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Does CBD work? The Migraine community shares their experiences
Remember when you couldn’t log onto social media without hearing about the daith piercing? While the buzz around daith has faded, another natural fad is rising to take its place: CBD oil.
Proponents claim CBD oil helps with everything from Migraine, to anxiety to treating pain in pets. But the experts aren’t so sure yet given the limited evidence available to evaluate.
CBD: The Basics
CBD is one of over 100 compounds in cannabis.
CBD stands for cannabidiol. It comes from – you guessed it – the cannabis plant. Cannabis (marijuana) contains hundreds of chemicals and compounds. CBD is the second most prevalent.
Remarkably, CBD on its own does not bring psychoactive effects, or ‘a high.’ This makes CBD oil a safer and more appealing option than more traditional cannabis, which tends to have high amounts of psychoactive compounds (notably, THC) (1).
According to a report from the World Health Organization, “In humans, CBD exhibits no effects indicative of any abuse or dependence potential…. To date, there is no evidence of public health related problems associated with the use of pure CBD.”
High quality evidence for CBD oil and cannabis for Migraine is lacking, however. Cannabis and its compounds have been legally classified as Schedule 1 Drugs in the United States, making them illegal to study. Even so, CBD oil is only getting more popular as states pass recreational and medicinal cannabis laws.
Eric Baron, DO, Cleveland Clinic Department of Neurology
What Headache Doctors Say
“There have not been a lot of studies actually looking at pure CBD and pain. There’s a big void of research, but anecdotally, a lot of patients are reporting that it helps,” said Dr. Eric Baron, neurologist at the Cleveland Clinic, during a 2019 Migraine World Summit interview (2).
“CBD is a strong anti-inflammatory. It’s several hundred times more anti-inflammatory than aspirin, ” said Dr. Baron. “It would make sense it could help with pain, especially if there’s an inflammatory nature to it.”
He isn’t the only doctor excited about CBD for Migraine. Dr. Stephen Silberstein, director of the headache center at Jefferson University Hospital, said, “In some ways, one can look at CBD as a chemical which, when applied to the skin, turns off pain. When taken internally, it may do the same (3).”
“If you have a lot of neck pain or soreness, it is perfectly reasonable to use CBD oil,” said Dr. Silberstein. “It may even prevent nausea and vomiting (4).”
Without good research, it’s hard to know if CBD oil lives up to the hype. Before you spend your cash on a bottle, read the Good and Bad reports from real people in our community.
CBD for Migraine: The Good
Does CBD oil work for Migraine? We put the question to the most brilliant group of people with Migraine we know: the Migraine Again Facebook community.
We received more than 150 responses from real people – many of whom are pleased with their experience with CBD oil.
Fewer Side Effects
Yes, please! Anything to ease this excruciating pain. More natural, the better. I hear CBD side effects amount to nothing in comparison to preventatives and pain killers. – Stina I.
The only way I find relief sometimes!!! – Amy E.
Yes! It helped immediately! – Eileen P.
Yes! CBD oil has been very helpful for me. – Therese M.
I take CBD when I get a hint a migraine is brewing, it really helps!! – Kristi M
My doctor discussed this as the next step for me. I have severe chronic migraines and cervicogenic headaches, too. I’ve been using CBD for a month, and noticed some decrease in pain level. – Heather S.
I’ve been using CBD Oil, and it has definitely made a difference! I need to get a med card to be able to try some of the THC strains. I have heard those will help even more. – Diana
It’s a lifesaver for some
I take CBD oil after once having a daily headache/ few migraines a week and I feel like a different person. I am no longer in constant pain all the time it’s been a lifesaver. – Laura H.
I was on 100mg a night of amitriptyline as a preventative, and it left me feeling groggy and gross every morning. Since starting CBD drops daily and medicinal marijuana when needed, I have been off my meds for close to 6 months AND have been migraine free… I have battled migraines since I was a child. – Aimee W.
I use CBD oil and it has really helped. I also use CBD balm on my temples and joints for pain. That stuff is amazing – it’s like magic cream. – Sarah K.
It has saved me. I was getting daily migraines, hospital grade, nothing worked. CBD daily has stopped them. When I do get an aura, I take some THC strain and it knocks me out and I miss the migraine. There are different strains, several didn’t work for me. Midnight and Wilbur work for me. – Robyn G.
CBD for Migraine: The Bad
CBD may not be powerful enough on its own to stop or prevent a migraine attack.
Even while some people noticed results with CBD oil, many noticed no results, slight results, or only temporary improvement.
It doesn’t help
With NDPH our results were zero pain relief. – Simon A
Tried it. Didn’t help. -Carla
Didn’t help me at all….my migraine still progressed to next stage of pain even with it.” -Carrol
It didn’t do a damn thing for me. – Donald S.
I tried drops but no relief at all even after taking it daily for 2 weeks and still had insomnia so ? – Sandy S.
Didn’t work for me. Tried CBD and the pure stuff. Nothing. – Stacy K.
It helps temporarily
I have used CBD drops that have helped temporarily. -Lindsay
It may not work right away
You have to use CBD long term for results. It’s not immediate like THC, it can take at least 6 weeks of daily use and it’ll be more like ‘hey, I feel better than I did a few weeks ago.’ It helps with the pain, but in general, it’s preventative not rescue.” – Racheal T.
Experimenting can be pricey
Took the CBD/low THC drops under the tongue. Helped with inflammation problems but caused headaches that nothing would touch. Was medically prescribed but had to return to migraine rescue meds. Tried 2 different LPs. Can’t afford to keep experimenting. – Andrea S.“So far it makes me worse, but I’ve been trying to find the right dosage, strain, delivery system for a long time. “ – Sara B.
CBD for Migraine: Issues
It can be expensive and time-consuming to find to the brand or dose that works for you.
Some community members discovered that pure CBD was not effective. “CBD and THC are synergistic,” explains Dr. Silberstein. “Some of the experts in the field say there may be the other chemicals in marijuana itself that may have benefit in addition to CBD and THC5).”
Issues associated with CBD include:
CBD alone doesn’t cut it
It’s been fantastic. It took time to figure out what helped and when to take it but I’m getting closer to finding what works for me. Medical marijuana rather than CBD oil is what works. – Catherine A.
I am currently using medical cannabis and it really really makes a difference for me. I’m using fewer narcotics and opiates and my doctors are all ok with my Rx. I’m glad I found some relief and I only hope everyone here can potential find something as well. – Travis B.
THC is illegal in many places
A low THC oil is extremely helpful in prevention. I wish everybody had access to it! – Kara
Absolutely helps my migraines, but petrified to use as still illegal in Australia and worried about driving. It’s literally the only thing that takes the pain, nausea, vomiting away and makes me feel happy and relaxed to help me sleep. Also allows me to eat which is usually a struggle when retching or struggling with debilitating nausea – Simone D.
Sadly still against US Federal Law! So if you work for the federal government or one of its many contractors or subcontractors using it is a major no no. – Lisa N.
CBD is stigmatized
My neurologist “recommended” cannabis after all other meds have failed me. The goal was to be relaxed enough to release all the tension in my neck, where my migraines trigger, years of scar tissue have built up and actually be able to sleep. This recommendation came before the next step was the pain clinic and very invasive shots. Cannabis is natural and actually works. Going from hundreds of hours of migraines a month to next to none is unbelievable… it’s very frustrating to me that this medical miracle for so many illnesses is taboo. – Kelly
It can be disappointing if it fails
I suffer chronic daily migraines, as well as Chiari malformation, herniated disc, and chronic pain, and I have tried many different strains of oils and dried and nothing…I was very disappointed. – Tanya B.
As with any decision regarding your health, the final verdict on whether CBD oil is right for you ultimately lies with you. It would be wonderful if there was more data-driven information available, but that requires funding for double-blind placebo studies.
A Migraine attack can feel like a battle. Murky, violent, and painful – they don’t us Migraine Warriors for nothing. With vivid imagery and abundance of color, artist Abi Stevens captures the epic drama of Migraine in her new series.
Abi Stevens holds a BA in Illustration from Cambridge School of Art, but it wasn’t until Migraine stopped her in her tracks that she decided to capture her symptoms visually. “I’d like people to understand that Chronic Migraine is a neurological condition and not just a series of isolated attacks,” she said. “Yes, I get flare-up attacks that leave me unable to function, but I also deal with muscle pain, fatigue, light sensitivity, sound sensitivity, and brain fog on a daily basis.”
“These symptoms don’t just go away between attacks, and even if we say we’re ‘fine’ our definition of ‘fine’ is very different from a non-migraineurs,” she said.
Interview with Artist Abi Stevens
Old Blunderhazard by Abi Stevens
We had the opportunity to listen to Abi’s story, and how she found new creative life in a disease that leaves so many feeling hopeless.
Angie Glaser: How would you describe your art and your artistic style?
Abi Stevens, digital artist
Abi Stevens: I make colourful and detailed illustrations inspired by mythology, folklore, history, and all things fantastical. My more recent work explores chronic migraine.
I enjoy discovering obscure little tales, creatures, and characters from around the world. I really enjoyed working on some personal illustrations inspired by East Anglian folklore earlier this year.
Angie Glaser: Where do you look for inspiration?
Abi Stevens: My work is often influenced by elements of ‘visual history,’ like historical art forms, architecture, and objects. In particular, I love stained glass windows and illuminated manuscripts. You can see references to these sources in the stylized borders and iconography in my work.
I also enjoy including hidden details in my illustrations and incorporating symbolism, such as the language of flowers.
Angie Glaser: What inspired you to capture your experience with Migraine through art?
Abi Stevens: I’ve had migraines in bouts (usually in summer) since I was a teenager, but over the last few years they have grown steadily worse. Last year they broke through my preventative medication and became chronic. I experienced such a severe initial attack and ongoing symptoms that I couldn’t work for nearly 4 months straight.
For a lot of that time I was pretty much stuck in bed or maybe on the sofa and I couldn’t do anything! This included making artwork for quite a while due to the huge impact migraine had on my motivation, my mood, and my ability to sit at the computer long enough to finish anything.
Dragon of Bures by Abi Stevens
I hadn’t realised how much of my confidence and self-identity was tied up in my perceived productivity until I couldn’t do it any more!
As I started to be able to spend more short stints at drawing again, I decided that all the frustration, isolation, and pain I was feeling had to be directed somewhere, so I might as well direct it into my art.
My work had never really been autobiographical before, and I wanted to see if I could use it as a form of catharsis – a personally directed art therapy.
It turned out to be much more effective than I’d anticipated. It made me feel as if I had a voice again. When I received great positive responses from other people with migraine and other chronically illnesses, I realised my art could serve multiple purposes: I could process my own experiences while also helping others to feel seen, and advocate for chronic migraine by raising awareness of the various symptoms.
It has opened up a whole new side to my creative practice that I wasn’t expecting.
Angie Glaser:Can you tell me a little bit about the illustrations in your chronic migraine series?
Abi Stevens: The pieces I have so far are all autobiographical and feature myself experiencing various aspects of migraine, using shapes and symbolism to represent the symptoms. I started by approaching different forms of migraine pain and created Sharp and Burn.
I then created Mood which represents that breakthrough feeling of having a much better day, when you’re brain is less foggy and you feel like your personality has broken free.
This led me to further explore the impact chronic migraine has on mental health and I created these two illustrations, which may be my favourite so far:
Monster and Fight represent respectively; the feeling of your life being swallowed up by migraine, and the value of support from friends and family in helping you fight back against the mental drain caused by being chronically ill.
The images are deliberate inversions of each other, right down to a roughly key-shaped border being right-way-up for Fight and inverted and barbed for Monster.
Next came my twin nemeses Light Sensitivity and Sound Sensitivity.
Followed by the neurological impairments Aphasia and Brain Fog
The last addition to the pain roster is Splitting.
Angie Glaser: How does making art fit into your Migraine experience? Does it help you cope or communicate the experience to others?
Abi Stevens: I think it’s helped a lot. It’s a useful shorthand to explain to friends and family why it’s ‘not just a headache’, and it’s had a nice cathartic effect on me. I feel more in control of my chronic illness because I am consciously choosing how I let it influence certain aspects of my life. I think I’ve gained more confidence in my work and in myself as well because creating work that is this personal to me requires a certain bravery and openness that isn’t present in my more fantastical illustration work.
Angie Glaser: What is next for you? Where can we see more of your work and connect with you further?
Abi Stevens: There are still a lot of symptoms I haven’t covered yet, and I’m planning to expand on the series over the summer in order to display them at a fundraising exhibition night I will be hosting at CUC Winebar in Cambridge on September 14th. I’ll be displaying hand-embellished digital prints and selling them in order to raise money for National Migraine Centre, who have been treating me for almost a year now.
Go to her Kickstarter to support Abi Stevens on her quest to make these amazing pins.
I’m also currently running a Kickstarter to fund enamel pins featuring ‘Migraine Warrior’ and ‘Chronic Warrior’ designs. After making this series depicting many of the hardships of migraines I wanted to make something more uplifting to celebrate our successes as well.
How and when did you first get diagnosed with Migraine? Any specific type?
I was born with migraines and as I got older they got worse. By the time I was 25 over the counter meds no longer worked. I began to have daily migraines and now require preventive medications and abortive medication. I had to change my eating habits, and I am sensitive to sounds, light, and noise. Smells can also be a trigger for me.
Migraine is one of those things I cannot control but work to manage as best I can. I am now on a clean eating diet with no process foods to help avoid any food triggers. It is really one day and one step at a time.
What lifestyle changes have you made to help prevent Migraine attacks?
I have changed everything I eat and now focus on eating clean, fresh foods. I had to learn to go without caffeine and avoid any and everything containing it. I workout 3 to 5 days a week to help manage stress. I have changed to lightly scented lotions and perfumes to avoid triggers. I have soft Migraine lights at home and good windows to help keep the sound out as much as possible. And I track my migraines, looking for triggers to avoid.
What was the turning point in your Migraine Journey?
The turning point in my Migraine journey was been taking to the ER eleven times in a row! At some point, the doctors then realized that my migraines were onto a whole new pattern and were now more severe and chronic. We also realized that my body was rejecting caffeine, which is what the ER staff kept trying to give me for the migraines!
Who has been the biggest help to you on your Migraine Journey, and how?
My primary doctor and neurological doctor were the biggest help. They realized that my body was rejecting caffeine and that I could no longer take over the counter cold medications. They worked to get me on preventive medications ASAP to get the migraines under control. Then we worked to find the right medicine to take when I got a migraine. Next, we worked on journaling my triggers. It took time but was worth it.
What is the most surprising thing you have learned about Migraine during your Journey?
The most surprising thing I learned was what my triggers were and how they affected me. Like the weather: here in Cleveland the weather has a big impact on my migraines. In Valdosta, Georgia, where I am from, weather had very little impact on my migraines.
I was also very surprised to realize how heightened my senses are! I can smell a lotion or perfume and right away have a migraine or know it’s coming. Light and noise is the same way. I have always had the flashing dots and black spots in front of me, but did not know it was a clue warning me that a migraine was on its way! These clues now help me plan and prepare for the pain.
What’s your advice to someone else living with Migraine?
I would encourage them to find a good doctor. Join Migraine groups and blogs, because this is where good tips and advice comes from others who suffer also. There is help to make these days less painful.
What’s the next step on your Migraine Journey?
Learning to use my heighten sense of smell to my advantage during Migraine attacks! Such as smelling lavender, vanilla, lemon, peppermint, or eucalyptus.
Like ice cream, Migraine comes in a variety of different “flavors,” and it “tastes” different to each of us. Yes, the base ingredients are the same, but symptoms and severity can vary by person, attack, and over time.
Knowing exactly which type of Migraine you have is essential to finding the most effective treatment.
It’s a fact: 60% of women and 70% of men with Migraine aren’t diagnosed properly. Getting an accurate diagnosis is critical for the right treatment. Some medications are actually dangerous to people who actually have Migraine with Aura, for example.
According to the International Headache Society’s ICHD-3 classification system, there are seven types of Migraine. They’re classified by how doctors diagnose and treat them, not when or how we feel them (1).
According to the International Classification of Headache Disorders (ICHD-3), there are seven types of Migraine: the two major types (Migraine without aura and Migraine with aura), the four subtypes of Migraine with aura, and Chronic Migraine. The criteria for doctors to use in diagnosing these types of migraine are based on scientific evidence.
The two major types of Migraine are:1 – Migraine without Aura (formerly called Common Migraine)
This is the most frequent type of Migraine. Symptoms include moderate to severe pulsating headache pain that is aggravated with movement. The headache comes with nausea and/or vomiting, and photophobia (sensitivity to light) and/or phonophobia (sensitivity to sound).
A prodromal phase (warning phase) may occur hours or days before the headache. Warning symptoms may carry on into the headache phase. Along with the nausea, vomiting, and sensitivity to stimuli, common warning symptoms include confusion (cognitive dysfunction), blurred vision, mood changes, fatigue, food cravings, yawning, neck stiffness and/or pain. These symptoms may also occur in Migraine with Aura (see below).
The headache phase may be followed by a postdrome phase (hangover phase). Postdrome symptoms include feeling tired or washed out and cognitive impairment.
Migraine attacks typically last 4-72 hours, and they repeat a few times a year to a few times a week (see Chronic Migraine, below). Importantly, Migraine without Aura is the type more prone to worsen with frequent use of symptomatic medication.
This type of Migraine includes visual disturbances and other neurological symptoms that appear about 10 to 60 minutes before the actual headache and usually last no more than an hour. You may temporarily lose part or all of your vision. The aura may occur without headache pain, which can strike at any time.
Visual aura is the most common, featuring a zigzag figure that may spread right or left across your vision. You may temporarily lose part or all of your vision.
Less frequent aura symptoms include an abnormal sensation, numbness, or muscle weakness on one side of the body; a tingling sensation in the hands or face; trouble speaking; and confusion.
Many patients who have Migraine with Aura attacks also have Migraine without Aura attacks andTension-Type Headaches, so it’s possible for your Migraine case not to fit neatly into one “type.”
Migraine with aura is characterized by sensory disturbances, especially visual disturbances. Image: Unsplash
Subtypes of Migraine with Aura include:3 – Migraine without Headache
Technically, this is known as Typical Aura without Headache.
It is characterized by visual problems or other aura symptoms, nausea, vomiting, and constipation, but without head pain.
Headache specialists have suggested that fever, dizziness, and/or unexplained pain in a particular part of the body could also be possible types of headache-free Migraine. It’s different from the complications known as Abdominal Migraine and Cyclical Vomiting Syndrome, which often occur in children.
4 – Migraine with Brainstem Aura (formerly called Basilar-Type Migraine)
Mainly affecting children and adolescents, this type includes Migraine with Aura symptoms that originate from the brainstem, but without motor weakness. It occurs most often in teenage girls and may be associated with their menstrual cycles.
Symptoms include partial or total loss of vision or double vision, dizziness and loss of balance (vertigo), poor muscle coordination, slurred speech, a ringing in the ears (tinnitus), and fainting. The throbbing pain may come on suddenly and is felt on both sides at the back of the head.
Hemiplegic Migraine (HM) is a rare but severe form of Migraine that causes temporary paralysis – sometimes lasting several days – on one side of the body prior to or during a headache. Symptoms such as vertigo, a pricking or stabbing sensation, and problems seeing, speaking, or swallowing may begin prior to the headache pain and usually stop shortly thereafter.
When it runs in families, the disorder is called Familial Hemiplegic Migraine (FHM). Though rare, at least three distinct genetic forms of FHM have been identified. These genetic mutations make the brain more sensitive or excitable, most likely by increasing brain levels of a chemical called glutamate. Read a Migraine Journey about a Hemiplegic Migraine patient.
6. Retinal Migraine
The fourth and final subtype of Migraine with Aura, retinal Migraine is a very rare type characterized by attacks of visual loss or disturbances in one eye. These attacks, like the more common visual auras, are usually associated with head pain.
And the final Migraine type is:
7. Chronic Migraine
Characterized by 15 or more headache days per month for more than 3 months. Headache may be Migraine-like or tension-type like but has the features of Migraine on at least 8 days per month.
Preventative habits are highly advised to keep the condition from progressing from Episodic to Chronic. Discover the factors that may increase your risk of developing Chronic Migraine here.
The International Headache Society recognized several official types of Migraine but there are even more unofficial types. Image: Unsplash
Many Migraine types formerly thought to be distinctive disorders have now been classified as “complications.” These include status migrainous, persistent aura without infarction, Migrainous infarction, and Migraine aura-triggered seizure (migralepsy).
Episodic syndromes that may be associated with Migraine include recurrent gastrointestinal disturbance (cyclical vomiting syndrome, abdominal Migraine), benign paroxysmal vertigo (vestibular Migraine) and benign paroxysmal torticollis (head tilt to one side).
For more on these, check out our article on Strange Migraine Complications. It can help unlock the mystery of your personal Migraine case, as it did mine.
What about Menstrual Migraines? Morning Migraines?
If you’re wondering: where is Hormonal Migraine? Morning Migraine? Complex Migraine? Well, these technically aren’t official Migraine types anymore, according to the IHS. I asked Peter Goadsby, MD, one of the top doctors influencing IHS and AHS policies why these new terms were adopted.
His explanation: the World Health Organization needed a common language to define all the Migraine sub-types so that doctors and patients around the world could compare notes and exchange data. That seems like a very good idea.
If you suffer from Menstrual Migraines three days before every period, you can keep calling that. Ditto for Weather Related Migraine and Morning Migraine, the kind that wrecks your day before it even starts. As Migraine Warriors, we tend to think of the occasions when attacks occur and major symptoms to name our pain.
Personally, I discovered after decades of suffering from Chronic Migraine without Aura that my own pain didn’t start at 23, but instead at 12 with Abdominal Migraine complications and a Migralepsy seizure.
Want to ensure you’ve been accurately diagnosed? Your best bet is to get to a board-certified headache specialist – click here for a free referral.Take Our PollComments? Does your official diagnosis match the type of Migraine you think you have?
If you’ve been living with migraine for five years or more, maybe you noticed how the disease continues to morph over the course of our lives. More or less frequent, higher or lower intensity, newly discovered or disappearing symptoms — the one thing that’s constant with migraine is change. (Ironic, since migraine brains hate change). The question is: when is it time to change your migraine treatment plan?
We sat down with Headache Specialist and world-leading expert Paul Mathew MD of Harvard Medical School to untangle the factors he considers with his own patients. As one of the thought leaders in the American Headache Society (AHS), Dr. Mathew helps set the guideline-recommended treatments that he and other doctors, neurologists and headache specialists around the world reference in clinical practice.
Bottom line: if your migraine has changed, so should your treatment plan. Using what you used in the past may not be giving you the best chance at wellness.
9 Smart Reasons to Change Your Migraine Treatment Plan
An Interview with Dr. Paul Mathew MD, Neurologist, Headache Specialist and Assistant Professor of Neurology, Harvard Medical School
1 – You’re Taking Too Much Medication for Attacks
Many people prefer to take medication only when pain occurs, which makes sense – until it doesn’t. If you aren’t tracking your
Dr. Paul G. Mathew is a neurologist, headache specialist, and Assistant Professor of Neurology at Harvard Medical School.
attacks or medication use, it’s easy to slip into a pattern of frequent over-the-counter medication or triptan use.
“Patients who are averse to preventative treatments … they’re the ones who often get into trouble,” explains Dr. Mathew. “These are the patients who run out of Triptans. Typically we’ll cover 12 or so a month. Likewise, these are the same patients who will develop an ulcer because of their frequent use of Ibuprofen.”
I confess to him that I was taking Excedrin Migraine or a triptan almost every day, and my doctor never told me that was a bad idea. [That was before MigraineAgain.com existed.]
“I tell patients: taking a low dose daily preventative is actually safer for you from a medication standpoint than to take frequent medication. And that even includes over the counters, like Tylenol and Ibuprofen” advised Dr. Mathew.
Gastro-intestinal problems can become a problem for people taking too much oral medication for migraine attacks. “Your body will warn you that something is wrong because you’ll get acid reflux and you’ll get a little bit of stomach irritation. If you let that progress, eventually it could lead to an ulcer.” Dr. Mathew warned, “After that you can actually go into kidney failure if you take enough nonsteroidal anti-inflammatories like Ibuprofen. People often equate over-the-counter [medication] with safe, which is clearly not the case.”
Diaries can be both eye-opening and deceptive, says Dr. Mathew. “Some patients will have 12 headache days per month. And then when you look at the diaries, every headache is clustered into three to four days at a time. And so the natural impulse would be… to add a preventative. In fact, if you had effectively terminated the headache on day one with effective treatment, it would have been a moderate headache that went away within a couple of hours. And so that one headache converges into a multi-day disablement headache.” The light goes off in my head as I recall trying an ineffective triptan.
“So by looking at the diary sometimes just by tweaking someone’s abortive treatments, you can actually avoid going on a preventative if they have headaches that tend to last multiple days.”
2 – Your Attack Frequency or Intensity is Climbing
A well-kept diary can also reveal a more accurate history that we, as busy patients, tend to forget or diminish. Specialists universally agree that it’s one of the most effective (and free) tools we can use to create a smart migraine treatment plan. Find one here.
Dr. Mathew explains why: “Intensity can vary tremendously. I actually break down the intensity into function. One to three is mild pain. They’re able to function fully. Four, five and six is moderate pain. They can function without as much as they like. And then seven through ten is disabling. They have to stop what you’re doing because the pain is so bad.”
Your true burden of migraine depends on how much you can function. One person who can take a triptan eight days a month and work through it is less burdened than someone who can’t take triptans or can’t get relief from alternatives, making it difficult to keep a full-time job, drive, go to school or care for others.
That’s when a preventive migraine treatment becomes a good idea.
Dr. Matthew advises, “Sit down with a doctor and discuss different preventative strategies. I’m a big fan of both employing a combination of medication, lifestyle modifications, and really understanding what your triggers are.”
3 – You’re Settling for Unpleasant Side Effects
Constipation? Neck pain? Throat constriction? Brain fog? Nearly every medication comes with some side effect. Whether it’s tolerable or not depends on whether there’s a better option out there for you.
Triptans are the current best-in-class abortive medication, but fewer people take them than those who could benefit from them. “A common misnomer is that all Triptans are treated equally. Oftentimes I will shop between three to five different Triptans before finding one that the patient finds effective and tolerates,” says Dr. Mathew.
“Sumatriptan may cause a tight sensation in the chest, or the teeth or something like that, but the patient will never tell you about it. Because they’ll say, oh, it works to get rid of my headaches and that’s what I’m stuck with it, so that’s fine, I’ll deal with it. Which is unfortunate.” People often delay taking triptans out of fear of side effects, he says, and then “the horse is already out in the barn. And the chances of that Triptan effectively turning the headache drop as every minute goes by in that attack.”
Topiramate and Botox both show strong efficacy as well, but may be dismissed by people who experience side effects. In the case of Botox, side effects can be a result of an inexperienced doctor and may be worth trying again.
4 – Your Symptoms Have Changed Due to Age, Hormonal Changes or New Triggers
One of the most encouraging things about migraine is that it can get better with age. But not before it gets worse – ask any woman going through perimenopause.
Concussions are another inflection point. With every head blow comes the possibility of worsening migraine, and a need for a new migraine treatment plan.
New trigger exposures or elevated sensitivity can also prompt a change in migraine treatment. Dr. Mathew recalls a common exchange with one of his patients: “Patients will say, ‘Oh, I don’t have much of a headache, but light bothers me every day,’ or ‘noise bothers me every day.’ A good preventative [treatment] will not only curb your headaches but actually could curb some of those migrainous symptoms, which can be present even when a Migraine is not present.”
Periods of elevated stress or insomnia also warrant a re-evaluation of your migraine treatment. “Choosing something that can kill more than one bird with one stone makes a lot of sense. So patients who have sleep issues as well as Migraine, something that can be a little sedating like amitriptyline or Gabapentin can be useful. Patients who have constipation and Migraine magnesium can be useful.”
5 – You Seem to Be Getting a Lot Better (Yay!)
If you’re having far fewer attacks than in the past, start with a happy dance. That’s worth CELEBRATING! Maybe you’re doing something very right, finally responding to your migraine treatment plan, or your prayers have been answered!
Getting fewer attacks? Time to celebrate!! (Photo: Unsplash)
“Even if the patient is happy, I look at their diaries and say, ‘how can we do better?’ Which always puts a smile on the patient’s face. So if there’s still a large number of disabling headaches, even though the overall number of headaches is low, I will certainly look at the abortive treatments that they’re taking.” Dr. Mathew is constantly looking for improvement.
The question is whether preventive therapy is still necessary. I was determined to get off of a daily Gabapentin as I improved.
“They should always have access to good abortives. But you do raise a good question. There are some patients who have suffered so badly no matter what you tell them, they say you know what, I’m under good control, don’t touch anything. And again, if it’s a preventative, that’s not really causing any other issues, then fine. I typically tell patients if a preventative is working, I would stay on it for at least six months to a year. And then at that point reevaluate.” Dr. Mathew cautions, “You always want to take life circumstances into account.”
If you do decide to wean yourself off of a preventive medication as your health improves, keep tracking, suggests. Dr. Mathew. “I let the diaries do the talking. We’ll decrease very gradually.” For example, one of his patients wanted to stop taking 50 milligrams of amitriptyline as her health improved. “I told her ‘decrease it to 40 milligrams at night for a month, 30 milligrams at night for a month and very, very gradually come down, but make sure to keep your diaries.’ Unfortunately a lot of them, they do fine at a certain threshold they do develop more headaches again.”
6 – You Just Began or Ended a New Chapter in Life
Started a new job? Moved to a new home? Got married or divorced? Finished school? All of these can throw the change-resistant migraine brain for a loop.
I discovered this the hard way last year when we sold our home of twenty years and downsized into a cool new city pad, full of new triggers: bright light, no silence, sleep interruptions, and a lot more stress. My attacks shot up tenfold.
A new workplace can have a similar effect. Dr. Mathew shares, “It’s not uncommon for someone to tell me, Oh, I only have five to ten headache days per month, but the lights where I work bother me. A preventative can help with light sensitivity if it’s of a migrainous nature. Or I can offer to write a letter of accommodation to their employer and say, ‘Hey, listen, is there any way we can use incandescent bulbs instead of fluorescent tube lighting, which will make your employee much more productive and also obviously reduce the amount of Migraines they’re experiencing.'”
Dr. Mathew shares another example of one of his patients, a woman entering the Big Change of Life: Menopause. “There are many patients who are in their late forties early fifties and say, Doctor Matthew, I’d like to come off of this medication. And I tell them many women during perimenopause actually the Migraines become a lot worse, and then once menopause firmly sets it, Migraines can get significantly better. It may make sense to hold on for another six months to a year, completely go through menopause, and that might be the best time to consider weaning.”
7 – Your Income or Insurance Have Changed
As health care costs continue to escalate, insurance companies have to keep a lid on costs. That means they are constantly reviewing therapeutic options and choosing which ones to keep on their formulary, add to it and which ones to retire. They are being lobbied by advocates, sometimes successfully, to cover therapies like Oxygen for Cluster Headache and CGRP medications for migraine that are expensive but the best choice for some patients.
Is the system fair? Dr. Mathew explains: “What people also need to keep in mind, unfortunately, is the reality of the economics of
Migraine treatment can add up. Consider changing if your financial situation changes. (Photo: Unsplash)
medicine. And that if every single patient with Migraine got Botox or got the CGRP antibody, we would bankrupt the healthcare system and there wouldn’t be any money to take care of anyone.” CGRP is one of the new therapies, below.
It’s also a good idea to review your formulary every year. If you or your family member are changing jobs and insurance carriers, the plans offered might even be a factor in your decision. Plans vary widely, especially on the coverage of complementary and alternative therapies.
Finally, you might consider switching to therapies that have been available, but more or less income makes them more feasible now. Less income: magnesium, riboflavin, sumatriptan. More income: devices, acupuncture, behavioral therapy. Good insurance: pharmaceutical therapies, new therapies. Poor insurance: natural therapies, generics.
For behavioral therapy, Dr. Mathew says it’s a good idea to “call the company number which is on the back of their insurance card. They’ll have a list of in-network providers. That’s sometimes a reasonable place to start just because you know they’ll be covered. Otherwise, it can be very expensive to I see psychologists or psychiatrists.”
8 – Something Better Comes Along with Good Evidence
For a couple of decades, this was not a viable option. But in 2018, we began to see new migraine treatment options become approved and available. Among those that should be on your radar:
CGRP Antibodies – With far fewer side effects than other medications, CGRP medications like Aimovig, Emgality and Ajovy help prevent attacks. The issue may be accessibility after the free trial period. “My guess is that most payers will not pay for a CGRP antibody, whether it’s for episodic, which is less than 15 days per month or chronic, which is more than 15 days per month unless you tried and failed a number of oral preventative therapies which are much cheaper” says Dr. Mathew.
Botox for Chronic Migraine – “If someone has tried and failed what I call the three major food groups of oral preventatives, which is beta blockers like propranolol. Tricyclic antidepressants, like amitriptyline, and then anticonvulsants or antiseizure medications like Topamax. Typically if you tried and failed those three or you cannot take though because of contraindications, then most insurance companies will approve Botox therapy for you. Botox I find to be effective and pretty good from a side effect standpoint,” Dr. Mathew reports.
Ditans – Hailed as the alternative to triptans for people with cardiovascular risk, lasmiditan is the first therapy that may get FDA approval in the year ahead. That could be life-changing for many people who can’t function on the job without a better acute migraine treatment option. Stay tuned for more.
Gepants – Another type of medication on the horizon that’s showing promise in clinical trials are the gepants. Discover more here.
Triptans – They’re not new but they remain the best in class abortives. Each year, companies release new delivery systems, like sublingual and nasal sprays.
Devices – Neuromodulation devices that stimulate the neck, the arm, the back of the head and the forehead are a promising drug-free solution. Dr. Mathew warns, “Coverage can be an issue for devices. So typically I will use those later on down the line if they’ve failed more conservative therapies like medication.”
9 – You Commit to a More Natural Lifestyle
Most people with chronic health disorders have a love/hate relationship with pharmaceutical therapies and medical procedures – we need them, but we’d rather use more natural means to achieve wellness.
For migraine, not all of the natural therapies can compete with the efficacy of pharmacological migraine treatment. Many are used, as Dr. Mathew advises, in a “complimentary fashion” with pharmaceutical therapies. Insurance coverage varies, and most doctors who are not headache specialists are less familiar with the evidence behind them. Those worth considering:
Going natural? Yoga, certain supplements and behavioral therapy are good migraine treatments. (Photo: Unsplash)
Acupuncture: At the 2018 AHS Scientific Conference, new evidence was introduced on the potential of acupucture as a preventive migraine treatment. Dr. Mathew thinks “it’s fine to try. Many of my patients tell me that those things can be helpful for kind of acute flares, but in the long run, they don’t have lasting benefits.” Learn more about acupuncture and acupressure.
Physical Therapy: PT can be especially useful if you have neck or postural issues that seem to trigger your migraines. The key, says Dr. Mathew, is learning the exercises and continue doing them at home. “People that say, oh, physical therapy didn’t work for me are the people that don’t continue the homework. It’s like going to the gym and expecting to lose 20 pounds after going to the gym five times. Results come if you continue with what you’re doing. There’s no magic trick.” If you don’t like to move, massage therapy may be helpful. Yoga is another community favorite with good research support.
Behavioral Therapy: Seeing a therapist isn’t just for people with mental health diagnoses. “Behavioral therapy I use the most often in people who have a headache disorder plus sleep issues or anxiety and things like that,” advises Dr. Mathew.
“I think it’s really important for patients who have comorbid disorders like anxiety and depression to partner with a behavioral health provider in their area.” Discover options like CBT here.
Supplements: Dr. Mathew advises, “Supplements can be useful, particularly in people who are averse to taking medications or drugs,” which ironically may be safer given how thoroughly they are studied for side effects and efficacy. Dr. Mathew endorses the ones that AHS deems most effective, with “the most robust information: magnesium, riboflavin, CoQ10.” He like the extra benefits: “Magnesium is good for constipation and also for muscle cramps. CoQ10 and riboflavin can be useful for people who are fatigued.” Discover more supplements here.
Start that Diary, Make That Appointment
If you haven’t discussed your migraine treatment options with your doctor lately, it may be a good time to make an appointment.
Between now and your appointment, catch up on that diary. “Patients may find them burdensome, but they’re really important,” implores Dr. Mathew. “The advice I give to patients is leave the paper diary next your toothbrush, your nightstand, on your bed, in a place where you are guaranteed to see it at the end of the day. So you’ll circle it. Fill it out. You’ll be good to go.”
Comments? Are you inspired or ready to update your migraine treatment plan?
One of the greatest challenges of living with migraines is having to frequently cancel plans on others – and the subsequent fear a migraine will interrupt your fun. That may keep you from committing to plans at all. It’s the “maybe life” referred to in some commercials. After 10 years of struggling with migraines and making plans, I discovered that my need to make and keep plans was actually raising my stress level.
That stress, fear, and anxiety of “maybe living” is one of the biggest migraine triggers. If you add that to other triggers, you may get a Big Event Migraine, a very common pattern. But it can be avoided if you can think differently.
In ancient Indian text Yoga Vasishta, it says “Our body is what our mind is; our body exists in our imagination only.”
“It is no secret that our mind and body are exquisitely linked to interact together. It was perhaps even better known in ancient times that our emotions affected our body, and vice versa,” shared Dr. Stephen Gurgevich on the integrative medicine website founded by Andrew Weil, MD, DrWeil.com. He continues: “Modern research on stress has shown that anything which influences our minds also influences our bodies. Expose someone to enough stress and sooner or later you will see their body showing signs of strain as a result of that stress.”
Like me, you may feel the desire to plan ahead and make commitments you are sure you can keep. But for people with Migraine, it’s a good idea to make two plans for holidays, special occasions or big events. Plan A and Plan B.
Plan A: Plan everything assuming that you will be healthy and migraine-free. Plan assuming you’ll have the normal capacity to handle and execute all of your plans and activities. Consider your migraine triggers and how you’ll avoid them. Otherwise, expect the whole event as usual.
For example, if you’re planning on going out for a picnic, assume you’ll be perfectly well that day.
Choose a beautiful, picturesque spot
Decide when you’ll go and how you’ll get there
Choose a menu and buy/prepare the food
Invite your guests
Include some outdoor activities like games, music, sports
Now imagine how your plan unfolds. You’ve planned your picnic to start in the morning. The night before, you can’t get to sleep because you’re worried about the possibility of rain, heavy traffic, whether one of your family members is not well enough to go, and if you have enough food to feed everyone. Then your mind races to the consequences if you have to cancel the picnic due to a migraine. You’ll have to call everyone, explain your condition, schedule another day – and that’d be really frustrating. And you still can’t sleep.
Plan B: If you do get a migraine, then what? That’s your Plan B. You’ll cancel the picnic, close your eyes and cover with an eye mask, get an ice pack, block out the sound, take a bath or try to sleep, and take medicine if necessary. Plan B needs to be realistic and accessible. Suppose you get a migraine once your picnic has already started. You may need to have two cars, for example, if you have to leave and don’t want to interrupt other people’s fun. You may need to pack extra water, your ice pack, eye mask and essential oil. You need to be ready to withdraw if necessary.
Examine why you might get a migraine prior to your event. You might initially answer: “not enough sound sleep.” True, that’s one trigger. Yet you should also consider what’s going on inside the mind.
Pain is one of our body’s languages to tell us something is not okay. Try to translate our body’s language. What is not okay? We’re anxious. We’re stressed.
Go to the root of this stress. We want to fulfill our desire to go out and experience life with people we enjoy. We want something to happen exactly in the way we’ve envisioned it in our minds.
How to Control Your Thinking and Plans
Now imagine you’re planning for the picnic in a different way. This is Plan B thinking. It has three parts.
First, give yourself an alternative. Tell yourself: ”If I get a migraine, I am going to stop all activities and take care of myself. I’ll just rest at home. At any point in time, I am ready to withdraw Plan A. I will come back home. I will follow Plan B.“
Next, check your motivations. Ask yourself: “Do you want this to happen, or do you want to participate in the picnic and have fun?” As the Yoga Vasishta advised, recognize that “our mind never wants to sit quietly, it wants to play or engage all the time.”
Finally, release control of the outcome. Now tell yourself: “I have no intentions. I don’t need anything. I’m okay whether I participate in the picnic or not. I am ready for Plan A or Plan B.” When you are convinced of these points, your stress, fear, and anxiety disappear. Once there is no stress, you’ve eliminated one controllable migraine trigger – and your chances of getting a Migraine are much lower.
You can’t control the weather, other people’s health or the traffic. You can control the food you pack, and to a large extent the stress, fear, and anxiety (and related sleep disruption) you experience prior to the picnic. Or any event, really.
Reduce your chance of a stress-related migraine by remembering this before the next big event you’ve planned:
Let Go: Don’t resist any thing or don’t try to hold on anything.
Plan: Have a Plan A and a Plan B, both of which you accept.
Adapt: Take the things as they come. Believe “anything is ok for me” and it will be.
Comments? Do you believe your plans or expectations create stress in your life that affects your migraines?
Personal stories have the power to change the world. We all have our personal Migraine stories, and a brave few share their stories through blogs. Stories connect us and help us remember we belong to something bigger.
Do you have a favorite Migraine blogger who speaks to you? Beyond MigraineAgain.com, where else do you turn for real-time advice or stories about living with Migraine?
You told us your favorite wellness websites. Now it’s time to vote for your favorite Migraine blogger – a shout out to the single-author bloggers and online community leaders who are flying solo, sharing their life experiences and insights.
This category is for individual bloggers (authored by real people with migraine and headache disorders), not websites with multiple writers like MigraineAgain.com. Some of our editors and contributors who maintain their own blogs are eligible for your consideration.
If we’ve missed your blog, please drop us a note at Editor@MigraineAgain.com to be added to the official list or write yourself in. We appreciate your work!
Weirdest Migraine Symptom: Speech aphasia in the postdrome. It’s very very mild, but I will substitute a word for another word.
Best Migraine Friend: Ice pack behind the head and a heated millet bag on my stomach
Most Amusing Pain Distraction: Comedy podcasts. Humour really, really helps take me out of myself.
How and when did you first get diagnosed with Migraine? Any specific type?
I was first diagnosed with ‘daily intractable headache’ about 10 years ago. My mum had had migraines for years, so there was a genetic component, but it took a series of big life events, coming too close on each other, to tip me over the edge. I’d had lots of big changes for a few years and then I gave birth to my first child and my dad died of cancer within the space of a couple of months.
What lifestyle changes have you made to help prevent Migraine attacks?
I don’t drink alcohol, I try to get to bed by 9 and I don’t usually go out in the evening. I’d like to say I don’t drink coffee, but that’s not true, but when I manage not to it really helps regulate my sleep which in turn helps with the migraines. I try to meditate as well, not to over schedule and to be ok with cancelling events.
What was the turning point in your Migraine Journey?
Taking headache classes organised by Kaiser’s chronic pain clinic here in San Francisco. The teacher was Dr Chris Gilbert, now retired, but he really turned things round for me. On the first day he said ‘You have to be very adult about this’ and it really stuck with me. It really encouraged me to take responsibility for managing my migraines. It also helped me not to think that I would find one solution that fixed everything, and most importantly of all, I became interested in learning more. That alone changed so much.
Who has been the biggest help to you on your Migraine Journey, and how?
I’d say Dr Gilbert, as mentioned above, and my family. They can be triggers too of course, but they ‘get it’!
What is the most surprising thing you have learned about Migraine during your Journey?
Khloé Kardashian, Ellen DeGeneres, Paul Giamatti and Erika Girardi Show the Ugly Reality of Migraine on TV
For years, it’s been pretty rare to see any substantial references to Migraine on TV or films. Until now. Three times this spring, main characters in popular television shows experienced Migraine attacks that figure prominently in the storyline. And a fourth special features a joke about a new Migraine medication.
If’ you’re a fan of Bravo’s Real Housewives of Beverly Hills (RHBH), Showtime’s Billions, E!’s Keeping Up with the Kardashians (KUWTK), or Ellen DeGeneres’ stand up special Relatable on Netflix, you might have leaned into your TV screen when scenes talking about Migraine appeared in recent episodes.
Did they get it right? We’ll share our take on each of these portrayals of the disease we all share.
Migraine, Get Ready for Your Close-Up
We can thank the makers of Emgality, Ajovy, and Aimovig for bringing Migraine back into the national conversation again. It’s hard to miss the prime time ads on network and cable for the first three medications in the anti-CGRP category that are now helping people prevent Migraine attacks.
The good news: that’s giving writers and entertainers greater permission to finally talk about Migraine on TV, mirroring what they are struggling with privately. Kristin Chenoweth and Terrell Davis shared their Migraine stories at this year’s Migraine World Summit. And People Magazine, Huffington Post and The Talk took notice – and so the buzz began.
Finally, Migraine is coming out of the closet and having a moment in popular culture.
Ellen’s Relatable: Migraine is Funny … But Not Really
Even Ellen DeGeneres incorporated Migraine into her “Relatable” comedy special on Netflix (which is excellent – don’t miss it). She jokes, “I saw an advertisement for [a pill] that stops headaches and migraines before they start. That’s some good marketing right there, isn’t it?” And then she imagines the conversation that might happen between a doctor and a patient.
“Are you in any pain?
No, not at all.
I’m going to give you something for that.
But I’m not in any pain …
… And you won’t be.”
Ellen pokes fun at the new preventive medications for Migraine. Image: Netflix
This mention made me chuckle, as Ellen often does. She’s probably referencing the new CGRP Migraine medications which help prevent attacks before they occur, the latest entries in a slew of Migraine prevention drugs like Botox that people have been using for decades.
And who wouldn’t want that? It’s very relatable and likely to pique the curiosity of anyone with Migraine looking for relief.
“I get really bad migraines but they’ve been increasing more and more. And I don’t know if my migraines and nausea are caused by the same thing, I’m not really sure,” she said. Her sister Kylie Jenner suggested it might be pregnancy, a reasonable suspicion that turned out to be false. It was Migraine.
“Some days I feel great and I don’t feel nauseous at all and I don’t have a headache and I’m fine,” Khloe shared. “And then the next day, the slightest thing might really upset me, and I get blindsided by them.”
We know. Attacks are frustratingly unpredictable.
Khloe continued, “I’m happy that I’m not pregnant because I didn’t want to be. But with that being said, now I’m like, ‘Why the f— am I nauseous all the time?’ I almost wish I was so I could say that’s why I’m nauseous.”
Stressful days for Khloe and Tristan may have triggered Migraine. Image: Entertainment Tonight/YouTube
No Danger, No Answers
“Literally my whole head feels bruised because it’s been pounding for so long and it’s terrifying,” Khloe continued. “I’m supposed to go to Cleveland tomorrow to see Tristan, but the way I’m feeling right now, I don’t know if I can be on a flight like that. I’ve been throwing up blood. It’s so intense. I’m blind in my left eye.”
Some people might have dismissed the symptoms, but Khloe postponed her trip to get an MRI. No danger, the doctors said, but no answers either.
“I want everything to be all fresh and perfect for him,” Khloé said. “But today I have a migraine again, and that’s just annoying because I want to see Tristan. I miss him.”
Kudos to the producers for capturing the reality that it’s not just a headache – nausea and vomiting are incredibly common symptoms. We can also relate to the mystery of inexplicable and scary Migraine symptoms. And the stress from a move, inexplicable symptoms and the risk of an unplanned pregnancy.
All in all, a pretty accurate depiction of the stress that can trigger a Migraine attack, the symptoms that accompany it, and a typical approach to medical care.
JAMIE MCCARTHY/GETTY; GEORGE PIMENTEL/GETTY; MIKE MARSLAND/WIREIMAGE
Billions: Chuck Rhoades Gets Migraine-Shamed by His Dad and Wife
Speaking of stress, few characters experience a more intense, backstabbing daily life than Billions’ Chuck Rhoades, who plays an aspiring New York State Attorney General with a penchant for pain (of the S&M variety). Showtime can get away with that.
What made me lean in was the episode in which Chuck has a ‘tension headache‘ that his powerbroker dad tells him to suck up. Nope, it’s a migraine attack, at work, at a very inconvenient time.
In Episode 3 of Season 4, Chuck appears reclining on his sofa with a washcloth blocking the light from his eyes while he talks with his father on the phone.
It’s not a tension headache. Image: Creative Commons via Showtime.
Son, are you hungover again?
It’s a migraine, wearing out it’s welcome.
Well, walk it off!
Not Tonight, Honey
In the next scene, during an awkward negotiation about a bad press item, Chuck pauses to open a pill bottle and throw two tablets back without water. Delayed treatment…not the best idea.
Still hours later at home, Chuck explains to his wife Wendy, “I thought killing that article would’ve killed this migraine” and takes two more pills. No sleep for Chuck tonight – doesn’t he know they have caffeine?
Wendy diagnoses him flatly: “They’re tension headaches.”
He flirts back, suggesting that sex might be the ticket to relief. It’s not crazy – there is actually some evidence for using sex instead of Excedrin. “Well, there is one practice I’ve found helpful in tension relief.”
“I’m not a dispensary handing out palliative care, but …” she offers.
He sighs, “I’ve literally got the proverbial …” and she finishes his sentence “headache.” She still thinks it’s a tension headache, and she adds, “You still have those headaches” because people are coming after him, and he agrees. Stress is a trigger.
Next day, Chuck is still in pain. Apparently, the Excedrin didn’t help much, as he is applying a cold wet washcloth to his forehead at the office.
That evening, he and Wendy attend a fundraiser and she asks, “You okay?” He replies, “Yeah, I just need a second to get the game face on.” He fakes his way through the evening, sustained by one of his strange self-inflicting pain practices. Presumably, he thinks you truly can’t feel pain in two places at one time. Clearly, not an evidence-based relief strategy.
Storyline Misses Risky Choices
At the end of the evening, after listening to a concert, he groans and his father says “Head still pounding, eh?” Chuck nods and pops two more Excedrin Migraine. He closes the evening with a glass of whiskey on the rocks, a questionable choice if he’s really in the midst of a stubborn attack. But we won’t judge.
In the final scene of the episode, he resolves some of his campaign worries and exhaling, tosses the nearly empty bottle of Excedrin in the trash. Not exactly the best endorsement of the product, but a fairly reasonable depiction of a stress-triggered, stubborn pain that impedes your ability to work over a few days.
In this case, it’s not a woman having an attack – it’s a man. And he’s the one who isn’t able to make love to his spouse for a change – a nice switcheroo on the “not tonight honey” stereotype. As for his excessive use of OTC pain relievers, well, that’s pretty realistic, too, since about half of all people with Migraine never use prescription meds for relief.
Our only criticism: Chuck consumes at least eight pills in a short period of time, practically an invitation for aspirin-induced Medication Overuse Headache. The FDA warns us that’s not a good idea. Nor is chasing it with Scotch.
So don’t do what Chuck does.
RHOBH: Erika Girardi Isn’t Just ‘In a Bad Mood All the Time’
As reported in People Magazine, things between Erika Girardi and Kyle Richards came to a boiling point during a recent episode of Real Housewives of Beverly Hills after Kyle accused the singer of “being in a bad mood all the time.” Tension flared during the cast trip to Provence, France.
Girardi, 47, came down to breakfast wearing large sunglasses and a pained expression. She explained to the ladies that she had a migraine.
You can relate if Migraine attacks have ever made you irritable, anxious, depressed or a bit antisocial. In Erika’s case, she endured both the pain of the attack and the rejection of her friends. Ouch.
Which Real Housewife has migraine? Hard to tell with the glasses. Image: Instagram: Kyle Richards
During her confessional interview, she revealed, “I’m not in a good mood. I have a vicious migraine brought on by lack of sleep and bitches that want you to be offended by something you’re not offended by.”
Wine and Migraine Don’t Mix
In this episode, the ladies ventured off to a wine tour via helicopter. Several glasses of wine and silly impressions followed, but Erika mainly had to abstain from drinking due to her migraine.
“When you don’t drink, you get a little irritated with the drunks,” Erika said in her confessional. To which Kyle said she felt “sober Erika” is no fun. Someone else accused her of being a “Debbie Downer.”
Again, another fairly accurate depiction of the many ways that Migraine affects our lives, including social isolation and awkward dining situations. It must’ve hurt Erika when her friends didn’t understand that wine drinking is a calculated risk of triggering more pain.
Ultimately, Migraine is underrepresented on television. Given its prevalence in society, we should be seeing 1 in every 5 female characters and 1 in every 10 male characters dealing with an inconvenient, disabling attack. These four examples of Migraine on TV are a start in the right direction. We just need writers, directors, agent, and actors to create the disease reality that reality stars are living out onscreen.
Comments? Seen any other credible or erroneous scenes of Migraine on TV?
There is a ton of bad Migraine advice out there – most of which isn’t helpful at all. Most of the time, people offering suggestions mean well, but they just don’t get what it’s like to manage migraines day in and day out.
Are you drinking enough water? Have you tried chiropractic? What about acupuncture? Standing on your head?
They don’t get that each one of us has a unique and complex Migraine experience. They don’t get that we require (and deserve) an individualistic approach. They end up putting everyone with Migraine in the same, oversimplified box.
“It’s been really surprising dealing with all the misinformation and lack of knowledge out there,” Ashley B. from Virginia told Migraine Again in her Migraine Journey. “People think they can just approach you with their Migraine advice or solution or idea of what you should do, but if you don’t have Migraines yourself you will never truly understand what it is like to suffer with them.” Ashley has been living with Migraine attacks since childhood.
7 Migraine Tips No One Should Follow (and What You Should Do Instead)
Discover the kinds of bad migraine advice you can safely ignore – and consider these alternative tips instead.
Bad migraine advice #1: Just take an Excedrin (or Advil)
It’s a Migraine Catch-22 – you need medication to treat your Migraine attack, but taking too much can make it easier for another Migraine attack to hit. It’s an unfair phenomenon called medication overuse headache, and it can happen if you use abortive medications more than 2 days a week.
While medications like triptans or painkillers prescribed specifically for you can make a dent when a doozy hits, they can also contribute to developing medication overuse headache if used too often.
Smart migraine tip: Rotate therapies to avoid Medication Overuse Headache.
These rebound attacks can be avoided by varying your treatment plan as opposed to getting stuck in a persistent wheel of pain meds. Instead of relying only on painkillers like NSAIDs or opioids, try treating some attacks with triptans or neuromodulation devices. However, triptans can also cause medication overuse headache, so be sure to take no more than 9-10 tablets per month.
If you find yourself reaching for abortive meds to treat an attack more than 2 or 3 times a month, it might also be time to talk to your doctor about your options for prevention.
2 – Bad migraine advice: Try to relax – you must be letting stress get to you.
Nothing is more stressful than being told you’re too stressed!
Stress doesn’t cause Migraine, but it can definitely make it worse. Research has proven that stress is not only a trigger for individual Migraine attacks, but it can also contribute to episodic attacks turning into Chronic Migraines.
Smart migraine tip: Adopt some kind of relaxation therapy to practice regularly. Take extra breaks for relaxation during stressful times.
One of the most important things you can do is learn to recognize when your body is in fight or flight mode and allow yourself to take a break. Adopting a go-to stress-relieving practice that you put into use during tense times will help you avoid what’s known as a “letdown” headache or migraine.
According to psychologist Dawn C. Buse, Ph.D., “It is important for people to be aware of rising stress levels and attempt to relax during periods of stress rather than allowing a major build up to occur. This could include exercising or attending a yoga class or may be as simple as taking a walk or focusing on one’s breath for a few minutes.”
3 – Bad migraine advice: Just figure out your triggers and avoid them
If only managing Migraine was as simple as cutting out triggers!
First off, there are hundreds of potential triggers and it is impossible (and unhealthy) to avoid them all. Not all triggers affect every person, and different triggers can affect you differently at different times. Some are controllable, like strong smells, and some are uncontrollable, like hormone fluctuations. Check out the seven biggest triggers to see what you can try to control.
Most people only have a few triggers and some Migraine attacks even occur without clear triggers. To make it even more complicated, doctors disagree about the role triggers play: some think eliminating triggers is essential while others think triggers play a very small role.
In an interview with Migraine Again, Dr. Andrew Charles of UCLA, said, “Many patients can have what they perceive as trigger foods without evoking a headache after eating it, as long as they have these foods in moderation and not on an empty stomach. Alcohol, for example, is commonly reported as a trigger, but some people may be able to have small amounts of alcohol without having it cause a headache, as long as they have food first.”
Smart migraine tip: Keep a diary to identify potential triggers and consider adjusting your diet, sleep, exercise, and hydration … but watch out for trigger anxiety.
Rather than living a life of avoidance, take prevention into your own hands by identifying your personal triggers with an app or migraine diary. A diary can help you identify patterns in your attacks. Record factors like sleep, stress level, food, water intake, and exercise alongside notes about your Migraines to get a clearer picture of what kind of triggers increase your chances of getting an attack.
Often, food can be guilty of triggering an attack—here are three simple things to remember when navigating the grocery aisle.
4 – Bad migraine advice: Don’t obsess about your health! Try to forget about Migraine between attacks.
It seems like everyone has an idea about your health.
When it comes to Migraine, we all would agree that it’s better not to get one versus trying to nurse ourselves out of an attack. Migraine attacks are notoriously difficult to get rid of once they’ve taken hold.
Smart migraine tip: Focus on prevention rather than treating an attack that’s already happening.
The good news is, you have a ton of options when it comes to preventing attacks. The fundamental goal of prevention is keeping your brain and body in equilibrium.
Medications and lifestyle choices like diet, sleep, and hydration can play a role. Take a look at these prescription options to prevent attacks and lifestyle changes you can make to decrease your Migraine count.
5 –Bad migraine advice: It’s just a headache; push through it.
It can take a lot of patience and personal strength to remain calm when you feel dismissed by bad migraine advice.
Just – no. Migraine is not simply a headache—leading experts agree that Migraine is a disorder of the brain. A severe, throbbing headache is just one of more than 40 symptoms that can come with an attack. It’s a neurobiological disease that often runs in families, with a strong genetic component.
Smart migraine tip: Allow yourself to rest.
We get it—you have a huge to-do list, you have places to go, and people to see. To put it simply: you have a busy life. Putting the brakes on what you’re doing is the last thing that you often want or can do, but it could be the most important.
Pushing through Migraine symptoms can make an attack hurt more and last even longer. Rest isn’t a choice – it can be a must. Sometimes, you need to take a time out. It’s all about ‘me time’ and knowing when to take it.
6 – Bad migraine advice: It’s all in your head. Examine your psyche to discover what is ‘really’ wrong.
A 2014 study found that those with adverse childhood experiences had a significant increase in Migraine incidents as adults. Migraines are also linked to bad experiences that can remain lodged in the subconscious, as well as trauma which can exacerbate Migraine.
Migraine comorbidities, which mean other disorders like anxiety and depression go hand in hand with Migraine, although they don’t necessarily cause each other.
“I want people to know that comorbidities are not a sign of weakness. They are medical conditions that are related to the wiring of the brain and the body, neurotransmitters, and possibly a genetic predisposition,” said psychologist Dawn C. Buse. “That does not mean that there is nothing that can be done about them. In fact, they can be improved with both behavioral approaches and/or medication. Improving these comorbidities may also improve Migraine.”
Migraine is a debilitating chronic disease that has a staggering impact on both the person with the Migraine as well as their friends, families, and livelihoods.
Smart migraine tip: Try to accept that Migraine is not your fault. Remember that Migraine is a neurological disease.
You did not do anything to deserve or ‘cause’ your Migraine attacks. Period.
7 – Bad migraine advice: You should try ___ (fill in the blank)
When your well-intentioned neighbor doles out unsolicited and obviously bad Migraine advice, it just adds insult to injury. People think they are helping, but it is frustrating at best and painful at worse to be on the receiving end of advice. Migraine is an invisible disease that is so often dismissed by friends, family, coworkers, and the general public.
When people offer advice, they assume that you aren’t already doing everything you possibly can. And you probably are. Simply smile and say “Thank you for your concern. I’m continuing to research and test any and all options.”
An empathetic, open ear is always a better way to support a friend who is struggling with Migraine than offering unsolicited advice.
Smart migraine tip: Do your homework and look for evidence-based treatments.
Open-mindedness and tenacity are two excellent characteristics for people with a mysterious disease like migraine. Don’t stop searching and asking others – you never know who may have an idea that can make a difference in your health. Look for evidence-based therapies backed by independent, credible research studies. It’s the only way to avoid wasting money or time. Find out how to interpret migraine research here.
Best Advice Above All: Listen To Your Body
Listen to your body. You know your body best, but, sometimes the simplest thing—listening to yourself—can be the hardest. We all have responsibilities, but if you don’t make taking care of yourself your first priority, then the other things will end up sliding too.
Take time to rest. Make your own plan of attack with preventative care strategies and alternative treatments. Adopt self-care and de-stressing practices that you can turn to on a regular basis.