5 Ways to Optimize Your Migraine Care

While it may seem like your migraines are overwhelming your life, there are ways to become more proactive in your migraine care—so you can feel empowered and not so vulnerable to these debilitating, painful attacks.

These five strategies will help you optimize your migraine care (under the guidance of your doctor):

• Engaging in Healthy Habits
• Seeing a Primary Care Physician
• Keeping a Migraine Diary
• Taking Your Acute Migraine Medication Properly
• Taking Your Preventive Migraine Medication (If Prescribed)

It is important to understand that while trigger avoidance and/or coping is an essential component of migraine management, it may not be the first thing for you to focus on as you begin taking back control of your migraine health.

Instead, start with the basics. Get yourself into a daily routine that promotes physical and mental health. This includes:

• eating a healthy diet rich in fruits, vegetables, whole grains, and lean proteins
• choosing meal-times that are consistent from day to day and not too spaced out that you experience distressing hunger
• staying hydrated—consider flavored water, alkaline water, or throwing a lemon in your water to boost its taste and appeal
• maintaining a regular sleep routine—going to bed at the same time every night and waking up at the same time every morning (even on the weekends).
• engaging in regular relaxation activities  (for example, yoga, mindful meditation, reading, listening to music)
• exercising at least 150 minutes a week (it is OK to break this down into sessions, like 30 minutes 5 days a week) of moderately-intense exercises (for example, jogging, walking briskly, ballroom dancing, doubles tennis)

It's important to see your primary care physician, in addition to your headache specialist or neurologist (if you have one). This way, any underlying medical conditions can be addressed—you may be surprised how other aspects of your health are impacting your migraine disorder.

For example, discuss any sleep problems with your doctor. Snoring, a morning headache, urges to move your legs, or difficulty falling or staying asleep may indicate an underlying sleep disorder like sleep apnea, restless leg syndrome, depression, or anxiety.

It's also important to discuss any physical changes or mood symptoms with your doctor, even if you are not sure they are pertinent. For example, weight loss, a loss of interest in activities, and/or feeling guilty or hopeless most of the time could be symptoms and signs of depression—and research indicates that treating your depression may help your migraines (and vice versa).

Other important points to bring up with your primary care doctor include:

• a list of medications you are taking, including over-the-counter supplements, vitamins, or herbals
•  alcohol and caffeine use
• other sources of pain in your body (for example, "the muscles of my neck hurt" or "I have pain all over")—these could indicate a second pain process occurring along with your migraines, like fibromyalgia or a myofascial trigger point

While the idea of maintaining a migraine diary may seem a bit tedious (or even old-school), you may be surprised at how useful it is.

Diaries may be particularly helpful in assisting doctors with confirming your migraine diagnosis. Remember, it is always possible that you are actually having a different type of headache or migraine disorder than what you thought, or than what a prior health care provider diagnosed you with. You could also be having more than one headache or migraine disorder occurring simultaneously. A detailed diary can help a doctor sort this all out.

In terms of identifying triggers, your diary may enlighten you to foods, habits, exposures, and stresses that may be related to your migraines. The simple task of writing can also be therapeutic—a form of relaxation, as you take the time to review your thoughts and care for your health.

If writing in a journal does not appeal to you, try typing notes in your phone, using a small tape recorder, or asking for the writing help of a friend or partner (a nice excuse for some quality time together).

Many people with migraines are not sure when to take their migraine attack medication. This is not surprising, especially for those who endure chronic migraines—it can be challenging to delineate between a headache that has persisted for days ("it never ends") and a new headache that erupts on the background of a chronic headache.

Another caveat is that some people with migraines are at risk or already suffering from medication overuse headache. This means that a person develops another type of headache disorder on top of their pre-existing headache disorder, which can further confuse the picture.

In fact, do not be surprised if your doctor asks that you stop taking acute migraine medications at the beginning of your treatment plan. This is meant to help you (although it can be a bit brutal at first), so your doctor can determine if medication overuse headache is playing a role in your head pain.

These two reasons are why it's extremely important to seek out help for your migraine from your doctor, usually a neurologist if your migraines are chronic. With your doctor, you can learn how to distinguish between migraine "on" and migraine "off" days, so that you can treat migraine attacks rapidly when the pain is mild.

Your doctor can also teach you exactly how to take your acute migraine medication, as there are a few tricks to it. For example, many people do not take the appropriate dose at the onset of their migraine attack.

Others are unaware that their therapies can (and should) be taken again at a specific time interval after the first dose, before beeing deemed ineffective.

Still, others do not realize that there are a number of unique medication formulations. For instance, there are triptans available as a nasal spray or as an injection that can be given underneath the skin.

The purpose of a migraine preventive medication is to reduce the number, duration, and/or severity of migraine attacks, and to decrease the use of acute migraine medications (which can lead to medication overuse headache).

This being said, you may be surprised to hear that a preventive migraine medication is considered to be effective when it decreases the number of migraine attacks by at least half within three months. This means that you should not stop taking your preventive medication just because you continue to get migraines. Remember, migraines are not "cured," rather they are managed.

If you are not happy with your migraine preventive medication because of its effectiveness, side effects, or other concerns, please speak with your doctor first. Do not stop it on your own.

It's also important to know that there are a number of reasons why your doctor may recommend a migraine preventive medication—meaning it's not just for people who have chronic migraines.

For instance, if a person experiences 4 or more migraine attacks per month, he or she should be considered for a preventive migraine medication.

In addition, migraine attacks that negatively impact a person's quality of life or ability to function daily (despite more conservative measures like lifestyle changes and proper use of acute migraine medications) should also seriously consider a migraine preventive medication.

Finally, some people cannot tolerate acute migraine medications or they are contraindicated (for example, a person with heart disease may not be able to take a NSAID or triptan). This may be another indication for a migraine preventive medication.

You should also know that taking a migraine preventive medication is not a life-long commitment. Most people take it for six to nine months. It's often a good bridge for people to gain control of their attacks until they can sort out potential triggers or acute migraine therapies that work best for them.

The good news is that there are a number of preventive migraine medications to choose from, each with their own unique side effects, mechanisms of action, and dosing regimens. Therefore, it may take some patience before finding the preventive medication that works for you.

Examples of first-line preventive migraine therapies include:

• Topamax (topiramate)
• Depakote (divalproex/sodium)
• Inderal (propanolol)
• Toprol (metoprolol)

Remain persistent in your effort to gain knowledge about you or your loved one's migraines. While there are a number of effective therapies available, it may take hard work and patience to get to the bottom of how to best and uniquely care for your migraines.