Patients with recurrent migraines often experience significant impairment as a result of their condition, which negatively affects their quality of life.¹ When discussing migraine prevention with your patients, they may ask about preventive measures and whether they require lifestyle changes or a more targeted treatment approach.
There are a number of options for patients seeking to prevent migraine recurrence that may be worth mentioning. Be sure to have a thorough discussion with them about their migraine history and overall health to determine whether lifestyle changes and medications are worth exploring for migraine prevention.
What should your patients know about how certain preventative measures affect migraine?
Food Management
Food management, in the context of migraine prevention, is about noticing the ways your diet affects your migraine; for example, keeping track of whether certain foods have seemingly triggered a migraine or if you’ve been eating meals at consistent times.² A consistent meal schedule may help keep migraine in check, whereas fasting can increase risk. In addition, keeping a food journal that also tracks migraine occurrences may help patients recognize potential triggers to avoid.
A 2020 study in Headache: The Journal of Head and Face Pain examined the role diet and nutrition play in migraine triggers and prevention. The researchers found that diets that eliminate certain foods may help reduce migraine risk.³ Specifically, alcohol and caffeine were often associated with an increased risk of migraine, therefore reducing consumption of both may help reduce migraine. The investigators also suggested that low-fat diets may be effective at reducing migraine, although they acknowledged more in-depth research is needed.
Other data the researchers analyzed suggested that diets rich in omega-3 polyunsaturated fatty acids show potential to reduce migraine frequency, and that ketogenic diets and diets that eliminate IgG-positive foods may also help depending on triggers. Discussing with your patients how different foods and nutrients affect migraine and overall quality of life may help to create a structured diet centered on preventing migraine.
Sleep Management
Migraines can potentially be triggered by a lack of quality sleep.² Therefore, prioritizing healthy sleep habits is key – and another instance in which keeping a journal may help identify what’s causing a lack of sleep and triggering migraines. Patients may find that distractions like their phone can affect their sleep. They might also find do exercise and dietary habits prior to bed play a role.
Patients experiencing migraine may also have comorbid sleep disorders, which can exacerbate one another. A 2021 study published in the International Journal of Molecular Sciences examined the association between migraine and sleep disorders, finding that insomnia, obstructive sleep apnea, and parasomnia were among the most common sleep disorders in patients with migraine.⁴ Per the researchers, patients with migraine and insomnia often have increased migraine attack frequency and pain intensity. The investigators also claim that, among parasomnias, sleepwalking has been associated with migraine and somnambulism has a higher rate in patients with migraine with aura.
Health care professionals may consider informing their patients of the ways sleep disorders may affect migraine and how to address the problem.
Stress
A common mnemonic device when discussing lifestyle changes for reducing migraine triggers is SEEDS: Sleep, Exercise, Eat, Diary, and Stress.⁵ Stress can be a trigger for migraine attacks, and if patients are finding an association between stress and migraine incidence, they may benefit from relaxation and mindfulness techniques. Patients may seek mental health care treatment if stress becomes overwhelming, or may opt to journal about their stress.
Beta Blockers
While lifestyle changes can be beneficial, many patients still require additional treatment to prevent migraine. Beta blockers, often used to treat blood pressure, may be an option. One beta blocker, propranolol, is a common first-line treatment for migraine and is seen as one of the most effective options.¹ As it is also used to regulate blood pressure, beta blockers may be considered for patients with migraine and cardiovascular disease.
Other options include atenolol, metoprolol, nadolol, and timolol.⁶ Though they may be effective, they also come with potential side effects patients should know about. These include fatigue, shortness of breath, nausea, insomnia, and low physical tolerance for exercise.
Various studies have come to similar conclusions about beta blockers – that they are potentially an effective option but may lead to side effects. A 2023 study in the Journal of Headache and Pain reviewed the comparative effectiveness of different migraine medications, including beta blockers.⁷ The researchers concluded that beta blockers were likely effective at creating a 50% or greater reduction in monthly migraine days for patients, but also had a higher likelihood of adverse events than other treatment options.
Antidepressants
Certain antidepressants have shown promise in their ability to prevent migraine, particularly amitriptyline.¹ Venlafaxine is another option that has been used for migraine. Side effects, depending on the antidepressant used, can include fluctuations in weight, dry mouth, and sedation.⁶
Treatments that focus on inhibiting the calcitonin gene-related peptide (CGRP) to block the pain signal are designed specifically for the treatment of migraine.⁶ Some studies have suggested that antibodies inhibiting the CGRP or its receptor are among the most effective treatments at reducing monthly migraine days while posing a lesser risk of adverse events.⁷
Ultimately, patients will need to discuss with their health care professional the ways their migraine is affecting them and the specific triggers they’ve noticed to determine the best course of action for prevention.
References:
1. Kumar A, Kadian R. Migraine prophylaxis. [Updated 2022 Sep 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507873/
2. Migraines: simple steps to head off the pain. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/migraine-headache/in-depth/migraines/art-20047242. Updated October 4, 2022. Accessed November 27, 2023.
3. Hindiyeh NA, Zhang N, Farrar M, Banerjee P, Lombard L, Aurora SK. The role of diet and nutrition in migraine triggers and treatment: A systematic literature review. Headache. 2020;60(7):1300-1316. doi:10.1111/head.13836
4. Waliszewska-Prosół M, Nowakowska-Kotas M, Chojdak-Łukasiewicz J, Budrewicz S. Migraine and sleep-an unexplained association? Int J Mol Sci. 2021 May 24;22(11):5539. doi: 10.3390/ijms22115539. PMID: 34073933; PMCID: PMC8197397.
5. Lifestyle changes for migraine. American Migraine Foundation. https://americanmigrainefoundation.org/resource-library/lifestyle-changes-for-migraine/. Updated May 6, 2021. Accessed November 28, 2023.
6. Migraine prevention 101: what it is, when to use it and why. American Migraine Foundation. https://americanmigrainefoundation.org/resource-library/migraine-prevention-101/. Updated May 8, 2023. Accessed November 28, 2023.
7. Lampl, C, MaassenVanDenBrink, A, Deligianni, CI et al. The comparative effectiveness of migraine preventive drugs: a systematic review and network meta-analysis. J Headache Pain 24, 56 (2023). https://doi.org/10.1186/s10194-023-01594-1
