Breaking the cycle of chronic migraines

Breaking the cycle of chronic migraine was one of the most difficult things I’ve ever done. But it is very acheiveable. This is a survival guide to help break the cycle of chronic migraines and dramatically reduce your attacks. I realise that is a big promise to make. What gives me any right to make such a claim?

Here is a little more about me:

  • I’ve previously worked for one of the world’s largest pharmaceutical companies which makes a billion dollar migraine drug (don’t worry, I will not be endorsing any drugs).
  • I’ve had migraines for over 20 years; I’ve seen over 15 different types of ‘experts’ ranging from doctors to dietitians to ancient Indian alternatives in a desperate search for a cure or significant relief.
  • I’ve recovered from chronic migraines with sustained results.
  • I founded MigrainePal, a free tool for migraineurs, which has prevented over 1,200 migraine attacks for our several hundred migraineurs during beta trial.

So after all the money spent, experience, research and work with other migraineurs I’ve broken down the process to break chronic migraines into 6 steps. An entire book could be written about this subject, but this is short guide to get you started:

1. Keep a diary

If you’re getting 15 days or more of migraine per month you need to keep a diary. This is the first and most important step for both you and your doctor’s sake. Without this you don’t have the facts to make informed decisions.

Just 10% of migraineurs keep a diary but over 70% report significant to very significant benefits.1

I thought I knew enough without keeping a diary. Afterall, I’d had migraines for almost 20 years. But after just 3 months I realised just how wrong and stubborn I had been all this time. There are lots of options out there, but you want a diary that can record attacks, triggers, symptoms and medication. I use MigrainePal which shows my individual migraine health dashboard, provides summaries for the doctor and allows me to chat with experienced migraineurs in a private environment.

If you have no intention of keeping a diary then there isn’t much point to reading any further. It’s that important.

2. Find a great doctor (if you don’t have one already)

If you received a bad haircut, would you go back to the same hairdresser again? Probably not. So why are we so different with our doctor? Especially when our very health and happiness is at stake.

Strangely we often settle for much less than we should and when we’re dealing with something as life destroying as chronic migraine, you want to be working with the best you can afford. Typically these are migraine specialists or at least neurologists. Quick Tip: note that these people are not always the same.

If you’re not happy with your doctor, if they aren’t taking you seriously; aren’t listening to you or you don’t feel like you’re both working together towards a productive solution, then maybe it’s time to start looking around. Seek a referral to a specialist.

3. Manage your attacks

With a good doctor and a growing record of your condition, managing your attacks becomes much more deliberate and achievable. With the help of a good doctor you’ll have at your disposal a greater array of choices. There are literally hundreds of treatment options for migraine. But only your doctor who knows your particular history, condition, symptoms, allergies etc. will be in the best position to recommend what is likely to have the best chance of delivering results for you. This is an important source of hope and relief.

Quick Tip: Up to 50% of those who present to a specialist with chronic migraines have migraine overuse headache. A condition caused by taking too much medication over an extended period of time. Treatment of MOH is serious and must be performed under the supervision of an experienced doctor. If MOH is present, no other treatments for migraine will be effective until this is addressed! Often patients may have unknowingly had undiagnosed MOH for years.2

4. Uncover your causes

Steps 1-3 lay the foundations for migraine management but they will only get you so far. Attacks will continue to occur unless you uncover the root causes or triggers. These vary for each individual but here is a list of the most common ones.

5. Prevent further attacks

“An ounce of prevention is worth more than a pound of cure.”

This is doubly true for migraineurs given that there is no cure for migraine. Preventing attacks by managing your triggers should be a top priority. Learning to live well despite your condition is a part of migraine management.

This doesn’t mean becoming a hermit and living on rice and water. But it does mean getting a sustainable and healthy balance of exercise, rest, relaxation, work and diet. These are fundamental pillars of your health. If these elements aren’t in balance how can you expect your health and migraines to improve?

6. The Virtuous Cycle

In your first pass through steps 3-5, you will make a shallow sweep. That is fine and completely normal. You may have only a few weeks worth of your migraine diary record. Your doctor may not have much of a history of you. You may not have tried many treatment options.

But after several months, if you continue to monitor your condition, evaluate different treatments and better manage your key triggers you will start a virtuous cycle of recovery.

This is the holy grail of migraine recovery.

This is when you are experiencing positive momentum in the reduction of migraine. It may only be subtle. For example, reducing your migraines from 20 to 16 attacks per month. But it’s progress.

It may be that any rain would trigger an attack and now an attack occurs only from a massive thunderstorm. It’s a sign that your condition and your migraine threshold are improving.

Virtuous cycles and positive momentum is what pulls you out of chronic migraine. Step by step. But it’s only by keeping up progress, staying diligent that you make it out of chronic attacks.

Chronic migraines often take years to develop. So often the process of breaking out isn’t overnight. It’s about small wins, momentum and positive steps in the right direction.

Watchout: Often I’ve experienced positive results only to become complacent and eat the wrong trigger food I’ve been craving and I slip backwards. Learn from my mistakes. Don’t be complacent. Give yourself rewards for being good. But don’t reward yourself in ways that can cause a relapse like eating the wrong food, drinking alcohol etc. Reward or indulge yourself in other ways, like hiring a cleaner this weekend, watching a favourite show etc.

Having chronic migraines was one of the toughest things I’ve had to deal with in my life. It wasn’t just the migraines. It was the depression, the anxiety, the social isolation and the utter hopeless that I felt alongside the condition. I’ve been where you are now. There is nothing I want more than for you to turn things around.

Don’t get me wrong. I’m not cured. This process doesn’t end. I’m still on Step 6. But I’m happier and healthier now than I’ve been in a long time. And I’ve got the energy and willingness to help those who want it.

Are your migraines getting better or worse? Let me know in the comments below.

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1. MIA - Migraine Impact in Australia– survey by Stollznow Research, via national online panel, conducted in April 2011 amongst 507 Australians with migraine aged 18-64. The MIA survey was developed as a partnership initiative between Headache Australia and MSD. The survey was funded by MSD.

2. Negro, A. Martelletti, P. “Chronic Migraine Plus Medication Overuse Headache: Two Entities or Not?” J Headache Pain. Dec 2011; 12(6): 593–601.Published online Sep 22, 2011. doi: 10.1007/s10194-011-0388-3]