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.


Migraines: Plan of Attack

Continuing with the second post of this three-part migraine blog series, we explore the various triggers and map the battlefield.


Part 2:  Mapping the Battlefield


While we may be eager to start fighting every migraine that comes our way, we first need to step back and map out our “landmine” triggers.  


The triggers come in many shapes and forms.  Some we can avoid and some we cannot.  Some may be obvious; some more subtle.  Sometimes we don’t have just one significant driving force but several sneaking up against us.  To be successful in our fight against migraines, we need to recognize when to step around, get rid of, or know how to deploy strategies against our triggers.


Here are some “landmine” triggers to consider:


Stress:  Can be negative stress (e.g., anxiety/worries, uncertainty, illness) or even positive stress (e.g., new job, promotion, coordinating your active family schedule).


Sleep:  Lack of sleep is usually an instigator or at least an enabler in fueling the migraine state.  This may result from insomnia, low total hours of sleep, or poor quality of sleep.


Let-down:  Sometimes you are amazed that in the middle of the hecticness you don’t get a migraine, but as you finally finish the deadline, complete finals, finish a busy week, or get started on a vacation and you treat yourself to sleeping in--bam, you’re instead rewarded with a migraine.


Suboptimal hydration:   This can come about not only from not drinking enough fluids, but also from heat and exercise losses, as well as from things that make us urinate more, such as alcohol, caffeinated beverages, and medications.


Foods/drinks:   This is not an exhaustive list, nor does it mean it will be a trigger for you, but you may want to look for any patterns

around the consumption of:

  • Red wine (or for some any type of wine, beer, or liquor)
  • Chocolate/cocoa (sorry)
  • Caffeine (trigger for some, helpful for others)
  • Gluten/Dairy/Sugar containing foods/drinks (may increase inflammation process in some)
  • Nitrites/Sulfites (left over food, additive in processed meats, found in some fruits/veggies/preservatives)
  • Aspartame (sugar-free foods, diet drinks, low calorie desserts)
  • Histamine/Tyramine (aged cheeses, smoked/cured/processed meats, fermented fruits/veggies, vinegars, nuts)

Weather/Climate:  Barometric pressure changes, storms, altitude changes


Lights:  Fluorescent lighting, bright sunlight, flashing lights


Sounds:  Loud or busy


Smells:  Perfume/Cologne, deodorizing sprays/scented candles, smoke, cleaning products


Seasonal Allergies:  Sometimes these trigger or exacerbate our migraines, but also be aware that the “allergy” symptoms we sometimes experience such as red/watery eyes, congested/runny nose, sinus area pressure/tenderness, or a droopy/puffy eyelid, may actually be manifestations of the migraine process itself.  You might think twice about some of your  “sinus headaches”.


Hormonal/Perimenstrual:  These can be some of the hardest triggers to control and sometimes we need to get ahead of it by a strategy called mini-prophylaxis.


Neck pain:  Can be an aggravating factor or can be part of the chronic migraine set of symptoms where neck and shoulder pain/tightness play more significant roles. 


With a better understanding of your particular migraine triggers, in the third and final blog post on migraines, we will focus on your Migraine Plan of Attack--the strategies to fight back!


Migraines: Plan of Attack

Migraines are complex.  Their effects, diagnosis, treatment, and prevention are personal and can vary from patient to patient, which is why I sometimes think of them as MYgraines.


My goal is to provide a framework in this three-part blog series, to empower you or someone you know that feels overwhelmed or is already losing out on enjoying life to the enemy--migraine.  In Part 1, we will study the enemy, in Part 2, we will map the battlefield, and in Part 3, we will explore weapons to fight back.


Migraines involve a dynamic process, and, as such, the treatment and prevention plans may require changes in course for different scenarios or different times in our lives.  Moreover, we may think we know our migraines’ every move, but some still surprise us, some seem eager to pounce at every opportunity, and some hold us captive without headache-free days.  Establishing a solid working relationship with a neurologist you trust can be an invaluable ally.


Part 1: Study your enemy


Migraines can be intimidating so let's begin by breaking them down.  Migraine headaches are primary headaches, meaning they are not a symptom of a secondary condition or disease (such as tumor, structural brain or blood vessel abnormality, stroke, bleed, infection, or medication effect).  Because they are primary headaches, there is an innate and likely genetic predisposition to why we develop these headaches.  While they can wreak havoc on our lives, migraines themselves are not dangerous as are some of the secondary headache causes.  There are multiple other primary headache syndromes, but migraine is by far the most common of that group.


Migraine is more than just a bad headache.  To keep an eye out for trouble before it gets out of hand, we should not simply recognize migraines by the intensity level of the headache but by the company it keeps.  There can be increased sensitivity to light (sunlight or fluorescent lights may seem more bothersome than usual) or to sounds in our environment (your kids/TV/radio volume seem louder than usual!).  Sometimes we might not realize we are more sensitive or irritated by things, but we can appreciate that we prefer to be in a more dim, quieter place, away from it all.  For others, they may instead feel nauseous, queasy, loss of appetite, and can lead to vomiting for an unfortunate group of migraineurs.  Other classic characteristics of migraines is that the headache climbs in intensity over time, can be throbbing/pulsating, or can feel worse with even basic physical activity, such as bending down or walking.


Some migraines come with warnings called auras before the actual pain strikes.  Note that auras can occur at the same time as the headache or even without any headache at all!  Migraine auras can include: vision changes (blurriness or loss of vision in different patterns, flashing/flickering lights, colorful/dark spots, wavy lines, jagged or zig-zag patterns), sensory changes (pins & needles sensation or numbness that can affect the face, tongue, arm or leg), language abnormalities (trouble getting words out or misspeaking), and rare motor auras (weakness on one side that must thoroughly exclude other serious causes before arriving at a hemiplegic migraine diagnosis).


In addition to headaches and auras, other symptoms of migraines can include vertigo, dizziness, and lightheadedness. It is important to note that some patients can have autonomic symptoms, including sinus-area pain, red or watery eyes, nasal congestion or runny nose, eyelid puffiness or droopiness.  It’s no wonder why so many people blame sinus problems and allergies for what may actually be migraines!


Now you are better equipped to identify the number one enemy of headache sufferers, migraines. In the next blog post, we will map out the battlefield and explore the various minefields that can set off this complex enemy.