Migraines are pathophysiological and still aren’t well understood.
Here’s the bad news: There is currently no cure.
The good news: Migraine can be managed
Before learning about treatments, we recommend that you better understand the nature of migraines.
This doesn’t mean it can’t be treated and managed. While [migraines may dominate your life and senses](https://migrainev.com/blogs/the-prodrome/the-prodrome-migraineur-savant-this-is-me), many migraineurs can control attacks and live free.
Migraine treatments approach the challenge from two angles: Prevention of attacks, and relief of symptoms
A migraine journal is your single greatest weapon in the battle against migraine: you can’t improve what you don’t measure.
Tracking your sleep, food, drink, medications, weather and any other potential migraine triggers. This part can be a little tedious but is incredibly important. Whether pen & paper, spreadsheet, or migraine tracking app - the media doesn’t matter, use whatever works for you. Check out our list of common migraine triggers for some more guidance on what to track.
This is the ideal – preventing migraine attacks from occurring in the first place. Prevention treatments will be either lifestyle, drugs, or more likely a combination of both.
Preventative medications should be considered if migraine attacks occur twice or more per month with significant impact on your ability to perform normal daily life and work tasks.
Before turning to medication, a number of lifestyle management strategies should be employed. A treatment is considered successful if you experience a reduction in frequency and/or intensity of migraine attacks.
Sleep is an area that can yield great results: getting enough of it (not too much, not too little, just right – think Goldilocks). Migraine is often a reaction to change, ensuring that you sleep and wake at the same time daily even on weekends is an effective method of creating stability and reducing migraine attacks.
Mild exercise is great for stress reduction and weight control – but take care when starting out as some migraines can be triggered by vigorous exercise.
Relaxation techniques help reduce stress and anxiety. These allow for a quiet mind and can aid in sleep. These can be worked into your exercise regime with yoga, or as a separate treatment such as breath control and mindfulness practices.
Food and Drink
Many food and drinks contain ingredients that may trigger migraine attacks. Good habits are important for migraineurs: eat regularly, and don’t skip meals. Stay well hydrated. Check out this article on common triggers.
The majority of migraine sufferers experience light sensitivity as a symptom, and many as a trigger. Have you ever hid in a dark room with a towel, pillow or eye mask to reduce migraine pain? If so, you are likely light sensitive. High energy lightwaves like blue light, and ultraviolet (UV) lights cause eyestrain - another migraine trigger.
Wherever possible, reduce exposure to blue light from computer screens, smartphones, fluorescent lights, and the sun. Replace fluorescents with LEDs, install blue-blocking screen covers on monitors and smartphones, wear specialized sunglasses while outdoors and blue blocking glasses indoors. During a migraine attack, dark sunglasses and blue blocking glasses may provide relief from photophobia.
Studies show that sex and the orgasm can provide migraine relief. One such study showed that 60% of migraineurs experience pain relief and lessening of other symptoms.
However, one third of the respondents reported that their migraines intensified as a result of sex.
Medication for Prevention
**Real talk: always consult your healthcare provider for guidance on prevention medication. Don’t screw around.**
There is a seemingly endless variety of drugs for prevention and treatment. Many of which were initially developed for other purposes like depression, epilepsy, heart conditions, high blood pressure, seizure, anxiety and more. These drugs have been shown to help migraine some migraine sufferers with varying degrees of effectiveness. Since it is impossible to predict when and attack may strike, preventative medications must be take daily.
This class of drugs was invented to treat heart conditions but can be effective in reducing frequency and intensity of migraine attacks. They work by suppressing certain nerve impulses. While there are many drugs under this class, propanolol is commonly prescribed for migraine sufferers. It is not completely understood why beta-blockers are effective in the prevention of migraines, it is thought that it helps with the vascular nature of migraines (think of the thump, thump, thump of pain that matches your heartbeat).
Beta-Blockers are also useful in the treatment of anxiety, and a reduction in anxiety can lead to a reduction in migraine.
Anti-Seizure Drugs - Topimax (Topimate)
An anti-seizure drug often used in the treatment of chronic migraine. Generally not intended to be taken for the long-term because of its sedating side effect (nicknamed dope-imax by some migraineurs). The intended use is to *break the cycle* of chronic migraine to bring attacks down to a more manageable level with the goal of discontinuing treatment or moving to another, less sedating medication.
Botox (Botulism A)
Botox has been shown to help many chronic migraine sufferers reduce the frequency and intensity of attacks in chronic sufferers – which is our goal, after all.
Generally this treatment is tried after more conventional treatments fail and is reserved for chronic daily migraine sufferers. In Canada Botox was approved for treating migraines in 2011, but only for those effected 15 days per month or more by migraines.
Relief of Symptoms
When prevention fails, we look for relief. Regardless of migraine phase, while a migraine attack is underway there are drugs and treatments that can provide relief. Migraine is a complex disease and finding treatments that work for a particular migraineur takes trial and error.
Don’t be discouraged if a treatment doesn’t work for you – there are over 100 medications available: if one doesn’t work, you may find relief with another. Always work closely with your physician and record medications and results in your migraine journal or migraine tracking app.
Acute/Abortive Medications for Migraine Attacks
There are dozens of abortive medications designed to mitigate or abort attacks that are already underway but most have one thing in common: they should be taken as early in your attack as possible for maximum effect. The longer you wait, the less effective they are like to be.
Migraineurs who experience prodrome phase should take your abortives once you experience preminatory symptoms. For more guidance on which symptoms to watch out for, check out our article on **migraine symptoms**.
For those migraine attacks that begin before you wake up this can pose a serious problem, but it is still worth experimenting with different medications under doctor supervision.
Over the Counter Drugs
Some (relatively) lucky migraineurs will find relief with over the counter medications such as analgesics like ibuprofen or aspirin, and anti-inflammatories like naproxen. Those who experience nausea or vertigo symptoms may find relief with antinausea medication such as Gravol. Most will need more specialized abortive drugs.
Sumatriptan, Naratriptan, and their cousins were developed as an anti-seizure medication of moderate effectiveness. They were found to be extremely effective as an abortive migraine treatment in many migraineurs. Meant to be taken as early in the attack as possible. Relief comes relatively quickly – within 20-30 minutes if effective. Triptans are often the first prescription abortive recommended after (or in conjunction with) preventatives.
Ergotamine has been found to be for some migraineurs with infrequent or long duration migraine attacks. Triptans are more likely to be effective for most migraineurs.
**Real Talk: Consult local legislation for to find out if marijuana use is legal in your jurisdiction.**
Where legal, medical marijuana is being used to successfully treat symptoms and triggers in many migraineurs. Marijuana can reduce the pain, nausea, anxiety, depression and stress related to migraines.
There are many strains of marijuana with different levels of THC (Tetrahydrocannabinol) and CBD (Cannabidiol). THC generally has a more ‘heady’ effect while strains high in CBD are can treat pain without producing a high.
Smoking is bad for you. You know this. We recommend vaping herb, or taking edibles. Many producers now make CBD oils and capsules for better control of dosage.
Talk to your doctor for more information.