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Getting back to the basics

Getting back to the basics

My first migraine occurred about 40 years ago. Since my dad is also a migraineur, I never had to live with the fear that grips so many people before they finally get a diagnosis. I was only five years old, so nobody questioned my motives either. The attacks were quite obvious, too.  In the beginning, my first symptom was photophobia, quickly followed by loss of color in my face. The ghostly white skin and dead look in my eyes were unmistakable. Vomiting wasn’t far behind, either.

I was lucky.

Migraines are strongly genetic in my family. From the beginning my experience was validated. I never once thought it was my fault. I had witnessed both my father and aunt in the middle of terrible attacks. In my home, migraine was just another part of life. It was only much later that people outside the family began to question the validity of my pain.

It’s easy for me to forget that most people don’t have that kind of early validation. Many suffer for years not knowing there are effective treatments. Still others are new to migraine and desperate for a proper diagnosis. So I started thinking about all the migraine knowledge I’ve take for granted.

Fundamentals every migraineur needs to know

  1. Track your migraine attacks. Make sure to include time of onset, duration, what you did to abort the attack or relieve symptoms, anything you thing may have triggered the attack, and severity.
  2. Don’t wait to treat your attacks. Use your preferred abortive at the first sign of an attack. The sooner you treat it, the more manageable the attack.
  3. Don’t skip meals. Keep nutritious snacks with you just in case your next meal is delayed.
  4. Drink plenty of water. Sometimes SmartWater or Gatorade is a good choice, too.
  5. Save yourself the hassle and just avoid common triggers (MSG, artificial sweeteners, processed meat with nitrates, anything fermented, strong smells, loud noises, flashing lights, etc.)
  6. Don’t just use medicine to treat your attacks. Invest in plenty of ice packs, hot packs, heating pads, massagers, ointments, sleep masks, pillows, blankets,and anything else that helps you relax during an attack.
  7. Have a back-up plan in case your medicine fails. No medicine works all the time. Work with your doctor to create a back-up plan.
  8. Reduce your risk of developing “Medication Overuse Headache” by limiting your total intake of pain-relieving medication to 2-3 times per week. If you are having more than 2-3 attacks or they are lasting a total of more than 2-3 days each week, please call your doctor.
  9. Know when to ask for help, both from loved ones and health care providers. Martyrdom is not a good migraine management strategy.
  10. Know the warning signs of a migraine emergency. Pain lasting more than 72 hours should be checked out by a doctor. If you suddenly experience numbness, tingling, paralysis, or difficulty thinking, speaking, swallowing, or breathing seek emergency medical help right away. Also get to the ER if you are experiencing the worst pain of your life.
  11. If you get more than 2 attacks per month, you need to see a headache specialist and get started on a preventive medicine.
  12. Treat all your symptoms, not just the pain. There are effective medicines that ease nausea, gastric stasis, photophobia, phonophobia, anxiety, and restlessness. Tell your doctor about all your migraine symptoms. Don’t just talk about the pain.
  13. Learn to recognize the signs of all FOUR phases of a migraine attack: prodrome, aura, headache, postdrome (hangover).
  14. Accept that there is NO CURE for migraine. Think of it like epilepsy. You always have migraine disease and sometimes get attacks.
  15. The goal of preventive treatment is reduced attack frequency and severity. Shoot for a 50% reduction from baseline (i.e. without preventives)

Keep this list handy to remind you of the essentials. Every migraineur needs to know these fundamentals.

Every migraineur deserves to know…

  1. It’s not your fault.
  2. You don’t deserve it.
  3. You don’t have to suffer.
  4. You are not alone.

There is hope.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • rebecca
    4 years ago

    Preventives only work if you can take them/if the side effects don’t outweigh the positives. I can’t take Depakote because I want to have a baby and also it made me gain a ton of weight when I was on it. I can’t take Topamax because it gave me kidney stones–and believe me, I’d rather have the migraines. I can’t take beta blockers or tricyclic antidepressants because they don’t work.

    So I’m SOL for preventives, and still having multiple attack days a week. I realize I’m probably having rebound headaches at this point but I also don’t have two weeks to take off work and suffer through stopping all the pain killers I take. I feel caught between a rock and a hard place, and I never know what to do about it.

  • Tammy Rome author
    4 years ago

    Unfortunately there are no medicines that specifically treat photophobia. Triptans, NSAIDs, and ergotamines all have the ability to stop the attack in progress. If the photophobia is part of the attack, then it will likely stop in response to these types of medications. However, in your case, as in the case of many migraineurs, photophobia occurs regardless of attacks.

    I am wondering though. Some other conditions also cause photophobia. It is an overlapping symptom with fibromyalgia, chronic fatigue syndrome, and autism-spectrum disorders. Additionally, people who wear glasses indoors a lot can set themselves up for chronic photophobia. My optometrist encourages me to avoid wearing sunglasses indoors as much as possible. He recommends tinted glasses instead. There are a few specialty brands that are migraine-specific for photophobia. That might be a safer way to go.

    Sorry I don’t have a better answer.

    4 years ago

    What medicines treat photophobia? I have this all the time, not just during an attack.

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