If you’re a migraine suffer, you know all too well a migraine attack is far more than a bad headache. It is a neurological disorder that causes incapacitating symptoms for 1 billion people worldwide, according to the Migraine Research Foundation. In fact, it’s considered the sixth most debilitating illness in the world, leaving 90 percent of migraine sufferers unable to function normally during an attack.
Yet it’s estimated that half of all people who suffer from migraine are never diagnosed, which is not all that surprising when you consider no one test or biomarker can determine its presence. Instead, migraine is a diagnosis of exclusion, which means it’s diagnosed through a process of elimination. Doctors will look at your symptoms and family history as well as conduct tests to rule out other conditions before making a diagnosis.
Whether you’ve been formally diagnosed or highly suspect you should be (if you’re in the latter group and struggling to get a diagnosis, definitely see a doctor who specializes in migraine), here are four things about migraine prevention and treatment you must be aware of.
Migraine Truly Is an Incapacitating Condition
No, you are not being dramatic or overly sensitive. A migraine attack really is that bad, and its symptoms go beyond a throbbing pain in your head. There can be visual disturbances (temporary blindness included), dizziness, nausea, vomiting, vertigo, fainting, numbness in your face as well as extremities, and extreme sensitivity to light, smell, sound, or touch.
Most migraine sufferers experience one to two episodes per month, each one lasting anywhere between four and 72 hours. But add that all up several decades, and it totals about 5 percent of the average person’s life. What’s even worse is about 4 million migraine sufferers experience chronic daily migraine, meaning they have 15 or more migraine days per month. The majority of these people have a comorbid condition, such as arthritis, hypertension, sleep disturbances, or a mental health issue like anxiety, depression, or bipolar disorder. The result? Over 20 percent of chronic migraine sufferers are considered disabled.
Once symptoms of a migraine attack appear, it can be very difficult to stop it in its tracks. “Often the only ‘cure’ is to go lie in a dark room and, pretty much, pass out for a big chunk of time, which isn’t that practical when you have three kids” Andrew M of Thrifty Parent tells SheKnows. “Often the cure has to be postponed as best I can manage.”
Know What Your Individual Triggers Are
Preventing migraine attacks is by far the best way to manage the condition. Kim Peirano, DACM, LAC is an acupuncturist and doctor of Chinese medicine who helps patients manage migraine through acupuncture and lifestyle changes, and she says one of the best ways to do this is by pinpointing your triggers.
“While there are certain triggers for migraine attacks and common foods that people can have sensitivities to, they actually vary quite a bit from person to person,” Dr. Peirano tells SheKnows. “It’s imperative that each person starts to become more aware of their specific triggers through journaling or tracking.”
Hormonal fluctuations are a huge trigger for women, who are three times more likely than men to have migraine. Dr. Peirano says attacks are common during ovulation (caused by a spike in estrogen) and right before periods (caused by a drop in progesterone). “These swings in hormone levels is what triggers the migraines, not the hormone level itself but the abrupt changes,” she says.
Other common triggers include stress, noise, light, eyestrain, exercise, alcohol (particularly red wine), caffeine, scents, weather (excessive heat or changes in barometric pressure), lack of sleep or irregular sleep, dehydration, skipped meals, food additives (nitrates, MSG, aspartame), tyramines (found in fermented and aged foods), and specific foods like chocolate, nuts, citrus and onions. Triggers are incredibly individual though, and the above list is not exhaustive.
Samantha Morrison, a health and wellness expert at Glacier Wellness, says triggers don’t need to be inherently off-putting, using smells as an example. “Although there is a wide range of noxious scents which can trigger a migraine, the most common odors include gasoline, perfumes, fragrances, and cigarette smoke,” she says. “The smell does not have to be considered unpleasant. For instance, perfume can often trigger a migraine as a result of an acute sensitivity or a fragrance allergy.”
It can also be a mix of things that add up to a trigger. After a bad a migraine bout, Andrew M. found his perfect storm through journaling. “I found there is a strong correlation between two to three successive nights of bad sleep compounded by stress (could be anything — work, family, even a big event or occasion coming up — which was often related to the bad sleep). Then I’d be so ‘busy’ and pressing on with things, I wouldn’t drink enough water during a day…and bam — migraine.”
Helpful Lifestyle Changes Can Make a Difference
While medication can do wonders for migraine and is absolutely worth talking to your doctor your about, managing migraine is an ongoing process. Many people find they reduce their number of migraine days through changes in their diet and other day-to-day habits.
Considering migraine attacks can be triggered by things like lack of sleep, dehydration, skipped meals, and eyestrain, it’s no surprise that creating good daily habits, particularly ones in response to your triggers, can help keep them at bay. The same is true for food triggers. If through journaling, you discover a connection between any food — it doesn’t have to be a common trigger — and migraine attacks, try reducing your intake or cutting it out completely to see if it makes a difference.
Maintaining a healthy weight and exercising regularly can also be helpful. Though because physical exertion, skipped meals, and dehydration can cause migraine attacks, it’s important to take any weight loss slow and be mindful of your triggers. To avoid exercise-induced migraine attacks, the American Migraine Foundation recommends staying hydrated before, during, and after your workout; eating about 1.5 hours before exercising; and warming up first. If vigorous workouts trigger attacks, try something more gentle like walking, swimming, cycling, or dancing.
Consult Your Doctor About Alternative Treatments and Therapies
Elizabeth Muirhead, the health content lead at BiologyDictionary.net, knows her triggers (too much stress and not enough sleep and caffeine), and takes medication, among other things, to control flare-ups, but the treatment that stands out above all is an alternative one. “The best thing I’ve found for helping minimize my migraine attacks was my chiropractor. As soon as he got me squared away, I noticed a profound difference in my quality of life,” Muirhead said.
While large, high-quality studies on chiropractic therapy have not yet been done, some small studies have shown it can help. The same is true for massage therapy. One alternative treatment with more evidence is acupuncture. Studies have shown it can prevent migraine attacks and stop them in their midst; however some researchers say the benefit is little more than placebo effect. The American Migraine Foundation suggests more studies need to be done to clarify the debate.
While evidence for alternative treatments is always a harder to come by than it is in traditional Western medicine, this doesn’t stop many people from trying them. A 2018 Migraine in America survey of 4,356 people found 8 out of 10 tried alternative therapies. Ultimately, many people find a mix of traditional medicine, alternative therapies, and personal habits is what works for them. And as long as it’s safe, whatever works for you, works for migraine.
Additional reporting by Kim Grundy.
A version of this article was published in December 2014.