Doctor Tips on What to Avoid With Migraines

What if you could ask some of the nation’s top migraine doctors for advice on how to get control of your headaches? We did!

First, Stop the Self-Blame

“Patients come to me and say, ‘Oh, I shouldn’t have had that glass of wine when I went out to dinner,’ or ‘I shouldn’t have stayed up so late.’ A lot of my migraine patients are type A personalities who are very successful and overachievers. I tell them it’s OK to slip up every once in a while. You can’t prevent your migraines 100%. Berating yourself only raises your stress levels, and we know stress is a top trigger of migraine.”

Mary Ann Mays, MD

Drop the Extra Pounds

“We’ve known for a while that people who are obese are more likely to get migraines. They’re also more likely to have chronic migraine, which means they get at least eight a month. One theory is that your extra fat cells produce inflammatory proteins that trigger these headaches. The good news is if you lose weight, research shows your migraines will improve.”

Alan Rapoport, MD

Ditch the ‘Headache Diet’

“About 30% of migraine patients have at least one food trigger. But the list of foods that can potentially cause problems is overwhelming. Also, most of the information about food triggers is anecdotal, not based on studies. That’s why I don’t recommend that my patients go on a specific ‘headache’ diet or avoid certain foods. Why force them to avoid things they enjoy, when they may not even be a trigger in the first place? Instead, on the days they get a headache, I have them think back to what they’ve eaten over the past 24 hours. If any of the foods are on the trigger list, they can avoid them for a couple of weeks to see if that makes a difference.”

Merle Diamond, MD

Get Treatment

“It sounds obvious, but it really isn’t. More than half of all people who get migraines are never diagnosed. They’re at home, treating their headaches with over-the-counter medications. But this is bad. First, they are living with debilitating pain when they don’t need to. Secondly, they end up taking over-the-counter pain relievers like ibuprofen or acetaminophen several times a week, which can lead to what’s known as medication overuse headache. This in itself becomes a huge headache to deal with. Your primary care physician is a good start, but if you can’t find relief, see a headache specialist.”

Mary Ann Mays, MD

Consider Complementary Medicine

“There are a few supplements I recommend to my patients. None are a panacea, but they can sometimes help along with traditional prescription medications. They include:

• Butterbur. The usual dose is 50-75 milligrams twice a day. I personally have not found it to be too effective in my practice, although one of my most challenging patients swears that she’s been cured by it
• Magnesium, 400 milligrams a day
• Melatonin, taken an hour or so before bedtime to regularize sleep
• Co-enzyme Q10. Usually, 300 milligrams a day
• Vitamin B2. 400 milligrams a day

Usually, I start with one for my patients, and if they don’t respond, I add a second. And if they still don’t respond but don’t have any side effects, then I add a third.”

Alan Rapoport, MD

Have a Headache Plan

“The better it is, the less likely you’ll be to end up in the ER. A lot of my patients need a three-prong strategy. The first prong is an acute medication like a prescription triptan or ergot, to take once you feel your headache coming on. Then there’s a rescue medication, like a prescription-strength NSAID, which you’ll take if that first medication didn’t work. Finally, if you get more than eight headaches a month, you’ll probably need to be on a preventative medication like a beta-blocker or CGRP antagonist. If, after all this, you’re still landing in the ER, or you’re missing work because of your headaches, you need to see your headache specialist again to come up with a better plan. “

Merle Diamond, MD