Get Through a Migraine

Migraines can be extraordinarily debilitating and require much more intervention than common tension headaches. If you suffer from migraines, or if you think you may suffer from them, the best course of action is to try to prevent your migraines. Since it's just about impossible to prevent migraines entirely, though, here are some steps that can help you get through your next one.

Steps

Act fast. Many of the steps you can take to stop or minimize a migraine work best when taken at the first sign of migraine symptoms. For example, some migraines may respond well to medications taken in the first couple hours, but may not respond at all if the medications are taken later than that.
- Learn to recognize the warning signs of a migraine. Migraines are often preceded by prodrome symptoms such as nausea, dizziness, neck stiffness, and irritability. If you administer treatment when you notice these symptoms, you may be able to stop the migraine in its tracks. For more information on prodrome symptoms, see this article.
- Remain calm. Unfortunately, when you start paying attention to the early symptoms of a migraine, you may tend to get panic. Anxiety and fear may worsen your migraine, however, or they can turn an ordinary tension headache into a migraine. Relax, and try to think positively.
Take the maximum safe dosage of ibuprofen, aspirin, acetaminophen, or another over-the-counter painkiller or nonsteroidal anti-inflammatory drug (NSAID) at the first sign of a migraine. Combination drugs formulated especially for migraines may be effective when individual drugs are not. Painkillers often don't work for migraines, especially severe ones, but they're worth a try. In fact, at least one study has found that a higher than normal dose of aspirin is nearly as effective as prescription migraine drugs. That said, you should never take more than the recommended dosage without first consulting your doctor. In addition, if you find that you are having to take painkillers more than two days a week, you need to see your doctor for more effective abortive medications or for daily preventive medication (see Warning below).
Get a caffeine fix. Caffeine paradoxically both causes and relieves headaches. The caffeine paradox is readily explained by the mechanism of addiction and withdrawal: caffeine causes migraine by provoking nervous adaptation to caffeine thereby rendering the patient susceptible to headache if caffeine dosing is delayed, and caffeine relieves migraine by reversing caffeine withdrawal. If caffeine relieves your headaches, it stands to reason caffeine withdrawal causes your headaches. If you use caffeine, caffeine withdrawal cannot be ruled out as a possible cause of your migraines. The logical strategy is to assume caffeine is the likely culprit, and to wean yourself from caffeine. Nobody bothered by headaches should use caffeine, an elective, headache-causing drug. That's just common sense.
The "headache cocktail" recommended by Kaiser Permanente neurology research consists of 600 mg. of Advil gel-caps (3 gel-caps) and a caffeine cola taken at the onset of migraine symptoms. The gel-caps and caffeine get into the bloodstream faster, thanks to the carbonation in the soda. Diet sodas are not recommended because many migraine sufferers are very sensitive to artificial sweeteners.
Stop what you're doing, and relax. Relaxation can relieve migraines for some people. Practice deep breathing or meditation, for example, and minimize your movements. In the long run, it may help to use biofeedback to learn to effectively relax your body and exert some control over its responses.
Get to a dark, quiet place. Bright lights (and sometimes even not-so-bright lights) and noise seem to trigger migraines in some people, and many migraine sufferers are extremely sensitive to light and noise when a headache strikes. Simply sitting in a dark, quiet room may ease your symptoms considerably.
Take a nap. Migraines are sometimes so painful that sleep is unbearable. If you're able to sleep, however, do so. As long as you're sleeping, you're not in pain, and your headache will often be gone when you wake up. Some patients take sleep medications or antihistamines, such as Benadryl, to help them sleep. These medications may also help relieve migraines in other ways. Consult your doctor before using these drugs to assess the risk of dependency or adverse interactions with other drugs. Simply lying down may help, although some migraine sufferers find that lying down makes the pain worse.
Apply an ice pack to the affected area. Ice the painful area for 15-20 minutes, and then wait a while and repeat if necessary. It may also be helpful to ice the back of your neck. Interestingly, some people find that taking a hot shower relieves their symptoms or that sitting in a hot bath while icing the neck or affected area helps.
Massage yourself. Kneading the face, head, shoulders, back, and neck may relieve the symptoms in some people. In others, however, massage may cause the symptoms to worsen. As with everything migraine, there's a bit of trial and error involved to find out what works for you.
Treat nausea or diarrhea if present. Migraines are often accompanied by nausea, either with or without vomiting, and/or diarrhea. OTC anti-nausea or anti-diarrheal drugs may help relieve these symptoms. You may find, however, that allowing yourself to purge may help your migraine go away faster. If this is the case, avoid taking these drugs unless absolutely necessary.
Talk to your doctor about prescription medications. If you suffer severe migraines that don't respond to other treatments, your doctor may prescribe an abortive medication which stops migraines or reduces their severity or duration. As with painkillers, these medications are usually most effective if taken at the first sign of a migraine. The most commonly used classes of migraine-abortive drugs are triptans and ergots. Your doctor may also prescribe painkillers, either stronger versions of OTC drugs or, in more extreme cases, opiates or the sedative butalbital combined with non-steroidal anti-inflammatory drugs. All of these drugs have potentially serious side effects, and the latter two classes also carry strong risks of dependency. In general, none of them should be used regularly, so if you find you need to take them daily or even more than twice a week, you should talk to your doctor about prescribing preventive medications.
In some cases, low levels of the hormone progesterone appear to increase the frequency and severity of migraines. If you are a woman, and your migraines occur more often in the 2 weeks before menses, be suspicious and ask your doctor to check your progesterone levels (note: many doctors are unaware of this link, but if your levels are found to be low, they may be willing to prescribe supplementation). Progesterone is safe enough to be sold without prescription (Progest cream is a good brand), and it's worth a try, but some migraine sufferers require a higher dose than the non-prescription cream can provide. There are even occasional reports that a much smaller dose of progesterone can help relieve migraines in men (no studies done, though). More information on progesterone supplementation can be found at How to Get Through PMS. WARNING: Provera is NOT the same as natural progesterone and has been known to INCREASE migraine symptoms; if you are going to try progesterone make sure it IS progesterone (Progest, Prometrium, or compounded progesterone are; Provera, medroxyprogesterone, or birth control pills are NOT).
All migraneurs are different, try different approaches and treatments to find one that could work for you. Heat, for example, applied to the area of acute pain, can ease the pain and speed recovery for some.
Light activity is also beneficial for some sufferers, such as taking a walk, or tidying up. One's instinct is to lie down, but activity can help in some sufferers.

Tips

Migraines are not well understood, and different people respond differently to different treatments. In fact, a treatment that works well one time may not work as well on the same person the next time. Be patient, and work with your doctor to find the best treatments for you.
If you speak to other people who experience migraines, or if you do some research on the internet, you'll find a mind-boggling array of methods to treat and prevent migraines. Many of these work for some people, and some are probably pure quackery. Others may even be dangerous. Use common sense. Don't do something or take something that seems dangerous, and always consult your physician when in doubt.
A headache diary can help you identify potential triggers as well as to assess the effectiveness of different treatments.
If you believe you're suffering from migraines, see a doctor to get a diagnosis. You may be suffering secondary headaches from another illness or disorder.
If you're prone to vomiting during migraines, keep a can of Campbell's chicken broth upside down in your refrigerator. Really. After you're finished in the bathroom, take out the can, turn it right-side up, open, pour out the broth (leave the fat stuck to the top), and drink it once you're able. Replaces needed electrolytes, etc., helps relieve the weakness and general malaise. Don't know why Campbell's works better than any other brand, but it does.
Drink a can of cola such as Coke or Pepsi when you feel a migraine starting. The caffeine, as stated above, may help abort or alleviate a migraine. This is a trick my dad taught me and it works most of the time.
Avoid bright lights and flash camera photography if light sensitive.
Pay attention to visual disturbances. Sometimes shortly before a migraine starts, visual symptoms such as colored lights or spots may appear in the vision field.
There are tablets to treat migraines e.g. Imigran, Migraleve.
If you feel a headache coming on, take a paracetamol with an anti-sickness tablet or you can take migraine tablets e.g. Imigran, Migraleve and have those on standby.
If you have had vomiting, it is very important to drink plenty of fluids, water is best to replace the lost fluids.
Some migraine sufferers can have visual disturbances, sensitivity to sounds and smells and slurred speech.
Lie down in a darkened and quiet room.
If you still feel unwell, rest and/or go to bed.
If unsure or things are not right, don't hesitate to see your doctor.
Do take time off sick from work, make sure your boss and your colleagues are understanding, but be aware that not everyone is understanding with migraines.
Some women can have migraines just before, when they are on or at the end of their menstrual periods.
Find out triggers e.g. chocolate, cheese, alcohol, citrus fruits, if you know the trigger, avoid that food, drink or element.
Do a rigorous study on which foods may be triggering migraines. Migraines can be reduced 30-50% by removing all triggers from your diet. You may, with practice, also learn to identify a migraine-trigger food even as it enters your mouth. Some sufferers learn to pick up on an oral "migrane feeling" and avoid that food.

Warnings

This article is a general guide and is not intended to substitute for professional medical advice. Talk to your doctor if you suffer from, or suspect you suffer from, migraines, and do not use prescription medications without a doctor's prescription.
Overuse of painkillers, even over-the-counter medications, can result in rebound headaches, which can cause you to take ever-increasing dosages of the painkillers while getting even more headaches.
If you know people who have migraines, please give them extra attention and extra latitude. This is a terrible condition, and people who do not get migraines cannot possibly understand the extent of pain and disability involved.
Be sympathetic with migraine sufferers, never say things like 'stick it out', or call them attention seekers, malingerers, whingers, liars etc, these words are very insensitive and very unhelpful. Migraine is a debilitating and painful illness and people can be very unwell with them.