6 Steps to Migraine Relief

Woman Seeking Migraine Relief

Have you been reading articles that suggest migraine relief is as simple as a few pills or juicing a smoothie to make it go away?

Maybe it’s because these articles aren’t written by those who experience migraine, work with migraine patients or who have studied the research. Nothing on the web provided a good summary of ‘how to relieve migraines’…so we created this article based on the latest academic research and co-wrote it with a migraine physician and migraine patients.

As nice as it would be to have a simple solution for migraine relief, for many people… it simply doesn’t exist.

It’s important to acknowledge that migraine has a spectrum of severity and disability. A few people may respond to a small painkiller and be fine. Others may have tried dozens of different treatments and suffered years of anguish without finding relief from migraine.

Everyone is different.

So there is no confusion… there is nothing that currently exists, anywhere, that either prevents 100% of all migraines for everyone or aborts 100% of migraine attacks for all who experience migraine.[1]

Just before you throw up your hands and give up, there’s a secret worth sharing. In spite of this, you don’t have to live a life controlled by migraine.

Migraines can be effectively managed and in the vast majority of cases, dramatically reduced (i.e. by 50-80%) when a few key practices are employed.

There are exceptions. Particularly when migraine is a secondary disorder, in other words, the migraine is a symptom of another underlying cause such as:

  • a brain tumor
  • meningitis
  • a significant brain injury or trauma which may have permanent consequences such as a shunt implant.

There are a few others, but generally these cases are rare compared to the hundreds of millions with primary migraine.[2]

To rule out other conditions, make sure you visit a certified physician who is able to make a qualified diagnosis.

Chances are that if you follow a few key principles in this article you can dramatically reduce your migraine attacks, improve your preventative strategy and take control over your condition.


Contents

Introduction: The Secret to Migraine Relief

Step 1: Keep a diary

Step 2: Find the right support

Step 3: Treat attacks effectively

Step 4: Uncover triggers

Step 5: Prevent attacks

Step 6: Create a virtuous cycle

Migraine Relief Summary


 

The Secret to Migraine Relief

If there is a secret to finding migraine relief it is all about prevention. You’ve heard the mantra that an ounce of prevention is worth more than a pound of cure. This is especially true when it comes to migraine.

During a migraine attack most people are in damage control. Typically it catches you off guard and causes a huge disruption to your responsibilities and commitments with often moderate to severe disability that can last 4 to 72 hours.[3]

The bottom line is that by the time a migraine attacks it is often too late.

So how can we focus on prevention? There are a few key steps to get there.

Step 1: Keep a Diary

Step 1: Keep a migraine relief diary

 

The first step is often met by groans and guilty admissions of poor compliance.

The reality is, without keeping a sufficiently detailed diary you have little hope of gaining control over your condition.

There are just too many factors to keep track of in your head.

There is also something that happens each day as you self report your own condition and progress.  You start to notice patterns and behavior which affect your condition. In as little as a few weeks of keeping a daily diary most people notice improvements and a much greater awareness of their own condition.

A small pilot study by MigrainePal found that a 55% of participants who kept a daily diary where able to halve their migraines within the first 3 months.

When you keep a diary you need to make sure you’re keeping track of your condition, triggers, medications and symptoms on a daily basis.

Several diaries that are worth considering are Curelator and Migraine Buddy. Both have free and premium options that are well worth the effort.

The next step involves working with the right doctor and building a team around you to help manage what is often an overwhelming and debilitating disease.

 


Key Takeaway: Keep a migraine record or diary. Studies show they really do help, but stick with the top tier apps like Migraine Coach or Migraine Buddy.  See our review of top 5 migraine tracking apps.


 

Step 2: Find the right support

Man looking For Migraine Relief Support

Migraines are complex, multifactorial and evolve over time. Just when you think you have it all figured out, you get slammed with another skull crushing attack.

Migraine is a chronic illness and as such it requires ongoing management. Who you have supporting you is extremely important.

A key member of your support team is your doctor. Look for someone empathetic, knowledgeable, interested and a good listener.

Many of us overestimate what our doctor is capable of. If we aren’t able to see a neurologist or headache specialist then chances are it’s a family physician or general doctor.

Many general doctors have only had around 4 hours of undergraduate medical training dedicated to headache disorders.[4] Their knowledge may be limited.

This improves with neurologists and even more so with specific headache specialists but the reality is, most of us will be working with family physicians.

There are around 85,000 migraine patients for every headache specialist in the USA.[5]

Therefore whilst your doctor is important, the most important person in your healthcare team is you. There are no two ways about it. If you want to successfully relieve your migraines then you are going to play the star role.

Often it’s not enough to have simply a doctor and yourself.

You need support and to be able to connect with others about your condition and share what you’re going through. Family can be helpful, but if they don’t experience migraine themselves it doesn’t take long before they tire of the same issues they’ve heard before but don’t understand.

Support groups either online or which have regular meet ups can be helpful. They allow you to connect and meet others who are going through the same thing you are.  Even if it’s only just to hear someone else talking about the same thing you are experiencing, it can be extremely validating if you feel isolated and trapped.

A good place to start are a number of either public or private support groups available freely on Facebook.

Remember that when you post in a public group it will also be available to be seen by your connections. This is not the case in private groups. Only group members can read posts inside the group.

Here are some groups to consider:

Doctor Directory

A helpful doctor directory of Board Certified Headache Specialists can be found here: http://www.headaches.org/physician-finder/

 


Key Takeaway: Find a doctor who genuinely cares and listens to you. They don’t need to be a specialist if they demonstrate an interest in migraine. Support groups are also a good place to connect with others who understand what you’re going through.


 

Step 3: Treat attacks

Drugs in cup to provide migraine relief

Let’s deal with the most urgent aspect of the migraine itself, the migraine attack. Our end goal is prevention but we want to limit the amount of pain and disability in the meantime.

That means that we need to find effective treatments and also learn to identify the early warning signs of an attack to intervene as soon as possible.

Timing is important and early warning signs vary for different types of migraine such as migraine without aura and migraine with aura and for different individuals.

The benchmark for a successful treatment for an acute migraine attack is something that relieves the disability, pain or timeframe of an attack by at least 50%. [6]

If you’re cutting your pain or duration of a migraine by 50% then doctors will often consider that treatment a success.[7]

There are a range of different migraine treatments. What works for one person won’t necessarily work for another.

Below is a list of medicinal treatments that have been shown to reduce moderate to severe migraine pain to mild within 2 hours for at least 50% of patients:

Prescription Migraine Drugs

  • Sumatriptan injection[8]
  • Sumatriptan 100mg tablet[9]
  • Sumatriptan Nasal spray[10]
  • Zolmitriptan 2.5mg[11]
  • Diclofenac 50mg[12]
  • Paracetamol 1000mg[13]

Over the Counter Migraine Drugs

  • Ibuprofen 400ml[14]
  • Aspirin 1000mg[15]
  • Naproxen 500mg or 825mg[16]

In an independent study, a double blind randomized trial found that one eight of a teaspoon of ginger was as effective as Sumatriptan. [17] Given that ginger is considerably cheaper with fewer side effects, this may be a natural option to take at the first signs for a potential attack.

Other natural alternatives that can help take the edge off an acute migraine attack include[18]:

  • Rest
  • Sleep
  • Dark, quite room
  • Re-hydrating

Once you have developed an effective regime for treating an acute migraine. The next step towards prevention is understanding your triggers.

 


Key Takeaway: There are many potential treatments which might be effective for you. Work with your doctor to find what treatment or combination provides significant relief within 2 hours.


 

Step 4: Uncover Triggers

Image of Alcohol which is a migraine trigger

When we talk about triggers we are referring to the factors which contribute or lead to an acute migraine attack.

Most people get this part terribly wrong.

…That’s because they skip the first step of keeping a detailed daily diary.

Most readers will still skip the diary step. There’ll be a few who won’t, and for them it will make an incredible difference.

You cannot even remotely assess your migraine triggers and evaluate their contribution to your migraine condition unless you are keeping a diary.

The diaries mentioned in the previous section are far more advanced than 99% of the generic apps you find in the app store.

Use them to discover your triggers and once you uncover your triggers to a reasonable confidence level you can begin to either:

  • manage that trigger
  • avoid or reduce that trigger
  • eliminate the trigger

There are two important concepts to understand as part of trigger management.

The first is that triggers can combine together. Most people assume that the migraine was triggered by one single item but often it can be due to a combination of factors.

This is again why the diary is so important.  So you can discover your hidden triggers.

The second concept is your ‘migraine threshold’. This refers to the level of exposure to certain triggers you can withstand before triggering a migraine. Another way to think about your migraine threshold is your resilience or sensitivity.

Migraine Threshold Chart

What makes migraine so particularly challenging at times is that often your migraine threshold can change.

This is good news for those who have a very low ‘hair-trigger’ sensitivity and are looking to build their resilience.  It is also problematic for those who have a high threshold but may experience sudden or gradual deterioration over time.

What determines your migraine threshold is often determined by a whole range of factors including your genetics, personal health history, treatments, lifestyle, environment, behaviors, trigger management and prevention strategy.

Triggers to manage

Triggers that need to be managed are factors like stress, menstruation and weather.

These are almost inevitable and unavoidable factors in our life that we cannot directly control. But once they are identified, there are things that can be done to address menstruation and to defend against the weather.

Triggers to avoid

Things to avoid or reduce might be cigarette smoke, loud busy concerts or other triggers that you have more discretionary control over.

These are triggers that have been shown to lead to a migraine attack when combined or stacked with other triggers.

For example if you’re going to a loud concert and you are drinking alcohol and both are known migraine triggers for you, then the combination could lead to a migraine. But if you attended the concert without consuming alcohol whilst it may increase your vulnerability, you still may be able to enjoy the concert without a migraine.

Triggers to eliminate

These are triggers which even by themselves will trigger a migraine and are within your ability to remove entirely.

For example, some people consuming a single drink of champagne or eating a bowl of ice cream is enough to trigger a migraine all by itself.

Therefore eliminating these items makes sense.

Note: if you are eliminating a large number of food groups to see if there is any improvement (eg. dairy, gluten, soy, eggs etc) ensure you consult a dietician or nutritionist to avoid malnutrition which can lead to further issues.

For more information on foods that trigger a migraine, check this NIH study that revealed the most problematic migraine trigger foods.

Once you have an understanding of your triggers and your migraine threshold then it’s time to focus on preventing attacks in the first

 


Key Takeaway: Remove unnecessary fuel from the migraine fire by uncovering your triggers. Some triggers can be eliminated but most will likely need to be either avoided or managed.  A diary is needed for this process.


 

Step 5: Prevent attacks

Brick wall representing migraine prevention

Prevention is different than dealing with acute migraine attacks.

Acute migraine management is about reducing disability, discomfort and duration.

Prevention is about having less attacks.

Similar to acute migraine treatments, if you are able to get a 50% improvement i.e. halve your migraine frequency from a prevention strategy or approach, it is deemed to be effective.

Just as there are hundreds of thousands of people worldwide who slip into chronic migraine, there are also an approximately equal number who achieve remission.

The good news is that there are many different forms of preventative treatments. Often when multiple approaches are utilised you can create your own positive defense “stack” to build your resilience and reduce your vulnerability to migraine attacks.

Below are a couple of different types of ingredients you might use in your prevention strategy:

  • Medication – refer to step 3. Medication is often the first choice many people turn to when their migraines are out of control. There are different classes of medication which can be effective. None are effective for all and most come with side effects.
  • Lifestyle – sleep, exercise, stress management strategies, work load
  • Natural therapies – acupuncture, chiropractic therapy, biofeedback, physical therapy, CBT, migraine glasses
  • Diet –  alcohol intake, allergy blood tests to determine food sensitivity, fresh food versus proceed, consumption of common trigger foods
  • Environmental – weather, pollution
  • Behavior – relaxation training, meditation, trigger management
  • Supplements – CoQ10, Feverfew, Riboflavin, Magnesium, Butterbur
  • Devices – Neurostimulation devices like Cefaly, SpringTMS

Going into depth of each of these potential strategies, treatments and approaches is beyond the scope of this article but it is a pursuit that must be undertaken by every migraine patient with the help of their doctor who is serious about improving their condition.

When multiple effective prevention strategies are employed it can have a synergistic effect that can result in significant reductions.

It is also possible, however less likely, that you may even be able to eliminate your attacks for extended periods of time.

Remember this is not the promise of a cure. This is about migraine relief. Our condition constantly evolves as it responds to our environment, treatment strategy, behaviors and lifestyle.

 


Key Takeaway: An ounce of prevention is worth more than a pound of cure. Once the foundations of effective management have been set, you and your doctor can begin to focus on preventing more attacks.


 

Step 6: Creating a Virtuous Cycle

Road representing a virtuous cycle of migraine relief

There is a constant and evolving feedback loop from ourselves and our environment which may play a role in the ongoing evolution of our migraine condition.

This is a good thing because just as we can slip into chronic migraine, it is also possible to pull ourselves out.

It is easier said than done. But with the help of a dedicated physician and the steps outlined here it is a realistic goal for most.

Many people feel trapped in a constant cycle of painful and debilitating migraine attacks. They feel trapped in the same pattern which perpetuates the cycle attacks.

The challenge is to break the cycle of chronic migraines by constantly refining and fine tuning the keys steps to migraine relief we covered:

  1. treat your attacks
  2. uncover your triggers
  3. prevention attacks

As your condition evolves so should your treatment and prevention strategy.

 


Key Takeaway: Migraine is a chronic disease and as such requires ongoing management.  Think of these 6 steps like one revolution in a circular stairwell. With each revolution you climb closer towards remission.


 

Migraine Relief Summary

Most people treat their migraines reactively. A migraine hits and it sends you into a tailspin of panic, anxiety followed quickly by pain and disabling symptoms which can last for days.

The first thing we must do is keep a diary. You and your doctor need to understand what’s going on and it only requires a minute or so per day.

You also need the right support network around you. While having the right doctor is important, you’ll likely need additional support from friends or family or even a support group.

Treating your acute migraine attacks is essential. Effective treatments exist which can limit attacks to 2 hours in a majority of patients.

To find out how you are fueling your own migraine attacks it’s important to understand your triggers. There are obvious triggers and not so obvious triggers that you need the help of a diary to uncover.

With this foundation you can begin to build a prevention strategy which is rooted in facts and personalized for you.

Ongoing management is required to achieve migraine relief and remission. It is also required to stay there.

It will almost certainly take several revolutions of this process but with each lap you receive more feedback and confidence. As you continue to inform and refine your management the closer remission becomes.

Effective migraine relief is a process not a magic pill.

 

 


[1] Purdy, R. Allan. “Migraine is curable!.” Neurological Sciences 31.1 (2010): 141-143.

[2] Goadsby, Peter J. “To scan or not to scan in headache.” (2004): 469-470.

[3] Headache Classification Committee of the International Headache Society (IHS. “The international classification of headache disorders, (beta version).” Cephalalgia 33.9 (2013): 629-808.

[4] World Health Organisation & Lifting the Burden. “ATLAS of Headache Disorders And Resources in the World 2011”. Report, 2011.

[5]Mauser, Emily D., and Noah L. Rosen. “So many migraines, so few subspecialists: Analysis of the geographic location of United Council for Neurologic Subspecialties (UCNS) certified headache subspecialists compared to United States headache demographics.” Headache: The Journal of Head and Face Pain 54.8 (2014): 1347-1357.

[6] Richard B Lipton, Migraine World Summit Interview 2016.

[7] Richard B Lipton, Migraine World Summit Interview 2016.

[8] Derry CJ, Derry S, Moore RA. Sumatriptan (subcutaneous route of administration) for acute migraine attacks in adults. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD009665. DOI: 10.1002/14651858.CD009665

[9]  Derry CJ, Derry S, Moore RA. Sumatriptan (oral route of administration) for acute migraine attacks in adults. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD008615. DOI: 10.1002/14651858.CD008615.pub2

[10] Derry CJ, Derry S, Moore RA. Sumatriptan (intranasal route of administration) for acute migraine attacks in adults. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD009663. DOI: 10.1002/14651858.CD009663

[11] Bird S, Derry S, Moore R. Zolmitriptan for acute migraine attacks in adults. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD008616. DOI: 10.1002/14651858.CD008616.pub2
[12] Derry S, Rabbie R, Moore R. Diclofenac with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008783. DOI: 10.1002/14651858.CD008783.pub3

[13] Derry S, Moore R. Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008040. DOI: 10.1002/14651858.CD008040.pub3

[14] Rabbie R, Derry S, Moore R. Ibuprofen with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008039. DOI: 10.1002/14651858.CD008039.pub3

[15] Kirthi V, Derry S, Moore R. Aspirin with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008041. DOI: 10.1002/14651858.CD008041.pub3

[16] Law S, Derry S, Moore R. Naproxen with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD009455. DOI: 10.1002/14651858.CD009455.pub2

[17] M Maghbooli, F Golipour, A Moghimi Esfandabadi, M Yousefi. Comparison between the efficacy of ginger and sumatriptan in the ablative treatment of the common migraine. Phytother Res. 2014 Mar;28(3):412-5. doi: 10.1002/ptr.4996.

[18] Curetogether Migraine Database. Acute Treatment Remedies, Accessed March 2017

 

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