Ask HN: Migraine prophylaxis?

Triggers for me are poor/insufficient sleep, stress, and large upwards or downwards changes in my caffeine intake.

Regular exercise seems to have dramatically reduced the severity of my migraines. Frequency seems to be decreasing too, as I am getting better at controlling my triggers.

I don't like taking triptans, they seem to give me a nasty hangover that almost as bad as just waiting the the migraine out, but it's hard to disentangle the migraine and drug after-effects.

Mostly, I follow my doctors advice and take the maximum safe dose of Ibuprofen as early as possible when I notice onset symptoms. Sometimes I use diclofenac instead. Check with a pharmacist, but if you can safely take paracetamol, you can combine paracetamol with ibuprofen or diclofenac.

I don't bother with over-the-counter medications that include some codeine - the codeine is not sufficient to do anything useful, and the dosage of whatever they are mixed with is often weird.

My migraines have mostly gone away now that I exercise regularly. For me it was cardiovascular. I'd see an aura and I'd get ready for the pain when I was a kid. Later in life I discovered that taking a simple Advil as soon as I saw the migraine would head it off. When I was a kid chocolate covered almonds and OJ would almost always hit me with a migraine. I discovered this by keeping a journal of what I ate. Changes in weather could bring them on too, especially if I was exercising hard right as the weather was changing. Bright screens in dark rooms could take a "maybe migraine" and turn it on. I've also found that if I wake up with a migraine that cannabis and Advil will put me to sleep pretty quick, though I decided not to use cannabis anymore because it makes me feel dumb for days and I was never a huge fan anyway.

As a background. I am nearly 40, 70 kg, 176m, pretty active person but not doing very regular sport. I had migraine starting at the age of 10 or 12.

The best ways, for me, not to trigger a migraine are:

- very good sleep. It means taking a 25 minutes nap during the day if I feel tired.

- very good hydration. I drink about 1.5L in the morning and just a single cup of coffee.

- low stress. The lower the better because stress reduces the quality of my sleep.

- if it starts, I try to stop the migraine as early as possible with directly 1g Aspirine. This is my way but here you need to ask your M.D. because of course I cannot tell you what you should take as medication!

I was only able to achieve this as I started working from home (for the nap if tired).

Sorry for the throwaway account. I am traveling, but if you have questions, just ask and I will answer here.

Edit: from the other comments we all follow more or less the same method.

Exercising 45 minutes a day, 7 days a week, reduced my migraines to near zero after close to 20 years of suffering. I would recommend carefully tracking them with a diary. (I used a separate calendar in my phone.)

I have many triggers. Some foods (probably histamine/tyramine sensitivity), smells, and weather. After a few years they became chronic and almost always had a migraine.

A combination of Zonegran, Botox every 12 weeks, and sphenopalatine ganglion nerve blocks and naproxen for acute migraine have them under control now. Topirimate negatively impacted my language skills and memory, but Zonegran is more tolerable and effective. SPG has a long history for TMJ and facial pain, and the Allevio and Sphenocath devices make the procedure easy. Other nerve blocks and Cephaly have been helpful in reducing the severity of the pain. A lower carbohydrate diet has also helped.

Vaping medical CBD has aborted a migraine immediately multiples times, but is not available where I live yet.

There are new CGRP blocking drugs that are supposed to be on the market soon. Aimovig is the first, and it's a preventative.

My doctor actually wrote an app to help people track their headaches: http://www.iheadache.com/

Dehydration, really fatty and dense foods, bright screens in dark rooms, and lack of sleep are my triggers. I find aspirin and sipping on water for a while will make the pain subside somewhat, and then a nap will clear it away.

I'm not sure if this is really the case physically, but I treat it as if there's a buildup of metabolites in my brain, and that is pretty effective at removing the problem.

Quick temperature changes. Bright light. Weather changes. Wearing something tight-fitting on the head. Large changes in stress level. Caffeine withdrawal is a big one. Getting 10 hours of sleep (first night) then 5-6 hours of sleep (second night) is a common cause for me.

I think the #1 underlying cause for me has been not getting enough hydration (or having electrolyte imbalances), though. As I've upped my daily fluid intake, they are occurring less often in general.

Though, it's changed over time. At one point my most common trigger was stress. Since I've changed jobs, that also has helped reduce the frequency, very noticeably (was getting multiple a week at a stressful/hated job)

It's odd because different days, different pain meds seem to work better. Aleve/Naproxen has the best overall efficacy for me, though. That, and/or putting something cold on my face and neck and being in a darker room.

I don't know what triggers my monthly migraine but I have found that Citrulline malate (an extract of watermelon) a vascular dilator prevents it for me 100%. Originally I had started taking it for sport reasons but subsequently found it fixes the migraine! Must be that my migraine is due to vascular constriction.

Does anyone else get migraines from... relaxing? Like having a few weeks of from work? Like I can wake up and after having enjoyed a full night of sleep and a steady breakfast and have the aura break out one hour after waking up. Christmas, easter, long weekends etc are times when I expect them to arrive.

As a child and young adult I just came to the conclusion that I got em when they felt on arriving.... They were much more frequent then but less intense.

I also guess stress is a trigger for me since I usually have multiple episodes around the day my father passed but that is the only stress I can remember being a trigger. (This has only been the case since he passed. Can't remember being triggered by stress before either.)

Edit: Does anybody else not really get "regular" headaches, like at all?

I usually have strong auras and medium pain, and it can take between weeks and months between attacks, though recently I had an attack two days in a row and I felt like I had aura-like issues with my vision for weeks. Not a fun time.

Most of my experience is typical and mirrors things already mentioned in this thread:

Triggers are a combination of stress, lack of sleep, strong light (particularly sunlight), and sudden increase in coffeine intake (people have mentioned a change both ways, and I'll have to pay attention if that's the case). Possibly red wine and nuts, but I don't think they're big factors.

Regular exercise seems to decrease the frequency, and 400mg of Ibuprofen taken once I notice the aura helps the pain.

I'm glad insofar as I've been experiencing them less and less as I get older. They were worst as a child and in puberty, bad during studying and kinda ok now.

They're too rare to pinpoint a real trigger, but maybe it's indeed https://en.wikipedia.org/wiki/Foehn_wind#In_popular_culture as I have suspected.

I'm also glad I can usually just sleep it off in a night even in the worst cases, or take 1-2 Ibuprofen and go to a dark, silent room for an hour or two if it's only moderate.

Triggers for me are dehydration, tiredness, stress and oo much bad food. I found that eating meat and dairy also had a massive effect on me and led to me giving them up. I have been more or less Vegan since figuring that out 20 odd years ago.

OTC codine which has just been made prescription only here in Australia. Worked perfectly for 30 years. I am not sure what I am going to do when my stash runs out.

Edit. I should add my trigger is UV light which is all too common here in Australia.

How I reduced my headache frequency by at least an order of magnitude. I still suffer from sinus headaches, but that physical cause is easier to deal with than other causes.

1. Take a long vacation someplace where it's possible to stay the entire day in bed with no light & no sound. (2-4 weeks).

2. Gradually reduce caffeine intake over the first half of the vacation, with no caffeine for the second half. Suffer through the withdrawal.

3. Go back to work, using caffeine in small amounts only for medicinal purposes. (Caffeine + ibuprofen works a lot better than just ibuprofen)

4. Fix sleep issues. The lack of caffeine will make this a lot simpler.

+1 for exercising. I'm commuting by bike 2*30min a day, almost no migraine now (except during the holidays, when i'm not). Paracetamol/acetaminophen 1g work pretty well when taken at the beginning of the migraine.

I found some relief by holding my breath several times a day (using Wim Hof's breathing protocol).

Not sure about the mechanism of action, but it seems that breath-holding causes vasodilation in the brain.

See: https://www.ncbi.nlm.nih.gov/pubmed/10472977

And: https://www.migrainekey.com/blog/10-reasons-why-the-wim-hof-...

(disclaimer: IANAMD)

Long term migraine-with-aura-without-headache patient here. I've found reddit's /r/migraine to be a pretty good resource/support group over the years.

I've not been able to find a source, in spite of years of logging all kinds of data. The only thing I have noticed, but which I don't want to contemplate, is that I have more frequent migraines when I have more sex. Much fun.

I take magnesium supplements and sometimes CoQ10, but I haven't really found either of them to be effective at preventing migraines.

My trigger was MSG (monosodium glutamate) but don't take my word for it. strong naturally occurring umamy taste can trigger for me too.

you should keep a journal of everything you eat, especially if you can take note of the ingredients.

For me 1 or 2 days after consumption triggers it, but staying away MSG helps in my case.

MSG sensitivity isn't taken seriously because it only really affect a tiny subset of the population and the food industry has interest in it not alarming the 99%.

I'm taking B2 which strengthens the blood brain barrier too.

2 likely triggers:

- excessive polyunsaturated fats in your diet

- poorly digested fibers in your intestines

Use butter/coconut oil instead of soybean/canola/sunflower oil if that's your case. Avoid PUFA at all cost.

Also, cut grain-enriched ('whole') bread and avoid grains in general, i.e., favor mashed potatoes over rice, avoid peanuts etc.

Find more here: https://www.google.com.br/search?q=migraine+ray+peat+forum

I'm a bit surprised not to see Excedrin mentioned anywhere. Perhaps it's because it has caffeine and reading some of the comments seems that caffeine (dependence) may be a trigger?

I'm not entirely sure if I get headaches or migraines, but whatever they are, they shut me down for hours and sometimes even a nights sleep doesn't clear them. Depending on the severity, 2-4 Excedrin will clear me up in about 30 minutes.

My triggers would be bright light, prolonged loud noise, insufficient food, dehydration, and (I think) pistachios.

In terms of prophylaxis, my neurologist had me supplement with 130 mg of magnesium, which helped. What really knocked down the frequency, though, was when my psychiatrist started me on Lexapro, an SSRI, for anxiety.

When I get an attack anyway, 50mg sumatriptan. Doesn’t always totally eliminate it, but usually at least helps.

Bright light for me is my major trigger. I wear sunglasses whenever it is bright and keep my head covered or stay in shade.

Cold air hitting my head (A/C air is worst. Fresh cold air doesn't seem to trigger the migraine).

Dehydration.

Direct hot sun hitting my head for 30 minutes plus.

Not eating for 20 hours.

For most of these, the solution for me is rest, sleep, being in a temperate zone and having an electrolyte drink. In extreme cases I might take a paracetamol or ibprophen or a muscle relaxant.

My triggers tend to be stress, dehydration and too much screen time. I find that if I can take some aspirin/paracetamol and get to a dark, quiet place as soon as I start to see an aura, I can usually limit the pain somewhat, but I'll still be unable to actually do anything for the duration.

In terms of prophylaxis meds, I've tried a few. Currently on a combination of Botox injections, and Sodium Valproate and Topiramate (brand names Epilim and Topamax). I've found they make a huge difference, but they do have some quite unpleasant side effects

Found this blogpost:

http://suppversity.blogspot.com/2013/06/natural-migraine-pro...

Been suffering since the last 10 years, for me it's the bright sunlight during the summer accompanied by humid weather conditions(most of the times), I prefer staying in the dark, I love dark rooms for some reason. Makes me feel like a nocturnal.

Suffering ever since I remember. What causes them for me and its sometimes unavoidable: 1. Stress. 2. Hunger / Dehydration (sometimes you can't just leave everything and go eat). 3. Spending too much time in the sun.

Trigger - less sleep, tension.

Drink 1.5 L of water as soon as you wake up before anything else (including bath etc) and always drink water when in sitting position.

For me magnesium (oral) works very well. 100mg to 300mg per day. Decreased my migraine from weekly to once per half year.

Of course I have no idea what your problem is. And while I'm not sure I ever quite raised to the level of "migraine", as I only on a couple of occasions got something like a full-blown aura or blurred vision, living with 3-4 major, debilitating headaches a week was a regular occurrence for me in my teens and 20s. (In hindsight I'm not even sure how I got through college. They mostly struck in the afternoon, so I guess I was mostly getting my life lived in the morning, which wasn't much fun since I was an evening person, due to, well, a good chunk of the things I'm about to list....)

In rough order: Discovering I had celiac disease. This was the big breakthrough without which I could make no progress, but it's not the only trigger I have.

Caffeine withdrawal; I have somewhat reluctantly dropped it from my diet because I withdraw at the drop of a hat (did you have 2.5 diet colas instead of 3 by 3pm? Headache time!) and I got tired of having to plan my days around making sure I got the right amount. (Possibly related to celiac; it can affect the speed with which things like that enter the blood stream.)

Discovering I'm not "allergic" to cashews or pistachios in the anaphylaxis sense but that they give me headaches.

Red dye 40. (Mostly in things I shouldn't be eating anyhow, but this was an extra twist of the knife.)

Poor sleeping posture; a new mattress for me was helpful, I'd recommend back exercises for everybody (specifically bridges), or at least everybody 6 foot plus. Excessive snoring/sleep apnea.

Excessive sugar, or even just excessive simple starches; blood sugar spikes.

Dehydration. (For whatever reason, there are a number of situations in which my thirst signal is simply inadequate and I must consciously consume water. I don't die (obviously), but I get massive headaches here that do not respond worth a crap to any OTC painkiller very well. I'm still sorta trying to figure this one out to see if it's a symptom of some other underlying issue, or if it's just the way I am.)

Real root beer, for whatever reason; appears to be more than just the sugar. (This took a while since I don't drink it very often, but it ruined a couple of ice cream social-type things before I figured it out.)

I'm not sure if this was a headache trigger, but discovering that I had some major heart issues that was a total asshole and only appearing while I sleep (vagal paroxysmal atrial fibrillation), so I had almost no clue that I had the issue, almost certainly a further effect of celiac. Treated with magnesium, potassium, taurine and l-arginine, vitamin C, vitamin K, and vitamin D. (Yes, it takes almost all of those for me. Celiac is "fun" when it comes to nutrition; you "get" to learn a lot about nutrients.) The heart issue itself may have been causing headaches directly, it certainly indirectly contributed to the several reasons my sleep has been poor for most of my life.

I recommend trying something like an elimination diet: https://greatist.com/grow/easy-elimination-diet-for-food-int... That particular link describes more of a "medium effort" sort of thing; you can also go whole hog and eat nothing but simple meats, fruits, and veggies for a while, and slowly fold things back in over weeks. It's extreme, but if you are someone who is sensitive/allergic to, say, soy, wheat, and dairy, it's really the only sane way to find that out. It blows to find out you've got one or more of the "major allergies" but it's a hell of lot better than not knowing!

Plus there's a chance you do the full elimination diet and it doesn't affect your migraines at all; well, you pretty much eliminated food issues in one fell swoop. Still a win.

Also grab a sleep recording app for your phone and record the audio of your sleep. I'm not sure science is 100% here yet but it seems to me we're going to end up in a place where basically all snoring beyond the most minor indicates bad sleep. If you've got a lot of snoring or any other sign your sleep is compromised, see about getting into a sleep study. In fact I pretty much just uniformly recommend everyone who has not done this do it, because the cost is virtually nil (the apps are free and it takes 5-10 minutes top to set this up for a night) and the potential benefits large; it's worth doing for anyone who isn't 100% sure they're awesomely healthy. If nothing else, the costs are so low it's just worth it to satisfy your own intellectual curiosity about how well you're sleeping; if you discover it's great, well, now you know, which is nice.

As you may have guessed from the previous paragraphs, it took me about 5-8 years to work it all out. But I have gone from being rocked by headaches almost continuously to pretty much never having a headache without knowing exactly what I did wrong, what I should have done instead, and how to prevent it in the future. Losing an evening to headaches is now almost always because I did something stupid, rather than inexplicable life.

Stress seems to be a trigger for me, so I actively try and keep my work related stress as low as possible - eg. not taking on work with tight deadlines. I also find that drastic changes in my caffeine consumption can also trigger a migraine.

I'm "lucky" in the sense that I start losing a significant part of my vision before a migraine attack, at which point I might smoke a small amount of low quality cannabis (I get extremely anxious when I realise I'm about to get a migraine and I've found this relaxes me and helps for the nausea) as well as taking an oral dose of Rizatriptan Benzoate. I've not had success with other triptans I've used, so I always make sure to have Rizatriptan Benzoate close by.

TLDR, by managing my stress levels along with keeping an eye on my caffeine intake, I've not had a migraine in months.

Don't skip your coffee.