Managing Your Migraine
Top 10 tips for managing your migraine
By: Dr Richard Wood, GP with a special interest in headache
Lifestyle is important
Any disruption of your natural balances can bring on a migraine. Big triggers include stress, a disrupted sleep schedule (this includes sleeping in too long), skipping mealtimes and dehydration.
Optimise pain relief
Many people find non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin more effective than paracetamol. Not enough? Ask your GP to consider a triptan. This is a special medicine that turns off migraines. When taken in combination with an NSAID it reduces the chances of a migraine bouncing back the next day.
Migraine needs bigger medicine doses
I often tell my patients to try larger doses of pain relief, such as three tablets of ibuprofen (600mg total) or aspirin (900mg total) rather than just two.
Take your pain relief with an anti-sickness medicine
Migraine stops the stomach emptying – that’s why we feel sick. But it also reduces the absorption of your pain relief. I often prescribe an anti-sickness medicine with the NSAID + triptan, to encourage natural emptying of the tummy, such as metoclopramide or domperidone.
Take your relievers early in an attack
Migraine attacks have to be treated early otherwise they might not work so well. I tell my patients to take three ibuprofen (or aspirin), one triptan, and one anti-sickness – five tablets in all – at the nearest onset of headache. Dr Wood’s Migraine Bomb! However, I normally advise my patients who get aura before their headache, to take the triptan when the headache starts.
Don’t take your relievers on more than 10 days a month
There is a cruel twist of fate that happens to people with migraine – it’s called ‘Medication Overuse Headache’. If a person with migraine takes a paracetamol or NSAID on more than 15 days per month, or a triptan or codeine on more than 10 days per month, for three months or more, it locks their migraine centres into ‘permanently on’. This makes your headaches untreatable. I normally advise seeking support from your GP to be completely off all relievers for eight weeks. During this time your headaches are miserable. The end light is that you’re very likely to be much improved at the end and you can resume occasional reliever use to better effect.
Start a preventives when migraines get too much
Migraine preventives are medicines that you can take on a daily basis to turn down the activity of the migraine centres in your brain. They don’t cause medication overuse headache. Most are prescribed by your GP. You can start a preventive whenever you feel like you are having too many migraines, but specialists certainly recommend it if your migraines are causing you to take a reliever on more than 10 days per month.
Persevere with preventives
Preventives take eight weeks to work at a working dose. Some preventives take eight weeks to get to a working dose – so that’s 16 weeks trial in all. We normally suggest aiming for a halving of how many headaches you get (we can’t yet cure migraines). If people hit side-effects they don’t like, dropping down a dose for a week and then going back up again often improves things. If not tolerated or not working after eight weeks – ask your GP to prescribe you a different preventive. If things are working well for you, we normally suggest a six-month course – but it is up to you.
Have a constructive dialogue with work or school
Migraine is a neurological condition. It can cause significant disability which impacts on the ability to work and learn. The Migraine Trust has fantastic resources to help you discuss how work or school may be able to make adaptions for you.
Let’s talk about mental health
Around three-quarters of people with migraine also have anxiety or depression. This isn’t just because the migraines are miserable; we think migraine and mental health problems share similar genes. If you or someone close to you thinks you are depressed or anxious, talk to your GP. Treating the migraine can improve mental health; treating the mental health problem can also improve the migraine. What have you got to lose?
This is general advice. Everyone experiences migraine differently and medications work differently for different people. Before you stop or start any course of treatment, it’s very important that you seek the advice of your GP or specialist health professional. There is help and support on seeking medical advice here and you can contact our support services if you have questions about treatment and how to access it.
26th September 2019