Living with chronic migraine means dealing with the unexpected. These debilitating headaches don’t care if you’re graduating, getting married, or starting your first day at a new job. In fact, for some people, migraine attacks are more likely to surface during big moments, thanks to all that stress and excitement surrounding them.
“Migraines are unpredictable,” says Dharti Dua, MD, an Ohio-based neurologist who specializes in headaches and lives with migraine attacks herself. “They can come out of nowhere and throw you under the bus right before an important life event.”
But constantly wondering if one is going to pop up at the wrong time is no way to live. While, yes, you can technically get one at any moment, you’re not completely helpless; there are steps you can take to lower the odds of a surprise attack.
With that in mind, we tapped three neurologists (including Dr. Dua), as well as several people who live with chronic migraine, for their best advice on how to stay ahead of symptoms when it matters most. Here’s what they shared.
First, See A Specialist
If you have chronic migraine attacks, or if you suspect they’re behind your pain, see a doctor for an evaluation. “A healthcare provider can confirm the diagnosis and work with you to develop a treatment plan,” says Vernon Williams, MD, a neurologist based in Los Angeles. For mild-to-moderate cases, that plan may include lifestyle and behavioral changes, mindfulness, supplements, or over-the-counter medications, he says. In more severe cases, interventional procedures and electrical-stimulation therapies may be helpful.
Your healthcare professional may also recommend prescription drugs, including preventative meds and others to take when you feel a migraine coming on. “Being on a preventative medication helps me have fewer migraine days per month,” Dr. Dua says, “and less disruption of my work and personal life.”
Stick To Your Daily Routine
Maintaining a consistent schedule around a major event can be difficult, but a healthy routine can help lower your risk of a migraine, says radiologist and migraine patient Mia Kazanjian, MD, who tends to experience migraine around her period—and they can wipe her out. “An episode starts with a dull, throbbing pain over my left eye that gets progressively more severe and becomes constant,” she says. “It’s accompanied by heaviness in my eyes and light sensitivity—meaning I just want to be in the dark. I also feel tired.”
But Dr. Kazanjian has found that sticking to her regular habits helps reduce the odds of an attack. For her, that means eating three meals a day at around the same time, and keeping her caffeine intake consistent: one cup of coffee in the morning and another in the early afternoon. “Routines are key for migrainers like me,” she says.
Hydrate Aggressively
Gigi Robinson, who has experienced bad headaches for several years, says she’s learned to plan ahead to lower the odds she’ll deal with “incredibly disruptive” migraine pain on an important day. A major key for her is getting adequate liquids. “I hydrate aggressively,” she says.
Fellow migraine patient Mandi St. Germaine also tries to stay on top of her liquid intake. “I’ve found that I need to be particularly careful to stay hydrated,” she says. “I drink a lot of water.” Dehydration is a common trigger for migraine headaches, Dr. Dua says, so making sure you’re taking in fluids throughout the day can help minimize that risk factor. Drinking at least 16 ounces of water with every meal and snack, as well as first thing in the morning, is a simple regimen that should keep you well hydrated.
Identify And Avoid Your Triggers
A migraine trigger is defined as any factor that leads to headache pain, Dr. Williams explains. If you can avoid these, then, you’ll lower the odds of dealing with discomfort during a big moment. Common triggers for many people include anxiety, specific foods, and alcohol, he says.
But every person’s triggers are different, so it’s crucial to figure out exactly what yours are. For instance, along with her period, Dr. Kazanjian’s are perfumes, Champagne, gum, and headbands, she says. For Robinson, sugar and dairy are primary triggers.
Dr. Williams recommends keeping a “headache diary” to identify what could be sparking your migraine attacks, detailing what you ate that day and the days before, as well as your sleep patterns. “These triggers may not always remain the same,” he notes. “However, doing the detective work to discover what your personal triggers are can help you avoid ensuing migraine.”
Keep A Regular Sleep Schedule
Getting to bed at a decent hour can be tough when you have a special occasion coming up, especially if you’re doing nighttime activities with friends or loved ones. But doctors stress that adequate sleep is crucial. “Irregular sleep schedules can trigger migraine,” Dr. Dua says. “This is why migraine patients should have the same sleep schedule throughout the week.”
Here’s where things get tricky: Consistency is important—meaning you don’t want to suddenly try to log nine hours of sleep when you usually snooze for seven a night. And staying up late puts you at risk for migraine pain, too. “Either too much or too little sleep can trigger a migraine,” says Joy Derwenskus, DO, a professor of clinical neurology in Nashville. “The connection between sleep and migraine is complex, and lack of sleep likely lowers the pain threshold, which can negatively impact an individual with migraine.”
Have A Plan—And Act Fast
You can do everything right, and a migraine might still show up. But being aware of the early signs and acting quickly when they appear can help minimize the pain and perhaps even shut the headache down entirely, Dr. Derwenskus says.
Every person living with migraine has their own management strategy, but there are some themes common to most. “I’ll take ibuprofen ahead of time if I notice even the slightest bit of pressure coming on,” St. Germaine says. “I’ve also found that cold compresses help, if I’m able to lie down and apply them before it gets progressively worse.”
Dr. Kazanjian finds that getting her heart rate up by running or using an elliptical machine for 10 minutes at a high speed can help. “The fast heart rate helps temper the migraine and sometimes prevents it from fully developing,” she says. She often follows that with moving to a cool, dark room and putting a cold pack over her eyes. For her part, Robinson says a combination of magnesium and electrolytes taken orally is “super-helpful” when she feels a migraine coming on.
Whatever works best for you, it’s best to act quickly, says Dr. Derwenskus, who recommends taking extra-strength acetaminophen or ibuprofen if a headache continues to build, and then any migraine-specific treatment your doctor has prescribed. “Generally, the sooner you take medication for a migraine, the better it works,” she says.
Get Reevaluated If Symptoms Change
This last tip is important: If you’ve been diagnosed with and treated for chronic migraine and feel like you’ve lost control, check back in with your doctor. “If there’s ever a change in headache pattern, discuss it with your provider,” Dr. Derwenskus says. They will go over your treatment plan with you, and whether it needs to change.
But whatever you do, don’t allow yourself to feel helpless. There are options available to manage your migraine attacks—possibly even some you haven’t thought of or tried yet.
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