Tips and Tricks

Women doing yoga

Managing Migraine is not all about medication. It's a combination of not only medication but behavioural and lifestyle measures. Different things work for different people, it's a matter of figuring out what helps you and seeing what works best. It's important to take care of yourself and understand how to cope when a Migraine attack strikes. This list is a combination of asking Migraine Australia Chat Group to tell us about their top tips and Migraine associations around the globe, such as Mayo Clinic and American Migraine Foundation.

Keep a migraine diary

Some people find recording their symptoms, medications, and triggers empowering and useful, and others find that the constant recording of being sick takes a toll on their mental health. They can be used when there's been a big shift in your migraine attacks, and you're trying to figure out what is going on, or you're changing medication and want to know if it is really helping or not. You don't need a special migraine diary; you can just keep notes in an ordinary journal or diary. Your neurologist may also have a diary format they prefer. Note when your migraines start, what you were doing at the time, how long they last and what, if anything, provides relief. Find what works best for you.

Sleep - both sleeping off an attack and creating good sleep routines

Fatigue can be a significant issue during migraine attacks, but even if it isn't, sleeping is a great way to allow your body to get through the worst of the attacks without you having to be awake and feeling all of it. Plus, because your brain is taking in very little in the way of light, sound or other things that your brain may find sensitive, it can help you get through the attack faster.

A poor night's sleep often triggers a migraine attack. Here's how you can encourage a sound sleep:

Establish a sleep pattern: Wake up and go to bed simultaneously every day, yes, even on weekends.
Avoid stimulants in the hours before bed: Stimulants like alcohol, sugar, nicotine, caffeine and even intense exercise can keep you from sleeping.
Unwind: Relaxing one's self can promote better sleep. Why not try to listen to soothing music, read a book, meditate, and a warm bath to unwind before sleeping.
Limit distractions: create a quiet and relaxing room by turning off any electronic devices before bed.

Read more about the relationship between sleep and migraines.

Dark, quiet room

When our brains are over-reacting to everything, anything you can do to remove stimulation is good. Lying down in a dark, quiet room is a very popular suggestion - particularly if you are in too much pain to sleep. But make it *really* dark: have blackout curtains or use an eye mask, and *really quiet*: use headphones or earplugs, or consider putting a towel across the bottom of the door to make it that little bit quieter.

Hydration

Dehydration can contribute to a headache, but it can be easily avoided. Ok, you can all take a minute to groan. And we'll take a minute to tell people who don't live with migraine to never, ever, tell someone with a migraine that we just need to drink more water - we hate it.

But this tip isn't about the amount of water that you normally drink: try drinking heaps of icy water just as the attack starts - think of it as an internal ice pack trying to cool your system down.

In a migraine state, the brain overheats and uses more sugars and fluids than it normally does. Sports drinks like Gatorade and Powerade can help rehydrate quickly and help relieve some migraine symptoms like nausea. If you find the flavours a bit too strong, you can get something like Hydralyte from the chemist, and if you find cold helps you, it's always worth trying the electrolyte ice blocks you can get from the chemist too. Like Coke, strong coffee is a great option to give you a big hit of caffeine and is a better option for those who respond better to heat than cold. Alternatively, iced coffee works great too.

But just as there are drinks that can reduce headaches, there are those that can trigger them. Drinking too much coffee or too many caffeine-filled soft drinks and alcohol can lead to headaches.

Medications

Take medications as soon as possible, especially triptans or aspirin. As soon as you get the first warning signs, you should be reaching for your medication. Triptans are 'abortive' migraine medications that can help stop the attack as it is just getting started. But, for them to be effective, you need to take them nice and early.

You'll figure out your own sweet spot over time; for most people, it's during the Aura phase (if you have aura) or just as the headache starts. The golden rule is don't wait to see if the attack will get bad - once the attack has settled in, most medications will not make a dent.

Many people find the best way to abort a migraine attack is not in which medications they choose but in the combination. Try combining caffeine with stemetil and aspirin, or taking Nurofen at the same time as your triptan. Be sure to combine medication from different classes, so you don't overdose or possibly cause problems with rebound headache (for example, combining Panadol Extra and Nurofen is ok, as paracetamol, caffeine, and ibuprofen are all different classes of drug, but don't take Voltaren and Nurofen together as they are both NSAIDs). If unsure, talk to your pharmacist about what you can combine safely. Remember, the goal is to hit your attack hard and fast, so you use less medication overall.

Obviously, anti-nausea medications like Stemetil, Ondansetron and Maxalon are useful if you are struggling with nausea, but did you know that they can help relieve the migraine attack too? Stemetil (procholarazipine) in particular has been proven to work as an abortive for migraine attacks.

The Aspirin Bomb: at least 900mg of aspirin

An oldie but a goodie and the preferred first line of attack by many is taking a big dose of aspirin. At least 900mg, which is 3 of the normal tablets that you can get from the supermarket, or a little bit more, taken as soon as you can. If your migraine attacks usually stretch over a couple of days, an aspirin bomb is a great choice on day 2 or 3, leaving your triptans just for day 1. This works even better if you follow it with a strong coffee or coke, and if you add stemetil or a triptan to your bomb.

Ice cold or frozen Coke

Controversial (because public health professionals will tell you that it's bad for you), Coke is a fantastic migraine management tool. It has everything most people need - hydration, sugar, ice or cold, and caffeine is a proven treatment for a migraine attack. Coke works very well in combination with the aspirin bomb too! In fact, caffeine can make many other medications work a little better in migraine patients. Just remember that caffeine can cut both ways, so treat Coke like medicine and only have it when you need it.

Hot/cold applications

Cold works for some people, heat works for others, and some people find that a combination is better. It's not clear whether it affects cooling the system while widening blood vessels or whether the combination confuses the senses that are overloading the brain and causes a kind of system reset. Whatever is going on, if it works, it works! Try an ice pack on the back of the neck while putting your feet in a warm bath, or sucking on an ice cube while in a hot shower.

Ice packs are a great way to cool down the overheating system. Popular options are an ice pack on the back of the neck, across the forehead or eyes, or special ice caps or ice hats like an icepack all over the head. Some also like to put their feet in an ice bath.

Getting the blood vessels open throughout the body can relieve pressure on the pulsating veins in the head, so some find a long hot shower or bath very helpful. Try jumping straight in the shower just after you've had your initial triptans or other medications. If you get very achy during your attacks, you may find that heat packs can be beneficial. A sore back or neck may be a prodrome or warning symptom of an attack starting rather than something unrelated, so it is best to treat those little niggles and discomforts to try and ward off a full attack.

Watch what you eat

Food triggers are common for many people living with migraine. Food-related triggers occur in about 10-20% of people with migraine. Many people will crave snack food such as chocolate or chips in the early stages of a migraine attack, leading them to conclude that particular food is a trigger. However, if the craving for a specific food is a symptom of the beginning of the attack, it probably is not a trigger, and you need to find out what you did or ate before that. While there are common culprits, everyone's food triggers are different. Try keeping a diary of the foods and drinks you consume daily or specifically when you experience an attack.

Some food products contain chemicals or additives, which may also be implicated in an attack. Ones that people with migraine frequently mention are monosodium glutamate, nitrates and aspartame. Tyramine is a chemical found in red wine and soft cheeses like camembert and brie that is often indicated as a migraine trigger.

If you think you have food triggers, The RPAH Allergy Clinic in Sydney developed the elimination diet and has the handbook and recipe books you can buy and some basic information on their website. Note: an elimination diet is a diagnostic tool to find your triggers, not an eating plan to avoid migraine attacks. Living on an elimination diet will mean you are not getting enough nutrients. However, an elimination diet is the only really effective way to clearly identify your food triggers and is more effective than trying to identify them through diaries.

Exercise

Like sleep, exercise can help prevent migraine and, at the same time, can be a trigger factor for some people. Regular exercise, which is built up gently, can help to prevent migraine. If exercise and sunlight don't exacerbate your migraine, then going for a walk and getting some fresh air may help. Sometimes just getting the body moving a bit can help regulate and normalise what's going on in your body, and fresh air is usually helpful for people with nausea.

A swim in a nice quiet pool or even in the ocean can be really helpful for some people. A nice dip can be beneficial if you can meditate or float a little. A cool bath or shower may also do the trick in a pinch. However, if you have vestibular, hemiplegic or brainstem migraine and are known to fall over or lose consciousness, please do not go swimming by yourself.

Stress relief

Stress and migraines often go hand in hand. You can't avoid daily stress, but you can do things to relieve it. Deep breathing from your diaphragm can help you relax. Focus on inhaling and exhaling slowly and deeply for at least 10 minutes every day. It may also help to relax your muscles, one group at a time, consciously. When you're done, sit quietly for a minute or two.

Manage your time wisely. If you feel overwhelmed, take a break, even a short walk or a quick lie down. Don't try to squeeze too many activities or chores into your day, know your limits and space things out and most importantly, find some time for yourself each day; even by doing something small, doing something you enjoy can combat stress.

There are many essential oils suggested that may help with migraine or symptoms like headache and nausea. Some are marketed in very expensive roll-ons or other packaging - the basic essential oils do the same thing. Peppermint, Rosemary, and Lavender are very common essential oils suggested for headache, while ginger is frequently recommended for nausea. Magnesium oil can also be worth a try as an alternative to magnesium supplements.