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Optimum Migraine Care
There are many steps to optimum migraine care. The patient can even perform a number of them without the input of a physician.
- Keep a headache calendar and write down headaches, severity, what you took for the headache, and how you responded to the medication. It is helpful for female patients to mark their menstrual cycles because this is a common migraine trigger. Dr. Loftus has designed the iPhone and iPod touch app iHeadache to do this for you. Most importantly, it prepares reports for you and your physician to use to determine the correct course of therapy.
- Dr. Loftus asks all patients to avoid caffeine and chocolate, the most common migraine triggers for a period of time to see the effect. This means going completely caffeine free and chocolate free.
- Try to set a consistent sleep schedule and get plenty of rest.
What else can I do?
In addition to acute medication, migraine prevention is key for patients with more than 2 headaches a week. There are natural migraine preventatives that you will find on the migraine prevention page. These are generally not as effective as the prescription medications and cost more than the cheaper preventatives but you do save yourself office visits.
Consider that you might have rebound headaches. Caffeine can cause rebound headaches. Fortunately, it stops in less than one week if you stop caffeine. As a rule of thumb, the close you are to a 6 cups of caffeine per day, the more likely you are to have rebound. Rebound to some medications like triptans and NSAIDs exist as well but have never been shown to limit the effectiveness of preventatives. On the other hand, butalbital containing products and narcotics definitely make you less likely to respond to migraine prevention.
Ideally, preventative medications should limit your headaches to no more often than twice a week. A this point, the patient and physician can work to determine the best acute migraine treatment. Using the acute therapy early at the onset of a headache minimizes disability. When headaches are frequent, you have to weigh the risk of rebound headache versus disability. Therefore, when triptans work well, I believe it is better to risk overuse with this class of medications than take butalbital or opioids which make prevention less likely to work. Periodically, rebound should be ruled out by taking a one week triptan holiday.
Patients who are not doing well with their current physician should consult another physician. For whatever reason, some physicians like to treat headache patients and some like to avoid them. Even among neurologists, some are much more likely to take on and treat the more difficult patients. This is human nature and it is unreasonable to fight it. If you are not doing well with your current physician or you feel that your needs are being ignored, go see someone else. If you see someone who identifies himself or herself as a headache specialist and you are not making progress, then see a second headache specialist. Being a neurologist and headache specialist, Dr. Loftus is partial to the overwhelming data that migraines are not an allergy, a surgical disease, or some hormonal deficiency although their are times when these are substantial triggers. Therefore if you are not doing well with your physician, please see at least one headache specialist who is a neurologist.