Tips for Managing Migraines

Having a migraine isn't just painful—it can make everyday tasks feel hard. Along with the headache, you may have other symptoms that make it difficult to focus, work, or relax. For many people, migraines interfere with daily life and activities.  

The good news is that managing migraines is possible through a combination of self-care, medication, and lifestyle changes. By learning what triggers your migraines and knowing how to treat them, you can reduce how often they happen and how bad they get. Everyone’s migraines are different, but finding the right plan can make a big difference in feeling better.

"Migraine affects your entire life," says Carolyn A. Bernstein, MD, FAHS, a Mass General Brigham neurologist and the Lavine Family Endowed Chair in Neurology at Brigham and Women’s Hospital. "It's more than a headache, and even if you aren't having a migraine, you may spend time worrying about when the next one will occur. Learning some techniques to identify your triggers may help." 

Dr. Bernstein shares her tips for preventing and managing migraines.  

Why am I getting migraines?

A migraine can happen for many reasons, including family health history, daily triggers, or environmental factors. Understanding these causes can help you prevent and manage them. Common causes and triggers include:

• Family health history: You’re more likely to experience migraine than other people if it runs in your family. 
• Stress, anxiety, or depression: Emotional stress can trigger a migraine.
• Sleeping too much or too little: Changes in your sleep pattern can cause a migraine.
• Not drinking enough water: Dehydration is a common migraine trigger. 
• Hormonal changes like during menstruation or ovulation: Changes in estrogen can trigger headaches in women.
• Certain foods or skipping meals: Foods that trigger a migraine include aged cheese, alcohol, and processed meats.
• Some medicines: Medications like oral contraceptives or vasodilators (medicines that help blood vessels relax and open up) can sometimes cause a migraine.
• Sudden physical activity: Sudden intense exercise can lead to migraine episodes.
• Environmental factors: Changes in weather, air pressure, or exposure to bright lights, loud noises, or strong smells can trigger a migraine.

“Understanding what triggers your migraines can help you prevent them,” recommends Dr. Bernstein. “Keep a headache diary to help you track your triggers and avoid them in the future.” 

What are the symptoms and phases of a migraine?

Migraine symptoms are different for everyone. A migraine happens in 4 phases:

1. Prodrome phase (early warning symptoms): This happens 24 to 48 hours before a migraine. You may feel irritable, have a stiff neck, crave certain foods, or experience mood changes. Other signs may include frequent yawning, fluid retention, and increased urination. 
2. Aura phase (sensory disturbances): You may see flashes of light or bright spots, have trouble speaking, or feel tingling in your body. Visual symptoms are common, but some people also may experience sensory changes like numbness or difficulty speaking.
3. Attack phase (headache symptoms): This is the migraine itself, which often causes throbbing pain on one side of the head. The migraine location can vary, but it’s usually on one side of the head. Movement or physical activity can make the pain worse.
4. Postdrome phase (after the migraine): After the migraine ends, you might feel tired or moody for up to 24 hours. Many people feel drained, while others might feel euphoric after the pain subsides.

Not everyone experiences all 4 phases. Some people may have additional symptoms like dizziness or vertigo. Tracking your symptoms through each phase can help your doctor recommend the best treatment plan for managing migraine. 

What are the different types of migraine?

There are 2 main types of migraine:

1. Episodic migraine: These happen less than 15 days a month and are classified by pain occurring up to 14 days a month. People with episodic migraine can have long periods without symptoms.
   
2. Chronic migraine: These happen 15 or more days a month. Chronic migraine is more severe and difficult to manage, often requiring regular treatment.

Other forms of migraine include menstrual migraine, which are linked to hormonal changes during the menstrual cycle, and hemiplegic migraine, where people can be temporarily weak on half their body during the migraine.  

How long can migraines last?

A migraine can last anywhere from 4 to 72 hours if not treated. The duration depends on the type of migraine, what triggered it, and how quickly you start treatment. Some migraines end in just a few hours, while others can last for several days, causing pain and discomfort.

If a migraine lasts longer than 72 hours, it’s important to talk to a doctor. Long-lasting episodes may mean you need different treatment, or medication for migraines, to help manage the symptoms and prevent future episodes.

How to practice migraine self-care at home

If you get a migraine, there are many migraine self-care techniques you can do at home to help reduce symptoms and manage your pain. These include:

• Resting in a dark, quiet room: Light and sound can make a migraine worse, so avoid them when you can. A migraine often comes with sensitivity to light, noise, and even smells.
• Drinking plenty of water: Staying hydrated can help prevent and treat a migraine. Dehydration can make symptoms worse, so it's important to drink enough fluids.
• Using a cold compress: Placing something cold on your forehead or neck can help reduce pain. Some people find relief using heat instead, so experiment with what works best for you.
• Practicing relaxation techniques: Deep breathing or meditation can lower stress, which can trigger a migraine. 
• Using small amounts of caffeine: Using a little caffeine at the start of a migraine can help reduce symptoms. However, too much caffeine or caffeine withdrawal can trigger a migraine, so be cautious.

If your home treatments don't work, or your migraine get worse, talk to your doctor. Severe cases may require prescription medication for migraines or other medical treatments.

How to prevent migraines

Migraine can be treated in two ways: managing symptoms during an attack, or trying to prevent them from happening in the first place. Your doctor may recommend a combination of medications and lifestyle changes to help.

Medication for migraines

If you get a migraine, there are several types of medications that can help either stop the pain or prevent it from happening. The right medication will depend on how severe your migraines are and how often you get them. These medications include:

• Over-the-counter medications: For mild migraines, medications like ibuprofen or acetaminophen can help. Non-prescription NSAIDs may also reduce inflammation and reduce pain.
  
• Prescription medications: For more severe migraines, doctors may prescribe triptans. Triptans work by reducing inflammation and narrowing blood vessels to relieve pain.
• Preventative medications: If you get migraines often, your doctor may suggest medicines to prevent them. These can include beta blockers, calcium channel blockers, newer targeted medications, or Botox for migraines, which help reduce how often migraines occur.

Lifestyle changes for preventing and managing migraines

In addition to medications, making certain lifestyle changes can help reduce the frequency of migraines and help you manage symptoms. These changes can make a big difference in how often migraines occur and how severe they are. These include:

• Stress management: Lowering stress through relaxation techniques, yoga, or meditation can reduce the frequency of migraines. 
• Healthy habits: Prioritizing better sleep, drinking enough water, eating healthy, and regular exercise are key factors in preventing migraines.

Living with migraines

Managing migraines can be tough, but with the right plan and regular migraine self-care, you can take control and feel better. By learning your triggers, working with your doctor, and making small changes to your daily routine, you may help reduce how often migraines happen and how bad they get. Whether it’s through medications, lifestyle changes, or a mix of both, finding what works best for you is important. If migraines are getting in the way of your life, talk to your doctor to find a treatment plan that helps you feel more like yourself.