Managing migraine is as much art as it is science, and it's not all about medication. Different things work for different people though - for example, some people are helped by heat, while others are helped by cold. Figuring out what helps you is just a matter of trying them all and seeing what works best. We asked the Migraine Australia Chat Group to tell us about their top tips or 'hacks' to manage attacks: here's the top 20.
1. Sleep it off!
Fatigue can be a significant issue during migraine attacks, but even if it isn't, sleeping is a great way to allow your body to get through the worst of the attacks without you having to be awake and feeling all of it. Plus, because your brain is taking in very little in the way of light, sound or other things that your brain may find sensitive, it can help you get through the attack faster.
2. Take medications as soon as possible - especially Triptans
As soon as you get the first warning signs is when you should be reaching for your medication. Triptans are 'abortive' migraine medications that can help stop the attack as it is just getting started. But, for them to be effective, you need to take them nice and early. You'll figure out your own sweet spot over time, for most people it's during the Aura phase (if you have aura) or just as the headache starts. The golden rule is don't wait to see if the attack will get bad - once the attack has settled in most medications will not make a dent.
3. The Aspirin Bomb: at least 900mg of aspirin
An oldie but a goodie and preferred first line of attack by many is to take a big dose of aspirin. At least 900mg, which is 3 of the normal tablets that you can get from the supermarket, or a little bit more, taken as soon as you can. If your migraine attacks usually stretches over a couple of days, an aspirin bomb is a great choice on day 2 or 3, leaving your triptans just for day 1.
4. Ice cold or frozen Coke
Controversial (because public health professionals will tell you that it's bad for you), but Coke is a fantastic migraine management tool. It has everything most people need - hydration, sugar, ice or cold, and caffeine is a proven treatment for migraine attack. Coke works very well in combination with the aspirin bomb too! In fact, caffeine can make many other medications work a little better in migraine patients. Just remember that caffeine can cut both ways, so treat Coke like medicine and only have it when you need it.
5. Ice packs
Ice packs are a great way to cool down the overheating system. Popular options are an ice pack on the back of the neck, across the forehead or eyes, or there are special ice caps or ice hats that are like an icepack all over the head. Some also like to put their feet in an ice bath.
6. Strong coffee
Like Coke, strong coffee is a great option to give you the big hit of caffeine, and is a better option for those who respond better to heat than cold. Alternatively, iced coffee works great too.
7. Hot shower or heat packs
Getting the blood vessels open throughout the body can relieve pressure on the pulsating veins in the head, so some find a long hot shower or bath very helpful. Try jumping straight in the shower just after you've had your initial triptans or other medications. If you get very achy during your attacks you may find that heat packs can be very helpful. A sore back or neck may be a prodrome or warning symptom of an attack starting rather than something unrelated, so it is best to treat those little niggles and discomforts in an effort to try and ward off a full attack.
8. Dark, quiet room
When our brains are over-reacting to everything, anything you can do to remove stimulation is good. Lying down in a dark, quiet room is a very popular suggestion - particularly if you are in too much pain to sleep. But make it *really* dark: have blackout curtains or use an eye mask, and *really quiet*: use headphones or earplugs, or consider putting a towel across the bottom of the door to just make it that little bit quieter.
9. Sports drinks
In a migraine state the brain overheats and uses up more sugars and fluids than it does normally. Sports drinks like Gatorade and Powerade can be very useful in rehydrating quickly and helping to relieve some migraine symptoms like nausea. If you find the flavours a bit too strong, you can get something like Hydralyte from the chemist, and if you find cold helps you it's always worth trying the electrolyte ice blocks you can get from the chemist too.
10. Anti-nausea medication
Obviously, anti-nausea medication like Stemitil, Ondansetron and Maxalon are useful if you are struggling with nausea, but did you know that they can help relieve the migraine attack too? Stemitil (procholarazipine) in particular has been proven to work as an abortive for migraine attacks.
11. Combine medications
Many people find the best way to abort a migraine attack is not in which medications they choose, but in the combination. Try combining caffeine with stemetil and aspirin, or taking nurofen at the same time as your triptan. Be sure to combine medication from different classes so you don't overdose or possibly cause problems with rebound headache (for example, combining Panadol Extra and Nurofen is ok, as paracetamol, caffeine and ibuprofen are all different classes of drug, but don't take Voltaren and Nurofen together as the are both NSAIDS). If unsure talk to your pharmacist about what you can combine safely. Remember the goal is to hit your attack hard and fast so you use less medication overall.
12. Drink lots of water
Ok, you can all take a minute to groan. And we'll take a minute to tell people who don't live with migraine to never, ever, tell someone with migraine that we just need to drink more water - we hate it. But this hack isn't about the amount of water that you drink normally: try drinking heaps of very cold water just as the attack starts - think of it as an internal ice pack trying to cool your system down.
13. Tiger balm or Vicks
These rub-on remedies may help with colds or muscle aches, but some migraine warriors use them to help manage attacks too. Try rubbing on the back of your neck or temples.
14. Go for a walk
If exercise and sunlight doesn't exacerbate your migraine, then going for a walk and getting some fresh air may be helpful. Sometimes just getting the body moving a bit can help regulate and normalise what's going on in your body, and fresh air is usually helpful for people with nausea too.
15. Salty food
Some people crave salt in the early stages of their migraine attack or in the prodrome, and if that's the case, you should feed it! Salt can help even out the chemical imbalance in the brain, particularly for those who have aura. Some natural therapists may suggest putting a teaspoon of sugar under your tongue - that's a lot of salt, talk to your doctor, but probably best to just enjoy some salt and vinegar chips completely guilt-free.
16. Weighted eye mask or weighted blanket
Weighted calming tools like an eye mask or blanket can help calm the system and aid in reducing the impact of a migraine attack. They're also really good for helping calm migraine-related anxiety and getting a good night's sleep.
17. Essential oils
There are a range of essential oils suggested that may help with migraine, or symptoms like headache and nausea. Some are marketed in very expensive roll-ons or other packaging - the basic essential oils do the same thing. Peppermint, Rosemary, and Lavender are very common essential oils suggested for headache, while ginger is frequently recommended for nausea. Magnesium oil can also be worth a try as an alternative to magnesium supplements.
18. Ice/heat combinations
Cold works for some people, heat works for others, and some people find that a combination is even better. It's not clear whether it has the effect of both cooling the system while widening blood vessels, or, whether the combination confuses the senses that are overloading the brain and causes a kind of system reset. Whatever is going on, if it works, it works! Try an ice pack on the back of the neck while putting your feet in a warm bath, or sucking on an ice cube while in a hot shower.
19. Go for a swim
Cold showers aren't much fun, but a swim in a nice quiet pool or even in the ocean can be really helpful for some people. A nice dip can be especially helpful if you can meditate or float a little. A cool bath or shower may also do the trick in a pinch. However, if you have vestibular, hemiplegic or brainstem migraine and are known to fall over or lose consciousness, please do not go swimming by yourself.
20. Anti-histamine medications
There's a lot of different things going on during a migraine attack. For some people the trigger is linked to an immune system reaction but you may not be aware of these links as the migraine attack itself can mask the normal symptoms. Try an over the counter anti-histamine like Claratyne or Zyrtec early in the attack to see if it can help reduce any immune system response that is exacerbating your migraine.
There are many tips and tricks for managing migraine: learn from other warriors and share the things that work for you in the Migraine Australia Chat Group.