By Puja Aggarwal, MD, as told to Kara Mayer Robinson
As a board-certified neurologist who treats migraines — and someone who gets migraine headaches regularly — I feel your pain.
About 2-3 times a month, I get a full-blown migraine at the back of my head. It also comes with photophobia, or light sensitivity, and floaters in my vision. When I get a migraine, it can hang on for 6-8 hours.
Between my own migraines and those I treat in my practice in Orlando, FL, I’ve become adept at managing them.
But just because certain things help me doesn’t mean they’ll help you. Different people have different types of migraine headaches, and that affects what works and what doesn’t.
First, Know Your Triggers
Everyone’s triggers are different. It’s key to be able to pinpoint your personal triggers and avoid them.
Mine include stress, lack of sleep, dehydration, skipping meals, and having a glass of red wine. (Yep, just one is all it takes.)
Yours may be different. Common triggers include:
- Some smells
- Certain types of light
- Eating too much
- Food additives
- Jet lag
- Loud sounds
- Your menstrual cycle
Once you know your triggers, you can do your best to steer clear of them. This may reduce how often you get migraines, how bad they are, or even ward them off before they begin.
How to Manage Triggers
To stay on top of my migraines, I always try to stay hydrated, exercise regularly, and avoid skipping meals.
Dehydration can trigger a migraine. It may also make migraines last longer. To keep your water stores up, try to drink at least 64 ounces of water a day.
If hunger is a trigger for you, try to have three set meals a day.
Lack of sleep can also bring on migraines and make them last longer. I tell my migraine patients to get at least 7 hours of sleep a night.
I also take 400 milligrams (mg) of magnesium every day. Magnesium oxide is best for migraines and can reduce how frequent and severe they are. It helps me, but it doesn’t help everyone. If you have frequent or severe migraines, magnesium may not work for you.
Editor’s note: Check with your doctor before you start taking supplements, to make sure it’s a good choice for you.
When a Migraine Strikes
As soon as a migraine comes on, one of the first things I do is drink fluids and eat something.
I also take medication. I usually take 400 mg of ibuprofen, which helps lessen my pain. You can also try over-the-counter medications like Excedrin Migraine or Tylenol.
But be careful. Taking too much medication for your migraine can actually make it worse.
Too much acetaminophen, ibuprofen, naproxen, or other pain medications can lead to medication overuse. This feels like a chronic, daily headache or migraine. It may happen if you take one of these medications 2-3 days a week for several weeks.
Again, keep in mind that certain treatments work for some people but not others. There are a lot of options, so talk to your doctor to find what’s right for you.
Your doctor may suggest certain medications that may stop severe migraines if you take them at the start of a migraine. They include:
- Almotriptan malate (Axert)
- Eletriptan hydrobromide (Relpax)
- Frovatriptan (Frova)
- lasmiditan (Reyvow)
- Naratriptan (Amerge)
- Rizatriptan benzoate (Maxalt)
- Sumatriptan succinate (Imitrex)
- Zolmitriptan (Zomig)
They may also recommend medication to help prevent migraines, like:
- Galcanezumab (Emgality)
- Rimegepant (Nurtec)
- Sodium valproate (Depakote)
- Topiramate (Topamax)
- Ubrogepant (Ubrelvy)
Other Things to Try
If you have frequent migraines, Botox shots may help. Botox is a drug that blocks neurotransmitters carrying pain signals from your brain.
Botox works to ease migraine pain for some people but not for others.
I haven’t tried it because my migraines aren’t frequent enough. It’s best for people with chronic migraines, or 15 headaches a month.
You can also try alternative treatments such as these:
- Yoga and meditation can help with stress and reduce migraines.
- A scalp or facial massage can help relieve pain.
- Acupuncture may help lessen the number of migraines you get or help them be milder when you do get one.
When a migraine makes it uncomfortable for me to be around light, it usually lasts about 20-30 minutes. I can sit in a room with the lights off, and it clears up.
I’m lucky — it’s quick for me. But it differs from person to person.
If you have light sensitivity when you get a migraine, try staying in a cool, dark room. You may need to wear an eye mask, too.
One last thing: Talk to your doctor about the type, severity, and frequency of your migraines. They can tailor your treatment to your personal needs.