Dr. Andrew Hershey outlines migraine’s contributing factors and what you can do to prevent a migraine attack
If you are one of the 37 million Americans diagnosed with migraine, your mind is likely overflowing with questions. These may include what’s causing my migraine attacks, and is there anything I can do stop them?
There are many different factors that can contribute to why you are experiencing migraine attacks. We recently spoke with Dr. Andrew Hershey, Endowed Chair and Director of Neurology at Cincinnati Children’s Hospital and Director of the Headache Center, about what causes migraine and how you can begin to identify effective treatments.
Genetic and Environmental Factors
“The reason you’re getting migraine could be because your parents or close family members have the genes,” Dr. Hershey says. However, there are a few simple things you can do to reduce your chances of experiencing a migraine attack. “We can’t change our genes, but we can change the environmental influence on those genes,” Dr. Hershey says. “Oftentimes, by taking better care of themselves, people can lessen that impact of migraine.”
Taking better care of yourself is one way to prevent migraine attacks. To do so, there are four main healthy habits patients with migraine should maintain, Dr. Hershey says:
- Adequate fluid hydration. This means drinking enough fluids to stay hydrated and avoiding caffeine, if possible, as caffeine withdrawal is a common trigger of migraine. (Be aware that suddenly stopping your caffeine intake could result in a caffeine-withdrawal headache.)
- Regular exercise. Dr. Hershey says there is good evidence that exercise not only makes our bodies healthier, but it helps our brains, too. He recommends patients with migraine exercise four or five times a week for 45 minutes.
- Proper nutrition. Patients with migraine should avoid skipping meals. In addition, focus on having a healthy diet full of fruits, vegetables, protein and dairy.
- Sufficient sleep. Always strive to get an adequate amount of regular sleep each night to prevent migraines. Avoid playing on your phone or working on the computer an hour before bedtime. The light stimulation can fool your brain’s sleep rhythm and prevent you from falling asleep quickly. Members of our Move Against Migraine support group say establishing a bedtime and sticking to it can also reduce the likelihood of a migraine attack.
Some patients can reduce their risk of migraine by taking preventive medications. In addition, some patients will also do cognitive behavioral therapy, which can help people better cope with stress and, in turn, lower their likelihood of migraine attacks, Dr. Hershey says. Speak with your healthcare provider or a headache specialist in your area to determine the most effective treatment plan for you.
Dr. Hershey says that oftentimes, doctors view these preventive medications as a bridge that can reduce the frequency of headaches and help someone feel better as they make appropriate lifestyle changes and put a preventive treatment plan into place. Preventive treatment plans are particularly effective for individuals who experience at least four migraine attacks a month, or attacks that are particularly severe. They include medications that were originally used to treat high blood pressure, seizures, or depression but were found to have a beneficial effect in migraine. Recently, three new medications, the first-class specifically designed for migraine prevention in 50 years, were approved to be used as migraine prevention.
Reducing the Severity of a Migraine Attack
In addition to preventing your attacks through the above steps, there are acute medications you can take that can reduce the severity of the attack. These include over-the-counter or prescription analgesics, triptans, and ergot alkaloids.
“I tell all my patients, ‘Our goal with you is to get you down to one to two headaches per month that you can make go away within an hour, and until we get to that goal, we’re going to keep working with you,’” Dr. Hershey says. “Once you get to the goal, then it’s your job to help maintain that.’”
Finding the Right Treatment
There are many reasons why your migraine medication may not work—whether the side effects make it difficult to adhere to the medication, or if the medication just doesn’t work with your lifestyle. If you’re taking good care of yourself but still feel like your preventive or acute medication is having little effect, Dr. Hershey recommends speaking with your healthcare provider to see if there is an alternative form of treatment for you.
Treating a migraine doesn’t just mean one quick fix. “It’s a combination of everything, including taking good care of yourself, acute therapy, cognitive behavioral therapy, and preventive medications,” he says. “Everything together is what makes the person get better, not just one particular thing.”
For more information on migraine diagnosis and treatment, visit our doctor-verified resource library. To find a headache specialist in your area who can diagnose you and create an effective treatment plan, use our find a doctor tool.
Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.