Latest news with #migraine
Medscape
3 days ago
- Health
- Medscape
A Review of Transnasal Cooling for Migraine Relief
Transnasal evaporative cooling as an acute treatment for migraine has been tested in two randomized clinical trials showing some level of efficacy and tolerability as well as safety. CALM1 Accrual Issues The first, CALM 1, was presented as a virtual poster at the 2023 American Headache Society meeting. Although this study enrolled 87 patients with migraine with or without aura, only 24 were randomized to the CoolStat Transnasal Thermal Regulating Device (CoolTech LLC). This comprised 15 minutes of air flow as soon as they arrived at their local testing center during an attack. CoolStat device in use The primary endpoint was pain relief at 2 hours; pain freedom, relief of most bothersome symptom, and tolerability were also measured at 2 and 24 hours. Three air flow rates were tested: 24, 18, and 6 liters per minute (LPM). It was originally assumed that the 6 LPM flow rate would act as the sham, but it turned out to be the most effective rate. In this group, 8 of 9 patients reported pain relief at 2 hours with 4 of them being pain free. Patients treated with the other doses reported a similar rate of pain relief, but none were fully free of pain at 2 hours. There were no adverse events in the lowest flow rate group and only mild events in the other groups. The study was terminated due to insufficient accrual rates. The company decided to do a second study with a smaller portable device which patients could use at home earlier in the course of their migraine attack. CALM 2 At Home Treatment The CALM 2 study used a 2 LPM dose as the sham: This used an inactive drying agent and patients experienced the sensation of treatment including saline mist. This small, phase 2, dose range-finding trial tested active doses of 4, 6, and 10 LPM. Patients treated their migraine for 15 minutes within 1 hour of pain onset using the Mi-Helper, an investigational device similar in size to a sleep apnea machine. The Mi-Helper The Mi-Helper No other treatment was allowed for 2 hours. Of the 172 adults randomized, 128 used the device and were included in the modified intention-to-treat analysis. Only 74 were included in the efficacy analysis because the others did not fully follow the protocol for a variety of reasons. In this study, the 10 LPM air flow rate was the most effective, producing pain freedom at 2 hours in 8 of 17 patients, vs 4 of 25 sham-treated patients. This difference was statistically significant. Two-hour pain relief was seen in 70.6% of this group vs 56% of the sham group, a difference that did not reach statistical significance. Sustained pain freedom from 2 to 24 hours with no rescue treatment was numerically but not significantly higher than sham with the 10 LPM dose. Results for the other air flow rates (4 and 6 LPM) were not statistically significant. The most common adverse events, scattered across the three active-treatment groups, were rhinorrhea, nasal irritation, ear pressure, nasal congestion, sore throat, and jaw pain. More events occurred in the 10 LPM group (with none in the sham group), but no patient discontinued the trial because of side effects. How Does it Work? The proposed mechanism of action for Mi-Helper, according to Steve Schaefer, the CEO of Cooltech, is that it 'noninvasively cools and inhibits structures of the pterygopalatine fossa, including the sphenopalatine ganglion (SPG) and the maxillary division of the trigeminal nerve.' The device delivers dry room-temperature air into one nostril with a nebulized saline mist for comfort and to facilitate evaporation. The evaporation from liquid to gas requires energy drawn from the surrounding tissues, particularly the vascularized membranes of the nasal turbinates. This purportedly results in a localized cooling effect targeting the structures of the pterygopalatine fossa, including the SPG and maxillary division of the trigeminal nerve (V2), both areas integrally involved with migraine and cluster headache. This hypothesis has yet to be corroborated; no preclinical trials have shown any electrical effect on the SPG. The Mi-Helper is not the same as remote electrical neuromodulation (REN) or other electrical stimulation devices that are already cleared by the FDA for the acute care and/or prevention of migraine attacks. REN uses electrical stimulators and works on various combinations of peripheral nerves involved with migraine. [By way of disclosure, I recently authored a poster on REN.] What Next CALM 3, a third, larger, phase 3 trial of the Mi-Helper is underway. It will test a 10 LPM dose of dehumidified air against a 2 LPM sham. According to CEO Steve Schaefer, it should be completed in September, 2025. I believe that we need to see data from at least two carefully done phase 3 trials at the correct flow rate (10 LPM), in an appropriate number of patients, before we will know if this device can successfully treat migraine, but the results so far are very promising.
Health Line
5 days ago
- Health
- Health Line
What Happens During a Migraine Diagnosis?
Key Takeaways A migraine diagnosis involves gathering your medical history, performing a physical exam, and possibly ordering scans to rule out other conditions. Migraine symptoms include severe head pain, throbbing, and sensitivity to light, sound, and smells. They can be preceded by warning signs like mood changes or visual disturbances. Treatment focuses on stopping symptoms with medication and preventing future episodes by identifying triggers and using preventative medications or therapies. Migraine can disrupt your entire day. Frequent migraine attacks can disrupt your life and make it difficult for you to work, spend time with family, or do everyday activities. Thankfully, getting diagnosed with migraine can give you the tools to help reduce or even eliminate your migraine attacks and their symptoms. Getting diagnosed can sometimes happen in a single doctor's appointment. If your doctor is concerned that there might be something else causing your symptoms, you'll need further testing before migraine can be diagnosed. What are the steps of migraine diagnosis? The steps of migraine diagnosis will depend on your overall health, family history, and a few other factors. You can start by seeing a primary care doctor. In some cases, you might need to see a neurologist (a doctor who treats diseases and disorders of the nervous system) for further testing and treatment. During your migraine diagnosis, a doctor will: gather your medical history perform an exam order scans to rule out other conditions You can read more about each step below. Gathering your medical history Your doctor will need to gather a lot of information about your personal medical history and your family medical history to diagnose migraine. They'll ask you to provide as many details as you can about your symptoms. They'll also want to know about any other medical conditions you've been diagnosed with and about any other symptoms you've been having recently. You'll be asked about your diet, stress levels, activity levels, and other aspects of your lifestyle. Your doctor might ask you to keep a migraine journal until your next appointment. In the journal, you'll record every time you have pain and describe what that pain feels like. You can also record anything you do for the pain at home and whether it helps at all. For example, you might want to make note of whether certain over-the-counter (OTC) medications help. You'll need to provide as much family health history as you can. Since migraine tends to run in families, it's important for the doctor to know whether you have any relatives who've been diagnosed with migraine. It's also important to let them know about any other conditions that run in your family. Performing a medical exam During your exam, the doctor will do neurological tests to check your reflexes and see how you respond to sensations. They might also test your short-term memory. You'll have your blood pressure and pulse taken. A doctor will also check your head, shoulders, and neck. For many people, this is enough to diagnose migraine. Generally, you'll be diagnosed with migraine if you've had at least five headaches that have lasted between 4 and 72 hours and your headaches have at least two of these four characteristics: are located primarily on one side of the head cause pain that's pulsing or throbbing cause pain that's moderate to severe are made worse by normal physical activity Your headaches will also need to cause you nausea or sensitivity to light and sound to be categorized as migraine. A physical exam and thorough medical history allow a doctor to make the migraine diagnosis. However, in some cases, the doctor might not be certain that your symptoms aren't being caused by something else. In this case, you might need to move on to the next step. Ordering scans to rule out other conditions If your pain came on suddenly or if you're having other symptoms that aren't typically caused by migraine, your doctor might order more testing. This testing isn't for identifying migraine. It's for identifying other things that might be causing your pain, such as brain aneurysms or tumors. Testing might include: Magnetic resonance imaging (MRI). An MRI uses magnetic waves to create a detailed image of your brain. The MRI will look for infections tumors, bleeding, and other abnormalities in your brain that could be causing your head pain. Computed tomography (CT scan). A CT scan creates a detailed image of your brain. Just like an MRI, a CT scan can be used to look for medical problems that could be the source of your pain. Your doctor might also order blood work to help pinpoint other conditions that might be behind your pain and symptoms. Keep in mind that these tests are for identifying causes that aren't migraine. However, if no infections, tumors, or other possible causes are found, those causes can be ruled out. Ruling out other causes can allow your doctor to make a migraine diagnosis. Tips for finding a doctor to diagnose migraine Getting a migraine diagnosis is the first step to getting the treatment you need. Here are a few tips for finding a doctor: Start with your primary care doctor. Your primary care doctor might be able to diagnose migraine or refer you to a specialist who can. Check with your insurance. If you have insurance, you can use it to help find a doctor to diagnose migraine. Many insurance company websites even have an online tool that will let you search for a doctor to diagnose migraine who works with your insurance. Look online. Review doctors in your area who treat migraine. Consult organizations. Migraine organizations, such as the American Migraine Foundation, have resources to help find a doctor who treats migraine. What is migraine? It's common for people to think of migraine attacks as simply bad headaches, but that's not actually the case. Migraine is a neurological condition that causes severe pain. It can make it difficult to complete your daily activities or even get out of bed. Untreated, a migraine can last for several days. In addition to the pain, migraine episodes can cause nausea, vomiting, and other symptoms. Some people also experience warning symptoms before a migraine episode strikes. This is called an aura. An aura can cause a variety of sensory disruptions. However, not everyone with migraine experiences auras. Migraine can begin at any age but is most often diagnosed in people in their teens, twenties, or thirties. Migraine tends to run in families and is diagnosed more often in women than in men. The frequency of migraine attacks can vary from person to person. Some people might experience a few episodes a year, while others might have several in a single week. What are the symptoms of migraine? The symptoms of migraine can be very painful. Many people need to rest in a dark, quiet place during their migraine episodes to help manage their symptoms. Migraine symptoms often include: pain on one side of the head throbbing or pulsing pain sensitivity to lights sensitivity to sounds sensitivity to smells nausea and vomiting Some people also experience warning periods before a migraine. These warning periods have their own symptoms. The two warning periods are known as prodrome and aura. A prodrome normally occurs 1 or 2 days before a migraine. If you have a prodrome period, you might experience: mood changes irritability food cravings increased thirst neck pain or stiffness constipation An aura generally occurs right before a migraine. Some people also have aura symptoms during their migraine. Aura symptoms buildup gradually and can last as long as 1 hour. Symptoms include: vision loss visual hallucinations, such as flashes of light or bright spots seeing shapes difficulty speaking weakness on one side of the body tingling sensation on one side of the body uncontrollable jerks or tremors auditory hallucinations, such as sounds or music Some people experience further symptoms once a migraine episode has passed. This is known as post-drome and lasts for about a day. During post-drome, some people report feeling: drained confused exhausted elated or other mood changes a dull headache How is migraine treated? There are generally two parts to migraine treatment. The first part is stopping the pain and symptoms of migraine when they occur. The second is preventing migraine from occurring. Your treatment will include both of these parts. Treatments for stopping migraine symptoms include these medications: OTC pain relievers. OTC medications, such as Tylenol, Advil, and Excedrin, might help relieve mild migraine pain. They're often not enough to stop moderate or severe pain. Long-term use of these medications can also cause damage to your stomach lining. Triptans. Triptans are a class of medications that block pain pathways in your brain. They're available in pills, nasal sprays, or injections. For many people, they're an effective way to treat migraine. Dihydroergotamines. These medications are taken as nasal spray or injection. They're often useful for people whose migraine attacks last longer than 24 hours. In some people, they can cause migraine symptoms to worsen. Opioids. Opioids such as codeine can be effective in treating migraine. However, these medications are very strong and highly addictive. You'll generally only be prescribed opioids if no other treatment has worked to stop your migraine symptoms. Anti-nausea medications. People who have nausea and vomiting with migraine might benefit from taking anti-nausea medication along with a pain medication. Treatments for preventing migraine include: Identifying and avoiding triggers. You might be asked to keep a migraine journal to identify triggers that cause or worsen your migraine. Triggers can vary from person to person and might include weather, smells, hormonal changes, stress, certain foods, and more. Avoiding your migraine triggers can help prevent a migraine attack from occurring. Beta-blockers. Beta-blockers are often prescribed to people with high blood pressure, but they've been proven to be effective in treating migraine, as well. Your doctor might prescribe a daily beta-blocker to help prevent migraine, especially if you have frequent or severe attacks. Calcium channel blockers. Just like beta-blockers, calcium channel blockers are generally used for high blood pressure. They've been found to be effective at preventing migraine, especially in people who have an aura with their migraine. Antidepressants. Antidepressants can be used to prevent migraine. Some antidepressants can have unwanted side effects or interactions with other medications. Antiseizure medications. Some medications that prevent seizures can also prevent migraine attacks. Like antidepressants, these medications can cause unwanted side effects in some people. Botox injections. Botox is most often associated with cosmetic procedures, but it can actually be used in migraine prevention as well. You'll need an injection every 12 weeks or so if you go this route. It can take a while to figure out the right combination of treatments for you. Tell your doctor what's effective and what isn't. They can help you try other options until you find something that works. Can you prevent migraine? If you've already been diagnosed with migraine, your doctor can help you figure out the best prevention methods. Often, your first step will be keeping a migraine journal so that you can figure out what triggers your attacks and avoid them. Many migraine triggers are related to everyday health habits. This includes: not getting enough sleep not eating regular meals not exercising enough being under stress For some people, managing those things can help you prevent or lessen migraine. You can also avoid common trigger foods and drinks, such as: chocolate red wine cultured dairy foods with added MSG processed foods or smoked meats You can try eliminating these foods from your diet for a week and seeing whether you have fewer headaches. Some people are also helped by natural remedies that aren't medications.
Medscape
7 days ago
- Health
- Medscape
Long-Term Rimegepant Use Safe for Migraine Prevention
TOPLINE: The use of the calcitonin gene-related peptide (CGRP) antagonist rimegepant 75 mg for 52 weeks showed a favorable safety profile and sustained benefits for migraine prevention in a new open-label extension (OLE) study. The treatment was associated with a reduction in monthly migraine days (MMDs), as well as a low frequency of adverse events (AEs) and no significant hepatic safety concerns. METHODOLOGY: The original phase 2/3 multicenter, randomized, double-blind, placebo-controlled trial included adult participants who had 4-18 moderate-to-severe migraine attacks per month. As reported previously, participants who received one tablet of rimegepant 75 mg every other calendar day for 12 weeks had significantly fewer MMDs than those who received matching placebo, meeting the primary endpoint. The treatment phase was then followed by a 52-week OLE period, where safety and tolerability were assessed through AE monitoring, vital signs assessments, physical examinations, ECGs, and laboratory tests, with special attention to hepatic-related AEs. All OLE participants received the active anti-CGRP. Exploratory outcomes during the extension period included the mean reduction in the number of MMDs and the proportion of participants achieving ≥ 50% and 100% reductions in the number of MMDs. TAKEAWAY: Among 603 participants who entered the OLE period, 71% of the participants completed the study; 52% experienced at least one AE, with most deemed to be mild. Only 2% of participants reported serious AEs, none of which were related to the liver or related to the study drug. Treatment-related AEs occurred in 15% of participants, leading to drug discontinuation in 3%. The most common AEs reported were constipation, upper respiratory tract infection, nausea, migraine, increased liver enzymes, and weight gain, although each occurred in ≤ 1% of participants. The hepatic safety profile was favorable, and liver-related AEs were rare. The mean number of MMDs decreased by 6.2 d/mo over the OLE period, with sustained and increasing treatment benefits being observed without a decrease in the effect. The proportion of participants achieving ≥ 50% and 100% reductions in the number of MMDs increased during the extension period. IN PRACTICE: 'This trial found that participants who took rimegepant every other day and as needed (up to one 75 mg tablet a day) experienced a reduction in migraine days and experienced few side effects. Moreover, the treatment benefits of rimegepant increased over a 1-year period without losing effectiveness,' the investigators wrote. SOURCE: This study was led by David Kudrow, MD, California Medical Clinic for Headache, Santa Monica, California. It was published online on June 30 in Headache. LIMITATIONS: Key limitations included the exclusion of participants with extremely frequent headaches (> 18 headache days per month), which limited the generalizability of the findings. The requirement for a consistent ≥ 50% monthly reduction may have underestimated sustained efficacy, post-randomization dropouts may have skewed the OLE sample, the lack of an active comparator may have introduced bias, and participants' awareness of receiving the drug may have affected reporting. Efficacy endpoints were also exploratory, so definitive conclusions on long-term effectiveness could not be drawn. DISCLOSURES: This study was funded by Biohaven Pharmaceuticals. Several investigators reported having financial or employment ties with the funder or other pharmaceutical companies. One investigator also reported being on the editorial board of journals, including Headache. Full details are provided in the original article. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Telegraph
16-07-2025
- Health
- Telegraph
What your headache is trying to tell you
How often do you feel the ominous sensation of a headache coming on? From a mild twinge after staring at a screen for too long, to a severe throb which makes work impossible, more than half the world's population has suffered from some form of 'headache disorder' recently, according to the most recent Global Burden of Disease (GBD) study. But despite their prevalence, most of us never question what they might mean for our overall health. 'The vast majority are primary headaches, which means they don't have an external cause, such as viral meningitis or a head injury,' says Peter Goadsby, a professor of neurology at King's College London. 'The tendency to experience primary headache disorders is inherited, and then things in life will amplify it.' Overall, there are more than 100 different clinical categories of headaches, ranging from those that can be tackled with paracetamol to frequent, seriously debilitating ones. Here is a guide to some of the most common headaches and their causes, as well as ways of preventing and treating them. Around 10 million adults in Britain suffer from migraines, which costs the country approximately £2.3 billion every year in lost working days. They are characterised as a severe throbbing headache on one side of the head, which lasts between four and 72 hours and can be accompanied by blurred vision, nausea and acute sensitivity to sight and sound. The most common trigger for migraines is variation, according to Prof Goadsby. 'Changing sleeping habits – getting too much or too little – skipping meals, suddenly starting to do overly extreme exercise, stress, drinking too much alcohol and a change in weather can all trigger a migraine,' he says. It's rare to have one reliable trigger; for most people, it's caused by a number of factors coming together. And Prof Goadsby points out that some of what people assume are triggers – bright light, for example – are part of the initial stage of the migraine itself, before the headache hits. Migraines are under-diagnosed and under-treated, says Dr Ben Turner, a consultant neurologist at London Bridge Hospital. 'There's a tendency to think a headache is only a migraine if there's visual disturbance, when this only happens to 20 per cent of people,' he says. How to treat them Migraines are ' highly treatable, so if your GP hasn't been able to help, seek a referral to a specialist and you're likely to find you've been suffering unnecessarily for years,' says Dr Turner. Triptans have long been used for migraine attacks, but recently a new class of drugs called gepants have become available, which are more effective, broadly tolerated and can be used to prevent as well as treat migraines. The most excruciating form of headache, confined to one side of the head, cluster headaches last for an hour or two, often waking sufferers in the night. They are rare, and those affected – most commonly men – have rated the pain at 9.7 out of 10 – worse than childbirth at 7.2, a gunshot wound at 6 and a migraine at 5.4. They will usually become agitated and feel the need to move around, rocking and possibly hitting their head. 'It will happen every day, once or twice a day, for six to eight weeks at a time,' says Prof Goadsby. The exact cause is unknown, but these headaches affect an area of the brain called the suprachiasmatic nucleus, a tiny region in the hypothalamus which acts as the body's central circadian pacemaker, regulating daily rhythms including the sleep-wake cycle. This may explain why cluster headaches tend to appear at the same time each day, and even occur at the same time each year. 'Peak times [for cluster headaches] tend to be spring and autumn, and in between, it's completely turned off,' says Prof Goadbsy. How to treat them Cluster headaches are sometimes misdiagnosed as dental pain or acute allergies because of symptoms including a watery eye and a stuffy nose on the painful side. They require specialist treatments to relieve the pain, such as oxygen therapy, sumatriptan injections or nasal spray. The drug verapamil, taken as a tablet several times a day, is the main treatment for prevention, but it can cause heart problems in some people. The most common type of headache, tension headaches cause a steady, mild to moderate ache that can feel like a tight band or pressure around the head, and can usually be alleviated with aspirin, paracetamol or ibuprofen. Unlike migraines, they do not cause nausea, vomiting or sensitivity to light and sound. Often caused by poor posture and stiffness in the neck muscles, or eye strain, they can also be an indication of dehydration, lack of sleep, emotional stress, or too much caffeine. How to treat them Tension-type headaches – their official term – usually get better when someone moves around, particularly outdoors, so factoring in plenty of screen breaks is crucial. Gentle stretches, massages and heat on sore muscles can also be beneficial. Prof Goadsby warns that if you're regularly getting headaches after staring at a screen for extended periods, there could be another underlying cause. 'A good starting point would be to get your eyes checked by an optician, but for most people in this situation, it's not a tension-type headache but migraine.' A sinus headache is a symptom of a sinus infection (sinusitis), where the lining of the sinuses becomes inflamed and swollen, causing congestion and a dull pain behind the eyes, in the cheekbones, forehead or bridge of the nose. Research has shown that between 50 and 80 per cent of cases labelled as sinus headaches are actually misdiagnosed migraines. Dr Taylor says neurologists often see patients in this situation. 'Unless there's significant nasal congestion and discharge, it isn't sinusitis,' he says. 'We see GPs prescribing antibiotics to clear an infection, but if the problem is really migraine, they won't have any effect.' How to treat them Usually the infection clears in seven to 10 days, and using over-the-counter painkillers such as Sudafed can help manage the pain. The vast majority of us will experience a dehydration headache at some point if we've been too busy to ensure we drink enough water. But why does dehydration manifest as a headache? The hypothalamus in the brain acts as a control centre, regulating bodily functions such as body temperature, hunger and thirst. If we become dehydrated, 'this area of the brain will be overstimulated,' says Prof Goadsby. 'In those who are susceptible, it can trigger migraine.' How to treat them Drinking 2-2½ litres of fluid a day (around six to eight glasses) is essential to keep headaches at bay. Drinking too much caffeine can cause headaches for some people, but conversely, if you are a regular tea or coffee drinker, suddenly reducing your intake can also trigger them. Caffeine's stimulating effects are exerted primarily by blocking adenosine receptors in the brain. Adenosine is a neurotransmitter that promotes sleepiness and relaxation by slowing down nerve cell activity. 'When you withdraw caffeine, you get a headache from the sudden increase in adenosine activity,' says Prof Goadsby. How to treat them Over-the-counter pain relief should help, but don't use it too often. 'If you're taking painkillers more than three days a week, it will give you a headache,' says Dr Taylor. Research shows that medication overuse can turn episodic headaches into chronic headache disorders, increasing their frequency and intensity. Ophthalmodynia periodica, or ice-pick headache, is characterised by sudden, sharp stabbing pains behind the eyes which last for a few seconds at a time and can spread to the rest of your head. 'It comes from nowhere, and you can't stop it,' says Prof Goadsby. The exact causes are unknown, though a 2017 study found that these types of headaches are more common in women, and tend to affect people who usually suffer from migraines or cluster headaches. 'Around a third of migraine sufferers experience this kind of headache,' Prof Goadbsy adds. How to treat them 'You just need to pause, let it play out and it will pass,' says Prof Goadsby. If they are happening frequently (over several consecutive days) and having a debilitating impact, seeing a doctor to rule out an underlying cause is a must. Can headaches be hormonal? Migraines disproportionately affect women – 20.7 per cent globally compared with 9.7 per cent of men, according to one 2022 review of research. For women aged 18 to 49, migraine is the leading cause of disability throughout the world. This is believed to be a result of hormonal fluctuations, particularly oestrogen, with migraines often most commonly occurring during a woman's reproductive and childbearing years. Researchers estimate around 50 to 60 per cent of women with migraines experience menstrual migraines, occurring in the days leading up to menstruation, when oestrogen drops. 'It peaks at around the age of 40 for women, and if you begin to experience migraines around this time, it's often the first sign of the hormonal fluctuations which come with perimenopause,' says Prof Goadsby. 'After menopause, women have a four-out-of-five chance of migraines going away completely.' If headaches are debilitating during perimenopause, hormone replacement therapy (HRT) can lessen their frequency and severity in some women. In others, it can worsen them, so speak to your GP about options. How can you prevent headaches? Many types of headaches can be prevented or at least reduced in frequency or severity. Proven prevention strategies include: Drinking enough water Keeping a consistent sleep and eating schedule Exercising regularly Managing stress Eating a healthy diet Supplementing with magnesium and vitamin B2 Lifestyle changes, including maintaining a consistent sleep and eating schedule, drinking enough water and taking regular moderate exercise, are the simplest and most effective place to start. Relaxing after stress is a known trigger, which explains why some people wake up after a lie-in on a Saturday with a pounding headache. This is because, as your levels of stress hormones drop, there is a rapid release of neurotransmitters which send out impulses to blood vessels to constrict then dilate, which causes a headache. Prof Goadsby says: 'It may sound slightly hair shirt, but it's better to resist the temptation to lie in and get up at the same time every day.' Managing stress throughout the week is vital, too. Techniques such as deep breathing, meditation or even a 10-minute walk around the block during a lunch break can help prevent stress levels climbing too high. Eating a healthy diet is also likely to help. Keeping blood sugar levels steady by avoiding too many refined white carbohydrates and replacing them with fruits, vegetables, nuts, beans and wholegrains is sensible. It's often believed chocolate is a trigger, but according to Prof Goadsby: 'Research indicates that during the 'premonitory' early phase of a migraine, people may crave certain foods. So rather than triggering the migraine, reaching for a chocolate bar could be a warning that a migraine is starting.' A 2025 review of research concluded that taking magnesium is effective in reducing migraine attack frequency and severity. Taking 400mg per day of riboflavin, or vitamin B2 supplements, for at least three months has also been shown to have a similarly positive effect.
Yahoo
15-07-2025
- Health
- Yahoo
The Migraine-Friendly Routine That Keeps You Ahead Of The Pain
"Hearst Magazines and Yahoo may earn commission or revenue on some items through these links." It's late afternoon when you feel it coming on: that telltale throbbing on one side of your head, the nausea, the dizziness. Suddenly, the overhead lights seem unbearably bright, and the clacking of your keyboard is jackhammer-loud. You message the boss ('leaving early again'), then head home and retreat to a dark, quiet room to ride out yet another migraine. If you've missed work or skipped out on social events due to the condition, you know how disruptive it can be. 'Migraine is a serious and highly disabling neurologic disease,' says Amaal Starling, MD, a headache specialist and associate professor of neurology in Scottsdale, Arizona. 'Left undiagnosed and untreated, it can worsen and progress over time and become more severe and disabling.' It's also very common, affecting more than 39 million people in the U.S., according to the American Migraine Foundation. Of these, 3 to 5 percent live with chronic migraine, defined as 15 or more headache days per month. Women are up to three times more likely than men to experience migraine, and their attacks tend to be more frequent, more intense, and longer-lasting. So what is it that makes migraine so uniquely debilitating—beyond the pain itself? More than just a 'bad headache,' migraine is a complex, largely genetic condition involving many systems in the body. The pain stems from abnormal interactions between the brain, blood vessels, and surrounding nerves. 'There are a lot of non-pain-related symptoms as well, such as sensitivity to light, sound, smell, and motion, nausea, and brain fog,' Dr. Starling says. Nearly a quarter of people with migraine experience an aura—usually a visual disturbance—right before or during the attack. A migraine attack is influenced by both biological and environmental factors, unfolds in phases, and can last anywhere from 4 to 72 hours. Triggers vary widely from person to person but often include specific foods (like red wine, nitrates, or aged cheeses), dehydration, hormonal fluctuations, changes in barometric pressure, and poor or irregular sleep. Stress can play a major role in the onset of migraine too, including the rapid drop in stress hormones that occurs after a high-stress period—a phenomenon known as "let-down migraine,' Dr. Starling explains. This is why symptoms may often arise at the start of a vacation or after a long weekend. The fallout from migraine is not solely physical. According to research published in a 2019 issue of Headache, the disease negatively affects many important aspects of life, including relationships, career, financial security, and overall health. 'It can disrupt your ability to work, care for your family, attend social events, or even get out of bed,' says study author Dawn C. Buse, PhD, a psychologist and clinical professor of neurology in New York. 'And it's not the attack itself,' she points out. 'It's the anticipation of the next one, the unpredictability, and the effort to avoid triggers that make life feel so restricted.' Not surprisingly given all this, people living with migraine disease have an increased risk of anxiety and depression. But while migraine can be unpredictable, building a consistent daily routine can help you regain control. Here's how to create structure, reduce symptoms, and get back to living on your own terms—morning, noon, and night. Migraine management begins with a personalized plan from your healthcare provider. It typically includes acute treatments (for when an attack strikes) and preventive treatments (to reduce frequency and severity), Dr. Starling says: 'Individuals who have four or more migraine days per month will need a prescription medication to manage the underlying disease and prevent it from progressing.' But medication is just one piece of the puzzle, Buse says. 'Maintaining overall routine and regularity in daily habits—such as the consistent timing of sleep, meals, exercise, and relaxation—can help to stabilize biological rhythms and reduce migraine susceptibility,' she says She and other experts subscribe to the 'SEEDS for Success' model: Sleep, Eat, Exercise, Diary (to track triggers), and Stress. Each signifies an area of support for raising your migraine threshold. By making your brain and nervous system more resilient overall, you'll become less likely to tip into a migraine even when you're exposed to a trigger. 'Basically, you want to keep everything—sleep, meals, hydration, exercise, and stress levels—on an even keel,' Dr. Starling says. There's no universal 'migraine hour' or specific time of day when attacks are most likely to occur, she adds. So the first step to gaining control is understanding when you're most vulnerable to migraine, and why. From there, create a daily checklist, incorporating these healthy habits: Wake up at the same time every day. Maintaining a consistent sleep and wake schedule, even on weekends, supports circadian-rhythm stability. Aim for seven to nine hours of quality zzz's per night. Eat breakfast. A recent review of studies found that fasting and skipping meals, particularly breakfast, can trigger migraines by reducing brain glucose levels. Instead, opt for healthy, balanced meals at the same time every morning. Get moving. 'Moderate aerobic exercise, performed consistently, has been shown to reduce the frequency, intensity, and duration of migraine attacks,' Buse says. Physical activity can also ease stress and improve sleep—thus addressing, of course, two known migraine triggers. Start slow, engaging in low-impact activities like walking, biking, or swimming for 20 to 30 minutes three to five times a week. The exercise doesn't have to be performed in the morning, though for many people this time of day is their best opportunity to get it done. Hydrate. Dehydration is a trigger for one third of people with migraine. Keep a water bottle with you, and sip often throughout the day. If you drink caffeine, stick with one or two servings a day and keep the timing consistent. Take a stress break. Even brief periods of relaxation can help keep stress hormones from yo-yoing. Set aside a quiet moment for some deep breathing or meditation. Or calm your nervous system with a biofeedback app. Soothe your senses. To prevent sensory overload as the day progresses, take screen breaks, dim the brightness on your monitor, and wear sunglasses outside. Can't stand the sound of your neighbor's lawn mower or the voice of your chatty co-worker? Noise-cancelling headphones can be a game-changer. Watch what you eat and drink. Avoid eating heavy or spicy meals close to bedtime, and monitor your alcohol intake. Even if it's not a migraine trigger, imbibing can interfere with the deep, restorative sleep that's so important. Establish a digital curfew. The blue light and stimulation from screens can 'suppress melatonin production and delay sleep onset,' Buse says. Power down at least 30 to 60 minutes before turning in. Prioritize sleep hygiene. 'Your bedroom should be cool, dark, and quiet,' says Buse, who suggests 'blackout curtains, white-noise machines, and earplugs as needed.' Engage in a regular bedtime routine (think gentle stretching, a warm bath, or reading) to signal your brain that it's time to sleep. Finding your rhythm with chronic migraine isn't about eliminating every attack. It's about reducing your susceptibility by creating stability and minimizing disruptions. Over time, with consistent, healthy habits, you can live the life you want to lead—with migraine disease firmly in the background. 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