5 Ways to Optimize Your Migraine Care

While it may sometimes seem like your migraines are overwhelming your life, there are ways that you can become more proactive in your migraine care that will help you feel empowered and not so vulnerable to these debilitating, painful attacks. Here are five strategies that can help you optimize your migraine care (under the guidance of your doctor).

While trigger avoidance and coping skills are essential components of migraine management, they may not be the first thing for you to focus on as you begin taking back control of your health.

Instead, start with the basics. Get yourself into a daily routine that promotes physical and mental wellness. Some healthy habits you can start implementing include:

• Eat a healthy diet that's rich in fruits, vegetables, whole grains, and lean proteins.
• Choose meal times that are consistent from day to day and not so spaced apart that you experience distressing hunger.
• Stay hydrated. Consider flavored water, sparkling water, unsweetened tea, etc.
• Maintain a regular sleep routine. Go to bed at the same time every night and wake up at the same time every morning (even on the weekends).
• Engage in regular relaxation activities like yoga, mindful meditation, reading, or listening to music.
• Exercise at least 150 minutes a week. Choose moderately-intense exercises such as jogging, walking briskly, ballroom dancing, or doubles tennis. It's OK to break this down into sessions (e.g., 30 minutes, 5 days a week),

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 much other aspects of your health can impact your migraine disorder.

Discuss any sleep problems with your doctor. Snoring, a morning headache, the urge to move your legs, or difficulty falling or staying asleep may indicate an underlying sleep disorder like sleep apnea, restless legs syndrome, depression, or anxiety.

It's also important to discuss any physical changes or mood symptoms with your doctor, even if you're not sure they're 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).

Give your doctor a list of medications you're taking, including over-the-counter medications, supplements, vitamins, or herbal preparations, as well as how much alcohol and caffeine you regularly use. This helps him zero in on any potential interactions and helps advise what he should prescribe for your migraines.

Tell your doctor about any other sources of pain in your body, for example, "the muscles in 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, even if you've already been diagnosed with a migraine disorder. Here's why keeping a log of your headaches can be so beneficial.

A diary may be particularly helpful in assisting your doctor to confirm your migraine diagnosis. Remember, it's always possible that you're actually having a different type of a headache or migraine disorder than you thought—or than what you may have already been diagnosed with.

Your diary may enlighten you to foods, beverages, habits, environmental exposures, weather changes, and stresses that might be contributing to your migraines. Keeping track of all of these factors can help you see patterns you may not have spotted otherwise.

The simple task of writing can be healing, a way to relax as you take the time to review your thoughts and care for your health. You can use your diary as a way to keep track of your emotional health as well.

If you're like many people with migraines, you may not be sure when to take pain-relieving medication for your migraines. This isn't surprising—especially for those who endure chronic migraines, it can be challenging to differentiate between a headache that has persisted for days and a new headache that erupts on the tail end of a chronic headache.

Another potential problem is that some people with migraines are at risk or are already suffering from medication overuse headache. This means that you develop another type of headache disorder on top of your pre-existing headache disorder, which can further confuse the picture.

Differentiating between headaches and medication overuse headaches are why it's extremely important to seek out help for your migraine from your doctor, usually a neurologist if your migraines are chronic (you have 15 or more migraines every month). Along with your doctor, you can learn how to distinguish between migraine "on" and migraine "off" days, so that you can treat your 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 don't take the appropriate dose when their migraine attack starts. Others are unaware that their medication can—and should—be taken again at a specific time interval after the first dose before being deemed ineffective.

Still others don't realize that there are a number of unique medication formulations. For instance, there are triptans that are available as a nasal spray or as an injection that can be given underneath the skin. There are plenty of options to find the right medication for your individual needs.

The purpose of preventive migraine medication is to reduce the number, duration, and/or severity of migraine attacks, as well as to decrease your use of acute migraine medications.

There are a number of reasons why your doctor may prescribe a preventive medication for you, such as:

• You experience four or more migraine attacks per month.
• You have migraine attacks that negatively impact your quality of life or your ability to function daily, despite more conservative measures like lifestyle changes and proper use of your acute migraine medications.
• You can't tolerate acute migraine medications or you can't take them due to another health condition. For example, if you have heart disease, you may not be able to take a nonsteroidal anti-inflammatory drug (NSAID) or a triptan, both commonly used pain relievers for migraines.

There are a number of preventive migraine medications to choose from, each with their own unique side effects, mechanisms of action, and dosing regimens. It may take some trial and error, as well as patience, before you find the best preventive medication for your needs.

Examples of first-line preventive migraine therapies include:

• Topamax (topiramate), an anticonvulsant
• Depakote (divalproex/sodium), an anticonvulsant
• Inderal (propranolol), a beta blocker
• Toprol (metoprolol), a beta blocker

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 shouldn't stop taking your preventive medication just because you continue to get migraines. Remember, migraines are not "cured," they're managed.

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 can be a good way for you to gain control of your attacks until you can sort out potential triggers or the acute migraine therapies that work best for you.

Be persistent in your effort to gain knowledge about your 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 care for your unique migraine situation. Try exploring non-pharmaceutical options as well, like diet changes, cognitive behavioral therapy (CBT), pressure-regulating ear plugs, meditation, light therapy, ice packs, Alpha-Stim or TENS units, and supplements (all under the guidance of your physician).