HEADACHEESSENTIALS

Thefollowing10pointsare“essential”formigrainepatientsandshouldbelearnedandfollowedtothebestofyourability.

1. Sleep.Thosewhosufferfrommigrainesshouldstriveforgoodsleephabits.Thismeansgoingtobedandgettingupatthesametimeeveryday.Noexceptions.Nosleepinginontheweekends.Missedsleep,stayinguplateoreventoomuchsleepcantriggeramigraine.Migrainesuffererstendtodobetterwithamorestableschedule.Manyheadachepatientsneedtobeonasleepmedication.TherearesomemedicationssuchasAmitriptylineandNortriptylinethatworkasbothasleepmedicationandmigrainepreventive(decreasingfrequencyandseverityofheadache).Thesemedicationsareusuallytiredfirst.Noteveryonecanadheretothisduetolifeorworkcircumstancesandespeciallyyoungchildreninthehome,butitisagoaltostrivefor.

2. MigraineDiary.Youmustkeepanaccuratediarytorecordyourheadachesandassociatedsymptoms.Byaccuratelyrecordingyourheadaches,youwilllikelydiscoverthingsaboutyourheadachesthatwillbehelpful,suchascertaintriggeringevents.YoucanprintoutadiaryfromtheNationalHeadacheFoundationordownloadanapponyoursmartphone,suchas“MigraineBuddy.”AnotheroptionistousetheDASHcalendarwhichmaybeprovided.PLEASEBRINGINYOURDIARYEACHVISIT!

3. Triptanmedications.Youmightbeprescribedadruginthisclassofmedicationsthatisdesignedto“abort”or“reverse”thechemicaleventsthatareoccurringinthebrain.Thereareanumberofthem,suchasImitrex(Sumatriptan),Maxalt(Rizatriptan)andothers.Thesemedicationscomeinanumberofforms,includinginjections,nasalspraysandpowders,oralpillsandsomethatdissolveunderthetongue.Thesemedicationsaretobetakenattheearliestonsetofthemigraine.DONOTWAITuntilyourmigrainebecomestoosevere.Thelongeryouwait,thelesslikelythe

medicationwillwork.YoumaybeprescribedNaproxenSodium(likeAleve)totakewiththeTriptan,whichmayhelpthemedicationworkmoreeffectivelyandlastlonger.Thismedicationcanberepeatedintwohoursbutnomorethantwoperday.Mostinsurancecompaniesonlypayforninepermonth.Takingtoomanyofthesecanleadtoa“medicationoveruseheadache”whichisverydifficulttotreat.Limitthesemedicationstonomorethanthreeperweek,ifpossible.

4. Diet.Obviouslyavoidanyfoodsthatmay“trigger”amigraine,includingalcohol,MSGinChinesefoodsandothers.Avoiduseofartificialsweetenersanddietsoda.Eliminatecaffeinetonomorethanonecupofcoffeeperday.Asfarasanyparticular“diet”goes,an“anti-inflammatorydiet”wouldbethemostlogicalandhealthydiettofollow.Thisdietisrichin“healthyfats”andOmega3fattyacids,suchascoldwaterfish(salmon,sardines,mackerel),plantsourcesthatincludeflaxoil,andcoconutandoliveoil.Avoidprocessedfoods,vegetableoils,junkfoodwhichishighindangeroustransfats,andespeciallysugar,whichisinflammatory.

5. Exercise.Ithasbeenshowninnumerousstudiesthatexerciseisbeneficialtoreducethefrequencyandseverityofmigraines.Weightlossintheoverweightmayleadtobettermigrainecontrol,aswell.Werecommendexercisingatleast30minutesonmostdaysoftheweek.

6. Prevention.Certainmedications(#3Triptans)areprescribedtoABORTorreversemigraineheadaches.ThereareothermedicationsprescribedtoPREVENTmigraines,orreducethefrequencyandorseverityofthemigraines.Thepreventivemedicationsreducetheoverallhyperexcitabilityofthebrain.NaturalmedicinescanincludeMelatonin3mgupto9mg,MagnesiumGlycinate400–600mg.daily,MigreliefCoenzymeQ10150mg,orPetadolex.Prescriptionmedicationsincludesomethatarepreventiveandassistsleep,likeNortriptylineorAmitriptyline,othersincludeTopiramateorTrokendiXR,BetablockerslikeTimolol,ZonisamideorDepakote,amongothers.Thesemedicationsaretakeneveryday.Note:itcantakeafewmonthsforthesemedicationstobeeffective.Bepatientandkeepaheadachediarytotrackyourprogress.

7. EmergencyRoomvisits.OurgoalisNOERorUrgentCarevisits.Ouradvice

regardingEmergencyRoomsisgenerally“don’tgo.”Itisamiserableexperienceandrarelyaretheheadachestreatedcorrectly.Ifyourabortivemedicationsfail,youmightbegivenarescuemedication.Ifthatfailsandit’sduringM-Fofficehours,callusaheadandwewillgetyouinASAPandcangiveyouaninjectionofToradol,getanoccipitalnerveblockorperformasphenopalatineganglionblockintheofficeusingtheSphenoCathdevice.Thissimpleinoffice,15-minute,painlessprocedurecancompletelyabortyourheadacheorreducetheseverityofit.

8. PhysicalTherapy.Youmaybereferredtoaphysicaltherapisttoevaluateandtreattheupperbackandcervicalmusculature.Onetherapygroupwerecommendhasdesignedaspecific“HeadacheProtocol”formigrainesufferers.Upperbackandnecktensionwhilenotthecauseofmigraines,oftenmaketheheadachesworse.

9. StressManagement.Stressisamajorfactorinmigraines.Manymigrainesuffererswouldbenefitfromstressmanagementclasses,counseling,meditation,cognitivebehavioraltherapyorbiofeedback.IalsorecommendlookingintoYoga,TaiChiorQiGongclassesforexerciseandstressmanagement.

10. Education.Finally,toimproveyourchancesofsuccessinmanagingamigraine,youshouldeducateyourself.AgoodresourceistheNationalHeadacheFoundationandtheAmericanMigraineFoundation.