Yeah it really does come down to trial and error. My husband use to get headaches once or twice a month that would knock him out for the day. He started eating better and exercising more and he has had no problems since the lifestyle change.
Even if you got stuck with migraines in the genetic jackpot, you might not know this: June is National Migraine Awareness Month.
And so today, I’m dedicating this column to the ladies of the migraine. (And, yes, it’s mostly ladies. Migraines happen to “three women to every one man,” says neurologist and headache specialist, Dr. Larry Robbins, MD. Lucky us.)
Why is this month so greatly needed? After all, if you’re a migraineur, you’re already abundantly aware of those incapacitating episodes of pain coupled with symptoms like nausea, vomiting, sensitivity to light and sound, blurred vision, or dizziness that last for hours (or days). This month is to let the general public know that these (often) debilitating episodes are more than “just headaches”—and the hope is that increased visibility will lead to more research and better treatment.
And as any migraineur will tell you, treatment is a very tricky topic. Take it from Heather Hefner, 29, who started the “War on Headaches” blog after she had seen four neurologists and was having up to 15 headaches a month: “There are so many things to try. Different things work for different people. It’s a process of trial and error.”
So to shed some light on that process (and make the most out of what we have in our current migraine toolkit), I sat down with Robbins and other headache experts to learn more.
The reason that migraines are difficult to treat is because there’s no one side-effect free silver bullet that works for everyone. The triptans or pure migraine medications (a.k.a. Imitrex, Maxalt, and Relpax) have been around for 19 years, and they “work pretty well—in about 65% of people,” says Robbins.
Self-treating with over-the-counter (OTC) meds like Excedrin Migraine or Advil may do the trick for infrequent or not-too-severe pain—but for others, it can actually make it worse, says Dr. Emily Rubenstein Engel, MD. “The problem with OTC meds is that they often just take the edge off a migraine but don’t resolve it completely, and this can contribute to a rebound headache where the brain becomes used to and dependent upon a constant infusion of pain meds.”
Some migraine sufferers find relief from hormonal options, says Dr. Susan Hutchinson, MD. “About 60% of women will experience worsening of migraines with menses. The drop in estrogen just before and during menses is felt to be the most important trigger for menstrual migraines. Continuous low-dose birth control pills may help with prevention [to create] an even estrogen level.”
Robbins also brings up a newer option (much loved and often abused by reality TV housewives everywhere)—Botox. The wrinkle-smoothing injectible was FDA approved for migraines in 2010 and is now increasingly covered by insurance. It’s hypothesized that Botox works by relaxing muscles and blocking transmission of pain messages to the brain.
It’s obvious that navigating through this dizzying array of treatment options can be as “painful” as the conditions they are purported to treat—but this can be eased with establishing an open line of communication with a headache specialist you trust.
“Things don’t always work—but often they do,” says Robbins. “People kick themselves because they go 10 years without seeing anyone, then find something that easily works and say, ‘I should have tried this 10 years ago!’”
And frustrating as this admission is—we also have to come to terms with the fact that complete relief is not in the cards for everyone (as of yet). For some, a more realistic treatment goal may be simply less headaches and less severe pain if an episode does occur.
Think Outside the (Pill) Box
But pills (or nasal sprays, or injectibles) can’t fight the battle alone. Explains Robbins, “there’s a lot that people can do outside of medicine” to fight the top migraine triggers: “stress, weather changes, hormones, under-sleeping, missing a meal, and bright lights.”
Basically, it boils down to lifestyle changes—both easy ones like wearing dark glasses when you’re outside and the harder ones like well, you know, the things we medical professionals harp on ad nauseum: Regularly scheduled sleep, not skipping meals, improved stress management, and a bit of exercise (Robbins likes yoga and Pilates). Consider it a long-term experiment in finding out what lifestyle change works for you.
And while some may see improvement with just a few tweaks, Hefner found that managing her headaches meant making sweeping changes to manage her stress—including leaving a 9-to-5 office job (where she sometimes brought a lamp so she could switch off the migraine-aggravating fluorescents) to study something she loves. “I’m hoping to be a freelance graphic designer so I can work from home and control my environment. Eating when you want, working certain hours, laying down if you have to and controlling the lighting… all that stuff makes a huge difference for someone with migraines.”
Setting Boundaries for a Pain-Free Future
Sometimes, the biggest lifestyle change that’s needed is learning to set boundaries. Maybe you can’t babysit until 2 AM for your lovable home-destroying nephew because you need scheduled sleep. Or perhaps you’ll have to stand up and say that skipping lunch isn’t an option at work today (or ever).
This is a stumbling block for many, as it can mean disappointing your sister-in-law, mom, BFF, or boss. But remember—they’ll probably thank you when you’re bright eyed, bushy-tailed, and totally present. “Healthy lifestyle habits show your family and friends that you are making a concentrated effort at helping your headaches and not playing the victim. The positive energy that comes from taking charge of your health can spill over into other areas of your life,” says Hutchinson. “I know because I am a migraineur as well!”
If there’s a bright spot for migraine sufferers, it’s this: Robbins and his team studied patients with severe headache for 10 years, and found that all groups tend to improve if they can find a doctor, stick with a prescribed program, and make lifestyle changes outside of medication. It may take trial and error, but, says Robbins, things do tend to get better over time.