Tips for Managing Migraines

Do you get intense headaches with throbbing pain? During these headaches, are you sensitive to light and sound, and sometimes feel sick to your stomach? If so, you may be among the 40 million Americans who suffer from migraines.

Migraines can have a significant impact on a person’s lifestyle. Migraine symptoms are often debilitating, forcing people to halt their normal activities until the attack passes—which can take hours or even days. Migraine sufferers often miss work or school and cancel plans for social activities.

The long-term effect of migraines can be devastating. Migraines are one of the leading causes of disability. Migraine sufferers may become socially isolated and develop mental health issues, such as anxiety or depression.

With so much at stake, it’s important for migraine sufferers and their loved ones to learn how to manage the condition. Here are tips you can use to reduce the impact of migraines.

What Are Migraines?

A migraine is a severe headache that is often accompanied by pulsing pain, usually on one side of the head. Migraines can be made worse by exposure to bright lights, loud sounds, or strong odors. 

The causes of migraines can be complex. Hormonal changes like fluctuations in estrogen levels, stress and emotions, diet, over-stimulation of the senses, changes in sleep patterns, and even shifts in the weather such as high humidity can all play a role in causing migraines. Triggers for migraines can vary from person to person.

Symptoms of migraines are divided into four stages:

• Prodrome — one or two days beforehand there are often subtle warning signs of a developing migraine, including constipation, mood changes, difficulty concentrating, insomnia, fatigue, food cravings, neck stiffness, increased urination, and fluid retention.
• Aura — in the minutes leading up to a migraine attack, some people experience vision changes such as seeing bright spots or flashes of light. Vision symptoms may be accompanied by ringing in the ears (tinnitus), a pins and needles sensation in an arm or leg, muscle weakness or numbness, and trouble speaking. These symptoms can also occur during an attack, however, not everyone experiences aura.
• Attack — during this phase, people often experience pain that pulses, greater sensitivity to light and sound, and nausea and vomiting. Attacks can be as short as a few hours or last several days.
• Postdrome — after the attack subsides, people can feel fatigued, dizzy, and confused for up to 48 hours.

How are migraines different than common headaches? 

• Pain intensity: Typical headaches are usually milder and have a dull, constant ache on both sides of the head. Migraines have a more intense, pulsating pain that is usually concentrated on one side of the head.
• Additional symptoms: Regular headaches seldom affect other body systems. Migraines can impact senses like vision, hearing, and touch. They can also have an effect on muscles, the nervous system, and digestion.
• Medications needed: Common headaches can be managed with over-the-counter medications like ibuprofen or acetaminophen. Mild to moderate migraines can also be managed with over-the-counter medications, but prescription medications are often used for more severe migraine attacks. Taking more of these medications than recommended can sometimes cause overuse headaches.
• Activity interruption: While they can be uncomfortable, standard headaches usually don’t interfere with daily activities. Migraines can be so severe that people are unable to carry on with their daily activities.  

When to Talk to Your Provider

It’s estimated that about half of the people who suffer from migraines are undiagnosed. You should talk to your primary care provider if:

• You have frequent headaches, such as more than twice a week.
• Your headaches are severe enough that they interfere with work, school, or daily activities.
• The headaches don’t get better after taking over-the-counter medications.
• The headaches are accompanied by other symptoms like vision changes or light sensitivity, numbness or tingling, muscle weakness, dizziness, ringing in the ears, or nausea.

Your primary care provider will ask questions about your headaches, such as how they feel and where they occur, the symptoms you experience, severity of symptoms, and how long they last. Your provider may order tests to make sure other things aren’t causing your headaches.

Unfortunately, there is no cure for migraines. If you are diagnosed with migraines, your provider can help you manage them. This may include taking prescription medications, avoiding things that can trigger migraines, and alternative therapies such as nutritional supplements, yoga, and acupuncture.

Prescription Medications for Migraines

Prescription medications commonly used for treating acute migraines work by targeting nerves and chemical pathways in the brain to shut down the migraine attack. They include these groups of medications:

• Triptans that act on serotonin receptors to narrow blood vessels and block pain signals
• Ergots that work similarly to triptans, but are less specific and tend to have more side effectsGepants which prevent a protein called calcitonin gene-related peptide (CGRP) from transmitting pain signals
• Antiemetics to relieve nausea
• NSAIDS to reduce inflammation
• Ditans to calm overactive nerves

Prescription medications used for other conditions can help keep migraines from occurring. Preventive medications include:

• Antihypertensives
• Antidepressants
• Anticonvulsants
• Botox
• CGRP-targeting medications

To see which prescription medications are covered under your Blue Cross VT health plan, check out our formulary drug lists. You can look up a specific medication or download the formulary PDF to see all the antimigraine medications covered.

Tips for Managing Migraines

Working with your health care provider is the best way to manage migraines, but there are also some things you can do on your own. Here are some tips:

• Keep a diary. Write down when a migraine started, what medications you took, the type of pain and its severity on a scale of 1 to 10, where you felt pain, how long the migraine lasted, and any associated symptoms. This will help you track your migraines, and you can share this information with your health care provider. There are many smartphone apps you can use to keep a migraine diary.
• Identify your triggers. Make notes in your diary about what happened during the 24 to 48 hours before a migraine occurred, such as what you ate and drank, your stress level, sleep quality, and the weather conditions. Women should log their menstrual cycles to identify hormonal changes. It’s important to note any exposure to bright or flashing lights, strong odors, and loud noises. Review your notes from several migraine episodes to see if there are patterns that might indicate potential triggers.
• Make changes to avoid triggers. Once you’ve identified possible migraine triggers, try modifying your lifestyle or activities to avoid them. For example, if stress is a trigger, do things to reduce your stress level such as practicing deep breathing, yoga, or meditation. Check out our blog post on how to recognize and manage stress.
• Adopt healthy habits. You can prevent migraines by adopting healthy habits, including getting better sleep, drinking enough water, limiting alcohol consumption, eating healthy meals, and exercising regularly. All of these are proven strategies to reduce the frequency of migraines. Our free Be Well Vermont platform can help you adopt healthy habits.
• Limit caffeine intake. Higher amounts of caffeine can trigger migraine attacks. People with migraines should keep their total daily caffeine intake under 200 milligrams. Check out our blog post on healthy ways to get caffeine.
• Maintain a routine. A sudden change in your daily routine, such as sleep disruption or eating a meal at a different time, can trigger a migraine. To reduce the chances of an attack, keep a consistent schedule for sleep, meals, and exercise.
• Rest in a dark, quiet room. Spending time in a dark, quiet room during a migraine can help reduce its intensity and shorten the attack.
• Apply cold packs. During a migraine attack, apply a cold compress or ice pack to your forehead, temples, or the back of the neck for 15 to 20 minutes. The cold helps narrow blood vessels to reduce pain, numbs the nerves, and decreases inflammation.
• Stay hydrated. Being dehydrated can make a migraine’s symptoms worse, so be sure to drink plenty of fluids during an attack. Water is best, but electrolyte drinks, coconut water, and herbal teas can also help. Drinks with small amounts of caffeine may be beneficial, as caffeine helps constrict blood vessels and reduce pain. However, don’t overdo it, as too much caffeine can make things worse. Avoid alcohol and sugary drinks, which can cause dehydration.

Reach Out for Support

Living with chronic migraines can be frustrating, as the condition may negatively impact your livelihood, daily activities, and social connections. At Blue Cross VT, we want to help our members cope with this and other long-term challenging health conditions. Please reach out to us for support. Our health care professionals can assist by reviewing medications you are taking and by connecting you to resources to help manage your health.