Migraine isn’t just a one-off headache. It’s an ongoing condition that can interfere with almost every aspect of your daily life. Even on days when you aren’t in pain, you may be worrying about the next attack, making it hard to function not just now, but also in the future.
“For the average person, migraine is a lifelong condition, and there isn’t really a permanent cure,” says Timothy Collins, MD, chief of the headache and pain division of the neurology department at Duke University School of Medicine in Durham, North Carolina. But there are still steps you can take to control attacks. A few key questions about how lifestyle and medicine work together can help you stay ahead of the pain.
1. How Effective Are Lifestyle Changes for Preventing Migraine?
For some people, though, it can be difficult to control migraine triggers such as stress. Other triggers, such as weather changes and seasonal allergens, can also be hard to avoid, says Collins. That’s where both prescription and over-the-counter medications can help. Often, lifestyle changes plus prescription and over-the-counter medications are used together as a part of a comprehensive migraine management plan.
2. Do I Need Preventive Medication for Migraine?
This can vary from person to person, but in general, if you’re having two or more migraine attacks a week, then you’re likely a candidate for preventive medication, says Collins.
You might also benefit from preventive medication if you’re experiencing migraine attacks four or more days per month; migraine attacks that are particularly painful; or migraine attacks that don’t get better with pain relievers, such as aspirin or ibuprofen.
“If you have two or more disabling [migraine attacks] a month — meaning, you couldn’t go to work or talk to people and just had to put a pillow over your head and darken the room — you may need to be on preventive medication,” says Medhat Mikhael, MD, a pain management specialist and medical director of the nonoperative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California.
3. How Many Migraine Attacks Are Actually Preventable?
Right now, there’s no medication that can keep every migraine attack at bay. But if you take preventive treatments, the goal is to reduce the number of migraine attack days by about 50 percent and lessen both the severity and length of the attacks, says Collins.
Usually, he says, “The goal is to decrease [migraine attack] frequency to once a week or less.”
4. If I Take Medication, Do I Have to Choose Between Fewer or Less Severe Migraine Attacks?
Luckily, no. The right medication regimen should help reduce both the number and severity of migraine attacks you experience. You shouldn’t have to choose between one benefit and the other, says Collins.
5. What Kinds of Side Effects Can I Expect on a Preventive Medication?
Because preventive medications for migraine all tend to work a little differently, side effects can vary. These potential side effects can play a big role in which medication you and your doctor decide is right for you.
Some medications, for example, can cause weight gain, so if you have obesity or are currently taking weight loss medication, these options likely aren’t your best match, he says. Other medications may cause difficulty speaking or trouble with word fluency. If your job requires public speaking or verbal precision — such as a teacher or trial lawyer — you may want to opt for another type of medication instead. These lifestyle factors and personal preferences are important to discuss with your doctor when deciding which preventive treatment is best for you.
6. How Do I Know if the Current Treatment Is Working?
It can take a few months to know whether a preventive medication for migraine is working, though some people may see results sooner than others. Often, the thinking is to give a medication three months before stopping it, but Collins says in practice, if a treatment isn’t working at all after about six to eight weeks, he usually recommends discontinuing it and trying another option instead.
That said, if you’re experiencing some benefits early on, that’s a good sign. Certain treatments may offer only minimal improvements at first but gradually lead to fewer symptoms over time, says Mikhael. Even if migraine attacks aren’t eliminated completely, “They may be minimal,” he says. “And when they come, they can be treated by over-the-counter medication.”
7. Will the Migraine Attacks Ever Go Away Altogether?
Research shows that in up to 70 percent of people, chronic migraine (15 or more migraine attack days per month) can revert to episodic migraine (fewer than 15 migraine attack days per month). Long periods of remission can also become more common as you find the right treatment plan.
In the meantime, it’s important not to give up, even if it takes some trial and error. “It’s a misconception that preventive therapy doesn’t work,” says Mikhael. “Different medications work with different mechanisms of action, so we don’t give up just because one didn’t work. It doesn’t mean that if one treatment fails, all of them will fail.”
Your best bet: Work with your doctor until you find the right regimen that eases migraine frequency and severity.
The Takeaway
- A combination of lifestyle changes and medications (both prescription and over the counter) can help ease migraine symptoms and prevent future attacks.
- Many preventive treatments can reduce the number of migraine attacks by about 50 percent. It may just take some trial and error to find the one that works for you.
- You should start to see an improvement within a few months of starting a preventive treatment. If you aren’t seeing any benefits by then, it’s worth asking your doctor about other options.
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