It’s a common scenario: You finally get your chronic migraine under control. Instead of knockout headaches half the month, you have mild headaches once in a while. Then, out of the blue, you get a doozy of a headache, followed by another bad one a week later.
Before you know it, your migraines are back.
“Every time somebody [with migraine] ends up with bad attacks here and there, it’s pretty likely they will end up worse and worse over time,” says Christopher Gottschalk, MD, director of the Headache and Facial Pain Center at the Yale School of Medicine.
But with a little work you can get back to life without chronic migraine, no matter what caused them to return.
Take Prescription Migraine Drugs
When people go through a period without migraines, they often undertreat their occasional headaches, Gottschalk says. For instance, they’ll take a mild painkiller like ibuprofen instead of prescription migraine medicine. That isn’t a good idea for people prone to migraines.
“I think it’s a mistake to use over-the-counter drugs for headaches,” Gottschalk says. “If you never let your system get ‘too hot,’ so to speak, then you will almost never get into trouble.”
He notes that reaching for powerful, prescription medicine is crucial for people with migraine -- but the opposite of what you should for muscle pain.
Rethink Your Triggers
If you have migraine, you've probably heard the advice to beware of common triggers like:
- Certain foods (aged cheeses, salty foods, processed foods)
- Food additives (aspartame, MSG)
- Bright lights
- Weather changes
Yet some migraine experts say there’s little proof that many so-called triggers cause migraines. “In almost every case that we’ve studied -- stress, weather, food -- we come up completely empty handed,” Gottschalk says.
So why do many people notice a connection between their migraines and a colleague’s strong-smelling perfume?
Gottschalk says when a headache is developing, you become more aware of and sensitive to things around you. What you think are triggers are likely warning signs that a migraine is on its way. If you notice a headache coming on when a perfumed colleague sits next to you, that’s the time to take your prescription medicine.
Figure Out the Root Cause
Stephen Silberstein, MD, director of the Jefferson Headache Center at Thomas Jefferson University, says that many common triggers, especially food, are “totally overdone.” But there are some triggers he says people should consider and address.
Perimenopause. This is the period when a woman’s body naturally starts to go into menopause. Estrogen levels are “all over the place,” which can lead to migraines, Silberstein says. He recommends an estrogen patch during perimenopause for migraines without aura. (Auras usually are visual symptoms, like flashes of light).
Menstrual cycles. Some women get migraines around the time they get their periods. Silberstein says birth control pills can offer relief, especially continuous birth control pills that cut the number of periods you have or get rid of them.
High stress levels. High stress levels lead to unhealthy behaviors that may contribute to migraines, Silberstein says. His advice:
- Find an activity that will de-stress you, like exercise, yoga, or biofeedback (a relaxation technique).
- Don’t skip meals. Have a snack on hand so you don’t go too long without eating.
- Get enough sleep.
- Don't drink too much alcohol.
MSG. Evidence may not be overwhelming for monosodium glutamate (MSG) as a migraine cause, but Silberstein feels it’s definitely a trigger for some. Look for labels that say “no added MSG.” And watch out for hidden sources of MSG, which may be listed on nutrition labels as:
You May Need a Drug Adjustment
Another reason your headaches returned: Migraine is a lifetime disorder, Silberstein says. There will be times when your headaches get better and times when they get worse. This will happen even if you’re on medications that can help prevent them, like:
- Antidepressants: amitriptyline and venlafaxine
- Anti-seizure drugs: topiramate and valproate
- Beta-blockers: metoprolol, propranolol, and timolol
“If a patient is being treated [with medicine] for the migraines, and they start to get migraines again, it may mean nothing more than the medication has to be adjusted,” Silberstein says. “If they’ve gone off their medicine, they may simply have to go back on it.”
Recently the FDA approved three medications called CGRP monoclonal antibodies for migraine prevention. These monthly injections are effective and well tolerated for many people.
Some people also get relief from Botox injections every 12 weeks.