087Measured record shows 26.0 severe-swing days per year, calmer than its v1.0 text profile suggested.
Portland, OR1156Measured record shows 57.4 severe-swing days per year, calmer than its v1.0 text profile suggested.

New York is the correction that prompted this revision: v1.0 scored only its fall storm window and missed the spring frontal season entirely. Nashville moves from 95th to 67th for the same reason in the opposite direction of magnitude: its measured volatility is real but concentrated, placing it mid-pack rather than among the most favorable.


Top 10 Most Challenging Cities for Migraine Sufferers

#1. Colorado Springs, CO - Score: 91.73

At 6,000 feet against the Front Range, Colorado Springs records rapid short-window pressure movement on more days than any other large metro: 221 days per year with a severe swing, across a trigger season that now measures nine months. Mountain-wave winds and chinook events drive fast pressure oscillation that sea-level cities simply never see.

#2. Denver, CO - Score: 77.86

Denver drops one spot but remains firmly in the top tier. The measured record shows 171 severe-swing days per year at a baseline pressure of just 838 hPa, so every passing system moves a larger share of the total air column above the city. The chinook wind pattern that defined the original ranking is exactly what the six-hour measurement window captures.

#3. Flagstaff, AZ - Score: 73.2

The highest city in the index at roughly 7,000 feet, Flagstaff records the most severe-swing days of all 100 metros, 231 per year. Its trigger season is shorter than the Front Range cities, five months, but when the pressure moves here it moves fast and far relative to the thin baseline of 794 hPa.

#4. Fargo, ND - Score: 70.11

Fargo's flat, continental exposure gives storms an uninterrupted run at the city. The measured trigger season is ten months, tied for the longest in the index, with 102 severe-swing days per year as Alberta clipper systems and polar fronts cross the northern Plains in quick succession.

#5. Santa Fe, NM - Score: 69.73

Santa Fe pairs 7,200 feet of elevation with a southwestern storm track that delivers 169 severe-swing days per year. Like the other high-altitude entries, its baseline pressure near 791 hPa means weather-driven changes are proportionally larger for residents than the same system would be at sea level.

#6. Duluth, MN - Score: 69.1

Lake Superior amplifies every system that crosses it, and Duluth sits directly in the outflow. The measured record shows a ten-month trigger season and 98 severe-swing days per year, with fall and early-winter lake storms producing the sharpest drops.

#7. Boston, MA - Score: 68.86

Boston is the highest-ranked sea-level city in the corrected index. Nor'easters, fast-moving cold fronts, and coastal low development produce a ten-month trigger season and 106 severe-swing days per year, the most of any Northeast metro.

#8. Providence, RI - Score: 67.86

Providence shares Boston's exposure to coastal storm tracks and adds Narragansett Bay's funneling geography. The measured record shows a ten-month trigger season and 100 severe-swing days per year.

#9. Salt Lake City, UT - Score: 67.53

Salt Lake City is the corrected index's biggest climber into the top ten, from 35th to 9th. At 871 hPa baseline in a mountain basin, it records 149 severe-swing days per year as Pacific systems spill over the Wasatch and lake-effect dynamics stir the valley air.

#10. Rapid City, SD - Score: 66.04

Rapid City sits in chinook country on the eastern slope of the Black Hills. The measured record shows 115 severe-swing days per year across an eight-month season, with midwinter chinook events capable of swinging conditions within hours.


Top 10 Most Favorable Cities for Migraine Sufferers

#100. Honolulu, HI - Score: 0.04

The most stable atmosphere of any American metro, by a wide margin. Honolulu recorded severe pressure swings on fewer than one day in three hundred, and no month of the year qualifies as a trigger season. Maritime tropical air simply does not move the barometer.

#99. San Diego, CA - Score: 0.42

San Diego held its position at the top of the favorable list almost unchanged. Two severe-swing days per year and a zero-month trigger season confirm the original finding: the marine layer and Pacific high keep pressure remarkably flat year-round.

#98. Miami, FL - Score: 0.55

Outside of named tropical systems, Miami's pressure regime is among the calmest in the country, under four severe-swing days per year. The hurricane caveat is real but narrow: the background atmosphere the rest of the year is exceptionally steady.

#97. Tampa, FL - Score: 1.6

Tampa climbs sharply in the corrected index, from 42nd to 97th. The measured record shows eleven severe-swing days per year and no month meeting the trigger-season threshold. Summer thunderstorms are frequent but move the barometer far less than continental frontal systems do.

#96. Los Angeles, CA - Score: 1.72

Seven severe-swing days per year across a zero-month season. The Pacific high and coastal mountains shelter the basin from nearly all rapid pressure movement.

#95. Fresno, CA - Score: 2.43

The San Joaquin Valley's sheltered geography produces just twelve severe-swing days per year. One honest caveat belongs next to that number: the valley also traps particulate pollution, and air quality is a real migraine trigger this index does not score.

#94. Bakersfield, CA - Score: 5.18

Bakersfield's measured atmosphere is among the calmest in the index, 29 severe-swing days per year and a zero-month season. The same caveat as Fresno applies: this is a weather index, and the southern valley's poor air quality sits outside what it measures.

#93. San Francisco, CA - Score: 6.93

Marine-layer dominance keeps San Francisco to ten severe-swing days per year. Fog is constant; pressure movement is not.

#92. San Jose, CA - Score: 7.09

Sheltered on three sides, San Jose records eleven severe-swing days per year with no qualifying trigger months.

#91. Orlando, FL - Score: 7.75

Central Florida's daily summer storms are dramatic overhead but modest on the barometer. Fifteen severe-swing days per year and a one-month season put Orlando among the ten most favorable metros.


Regional Breakdown

RegionAverage Risk Score
Northeast57.24
Midwest54.45
Mountain West49.87
South28.86
Pacific Coast19.18

The Northeast's rise to the top of the regional table is a direct result of measuring storm frequency: nor'easter and frontal activity give its metros long trigger seasons even at sea-level baseline pressure. The Mountain West average conceals the widest internal spread of any region, from Colorado Springs at 91.73 to Las Vegas and the Arizona desert metros deep in favorable territory.


Seasonal Patterns

MonthCities with month in peak season
January86 cities
February84 cities
March73 cities
April52 cities
May15 cities
June11 cities
July0 cities
August1 cities
September6 cities
October36 cities
November58 cities
December73 cities

January is America's worst migraine month in the measured record, qualifying as peak season in 86 of 100 cities, with February (84), March (73) and December (73) close behind. The v1.0 edition, working from written profiles, identified November; the observed pressure data shifts the peak deeper into winter, when continental frontal activity is strongest.

Summer is dramatically calmer. July qualifies as a trigger month in no city at all, and August in 1. Even thunderstorm-heavy metros move the barometer less in summer than a routine winter front does.


The Elevation Effect

The clearest signal in the corrected index is unchanged from v1.0: altitude concentrates risk. The three most challenging cities all sit above 5,000 feet.

RankCityElevation (approx)Measured Mean Pressure
1Colorado Springs, CO6,035 ft817.3 hPa
2Denver, CO5,280 ft838.4 hPa
3Flagstaff, AZ7,000 ft793.7 hPa
5Santa Fe, NM7,200 ft791.4 hPa
9Salt Lake City, UT4,300 ft871.3 hPa

Two mechanisms compound at altitude. Baseline pressure is materially lower, so the same absolute swing is a larger relative change. And mountain wind systems, chinooks on the Front Range, wave patterns over the Colorado Plateau, produce rapid short-window pressure movement on well over half the days of the year in the worst cases.


State-Level Averages

Most challenging states (2+ cities in index):

StateAvg ScoreCities
CO84.802
MN63.882
SD60.732
NM58.812
WI58.183
NY55.564
KS55.142
MI54.312
MO46.383
PA46.132

Most favorable states:

StateAvg ScoreCities
CA4.597
FL7.096
AL13.462
LA18.583
GA22.783
AZ26.974
TN29.464
NV32.382
NC33.834
TX35.468

Complete 100-City Ranking

RankCityScoreTrigger Season (months)Severe-Swing Days per YearMean Pressure (hPa)
1Colorado Springs, CO91.739220.8817.3
2Denver, CO77.868170.5838.4
3Flagstaff, AZ73.25230.5793.7
4Fargo, ND70.1110102.1982.3
5Santa Fe, NM69.736168.8791.4
6Duluth, MN69.11098.1989.7
7Boston, MA68.8610106.11013.3
8Providence, RI67.861099.71014.6
9Salt Lake City, UT67.537149.4871.3
10Rapid City, SD66.048114.7901.7
11Anchorage, AK65.881081.71003.9
12Missoula, MT64.438104.7904.4
13Green Bay, WI64.249103.1993.9
14Hartford, CT62.18997.11014.0
15New York, NY61.91993.71010.2
16Omaha, NE60.618107.7976.4
17Burlington, VT58.988109.11007.3
18Minneapolis, MN58.65897.7985.0
19Lubbock, TX57.92797.4906.4
20Grand Rapids, MI57.49892.4991.6
21Milwaukee, WI57.48893.1993.5
22Syracuse, NY57.06893.11000.7
23Chicago, IL57.04890.7995.1
24Boise, ID56.46793.1920.6
25Wichita, KS55.837108.7969.5
26Sioux Falls, SD55.437103.4963.3
27Topeka, KS54.457104.4982.2
28Des Moines, IA53.687100.1984.7
29Madison, WI52.82793.7983.6
30Rochester, NY51.68791.4997.3
31Buffalo, NY51.61789.7994.3
32Detroit, MI51.13786.4994.4
33Cleveland, OH50.7782.7992.5
34Spokane, WA50.64767.0955.1
35Kansas City, MO48.29699.1983.3
36Albuquerque, NM47.894116.1851.4
37Tulsa, OK47.42695.7989.6
38Pittsburgh, PA46.41688.4988.8
39Philadelphia, PA45.85695.11014.8
40St Louis, MO45.71688.11000.0
41Washington, DC45.45692.71015.6
42Baltimore, MD45.14689.71013.5
43Springfield, MO45.13672.0970.4
44Indianapolis, IN44.99679.7991.6
45Columbus, OH44.94678.7990.0
46Dayton, OH44.71677.1990.0
47Richmond, VA44.45683.11009.0
48Charleston, WV43.84673.1994.8
49Cincinnati, OH43.79669.0985.7
50Louisville, KY42.64667.01000.2
51Norfolk, VA42.56673.11016.5
52Lexington, KY42.38658.0982.6
53Oklahoma City, OK41.88587.4972.8
54Fort Worth, TX41.3591.4992.4
55Seattle, WA41.2661.01009.9
56Portland, OR40.32657.41015.9
57Dallas, TX40.04585.7999.7
58Reno, NV39.78465.4864.3
59Raleigh, NC37.56571.01005.7
60Charlotte, NC37.23561.4987.8
61Little Rock, AR36.65564.41004.9
62San Antonio, TX36.02491.7992.3
63Austin, TX34.74485.1997.7
64Asheville, NC32.25445.4942.6
65Shreveport, LA32.14472.41010.6
66Knoxville, TN31.79459.7985.4
67Nashville, TN30.61457.0998.8
68Memphis, TN30.5459.71007.3
69El Paso, TX29.75280.1889.5
70Augusta, GA29.65456.01012.5
71Wilmington, NC28.26448.01016.5
72Charleston, SC26.47435.71016.6
73Las Vegas, NV24.98269.4943.9
74Chattanooga, TN24.93352.4993.3
75Jackson, MS23.0344.41006.4
76Corpus Christi, TX22.17342.01014.5
77Houston, TX21.73339.01014.7
78Savannah, GA20.75333.01016.5
79Atlanta, GA17.94235.4979.8
80Birmingham, AL17.86241.4995.8
81Baton Rouge, LA15.22231.01014.9
82Tallahassee, FL14.64224.71009.4
83Mesa, AZ12.61068.0969.3
84Phoenix, AZ12.6070.0974.4
85Jacksonville, FL9.55129.41016.8
86Tucson, AZ9.46029.7928.8
87Mobile, AL9.06126.01016.7
88Pensacola, FL8.48121.31015.0
89New Orleans, LA8.38121.01015.9
90Sacramento, CA8.33119.31012.7
91Orlando, FL7.75115.01012.0
92San Jose, CA7.09110.71012.5
93San Francisco, CA6.93110.31014.3
94Bakersfield, CA5.18029.41000.4
95Fresno, CA2.43011.71003.6
96Los Angeles, CA1.7207.01004.2
97Tampa, FL1.6011.01015.9
98Miami, FL0.5503.71015.9
99San Diego, CA0.4202.01013.9
100Honolulu, HI0.0400.31016.1

Scientific Background

Migraine affects an estimated 12% of U.S. adults, with women three times more likely than men to be diagnosed (American Migraine Foundation). It is among the leading causes of disability worldwide (World Health Organization, Global Burden of Disease Study).

Weather has been a suspected migraine trigger for over a century, but only recently have large-scale studies begun to quantify the relationship. Recent findings include:

  • A 2025 retrospective cohort study in Frontiers in Neurology analyzed Japanese medical claims and meteorological data and found significant associations between seasonal atmospheric pressure change and migraine occurrence.
  • A 2023 study in Headache: The Journal of Head and Face Pain using smartphone-tracked data from 4,375 adults found migraines correlated with humidity, rainfall, and pressure changes.
  • A 2025 systematic review published in Cureus examined all available literature on barometric pressure and migraine and concluded that pressure drops and rapid fluctuations are consistently associated with increased migraine frequency, though not with migraine severity or duration. The six-hour severity window in this revision follows that finding: rapid fluctuation, not just daily change, matters.
  • The Washington Post reported in August 2025 on the emerging clinical field of "meteoropathy" - the study of physiological reactions to environmental changes, particularly barometric shifts - as practitioners begin to recognize weather sensitivity as a legitimate medical phenomenon.

The 2026 U.S. Migraine Risk Index translates three years of city-level pressure observation into a comparable risk metric.


About MigrAid

MigrAid is an iOS migraine tracking application that helps users identify personal triggers, forecast elevated-risk days, and share symptom data with their healthcare providers. The app integrates local barometric pressure, humidity, and temperature data with user-logged migraine history to produce 48-hour personalized risk forecasts.

The 2026 U.S. Migraine Risk Index was compiled by MigrAid's research team from hourly surface-pressure observations for the 100 largest U.S. metros, alongside peer-reviewed migraine trigger literature.


Press Contact

Ross Salimov, Founder MigrAid · Salimov Studios [email protected] migraid.app/press

High-resolution graphics, interactive maps, and interview availability: migraid.app/press/


Methodology notes, scoring source data, and city-by-city detail available on request. The v1.0 edition (April 2026) is archived as a PDF. This index will be updated annually.