Medications still hold the first place in migraine treatment. Painkillers and triptans are used for acute attacks. In patients with frequent attacks, beta blockers, certain blood pressure medications, antidepressants, epilepsy drugs, and in recent years new medications targeting the CGRP pathway are used for preventive treatment
You can find my article on CGRP-based migraine vaccines on our website. Of the two areas outside medication in migraine treatment, I will cover lifestyle changes in this article and neuromodulation treatments in my next one.
There are many triggers that can start migraine attacks. Weather changes are one of them. Falling barometric pressure, temperature changes, and increased humidity trigger attacks in some patients. Air travel and mountain climbing, which involve pressure changes, can have a similar effect. Light sensitivity is common in migraine patients. Bright light, flashing light, and long periods in front of a screen act as triggers in some patients. Wearing sunglasses and using anti-glare filters on computer screens can help with this. Odor sensitivity has a similar effect. Perfume, cigarette smoke, and cleaning products trigger headaches in some patients. Noise is another trigger. Traffic noise and continuous exposure to environmental sounds can increase attack risk.
Sleep patterns hold an important place in migraine. Too little or too much sleep, irregular sleep times, and changes in sleep schedule on weekends can trigger attacks. It is recommended to set a regular bedtime, avoid stimulants like television and phones in the bedroom, and wake up at the same time every morning. Other recommended practices include eating dinner at least four hours before bedtime, reducing fluid intake in the two hours before bed, and avoiding daytime naps. Treating sleep problems helps in migraine management.
Diet also requires attention. Skipping meals, prolonged fasting, and dehydration can trigger migraine. Eating regularly, in five to six small meals a day, is recommended. Alcohol, chocolate, caffeine, processed foods, ice cream, nitrate-containing cured meats, aged cheeses, and foods containing monosodium glutamate stand out as triggers in some patients. However, this effect varies from person to person. Keeping a food diary makes it easier for the patient to identify their own triggers. It is recommended to keep daily caffeine intake below 200 milligrams.
Physical activity has a two-way relationship with migraine. Excessive fatigue and prolonged exertion can trigger attacks. However, regular and moderate exercise, especially aerobic activities like walking and cycling, has a protective effect. It is important to warm up slowly before exercise and to make exercise a regular habit. Benefits may not be seen at first, and the effect can take time to appear.
Stress and anxiety are frequently associated with migraine. An attack can occur during the relaxation period following a stressful event. For example, stress experienced in the afternoon can turn into an attack in the evening or at night. It is not possible to avoid all stress. Coping skills, problem-solving, social support, relaxation exercises, and muscle relaxation techniques are recommended.
Some medications can trigger migraine attacks. Nitrates, theophylline, and certain blood pressure medications are among these. Overuse of painkillers can also lead to medication-overuse headache. Using simple painkillers more than fifteen days a month, or triptans or combination painkillers more than ten days a month, increases this risk. In this situation, the patient needs to be educated, the overused medication needs to be discontinued, and preventive treatment needs to be started.
Hormonal factors are particularly determinative in female migraine patients. A drop in estrogen levels before menstruation increases attack risk. During pregnancy, attacks decrease in some patients but can increase again after delivery. With menopause, as estrogen levels become low and stable, migraine improves in some patients. Informing the patient about these cycles contributes to treatment.
Excess weight can increase the frequency and severity of migraine. Weight loss, especially in obese patients, can reduce attack frequency. Support from a nutritionist, regular exercise, and healthy eating habits are recommended in this process. Accompanying conditions such as depression, anxiety, and sleep disorders that occur alongside migraine also need to be treated.
There is strong evidence for behavioral treatments in migraine management. Relaxation techniques, cognitive therapy, and biofeedback belong to this group. Through biofeedback, the patient can learn to control involuntary bodily responses such as muscle tension. A disadvantage of this method is that it can only be applied at a limited number of specialized centers.
Patient education is one of the cornerstones of treatment in migraine. It is necessary to explain that migraine is a chronic but manageable condition, to discuss triggers and accompanying conditions, and to explain the risk of medication overuse. Keeping a headache diary allows the frequency, duration, and triggers of attacks to be recorded. This diary helps both in confirming the diagnosis and in evaluating treatment effectiveness.
Some dietary supplements are also used in migraine management. Riboflavin, coenzyme Q10, and magnesium are among these. Daily doses of 400 milligrams of riboflavin, 300 milligrams of coenzyme Q10, and 400-600 milligrams of magnesium are among the recommended amounts. Acupuncture is also a method with relatively strong evidence for preventing episodic migraine. Its side effects are few, but its effect takes several sessions to appear.
