Migraines: Plan of Attack

Part 3:  Weapons to fight back


Migraine treatment can sometimes be as frustrating as the headaches themselves, because there is no assured quick fix.  Sometimes it can feel more like the “art of war” rather than a precise science to find the personalized MYgraine strategies for your particular battle.  A solid working relationship with a trusted neurologist can make a significant difference in guiding the proper approaches and building on what does and doesn’t work for you.


A common way to divide treatment approaches is into ACUTE and PREVENTATIVE treatment.  Think of it like a “one-two punch”:


 1)     Acute treatment strategies target the headache you have right then and there.  What treatments are used and when, needs to be thought out ahead of time, because you may have different variations or intensities of migraines that require different tools at different times.  I try to write these different scenario plans out for patients to refer to as cheat-sheets of what they can try without having  to rely on their memory in the middle of a throbbing headache.  While it’s important to have a plan for what to do when you get a migraine, it usually doesn’t execute as well if you are having to resort to it often.  Treating too many headache days with acute treatment can lead to rebound or medication-overuse headaches that keep digging you deeper into a hole.  I certainly don’t recommend taking acute treatment medications for more than 8 days per month for that very reason (and this can even include some over-the-counter medications!).  


Examples of some acute strategies include:  over-the-counter medications, prescription pills/ powders/ sprays/ exhalers/ injections/ wearable medical devices or IV infusions.


2)     Preventative treatment strategies target the goal of switching your system from staying in the “ON” migraine mode position to “OFF”.  These strategies usually involve taking something on a daily basis to shield one from as many attacks as possible.  Usually, preventative treatment is recommended for those that suffer a frequency of more than 4 migraine days a month, or depending on the presentation/duration/intensity of the migraines.  Sometimes, a preventative isn’t needed daily, but a pre-emptive strike is necessary to prevent certain migraines.  This is called a “mini prophylaxis” and patients take acute medication for a few days before symptoms even start  in special situations where they know a particular trigger will certainly bring them on (e.g., menstrual migraines).  It can make a big difference in mitigating or preventing the expected migraines.  Finding an effective preventative strategy can take time and patience, but it is a cornerstone for the overall plan of attack.  By reducing the overall number of headaches, it allows the acute treatments a better shot to work when they need to be used.


Examples of some preventative strategies include: dietary changes, correcting or optimizing vitamin levels, supplements, prescription pills (can include a variety of medication types from blood pressure medications, seizure medications, depression medications)/ medical devices/ nerve blocks/ acupuncture/ dry needling/ neurofeedback or botulinum toxin injections.


Overall, an integrative approach can help strengthen your “one-two punch”.  That means you have to realistically take into account your environment’s different stressors and triggers, your lifestyle choices in nutrition, exercise, and sleep, and what helps you achieve a better mind-body relaxation response.  If you can achieve a more grounded sense of wellness then you gain more consistent control of your life, and over time you become less dependent on needing to throw any “punches” at all. 


I hope this 3 part blog series has helped you or someone you know on the frontline of the fight against migraine.

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