4 Ways to Take Control and Reverse Your Chronic Migraines

There are a number of elements that can trigger the transformation from episodic migraines (fewer than 15 migraines per month) to chronic ones (15 or more migraines per month). Medication overuse is a major one. Other potential, but maybe less obvious, culprits are obesity, depression, excessive caffeine use, snoring, and sleep disorders.

It can be difficult to pinpoint exactly what triggers your migraines to become chronic. For many people, it's not just one factor, but a complex interplay of multiple elements, all of which can be challenging to tease apart. That said, research shows that adopting these four healthy habits may just reverse your chronic migraines to episodic.

ways to reverse chronic migraine
Illustration by Emily Roberts, Verywell

Implement Good Sleep Hygiene

Interestingly, the vast majority of people with migraines also deal with insomnia, which is also considered to be a risk factor for progressing from episodic migraines to chronic. Because of this close connection between sleep and migraines, research is continuously being done on the relationship between the two.

Behavioral Sleep Modification

A small landmark 2007 study of women with chronic migraine showed that the disorder may be reversed to episodic migraines using behavioral sleep modification. The researchers came up with five behavioral modifications, including:

  • Going to bed at the same time every night and allowing for eight hours of rest, e.g., 10 p.m. to 6 a.m.
  • No television, reading, computers, phones, or music in bed
  • No naps
  • Use of a visualization technique to help the participants get to sleep faster
  • Moving dinner to four or more hours before bedtime and limiting fluid intake within two hours of bedtime

The participants who used these behavioral modifications experienced fewer migraines with less pain. Close to half of them also reverted to episodic migraines.

Try Cognitive Behavioral Therapy for Insomnia

A specific therapy called cognitive behavioral therapy for insomnia (CBTI) is now considered the first-line treatment for this sleep disorder. CBTI usually consists of a combination of these components:

  • Education about good sleep hygiene
  • Relaxation techniques
  • Sleep restriction therapy
  • Cognitive therapy

Multiple studies show that an average of 70 percent to 80 percent of people who undergo CBTI have decreased insomnia and report sleeping better. Around 40 percent to 60 percent of these patients are still experiencing these results in the long term.

A 2016 study on adults with comorbid migraine and insomnia used behavioral instructions that had nothing to do with sleep with some of the participants and CBTI for the rest. CBTI included the first three behavioral sleep modifications mentioned above (consistent bedtime/eight hours of sleep, no activities in bed, no napping), as well as sleep restriction and instructions to get out of bed and do a quiet activity if they couldn't fall asleep within 30 minutes.

The researchers found that the people who went through CBTI had significantly better results, reporting longer periods of restful sleep, as well as a reduction in headaches by nearly half at the six-week follow-up. These results continued to improve even after treatment.

Treatment for an underlying sleep disorder may make all the difference in the frequency and severity of your migraines.

Talk to your doctor about getting diagnosed and consider finding a sleep specialist who uses CBTI. Even implementing behavioral sleep modifications on your own and working to improve your sleep hygiene may have a significant impact.

Take Your Migraine Preventive Medications

Preventive migraine medications play an important role in treatment. Around 50 percent to 75 percent of patients who use them see the number of their migraines reduced by half.

There are several options that have been proven to be effective, including:

  • Anticonvulsants: Topamax (topiramate) and Depakote (valproate)
  • Antidepressants: Elavil (amitriptyline) and Effexor (venlafaxine)
  • Beta blockers: Lopressor (metoprolol), Inderal (propranolol), and timolol

Other options that have less evidence but that are probably effective include:

  • Calcium channel blockers: Calan (verapamil) and Novo-Flunarizine (flunarizine)
  • Calcitonin gene-related peptide (CGRP) antagonists: Aimovig (erenumab-aooe), Ajovy (fremanezumab-vfrm), and Emgality (galcanezumab-gnlm)
  • Other beta blockers: Tenormin (atenolol) and Corgard (nadolol)
  • Neurontin (gabapentin), an anticonvulsant
  • Botox (onabotulinumtoxin A), but only for chronic migraine

Finding the right preventive medication can be tricky, either because of intolerable side effects or due to medical contraindications. You may need to try several different kinds before finding the best one for you.

The keys to finding the best preventive medication for you are patience and making sure that you see your doctor regularly for follow-ups. Your doctor will have to titrate up your dose to a therapeutic level (the dose at which the medication actually works to reduce your migraines) while making sure you have the least amount of side effects.

It's a delicate process so try your best to not give up during this adjustment period. If you really can't tolerate the side effects, talk with your doctor about trying something else.

Stop Overusing Your Migraine Medications

Overusing your pain-relieving migraine medications for acute migraines—whether it's a prescription medication like a triptan or an over-the-counter medication like a nonsteroidal anti-inflammatory drug (NSAID)—is a common trigger for the development of chronic migraine.

In addition, when you overuse pain-relieving medications, this can render your migraine preventive medications ineffective.

Stopping a medication you've used too much can eliminate your headaches and reverse your chronic migraines. But again, only do this under the guidance of your physician.

Important Warning

While most medications can be stopped immediately, be sure to talk with your doctor if your medication contains butalbital compounds or if you're taking large amounts of an opioid, as these medications need to be stopped gradually under the guidance of a physician.

Get Regular Exercise

You may associate exercise with bringing on a migraine, and it certainly can be a trigger for some people. However, it's a fact that having a low activity level is associated with more frequent migraines.

Scientific studies show that aerobic exercise can reduce the intensity of pain you feel during a migraine by changing the way the pain is processed and by activating reward centers in your brain. It can also lessen the frequency of your migraines. This is especially good news if you can't take preventive medications.

An additional bonus is that, since obesity is considered a risk factor in the transformation from episodic to chronic migraine, regular aerobic exercise can help keep your weight under control. As a preventive treatment, exercise is also a great option because there are no side effects and it doesn't need to be too costly.

Aerobic exercise has also been shown to improve your overall quality of life, as well as help with other conditions that tend to be comorbid with migraine, including:

  • Insomnia, sleep apnea, and other sleep disorders: Regular exercise regulates your sleep, helping you snooze more soundly.
  • High blood pressure: Exercise can reduce your blood pressure and help your heart function more efficiently.
  • Depression and/or anxiety: The rush of feel-good endorphins you get from exercise boosts your mood and helps to keep it balanced.

Choose Exercise You Enjoy

Remember, exercise doesn't necessarily mean going to the gym—walking briskly with a friend, swimming, Zumba class, biking, hiking, or joining a competitive sports league are all great choices for aerobic exercise. Choose an activity that you enjoy so you'll stick with it and make it a part of your daily routine.

A Word From Verywell

It feels good to take an active stance in your migraine health. Start by making a list, asking your partner to help motivate you, and devising a concrete plan with your doctor. Using these modifications, it is possible to reverse your migraines. Though it can take a lot of work and you may have ups and downs, the ups (no migraine days) will make it all worthwhile. You just might feel like you've gotten your life back.

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