7 Steps to control Migraine

Author: Raeburn Forbes MD

This assumes your diagnosis is correct. If you are not sure of your diagnosis you are advised to speak to your doctor.

Migraine affects 16% of women and ^5 of men. If you are a practicing nurse, it is inevitable that you will care of someone who has migraine and they may ask you about how to control them. Here's my 7 steps....

Step 1 - Sleep

Sleep has been recognized as a treatment for migraine. Many people with migraine take to their bed, as it is the only way to get comfortable. Sleep will inevitably follow, and it is a common experience to waken with your head feeling a lot better - if not completely gone.

An irregular sleep pattern and sleep deprivation can trigger migraine attacks. If you are able to do so, try and improve your sleep hygiene - wind down before bedtime, have a milky drink, make sure your day is active enough that you feel tired, avoid stressful situations - it is common sense really.

Step 2 - Water

Dehydration - a lack of water - can make migraine more likely to occur. A recent study looked at drinking habits and found that those who keep hydrated, were less likely to experience migraine attacks. I'd suggest aiming for about 1-2 pints extra each day (500 to 1000ml) on top of what you routinely drink. Please note that if you have kidney trouble, you may not be able to be free to increase your fluid intake by this amount - check with your doctor if you are unsure.

Step 3 - Exercise

It is a commonly accepted fact that exercise causes naturally made painkillers (called endorphins) to be released into your brain. While a direct link cannot be proven, it seems likely that regular exercise will contribute to a sense of well being, and that when you feel fit, headaches are less likely to occur. A problem is that migraine people can sometimes cause headaches by exercising too much, especially if tired or dehydrated or if exercising in bright sunlight. I'd suggest starting with gentle exercise such as walking half to one mile a few times each week, then building this up until you enjoy walking 2 or 3 miles at a time. Walk interesting routes, go with a friend, anything to make you stick to the routine. You do not have to train to run a marathon, but regular exercise, I'm sure, is a big help.

Step 4- Diet & Weight Management

There is no end to the amount of information written about diets. A lot of people talk about triggers such as coffee or chocolate. If you find that a specific food always produces a migraine, then it makes sense to avoid it. However, if you analyze a trigger food, you may find that when you ate the chocolate you were a bit underslept, had missed your lunch, were under a bit of stress and it was a warm day when you hadn't had much to drink. No wonder when you took that mid-afternoon snack of chocolate, you ended up with a migraine! My advice is this - eat regularly, try to avoid missing meals. When you eat - enjoy it! Better to enjoy your food and relax than get stressed over what is supposed to be one of life's simple pleasures.

If you do happen to be overweight, reducing your weight through a planned calorie restriction and exercise program can reduce the amount of headache you have.

Step 5 - Stress avoidance

This is hard. You are a young mother, holding down a job, your partner works long hours, you have deadlines, need to keep the house running, children or parents to sort out etc etc etc. This sort of common stress can take its toll. More major stress will also provoke headaches. Learning to deal with stress is difficult. However, I often find that people who get stressed are usually very bad at looking after themselves - when did you last take a few hours off just for yourself? Stress avoidance is helpful.

Step 6 - If you get a migraine take a medicine that is likely to work

There have been lots of studies on migraine treatment over the years. The tried and tested medicines can be obtained from your pharmacist (chemist) without prescription. These include (for adults) Aspirin, anti-emetics (metoclopramide, buclizine), non-steroidals (ibuprofen, naproxen), and some combinations that also contain caffeine. These will get about 50% to 75% of people with a migraine episode nearly pain free in 1-2 hours in most cases. There are specific migraine drugs that can usually be obtained on prescription only - called triptans, the commonest of which is sumatriptan. Any tablet for a migraine attack works best if taken as early as possible. I usually recommend that you take a painkiller or triptan as soon as you think "oh no, it's one of these rotten headaches again". If you leave it too late, you may have 'missed the boat' and will have to put up with the pain and take to your bed.

Step 7 - A preventative medicine that works.

There are several medicines which will reduce the number of migraine episodes if taken every day. They usually fall into one of three categories:

· beta-blockers (also used in treating blood pressure or angina)

· anti-convulsants (also used for treating epilepsy or chronic pain)

· anti-depressants (also used for treating depression!)

It is not clear how these drugs work, but if used at low doses on a regular basis, they can minimize the number of migraine headaches you have.

So that's it - 7 steps to controlling migraine - exactly what I tell my patients. Note that a lot of this is within your own control - sleep, exercise, water intake, diet, stress avoidance - it is a powerful thing to feel in control. Medicines will help, but unless you look after yourself, medicines are not the whole answer.

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RF

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Raeburn Forbes MD(Hons) is a practicing neurologist from Northern Ireland. He runs medical information websites in his spare time including www.lumbarpuncture.net and www.migrainenews.co.uk