Attacking Migraines

Use these tips to get fewer attacks

Woman with headache

From drugs to deep breathing, doctors have an arsenal of weapons to deploy against migraine headaches. While no sure-fire cure exists, most patients respond to treatment, often with a combination of therapies.

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Some possible headache triggers, such as weather changes, are uncontrollable. Even so, changing what you can control is preferable to taking medication.

Assess your lifestyle

Identifying and avoiding triggers of a migraine may be enough to ward off attacks. That’s why Jennifer Kriegler, MD, urges her patients to keep a daily diary noting such variables as diet, sleep schedule, travel plans and stress levels.

“When patients record these behaviors, they sometimes see patterns that bring on a migraine,” says Dr. Kriegler, who practices in Cleveland Clinic’s Neurological Center for Pain. “They can then alter their behavior: avoiding certain foods, eating before hunger triggers a headache, getting adequate sleep, staying well hydrated.”

Medicate if you must

For other people, however, migraines are so frequent or disabling that medication is essential. When pain interferes with normal activities, Dr. Kriegler prescribes preventive medication, taken daily to reduce the incidence and severity of migraines. Preventive medicines come in dozens of varieties, from natural supplements, such as vitamin B2, magnesium, butterbur (petasites hybridus) and Coenzyme Q10, to drugs originally developed for other conditions including antidepressants, anticonvulsants and blood pressure medications.

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Preventive drugs often are combined with abortive or rescue medications, which are migraine-specific and taken at the onset of a headache to stop it from becoming full-blown.

Cleveland Clinic neurologist Stewart Tepper, MD, is investigating new medications, including an orally inhalable preparation that may speed relief to headache sufferers.

Take a deep breath

Dr. Kriegler strongly encourages her migraine patients to manage stress through alternative approaches such as biofeedback, relaxation techniques, guided imagery and yoga. She recommends physical therapy to reduce tension and strengthen muscles in the neck and shoulders, where migraine pain commonly spreads.

Exercise is another staple — but not during an attack, when it worsens pain. Adequate sleep is a must, but don’t push it: Oversleeping on weekends may induce a headache. Patients with a sleep deficit are advised to get up at the usual time on weekends and take a nap later if they feel tired.

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Don’t despair

The goal of preventive migraine treatment is a 50 percent decrease in attack frequency and intensity. “There are no untreatable patients. The problem is that everyone wants an easy fix,” Dr. Kriegler says. “But if patients put into practice the strategies they learn, they can significantly decrease their vulnerability to migraine.”

Do you get migraines? Let us know how you control your headaches in the comments below.

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