DEAR DOCTOR K:
I’m plagued by frequent migraines. I take medications to treat the migraines once they’ve started, but I’d rather prevent them in the first place. Any suggestions?
Migraines can be debilitating. The severe, throbbing headaches are typically accompanied by nausea, vomiting or loss of appetite. Many migraine sufferers also develop blurry or distorted vision, or see pulsating lights or dark spots. Most migraines last from four to 12 hours, but they can last much longer.
Migraines can be triggered by certain activities, foods or smells. Emotions or stress can trigger migraines, too. And women often find that migraines occur or worsen around their menstrual periods.
Not all migraine headaches can be prevented. But if you can identify your headache triggers and avoid them, this may help reduce how often you have migraines and how badly they hurt.
Common migraine triggers include:
- Caffeine (either using too much or cutting back on regular use).
- Certain foods and drinks, including those that contain tyramine (aged cheeses and meats, fermented drinks); sulfites (preserved foods, wines); and monosodium glutamate (MSG), a common flavor enhancer.
- Stress, or relief from stress. (Some people get their migraines when they are home relaxing after a stressful day or week).
- Hormone levels (affected by menstrual cycles or hormone-containing medication such as birth control pills).
- Lack of sleep.
- Changes in weather or altitude.
- Overuse of pain medications.
Even if you avoid all triggers, you’ll probably still experience an occasional migraine. And many people have frequent and severe migraines no matter how well they avoid triggers.
Some other things to look into include biofeedback, yoga, acupuncture, massage and regular exercise. One or more of these may help to prevent your migraines.
I also recommend talking to your doctor about preventive medications. These are prescription drugs taken every day to prevent migraines. Different medicines are used to treat migraine attacks when they come.
Drugs to prevent migraine are all used more commonly to treat other conditions. They include beta blockers, calcium channel blockers, ACE inhibitors, angiotensin receptor blockers (ARBs), anti-seizure drugs, some drugs used for depression (in low doses), and the vitamin riboflavin.
You won’t find this recommendation from many authorities, but I have found low-dose aspirin to help in preventing migraines in some patients. This has not been proven in a large, randomized study. And you should check with your doctor before starting aspirin, since it can have side effects.
We have a lot more information on migraines in our book, “The Migraine Solution.”
Don’t be discouraged if you have to try multiple preventive medications before you and your doctor find the best one for you. Most migraine patients can find treatments that reduce how frequently they get attacks and how severe they are when they occur.