I truly sympathize with those who suffer from chronic migraines. While I occasionally have a mild headache, only once do I think I may have experienced something even close to migraine pain. When I had this extra-intense headache, it was impossible to function until the pain and associated symptoms (blurry eyes, sensitivity to light and noise, nausea) went away.
Symptoms of Migraines:
Migraines (https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072557/) tend to strike suddenly, with severe pain on one side of the head. Migraine pain is much worse than a common headache, and a migraine is classified as such if it has occurred at least five times. The pain of a migraine is described as pulsating, pounding, or throbbing. The pain, which can last between hours and days, may be accompanied by nausea, vomiting, and auras (most commonly presenting as visual disturbances – in this article is a detailed explanation https://www.mayoclinic.org/diseases-conditions/migraine-with-aura/multimedia/migraine-aura/vid-20084707).
The Bad Kind of Rebound:
It is important to note that frequent use of OTC (over the counter) pain relief medications for migraines may lead to rebound headaches, also known as medication overuse headaches. Here is a more detailed discussion of these headaches, including medications that are most often the culprits. (https://www.webmd.com/migraines-headaches/rebound-headaches#1) It is important to be familiar with rebound headaches if you do suffer from migraines, so that you can work with your neurologist to decrease or hopefully eliminate them.
Neurologists put a lot of thought into individualizing prescription drug regimens for each patient based upon other coexisting medical conditions, frequency and duration of migraine symptoms, other prescriptions that may interact, etc. I thought it would be helpful to discuss ways to treat migraine in addition to any prescription drugs that your neurologist has carefully selected for your individual case.
Nonprescription Approaches to Migraine Pain Prevention:
For this, I turned to neurologist Charles Asta, MD. Dr. Asta sees a large number of migraine sufferers in his neurology practice, about half of whom are newly diagnosed, and the other half of whom have suffered for many years. He agrees that migraines can dramatically affect functioning in patients’ daily lives.
Dr. Asta says that other underlying conditions must be addressed – for example, if allergies are contributing to headaches, it would be important to see an allergist and get the allergies under control. He also notes that even if a patient’s headaches are under control, they could be triggered by a variety of factors such as weather, stress, illness, etc.
There’s an App for That:
Dr Asta and I discussed the importance of keeping records at home. For some, an app (there are many great apps available) may be useful, while others prefer seeing data on paper and making or printing their own diary. Keeping a diary allows you to keep track of many factors that seem to contribute to your migraine pain. These might include sleep, stress, foods, etc. The diary whether as an app or on paper helps you and your doctor detect patterns and look at the big picture.
A diary may be very helpful in identifying food triggers. There are many foods that are notorious for causing headaches, including alcohol/red wine, strawberries, cured meats, chocolate, and aged cheeses. Here is a comprehensive list: https://migraine.com/migraine-triggers/food-and-drinks/ You may find, with journaling, that cutting some of these foods out of your diet may make a world of difference in frequency or intensity of migraines.
Sleep It Off:
Dr. Asta stresses that poor sleeping can contribute to migraine pain. He believes at least 6 or 7 to 8 hours of high quality (uninterrupted) sleep is very important. He suggests that you pick a time you will put your head on the pillow, when you know you have 6 to 8 hours to sleep. One hour before that time, start to switch off your brain and wind down – no iPhones, iPads, TV’s, or computers. (Books are okay.) Get in the mindset that you are almost ready to sleep. Dr. Asta advises keeping TVs out of the bedroom, because they are too stimulating, and if you can’t sleep, you will be tempted to turn it on.
For great sleep quality without interruptions, Dr. Asta also advises against alcohol after 8:00 pm, because it could reduce deep sleep, and will not allow you to get the complete, refreshing sleep that you need.
Also, be sure to limit fluid intake after 8:00 pm, as getting up at night to use the bathroom interrupts your sleep. Empty your bladder just before bed.
Sleep hygiene is the practice of employing habits to ensure a good night’s sleep quality and full daytime alertness. Here is some more useful information about sleep hygiene as related to migraine sufferers. https://americanmigrainefoundation.org/understanding-migraine/sleep/
Practicing good SLEEP hygiene is as important as practicing good hygiene in general for those with headaches. Here are some more general tips about getting great sleep https://sleepfoundation.org/sleep-topics/sleep-hygiene
Dr. Asta also suggests use of the natural product, melatonin, for those who are having sleep difficulties. Using 5 to 10 mg daily at bedtime for a few weeks may help regulate your sleep cycle and get you back on track. (You’ll find more information on sleep solutions in the upcoming broadcast, Show 1125.)
A Lot of Lattes?
Dr. Asta explains that patients can slowly work to decrease their caffeine intake, which will help with both sleep and headaches. For example, if you are drinking 5 large size cups of coffee per day, start by cutting down to 5 regular cups. Then after a week cut down to 4 regular cups per day, and every week decrease by one cup. When you are down to one cup per day, decide if you really need that one cup, or, as Dr. Asta says, you may do just as well with a cup of orange juice or vitamin water to wake you up and get you through the morning.
Managing Stress:
Dr. Asta advises finding a way to deal with stress that does not necessarily involve large amounts of Xanax. He finds many patients have great success with exercise. Whether kickboxing, doing yoga, meditating, even taking a leisurely walk outside, exercise can do a world of good by releasing serotonin and endorphins.
If you find it hard to manage stress, you may need to see a psychologist or psychiatrist, and if prescription treatment is needed, Dr Asta recommends talking to your doctor about starting with an SSRI (selective serotonin reuptake inhibitor) such as escitalopram (Lexapro) as opposed to alprazolam (Xanax). Keep in mind that any medication has potential side effects and inform yourself about them.
Triple Threat:
Dr. Asta also notes that his patients have a lot of success with this triple punch of vitamins.
- Magnesium – 400 to 750 mg daily, as tolerated (often causes diarrhea)
- Coenzyme Q10 – 300mg per day
- Riboflavin (Vitamin B2) – 200mg per day
Seek out Support:
As someone who relies on social media a lot, I think it would be beneficial to also try seeking out migraine support groups on Facebook, in-person or online support groups, and online message boards. Sometimes, connecting with others who share in your experience may be comforting.
I hope some of these tips help you to feel better!
Information in this article is intended to be general advice. For individualized advice, consult your doctor.
