Dr. Cohen's Approach to a Patient with Migraine

There are three ways we manage migraine:

1)  Preventative Therapies: These are daily medications or periodic procedures performed to reduce the frequency and severity of migraine attacks.
     The standard guideline for the initiation of preventative therapy is a migraine frequency of 4 days a month or more.

2)  Acute Therapies: These are medications taken at the time of a migraine attack. The most commonly used agents are the migraine-specific agents
     (known as the triptans) and a variety of anti-inflammatory medications.

3)  "Healthy Habits": These are lifestyle changes that have been shown to improve the experience with migraine. There are four healthy habits: eating,
     drinking, sleep, and exercise.

          a)  Eating: Migraineurs (those suffering from migraine) should eat regular meals throughout the day as drops in blood sugar can be a trigger for
                migraine. Eat protein at breakfast as protein provides essential amino acids the brain needs for function, and migraine studies have shown that
                getting protein early in the day can reduce migraine incidence. Diets should be rich in green leafy vegetables which contain vitamin B2 (Riboflavin)
                and meats, fish, or poultry which contain CoQ10. For vegetarians, other good sources of CoQ10 include soy, strawberries, and peanuts.
                B2 and CoQ10 are both involved in energy production for nerve cells.

          b)  Drinking: Dehydration is a potent migraine trigger, and most people are unaware that their level of hydration is inadequate. To replace what the
                body loses in an average day, one must drink 8-12 glasses, or 2-3 liters, of non-caffeinated fluid. An additional 2 glasses, or 0.5 liters, of fluid
                are required for every half hour of exercise. Migraineurs should avoid caffeine, not only because it can produce dehydration, but also because
                caffeine itself can trigger migraine if used on a regular basis.

          c)  Sleep: The amount of sleep one needs is based upon age, ranging from 8-9 hours per night for adolescents, down to 6 hours per night for those
                over age 60. Even more important than the amount of sleep, however, is the schedule on which one sleeps. Migraineurs should be on a regular
                sleep schedule, with the same bedtime and time of awakening throughout the week. Fluctuations in sleep schedule are one of the biggest triggers
                of migraine, and this especially affects adolescents who sleep in on the weekend and then find themselves suffering from weekend headaches
                or, more commonly, Monday headaches.

          d)  Exercise: Exercise plays a critical role in migraine control. Migraineurs should exercise a minimum of 3-4 times per week for 30-40 minutes
                each time. When one exercises at this level, the body produces endorphins which are natural pain fighters in the body. These endorphins will
                decrease migraine frequency and severity.