Migraine Management Techniques: Q&A with Stephanie J. Nahas, MD

Stephanie J. Nahas, MD, talks about means of reducing migraine’s burden by avoiding certain triggers

Combatting migraine symptoms is an important part of managing the disease and finding empowerment. While patients cannot fully prevent migraine attacks, they can make lifestyle decisions that help reduce the frequency of symptoms. As patients reduce the number of migraine days they experience each month, the disease can have less of an effect on their lives.

We recently spoke with Stephanie J. Nahas, MD, the director of the Headache Medicine Fellowship Program and the assistant director of the Neurology Residency Program at Thomas Jefferson University, about common patient questions on migraine prevention to help guide patients toward better migraine management.

Will I ever be headache-free?

The best answer is “maybe.” Becoming headache-free can happen, but it isn’t common. Many patients eventually age out of migraine, but it’s never a guarantee. What I do guarantee my patients is that we won’t give up. We’ll set and achieve goals incrementally. We’ll keep raising the bar higher and higher, but to have the goal of being completely headache-free is just not reasonably attainable for most patients yet.

What are migraine triggers?

Migraines can be triggered by many different factors. Things like smell, taste, light and sound can all cause someone to experience a migraine. For many individuals, migraine management revolves around avoiding their triggers, but this can become restrictive if someone avoids their triggers to the point that they miss out on what they enjoy in life.

It’s important to note that triggers are usually specific to individuals—there is no one trigger that all patients with migraine experience. Moreover, specific triggers don’t always cause migraines in people who know what influences their attacks. Triggers act less like an on-and-off switch and more like a volume knob—there have to be enough triggers in play at once, each turning the volume up higher, in order to trigger a migraine attack. Even as patients recognize their triggers, they may be able to desensitize themselves so the triggers are no longer an issue.

How can I help reduce the number of migraine days?

Thankfully, there are many ways to patients can potentially reduce migraine days. Migraine prevention starts with healthy lifestyle changes. One of the first steps is to keep a migraine journal where you track migraine days, sleep, triggers and other factors you find relevant to your migraine. Next, work to improve your lifestyle by getting more consistent sleep and eating on a regular schedule.

When working to reduce migraine days, preventive medication may be an appropriate option. Another important factor is to have an acute treatment strategy so that when an attack comes, it doesn’t linger or bounce back the next day. Patients should also know that there are devices available for migraine treatment, which help regulate brain activity and lessen the effects of an attack.

If I feel a migraine attack coming on, what should I do?

If you’re someone who has ten or fewer migraine attacks each month, you should treat the migraine right at the first sign of an attack. If you’re someone who has limited medication, you have to pick and choose which medicine will suit how the symptoms feel. Some patients can recognize an attack coming on hours—even days—before it occurs. This gives them more time to try to prevent the attack by changing their environment or altering their schedule.

Treating early and aggressively is the best way to eradicate an attack. Patients who have attacks 4 or more days each month could benefit from preventive treatments to decrease attack frequency and reduce the risk of acute medication overuse, which may cause chronic migraine to develop. Discuss medication use with your doctor to understand and prevent rebound headache and chronic migraine.

What can I do to help reduce the burden of migraine?

First, keep things regular. We like to say that the migraine brain is sensitive—it doesn’t like change or surprises. Keep a regular sleep schedule, exercise routine, meal times—just a regular schedule in general. The regularity trains the brain to know what to expect, which helps prevent migraine. This isn’t the case for everyone, but it is a good rule of thumb.

Second, be mindful of your lifestyle. There’s a lot of conflicting evidence about diet, but simply paying more attention to what you eat will help you make healthier choices. Incorporate ways to relax into your day, such as yoga or meditation, to reduce stress.

Finally, work with your doctor to create an individualized treatment plan where you’re in control. Migraine may make you feel as though things are out of control; they’re chaotic in their frequency and onset, which makes control feel distant. Set a goal with your doctor to help you feel more in control of your migraine attacks. This will help reduce the burden of migraine.

Although 100% prevention is not a realistic expectation, there are ways for patients to manage their migraine and lower the number of migraine days each month. If you would like to create an individualized treatment plan for your migraine, use your Find a Doctor tool to locate a professional near you.