
Ask HN: Migraine prophylaxis? - selmat
Did you find your migraine trigger? Do you have some prophylaxis which works for you?
======
NickNameNick
Triggers for me are poor/insufficient sleep, stress, and large upwards or
downwards changes in my caffeine intake.

Regular exercise seems to have dramatically reduced the severity of my
migraines. Frequency seems to be decreasing too, as I am getting better at
controlling my triggers.

I don't like taking triptans, they seem to give me a nasty hangover that
almost as bad as just waiting the the migraine out, but it's hard to
disentangle the migraine and drug after-effects.

Mostly, I follow my doctors advice and take the maximum safe dose of Ibuprofen
as early as possible when I notice onset symptoms. Sometimes I use diclofenac
instead. Check with a pharmacist, but if you can safely take paracetamol, you
can combine paracetamol with ibuprofen or diclofenac.

I don't bother with over-the-counter medications that include some codeine -
the codeine is not sufficient to do anything useful, and the dosage of
whatever they are mixed with is often weird.

------
3pt14159
My migraines have mostly gone away now that I exercise regularly. For me it
was cardiovascular. I'd see an aura and I'd get ready for the pain when I was
a kid. Later in life I discovered that taking a simple Advil as soon as I saw
the migraine would head it off. When I was a kid chocolate covered almonds and
OJ would almost always hit me with a migraine. I discovered this by keeping a
journal of what I ate. Changes in weather could bring them on too, especially
if I was exercising hard right as the weather was changing. Bright screens in
dark rooms could take a "maybe migraine" and turn it on. I've also found that
if I wake up with a migraine that cannabis and Advil will put me to sleep
pretty quick, though I decided not to use cannabis anymore because it makes me
feel dumb for days and I was never a huge fan anyway.

~~~
trowawy99
I used to suffer from painful and paralyzing migraines, especially when sunny
days took over bad weather. I don't have any anymore.

A few years ago, I decided to carry Ibuprofen wherever I'd go and take 400 mg
as soon as I felt it would come.

Doing this for a duration of 6 months made them become less and less frequent.

My father who was also suffering migraines told me he had met a doctor that
gave him the same advice but with a more powerful medication (Naproxen) with
the same outcome.

And I still eat a lot of chocolate and almonds. ;)

This trick saved my life, really.

~~~
3pt14159
Glad to hear. When I was a kid the doc prescribed T3s since normal Tylenol
wasn't working. I wish we would have tried other fixes first because T3s
barely helped. They would just make me high and didn't solve the underlying
problem.

------
throwaway1789
As a background. I am nearly 40, 70 kg, 176m, pretty active person but not
doing very regular sport. I had migraine starting at the age of 10 or 12.

The best ways, for me, not to trigger a migraine are:

\- very good sleep. It means taking a 25 minutes nap during the day if I feel
tired.

\- very good hydration. I drink about 1.5L in the morning and just a single
cup of coffee.

\- low stress. The lower the better because stress reduces the quality of my
sleep.

\- if it starts, I try to stop the migraine as early as possible with directly
1g Aspirine. This is my way but here you need to ask your M.D. because of
course I cannot tell you what you should take as medication!

I was only able to achieve this as I started working from home (for the nap if
tired).

Sorry for the throwaway account. I am traveling, but if you have questions,
just ask and I will answer here.

Edit: from the other comments we all follow more or less the same method.

------
colinbartlett
Exercising 45 minutes a day, 7 days a week, reduced my migraines to near zero
after close to 20 years of suffering. I would recommend carefully tracking
them with a diary. (I used a separate calendar in my phone.)

------
lnufnu
I have many triggers. Some foods (probably histamine/tyramine sensitivity),
smells, and weather. After a few years they became chronic and almost always
had a migraine.

A combination of Zonegran, Botox every 12 weeks, and sphenopalatine ganglion
nerve blocks and naproxen for acute migraine have them under control now.
Topirimate negatively impacted my language skills and memory, but Zonegran is
more tolerable and effective. SPG has a long history for TMJ and facial pain,
and the Allevio and Sphenocath devices make the procedure easy. Other nerve
blocks and Cephaly have been helpful in reducing the severity of the pain. A
lower carbohydrate diet has also helped.

Vaping medical CBD has aborted a migraine immediately multiples times, but is
not available where I live yet.

There are new CGRP blocking drugs that are supposed to be on the market soon.
Aimovig is the first, and it's a preventative.

My doctor actually wrote an app to help people track their headaches:
[http://www.iheadache.com/](http://www.iheadache.com/)

------
uoaei
Dehydration, really fatty and dense foods, bright screens in dark rooms, and
lack of sleep are my triggers. I find aspirin and sipping on water for a while
will make the pain subside somewhat, and then a nap will clear it away.

I'm not sure if this is really the case physically, but I treat it as if
there's a buildup of metabolites in my brain, and that is pretty effective at
removing the problem.

------
kup0
Quick temperature changes. Bright light. Weather changes. Wearing something
tight-fitting on the head. Large changes in stress level. Caffeine withdrawal
is a big one. Getting 10 hours of sleep (first night) then 5-6 hours of sleep
(second night) is a common cause for me.

I think the #1 underlying cause for me has been not getting enough hydration
(or having electrolyte imbalances), though. As I've upped my daily fluid
intake, they are occurring less often in general.

Though, it's changed over time. At one point my most common trigger was
stress. Since I've changed jobs, that also has helped reduce the frequency,
very noticeably (was getting multiple a week at a stressful/hated job)

It's odd because different days, different pain meds seem to work better.
Aleve/Naproxen has the best overall efficacy for me, though. That, and/or
putting something cold on my face and neck and being in a darker room.

------
user_rob
I don't know what triggers my monthly migraine but I have found that
Citrulline malate (an extract of watermelon) a vascular dilator prevents it
for me 100%. Originally I had started taking it for sport reasons but
subsequently found it fixes the migraine! Must be that my migraine is due to
vascular constriction.

------
PokemonNoGo
Does anyone else get migraines from... relaxing? Like having a few weeks of
from work? Like I can wake up and after having enjoyed a full night of sleep
and a steady breakfast and have the aura break out one hour after waking up.
Christmas, easter, long weekends etc are times when I expect them to arrive.

As a child and young adult I just came to the conclusion that I got em when
they felt on arriving.... They were much more frequent then but less intense.

I also guess stress is a trigger for me since I usually have multiple episodes
around the day my father passed but that is the only stress I can remember
being a trigger. (This has only been the case since he passed. Can't remember
being triggered by stress before either.)

Edit: Does anybody else not really get "regular" headaches, like at all?

~~~
pingec
My mother experiences migraines most frequently on weekends when she does not
work, she has a stressful job. I have always thought of it as a "post-stress"
collapse.

~~~
PokemonNoGo
That sucks! Like I've always said to people I need to have something to think
about or do or else I might get a migraine... I do a lot of crosswords in the
summer...

I don't feel that stressed at all actually. I guess I could sleep more during
the weekdays. I clock about 5-6 but I guess that's normal? 3-4 makes me feel
kinda hyped which is weird.

------
j_4
I usually have strong auras and medium pain, and it can take between weeks and
months between attacks, though recently I had an attack two days in a row and
I felt like I had aura-like issues with my vision for weeks. Not a fun time.

Most of my experience is typical and mirrors things already mentioned in this
thread:

Triggers are a combination of stress, lack of sleep, strong light
(particularly sunlight), and sudden increase in coffeine intake (people have
mentioned a change both ways, and I'll have to pay attention if that's the
case). Possibly red wine and nuts, but I don't think they're big factors.

Regular exercise seems to decrease the frequency, and 400mg of Ibuprofen taken
once I notice the aura helps the pain.

------
wink
I'm glad insofar as I've been experiencing them less and less as I get older.
They were worst as a child and in puberty, bad during studying and kinda ok
now.

They're too rare to pinpoint a real trigger, but maybe it's indeed
[https://en.wikipedia.org/wiki/Foehn_wind#In_popular_culture](https://en.wikipedia.org/wiki/Foehn_wind#In_popular_culture)
as I have suspected.

I'm also glad I can usually just sleep it off in a night even in the worst
cases, or take 1-2 Ibuprofen and go to a dark, silent room for an hour or two
if it's only moderate.

------
amcrouch
Triggers for me are dehydration, tiredness, stress and oo much bad food. I
found that eating meat and dairy also had a massive effect on me and led to me
giving them up. I have been more or less Vegan since figuring that out 20 odd
years ago.

~~~
wallace_f
Same--I generalized it as basically my body is vindictive about treating it
badly. Except I'm better off with meat and dairy. And especially cheese. I
have experimented with vegetarianism, but only for my fussiness about my
feelings for helpless animals.

~~~
amcrouch
I dumped meat and dairy as I was also finding the more of that I ate the more
time I spent on the toilet. Then you start to read up on what you're actually
eating and being an animal lover it all just added up for me.

I should have added that I have also found exercise really helps me as well.
High cardio if I feel I could be getting an attack coming usually see's it
off.

------
danieltillett
OTC codine which has just been made prescription only here in Australia.
Worked perfectly for 30 years. I am not sure what I am going to do when my
stash runs out.

Edit. I should add my trigger is UV light which is all too common here in
Australia.

~~~
wycx
I feel the exact same way. Codeine has been working for me since 1990, turning
hours of pain into ~30 minutes of blurred vision.

Is codeine abuse really a problem in Australia, or more than it has been in
previous decades?

------
bryanlarsen
How I reduced my headache frequency by at least an order of magnitude. I still
suffer from sinus headaches, but that physical cause is easier to deal with
than other causes.

1\. Take a long vacation someplace where it's possible to stay the entire day
in bed with no light & no sound. (2-4 weeks).

2\. Gradually reduce caffeine intake over the first half of the vacation, with
no caffeine for the second half. Suffer through the withdrawal.

3\. Go back to work, using caffeine in small amounts only for medicinal
purposes. (Caffeine + ibuprofen works a lot better than just ibuprofen)

4\. Fix sleep issues. The lack of caffeine will make this a lot simpler.

------
julienfr112
+1 for exercising. I'm commuting by bike 2*30min a day, almost no migraine now
(except during the holidays, when i'm not). Paracetamol/acetaminophen 1g work
pretty well when taken at the beginning of the migraine.

------
amelius
I found some relief by holding my breath several times a day (using Wim Hof's
breathing protocol).

Not sure about the mechanism of action, but it seems that breath-holding
causes vasodilation in the brain.

See:
[https://www.ncbi.nlm.nih.gov/pubmed/10472977](https://www.ncbi.nlm.nih.gov/pubmed/10472977)

And: [https://www.migrainekey.com/blog/10-reasons-why-the-wim-
hof-...](https://www.migrainekey.com/blog/10-reasons-why-the-wim-hof-method-
freezes-migraines/)

(disclaimer: IANAMD)

------
Tharkun
Long term migraine-with-aura-without-headache patient here. I've found
reddit's /r/migraine to be a pretty good resource/support group over the
years.

I've not been able to find a source, in spite of years of logging all kinds of
data. The only thing I have noticed, but which I don't want to contemplate, is
that I have more frequent migraines when I have more sex. Much fun.

I take magnesium supplements and sometimes CoQ10, but I haven't really found
either of them to be effective at preventing migraines.

~~~
amelius
You're not alone:

[https://www.mayoclinic.org/diseases-conditions/sex-
headaches...](https://www.mayoclinic.org/diseases-conditions/sex-
headaches/symptoms-causes/syc-20377477)

Use of porn can aggravate the condition:

[https://www.sciencedirect.com/science/article/pii/S030384671...](https://www.sciencedirect.com/science/article/pii/S0303846717302883)

Here's a support forum for related conditions (warning: not secure http):

[http://poiscenter.com/forums/index.php](http://poiscenter.com/forums/index.php)

------
jlebrech
My trigger was MSG (monosodium glutamate) but don't take my word for it.
strong naturally occurring umamy taste can trigger for me too.

you should keep a journal of everything you eat, especially if you can take
note of the ingredients.

For me 1 or 2 days after consumption triggers it, but staying away MSG helps
in my case.

MSG sensitivity isn't taken seriously because it only really affect a tiny
subset of the population and the food industry has interest in it not alarming
the 99%.

I'm taking B2 which strengthens the blood brain barrier too.

~~~
constantlm
I've had one experience in Indonesia where I had a massive amount of noodles
with a massive amount of MSG in it. Soon after consumption of said noodles, I
had a migraine attack. I also had a ton of work stress at that point, so I'm
not 100% that MSG was the actual trigger for me.

~~~
jlebrech
stress will increase the blood flow to your brain and chemicals your liver has
metabolised from msg might enter your brain.

that why it's doesn't affect everyone as everyone metabolises things
differently.

~~~
vinoo99
[https://uniqsofts.com/jio-dth-booking/](https://uniqsofts.com/jio-dth-
booking/) [https://strackit.com/](https://strackit.com/)

------
jgalvez
2 likely triggers:

\- excessive polyunsaturated fats in your diet

\- poorly digested fibers in your intestines

Use butter/coconut oil instead of soybean/canola/sunflower oil if that's your
case. Avoid PUFA at all cost.

Also, cut grain-enriched ('whole') bread and avoid grains in general, i.e.,
favor mashed potatoes over rice, avoid peanuts etc.

Find more here:
[https://www.google.com.br/search?q=migraine+ray+peat+forum](https://www.google.com.br/search?q=migraine+ray+peat+forum)

~~~
krageon
Migraines run in my family and a lot of my friends have them (so this is a
large anecdote, not research). From that experience, I think "likely" is a bit
of a strong term for these triggers. The common factors are pretty clear in
this thread: Strong sensory stimuli (visual/auditory, sometimes smell), stress
and poor lifestyle habits (little sleep, little exercise, etc). These things
are "likely" triggers - most people report one or more of these. The word
you're looking for is "possible".

Along with that I'd like to point out nutritional advice is always an option,
but in practice it is so personal that it's best taken with a healthy amount
of skepticism.

------
Ninjaneered
I'm a bit surprised not to see Excedrin mentioned anywhere. Perhaps it's
because it has caffeine and reading some of the comments seems that caffeine
(dependence) may be a trigger?

I'm not entirely sure if I get headaches or migraines, but whatever they are,
they shut me down for hours and sometimes even a nights sleep doesn't clear
them. Depending on the severity, 2-4 Excedrin will clear me up in about 30
minutes.

------
locutusofborg
My triggers would be bright light, prolonged loud noise, insufficient food,
dehydration, and (I think) pistachios.

In terms of prophylaxis, my neurologist had me supplement with 130 mg of
magnesium, which helped. What really knocked down the frequency, though, was
when my psychiatrist started me on Lexapro, an SSRI, for anxiety.

When I get an attack anyway, 50mg sumatriptan. Doesn’t always totally
eliminate it, but usually at least helps.

------
danielmg
Bright light for me is my major trigger. I wear sunglasses whenever it is
bright and keep my head covered or stay in shade.

~~~
kotapi
Bright light is the same reason for my migraine triggers, especially during
summers with humid conditions.

------
nobrains
Cold air hitting my head (A/C air is worst. Fresh cold air doesn't seem to
trigger the migraine).

Dehydration.

Direct hot sun hitting my head for 30 minutes plus.

Not eating for 20 hours.

For most of these, the solution for me is rest, sleep, being in a temperate
zone and having an electrolyte drink. In extreme cases I might take a
paracetamol or ibprophen or a muscle relaxant.

------
jaziek
My triggers tend to be stress, dehydration and too much screen time. I find
that if I can take some aspirin/paracetamol and get to a dark, quiet place as
soon as I start to see an aura, I can usually limit the pain somewhat, but
I'll still be unable to actually _do_ anything for the duration.

------
nickclare
In terms of prophylaxis meds, I've tried a few. Currently on a combination of
Botox injections, and Sodium Valproate and Topiramate (brand names Epilim and
Topamax). I've found they make a huge difference, but they do have some quite
unpleasant side effects

------
amelius
Found this blogpost:

[http://suppversity.blogspot.com/2013/06/natural-migraine-
pro...](http://suppversity.blogspot.com/2013/06/natural-migraine-prophylaxis-
treatment.html)

------
kotapi
Been suffering since the last 10 years, for me it's the bright sunlight during
the summer accompanied by humid weather conditions(most of the times), I
prefer staying in the dark, I love dark rooms for some reason. Makes me feel
like a nocturnal.

------
kyriakos
Suffering ever since I remember. What causes them for me and its sometimes
unavoidable: 1\. Stress. 2\. Hunger / Dehydration (sometimes you can't just
leave everything and go eat). 3\. Spending too much time in the sun.

------
shekade
Trigger - less sleep, tension.

Drink 1.5 L of water as soon as you wake up before anything else (including
bath etc) and always drink water when in sitting position.

------
menix
For me magnesium (oral) works very well. 100mg to 300mg per day. Decreased my
migraine from weekly to once per half year.

------
jerf
Of course I have no idea what your problem is. And while I'm not sure I ever
quite raised to the level of "migraine", as I only on a couple of occasions
got something like a full-blown aura or blurred vision, living with 3-4 major,
debilitating headaches a week was a regular occurrence for me in my teens and
20s. (In hindsight I'm not even sure how I got through college. They mostly
struck in the afternoon, so I guess I was mostly getting my life lived in the
morning, which wasn't much fun since I was an evening person, due to, well, a
good chunk of the things I'm about to list....)

In rough order: Discovering I had celiac disease. This was the big
breakthrough without which I could make no progress, but it's not the only
trigger I have.

Caffeine withdrawal; I have somewhat reluctantly dropped it from my diet
because I withdraw at the drop of a hat (did you have 2.5 diet colas instead
of 3 by 3pm? Headache time!) and I got tired of having to plan my days around
making sure I got the right amount. (Possibly related to celiac; it can affect
the speed with which things like that enter the blood stream.)

Discovering I'm not "allergic" to cashews or pistachios in the anaphylaxis
sense but that they give me headaches.

Red dye 40. (Mostly in things I shouldn't be eating anyhow, but this was an
extra twist of the knife.)

Poor sleeping posture; a new mattress for me was helpful, I'd recommend back
exercises for everybody (specifically bridges), or at least everybody 6 foot
plus. Excessive snoring/sleep apnea.

Excessive sugar, or even just excessive simple starches; blood sugar spikes.

Dehydration. (For whatever reason, there are a number of situations in which
my thirst signal is simply inadequate and I must consciously consume water. I
don't die (obviously), but I get _massive_ headaches here that do not respond
worth a crap to any OTC painkiller very well. I'm still sorta trying to figure
this one out to see if it's a symptom of some other underlying issue, or if
it's just the way I am.)

Real root beer, for whatever reason; appears to be more than just the sugar.
(This took a while since I don't drink it very often, but it ruined a couple
of ice cream social-type things before I figured it out.)

I'm not sure if this was a headache trigger, but discovering that I had some
major heart issues that was a total asshole and only appearing while I sleep
(vagal paroxysmal atrial fibrillation), so I had almost no clue that I had the
issue, almost certainly a further effect of celiac. Treated with magnesium,
potassium, taurine and l-arginine, vitamin C, vitamin K, and vitamin D. (Yes,
it takes almost all of those for me. Celiac is "fun" when it comes to
nutrition; you "get" to learn a lot about nutrients.) The heart issue itself
may have been causing headaches directly, it certainly indirectly contributed
to the several reasons my sleep has been poor for most of my life.

I recommend trying something like an elimination diet:
[https://greatist.com/grow/easy-elimination-diet-for-food-
int...](https://greatist.com/grow/easy-elimination-diet-for-food-intolerance)
That particular link describes more of a "medium effort" sort of thing; you
can also go whole hog and eat nothing but simple meats, fruits, and veggies
for a while, and slowly fold things back in over weeks. It's extreme, but if
you are someone who is sensitive/allergic to, say, soy, wheat, _and_ dairy,
it's really the only sane way to find that out. It blows to find out you've
got one or more of the "major allergies" but it's a hell of lot better than
_not_ knowing!

Plus there's a chance you do the full elimination diet and it doesn't affect
your migraines at all; well, you pretty much eliminated food issues in one
fell swoop. Still a win.

Also grab a sleep recording app for your phone and record the audio of your
sleep. I'm not sure science is 100% here yet but it seems to me we're going to
end up in a place where basically all snoring beyond the most minor indicates
bad sleep. If you've got a lot of snoring or any other sign your sleep is
compromised, see about getting into a sleep study. In fact I pretty much just
uniformly recommend everyone who has not done this do it, because the cost is
virtually nil (the apps are free and it takes 5-10 minutes top to set this up
for a night) and the potential benefits large; it's worth doing for anyone who
isn't 100% sure they're awesomely healthy. If nothing else, the costs are so
low it's just worth it to satisfy your own intellectual curiosity about how
well you're sleeping; if you discover it's great, well, now you _know_ , which
is nice.

As you may have guessed from the previous paragraphs, it took me about 5-8
_years_ to work it all out. But I have gone from being rocked by headaches
almost continuously to pretty much never having a headache without knowing
exactly what I did wrong, what I should have done instead, and how to prevent
it in the future. Losing an evening to headaches is now almost always because
I did something stupid, rather than inexplicable life.

------
constantlm
Stress seems to be a trigger for me, so I actively try and keep my work
related stress as low as possible - eg. not taking on work with tight
deadlines. I also find that drastic changes in my caffeine consumption can
also trigger a migraine.

I'm "lucky" in the sense that I start losing a significant part of my vision
before a migraine attack, at which point I might smoke a small amount of low
quality cannabis (I get extremely anxious when I realise I'm about to get a
migraine and I've found this relaxes me and helps for the nausea) as well as
taking an oral dose of Rizatriptan Benzoate. I've not had success with other
triptans I've used, so I always make sure to have Rizatriptan Benzoate close
by.

TLDR, by managing my stress levels along with keeping an eye on my caffeine
intake, I've not had a migraine in months.

------
anonu
Don't skip your coffee.

~~~
kotapi
Caffeine is a great drug to keep migraines under control. No wonder it's used
in so many pills to act as a catalyst.

