A migraine attack, or episode of symptoms, can cause moderate to severe pain and last from 4 to 72 hours. Anyone who has ever experienced a migraine attack knows how debilitating they can be. While there is no cure for migraine, there are many treatments available, including drugs that can prevent attacks, as well as drugs that can reduce the symptoms of an attack in progress. Lifestyle can make a difference. “Lifestyle routines can be key in migraine prevention,” says Nada Hindiyeh, MD, a clinical assistant professor in the department of neurology at Stanford Health Care in Palo Alto, California. Here are some things to keep in mind as you navigate life with migraine, including how to manage migraine triggers, identify complementary practices that can help, communicate with the people in your life about what it’s like to live with migraine, and connect with and learn from others who are facing the same challenges. That’s why establishing healthy habits that may prevent migraine attacks, such as following a healthy diet and going to bed and getting up at about the same time every day, are worth the effort, as is learning which pharmaceutical and complementary therapies help to prevent or reduce the frequency or severity of your attacks. It’s also important to find professionals who can help you manage your symptoms, your mood, and the many challenges that come with having a chronic condition like migraine. The following tools, tips, and resources can help you to live well with migraine.
Diet for Migraine
What you eat and drink and when you eat and drink can play a role in managing migraine. Most important is not to skip or miss meals. “Eating regularly for some people is really important — some people have to eat every two hours,” says Kathleen Digre, MD, a distinguished professor of neurology and ophthalmology at the University of Utah in Salt Lake City. Dehydration is a common trigger of migraine attacks, so make sure you drink plenty of water or other liquids throughout the day. Certain foods or types of food have long been identified as common migraine triggers: aged cheese, chocolate, caffeine, nuts, citrus fruits, aspartame, fatty foods, and food containing nitrates, the chemicals found in hot dogs and other processed meats. But according to an article in Migraine Again by Andrew Charles, MD, the director of headache research and treatment and a professor of neurology at the David Geffen School of Medicine at UCLA in Los Angeles, there’s little evidence these foods trigger migraine attacks. In fact, Dr. Charles writes, a craving for a particular food might instead signal the onset of a migraine attack, rather than trigger one. Red wine, however, may indeed be a trigger for some people, and the food additive monosodium glutamate (MSG) may similarly be a trigger. If you suspect that foods or beverages trigger your migraine attacks, it’s worth keeping a food diary to look for patterns and discuss it with your neurologist. According to Dr. Digre, some doctors have prescribed a ketogenic diet to control migraine, and there’s some evidence such a diet may have positive effects, as noted in an article published in November 2019 in the Journal of Headache and Pain. Magnesium and vitamin B2, or riboflavin, can reduce migraine frequency, according to the American Migraine Foundation, so you may want to incorporate magnesium-rich foods like dark leafy greens and legumes, and foods rich in B2, such as fish, almonds, and eggs, into your diet. Or speak to your doctor about taking supplements. There is some evidence that obesity is linked to the transformation of episodic migraine (attacks that come and go and occur no more than 15 days per month) into chronic migraine (more than 15 headache days per month), so maintaining a healthy weight may help keep the number and severity of your headaches at bay. RELATED: 8 Things You Need to Know About the Keto Diet and Migraine
Exercising With Migraine
Regular exercise can reduce both the frequency and intensity of migraine, so it’s beneficial to get in some exercise. “You don’t have to do a lot to gain benefits,” says Robert G. Kaniecki, MD, the director of the UPMC Headache Center in Pittsburgh. “A pattern of regular, moderately intense exercise can be valuable, but so can a simple regular walking program,” he says. Movement can exacerbate a migraine attack already in progress, though, so you should not work out once you begin to experience symptoms. Exercise-induced migraine attacks can also occur, particularly with more vigorous or strenuous sports or activities, such as weight lifting, running, tennis, or swimming. These headaches are sometimes related to other factors, such as inadequate hydration or not eating properly before a workout. In the past several years, several new medications that target migraine have become available, so if your current medication regimen isn’t working well, you may have new options. Your doctor may recommend daily preventive medication if you have frequent attacks (more than four migraine days per month) or long-lasting headaches that don’t respond well to treatment. Treatment for migraine is very individualized, and there is no typical treatment. People with migraine should work with their healthcare providers to figure out what works best for them.
Complementary and Alternative Medicine for Migraine
In addition to the numerous prescription medications available for the prevention and treatment of migraine, other approaches, including psychotherapy and some forms of mind-body therapies, can also help to reduce pain and psychological suffering. These include the following:
Cognitive Behavioral Therapy (CBT) This type of psychotherapy involves working with a psychotherapist to challenge negative thoughts and behaviors.Biofeedback Biofeedback uses electronic devices to consciously regulate bodily functions, such as breathing, heart rate, and blood pressure.Acupuncture Acupuncture is the practice of inserting very small needles into the body in specific places to reduce pain or alleviate other symptoms.Massage Massage involves applying pressure to the muscles and other soft tissues to bring about mental and physical relaxation. It can be particularly helpful for people who have neck and shoulder spasms along with migraine.
RELATED: Best Essential Oils and Scents to Ease Headache and Migraine Pain
Your Home Environment and Migraine
You can create a more supportive environment at home by eliminating certain triggers. For example, to reduce your exposure to uncomfortably bright light, cover your windows with curtains or blinds, and arrange your furniture so you’re not facing the windows when working or relaxing. In addition, use dimmers and soft lighting indoors. Set up a quiet room or use headphones to block out noise from family members or neighbors, particularly when you feel a migraine attack coming on. Keep scented candles, perfumes, fresh flowers, and air fresheners — all potential triggers — out of your home. RELATED: Is Working From Home Giving You a Headache?
Traveling With Migraine
Travel often involves stress — a major trigger for migraine — so planning how you will alleviate some of that stress is well worth your time if you will be traveling. Here are some ideas:
Be sure to get enough sleep before you leave home.Budget extra time to get to the airport or bus or train station so you’re not rushing.Try to stick to a regular eating and sleeping schedule on your trip.Remember to stay hydrated.If sunshine is a trigger for you, wear sunglasses, a hat, and sunscreen, and stay in the shade when you have that option.Don’t forget to bring your migraine medications.
In addition to your primary care doctor, you might consult with these other healthcare providers for your migraine care:
Neurologist A neurologist treats disorders of the nervous system. A neurologist can keep you aware of the latest migraine treatments and prescribe your medications.Headache Specialist A neurologist or other type of doctor who focuses on treating headache, including migraine, is called a headache specialist.Physical Therapist These health professionals use exercises and other techniques, such as assisted stretching and massage, that promote mobility, reduce pain, and help to restore physical function.Psychologist Living with migraine is stressful. A psychologist can help a person with migraine find ways to reduce stress, develop coping skills, and avoid or better deal with situations that cause emotional distress, which can sometimes be the trigger of a migraine attack.Psychiatrist Many individuals with migraine also experience depression and anxiety. A psychiatrist can prescribe medication to treat mental health conditions.Dentist if teeth grinding or clenching is contributing to your migraine attacks, your dentist may be able to prescribe an oral appliance to prevent grinding or clenching during the night or suggest other approaches such as relaxation techniques.Neuromuscular Dentist This type of dentist specializes in temperomandibular disorders (TMD), or disorders associated with the muscles that surround the temperomandibular joint (TMJ), which attaches your jaw to your skull.Sleep Specialist According to the American Migraine Foundation, people living with migraine are between 2 and 8 times more likely to experience sleep disorders (most often insomnia), compared with the general public. Sleep physicians and sleep psychologists can help people improve their ability to get adequate sleep.Biofeedback Specialist Biofeedback therapists help people incorporate relaxation techniques and exercises to alleviate chronic pain associated with migraine.Acupuncturist While acupuncture doesn’t work for everyone, for some, working with a licensed acupuncturist can help with stress management as well as pain management.Meditation Specialist These specialists help people learn and use strategies such as breathing techniques and mindfulness to calm the brain and body.Registered Dietitian (RD) An RD can help you develop a healthy eating plan that incorporates nutrients that may be helpful for migraine attack prevention, as well as eliminate any food triggers you may have.Chiropractor While little research supports the use of chiropractic manipulations for migraine treatment or prevention, some people with migraine find it helpful to see a chiropractor for complementary treatment.
“Interestingly, the more migraines per month someone has, the higher the risk of developing these other two disorders,” Dr. Broner says. The relationship goes both ways, Broner adds: “Some people may develop anxiety and depression first, while others may develop migraine first.” It’s been observed that a higher level of anxiety or depression can lead to an increase in migraine attack frequency and vice versa, Broner says. So treating each component is important. RELATED: What You Need to Know About Migraine and PTSD
Managing Depression and Migraine
Depression is a psychiatric comorbidity of migraine, meaning that people frequently have both, although neither condition appears to be directly caused by the other. “Underlying depression, particularly if untreated or inadequately treated, could lower the threshold for frequent and severe migraine attacks,” says Ferhad F. Bashir, MD, a neurologist and headache specialist at Memorial Hermann the Woodlands Medical Center in the Woodlands, Texas. “Similarly, if migraines are untreated or inadequately treated, it could result in a state of depression secondarily,” Dr. Bashir adds. Certain antidepressants can reduce the frequency and severity of migraine attacks, so those medications may prove doubly beneficial for people who experience both migraine and depression.
Managing Anxiety and Migraine
About half of people with migraine also have anxiety, but help is available. “Patients who have increased anxiety about migraines can see a psychologist to help identify triggers for the anxiety or migraines,” says Adelene E. Jann, MD, a clinical assistant professor of neurology in the division of headache at NYU Langone Health in New York City. “There are also different psychologists who specialize in treatments such as biofeedback or cognitive behavioral therapy, which can help manage anxiety and migraine symptoms,” adds Dr. Jann. RELATED: The Migraine and Anxiety Cycle (and How to Break It) As the person with migraine, you know the strain these attacks can put on your relationships. A migraine attack can typically last anywhere from four hours to as many as three days or longer. You may want to be alone, often in a dark and quiet room, while the attack is ongoing. Friends and loved ones may want to help, but they often don’t know what to do. RELATED: How to Make Room for Migraine in Your Relationships
Your Family Relationships
Open communication is essential when explaining any illness to family members. It can be particularly important when you’re dealing with a long-term condition like migraine. If you are a parent, it can be hard telling your child that you can’t make it to her school play because you are in the midst of a migraine attack and you’re experiencing nausea, or you can’t take her to the park because the bright sunlight and loud sounds of playing children will aggravate your symptoms. It’s best to be honest and explain why you need to stay home and take care of yourself. If possible, tell your child you might feel up to a quiet movie night later. You just might find yourself reclining on the couch with an ice pack on your head and the lights turned off but enjoying family time nonetheless. RELATED: How to Talk to Your Loved Ones About Your Migraine
Your Friendships and Migraine
Migraine attacks can often come on with little warning, causing you to cancel plans with friends at the last minute. Friends who don’t have migraine themselves might not understand the seriousness of your condition. Perhaps you’ve heard a friend say, “Why can’t you just take a pill and get over it?” You’ll need to educate your friends about what migraine is, including the triggers, symptoms, and treatments, and what you do to take care of yourself. That way, when you need to change your plans with them because of an attack, they will likely be more understanding. RELATED: Just Trust Me: How to Talk About Migraines with Family and Friends
Your Romantic Relationships and Migraine
In every relationship, people bring parts of their own lives into their shared experience. You may be hesitant to tell your partner about your migraine attacks, but it’s best to be upfront as soon as you feel it’s the right time. It may not be best to discuss this on the very first date, but it might make sense within the first three or four, or whenever you feel you are becoming “semiserious.” Inevitably, there will be a canceled date or outing in your future. Be honest about how often you experience attacks and what happens when you do — your partner will appreciate your openness, and it may bring you closer.
Family Planning With Migraine
Migraine runs in families; 70 percent of those who have it are found to have a hereditary influence, according to the National Headache Foundation. A child has a 50 percent chance of having migraine if one parent has it, and a 75 percent chance if both parents do. While it’s good to be aware of these figures, having migraine doesn’t preclude you from having children if you want them.
Sex Life With Migraine
Migraine can affect sex drive — usually decreasing it. Symptoms such as nausea, pain, dizziness, and fatigue don’t typically do much for the libido. In addition, engaging in sexual activity can trigger certain types of headache, including migraine. Some people with migraine don’t like to be touched when they are having an attack. It’s important to let your partner know what might help when you’re in the middle of a migraine attack. When it comes time for romance, let your partner know if strong smells or red wine can be triggering for you. The two of you may need to skip the wine, flowers, cologne, and scented candles and find other ways to create the right atmosphere. Treatment falls into two general categories, acute and preventive. Acute treatment refers to medicines you can take to relieve pain immediately, such as the following:
Pain relievers (both over-the-counter and prescription) such as aspirin, Tylenol (acetaminophen), and nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) and Aleve (naproxen)Triptans (migraine-specific pain relievers) such as Imitrex (sumatriptan) and Zomig (zolmitriptan)Reyvow (lasmiditan), a serotonin 5-HT1F receptor agonistErgots (migraine-specific drugs) such as Migranal (dihydroergotamine, or DHE), Ergomar (ergotamine), and Trudhesa, a new nasal DHE sprayDecadron (dexamethasone), a glucocorticoid (steroid)Neuromodulation, a type of treatment that utilizes devices that stimulate the brain and nervous system using magnetic waves or electric currentsCGRP-receptor antagonists, such as Nurtec ODT (rimegepant) and Ubrelvy (ubrogepant)
Preventive treatment refers to medicines you take on a regular (usually daily) basis to prevent migraine attacks in the future. These include:
Beta-blockers, such as Lopressor (metoprolol) and Blocadren (timolol)Antidepressants, such as nortriptyline (Pamelor)CGRP-targeted therapies, such as Aimovig (erenumab), Emgality (galcanezumab), Ajovy (fremanezumab), and Vyepti (eptinezumab)The CGRP-receptor antagonists Nurtec ODT and Qulipta (atogepant)Anti-seizure medications, such as Depacon (valproate) and Topamax (topiramate)Calcium channel blockers, such as Norvasc (amlodipine)Botulinum toxin type A (Botox)
According to research published in February 2018 in Headache, the total annual direct plus indirect cost for a person with migraine is $8,924 higher than for a similar person who doesn’t have migraine. Direct costs include healthcare expenditures such as doctor appointments and medications, while indirect costs are associated with lost productivity due to missing work.
Medication Prices for Migraine
Many people with migraine say they can’t afford emerging or expensive treatments that aren’t covered by insurance. In most cases, you must first try a less expensive drug on the prescription drug plan’s formulary that has been proven effective for most people with migraine before you can move up a “step” to a more expensive drug. Online price comparison tools like GoodRX.com and OneRX.com can help you save money on migraine prescription drugs in your area. You can also ask your doctor to submit a prior authorization request if you need a drug that is not covered by your insurance plan. RELATED: 10 Secrets to Save Money on Migraine Prescription Drugs RELATED: Who Will Pay for New Acute Migraine Medications?
Managing Your Work Life With Migraine
As an employee with migraine, having a support system that includes your team members and the HR department is vital. “Communication is important but often challenging,” says Zubair Ahmed, MD, an assistant professor of medicine at the Cleveland Clinic Lerner College of Medicine in Ohio, who advises letting your workplace know that you have migraine. Be open and honest with your boss about your needs to get accommodations that can be beneficial for your health. Maybe your workplace could remove the fluorescent lighting from your work area, provide you with a quiet, dark space when you need one, or ask team members to refrain from wearing perfumes or colognes if those bother you. You might also want to bring in a migraine-readiness kit that includes pain relief, sunglasses, and headphones or earplugs in case a migraine attack hits you at work. To learn more about managing migraine in the workplace, check out the resources on Migraine At Work, a project of the World Health Education Foundation that’s all about educating employers and employees on how to accommodate the needs of employees with migraine. RELATED: Hidden Pain: Migraine Stigma at Work Is a Big Problem
Can You Apply for Disability if You Have Migraine?
“You can get disability, but it isn’t easy,” says Mary Franklin, the executive director of the National Headache Foundation in Chicago. If you experience chronic migraine that makes it difficult or impossible for you to work, you can file a claim for Social Security disability benefits. You can file a claim for disability benefits online on the Social Security Administration’s website. Most claims are denied initially, but you can appeal the decision and try again. RELATED: 7 Hidden Challenges of Filing for Chronic Migraine Disability But as more and more people with migraine come forward to share their experiences, the public, teachers, and employers are becoming more educated about this relatively overlooked condition. Here are the stories of three celebrities working to raise awareness of migraine:
Whitney Cummings Has Learned How to Stick Up for Herself and Claim Space; Now She Wants to Help Others
Comedian Whitney Cummings started having debilitating migraine attacks as a child. Back then, her family and doctors were dismissive of her crippling condition — thinking she was just “crazy” or “dramatic.” Today she’s an advocate for migraine care. Read Whitney’s Story
Former Olympic Swimmer Amanda Beard Manages Her Symptoms Through Mindfulness Meditation
Four-time Olympian swimmer Amanda Beard first experienced migraine with aura as a 14-year-old training for her first Olympic Games. Hesitant to talk about her symptoms and attributing them to stress, she wasn’t diagnosed until she was well into her thirties. Today, she inspires others by sharing her experiences with depression, bulimia, and migraine. Read Amanda’s Story
Karamo Brown Wants Men and People of Color With Migraine to Know They’re Not Alone
Television host Karamo Brown had migraine attacks in his teenage years, but it wasn’t until he met a college classmate with migraine that he put a name to his debilitating headaches. Now, the Queer Eye culture and lifestyle expert is speaking out to remove the stigma around migraine and raise awareness that anyone, of any race, ethnicity, or gender, can have migraine. Read Karamo’s Story
How to Find a Clinical Trial
The National Institutes of Health runs ClinicalTrials.gov, a database you can search by condition and location to find a trial you may want to participate in. On the National Headache Foundation’s website you can find their Headache and Migraine Clinical Trials tool, which can match you to trials in your area. Talking to the physician who treats your migraine is also a good way to identify trials you might be eligible for.
What to Consider Before Joining a Clinical Trial
If you’ve tried just about every migraine medicine available and you still haven’t found relief, you may want to consider participating in a clinical trial. By doing so, you could gain access to a breakthrough migraine treatment long before it becomes available to the general public. But there are some things to consider before signing up for a trial. For one thing, it’s possible that you won’t be part of the treatment group but instead be assigned to the control group, which means you’ll get the standard treatment. For the vast majority of studies, you (or your doctor) do not get to choose your treatment, since treatment is usually assigned randomly. You may also end up as part of a no-treatment, placebo group. In addition, you may need to travel to the study site several times over the course of the study or even stay in a hospital overnight. Make sure you understand what will be expected of you before you agree to participate. Clinical trials are research studies performed on people. They are the primary way for researchers to determine if a new treatment (such as a drug or medical device) is safe and effective. Several days in June are set aside as observance days, each one representing a significant topic within the CHAMP community. Examples from years past include:
Headache at WorkVeterans With Headache DiseasesRemembrance DayDisparities in HeadacheHeadache Diseases and MenShades for MigraineChronic Migraine Awareness Day
Find out how to get involved and show your support by visiting the National Migraine and Headache Awareness Month website. But June isn’t the only month to pay special attention to migraine and headache. The Association of Migraine Disorders (AMD) works year-round to expand the understanding of migraine disease and to educate a broad range of medical specialists in the management of the disease, as well as to raise money for migraine research. And each March, a whole new set of interviews with migraine interviews are available for free, for a limited time, at the Migraine World Summit. An interview library from several years’ worth of summits lives on the site year-round behind a pay wall. You can register on the site at any time to be sure you don’t miss the March event.
Other Migraine-Related News
A lot of migraine news centers on new drugs and other treatments for the condition, such as these articles:
Migraine Nasal Spray With Novel Delivery System Gains FDA ApprovalNew CGRP Receptor Antagonist Shows Promise as a Migraine PreventiveA Fish a Day May Keep the Migraine Away
Expert Tips on Choosing a Migraine AppThe Best Apps for Headaches and Migraines [Our Community Favorites]The Best Health and Wellness Podcasts of 2019 [Results]The Best Migraine Bloggers of 2019
