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general measures in the management of migraine

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Some general steps in the management of migraine include:

  • identifying and avoiding trigger factors which can reduce the frequency of migraine attacks by up to 50% (1).

  • regular sleep and dietary measures:
    • sleep can aid recovery
    • keep regular mealtimes
    • avoidance of trigger factors
      • when migraine attacks are frequent, a trigger diary may be useful in addition to a diary detailing attacks
      • a patient can be given a list of common triggers and record those present each day whether they have a migraine attack or not
      • the daily trigger diary and attack diary are best reviewed after at least five attacks. The information in each is compared for coincidence of (multiple) triggers with attacks
      • examples of possible trigger factors include (2):
        • extremes of weather (e.g. very hot or cold, strong winds)
        • long distance travel
        • loud noise or bright lights missing meals
        • strenuous unaccustomed exercise
        • too much or too little sleep
        • emotional stress and anxiety
        • in about 20% a foodstuff may be a trigger factor for migraine (2)
          • dietary triggers, if real, become obvious to patients and are usefully avoided
          • a suspected food should be excluded for a few weeks - when many foods are suspect, supervision by a dietician is advisable as elimination diets can result in malnutrition. Excluded foods should be reintroduced if there is no significant improvement. There is no case for blanket avoidance of cheese, chocolate or other foods, nor for other dietary manipulation

Reference:

  1. Prescriber 2002; 13(20).
  2. British Association for the Study of Headache (BASH) guidelines 2004

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