A migraine is a type of neurological disorder characterized by recurrent, extremely painful headaches. This pain is often localized to one side of the head, and may be accompanied by stomach upset and hypersensitivity to smells, light or sound. Migraines may persist for a few hours to several days. Some potential triggers that bring on migraines include fluctuations of hormones in women, drinks containing alcohol or caffeine, worry, bright light, loud noises, strong odors, and erratic sleep schedules, among other factors such as where we live.

Here are five U.S. cities that are deemed the worst for migraine sufferers, along with how they came to rank in this list and the rationale behind their inclusion:

1. Cincinnati, OH
Cincy residents often partake of a diet high in foods that trigger migraines. Cincinnati-style chili, for example, has a tomato base and is often topped with onions and cheese. Tomatoes, onions, and dairy are all ingredients that may spur a migraine. The residents of Cincinnati also like to eat their pizza, another entree that is heavy on dairy and that also contains wheat in the crust. Pizza ingredients deliver nitrates, as well, if a slice or more of pepperoni is the order of the day.

2. Madison, WI
Madison, home to the University of Wisconsin-Madison, makes the list due to the lifestyle many of its inhabitants ascribe to. It may not surprise anyone to know that this city is also one of the cities with a high rate of alcoholism. Imbibing alcohol is a well-known trigger to bring on a migraine. Red wine is especially worrisome. Tannins present in red wine may boost serotonin production.

3. Little Rock-North Little Rock, AR
Arkansas is situated in the south, where its citizens of Little Rock and North Little Rock are subjected to fluctuations in barometric pressure as every front passes through. Its populace also endures hot, muggy weather during the summer months. It makes the list of most obese cities, as well. People who are obese are more prone to migraines than those of normal weight or those who are overweight.

4. Knoxville, TN
This city ranks in the top five US cities for obese residents, a co-morbidity of migraines. Knoxville also shares the environmental woes that bring on so much misery for migraine sufferers, namely barometric pressure changes. Pressure swings go hand in hand with frequent storms Knoxville residents are subject to, living in the south.

5. St. Louis, MO
St. Louis, home to the Cardinals, is associated with many foods high in ingredients that are known to spark migraines. A few examples are the fact that Panera Bread Company is headquartered there. Also many sandwiches that are enjoyed there contain wheat. In addition to wheat in bread, ravioli contains wheat, and it’s often served with marinara that contains tomato. The St. Louis Slinger checks off many boxes, including eggs, cheese, onions, and nitrate-containing sausage.

Medication has been shown to be an effective migraine treatment. It may prevent migraines when taken in conjunction with behaviors such as modifying activity at the first presentation of symptoms. Removing oneself from a stressful environment is key. Heat or cold packs placed on the head or neck may alleviate pain. Drinking a small amount of caffeine might ward off further, more severe symptoms. When the number of periodic headaches increases steadily, one may develop chronic migraine.