Why me? every headache sufferer at some point ask this question, let’s take a look at the most common kind of severe headache, migraine, upwards of 20 million Americans suffer from migraines, they are three times more common in women and cost the American economy more than 30 billion dollars a year but why do we get migraines? we know that pain tells us when there’s something wrong, it’s our body’s early warning system but when the system is too sensitive it can trigger migraine, that sensitivity is inherited, it’s in our genes. Environmental changes that may not strike most people as dangerous or harmful can set off the pain response in people with migraines, either external, environmental factors such as too much sun or internal environmental factors such as a drop in estrogen levels or a change in sleep patterns can trigger headache in those of us genetically wired for migraine, so what is the person with headaches to do? First we need the right diagnosis, then we need to take care of the headaches, we can’t get a do-over on picking our parents and certain aspects of the environment are beyond our control so we need to focus on those aspects of the environment that can be controlled. It comes down to two things; observation and planning. Each of us needs to learn about our own headaches, work with our doctor to get the right diagnosis and then make a plan or treatment strategy so that we can be prepared for them and manage them, when they hit step one, the observation, not everyone gets headaches from chocolate and generic lists of things to avoid rarely work out.

We need to observe our own patterns of behavior to identify the things that contribute to our headaches, a great way to get started with this is the headache diary, there are a host of smart phone apps, computer programs and paper diaries available to help create a record, you don’t need to make a career out of it but by recording your headache frequency and severity time of onset and similar information for just a month or three, you may begin to see patterns that weren’t readily obvious. When you simply think back on your headaches, of course keeping a headache diary does no good if you don’t analyze it or don’t go over it with your headache doctor or just forget to keep it on a regular basis. For example, if your headache diary shows that red wine sometimes gives you a headache and a lousy night’s sleep sometimes gives you a headache, you can make the decision about whether to have red or white wine with dinner based on whether you had a good night’s sleep the night before, once you have your observations, it’s time to make a diagnosis. The headache specialist can help you construct a headache history which combined with the neurologic and general physical examination and any testing that might be necessary should lead to a diagnosis. There are more than 150 headache types and they’re not all treated the same, so a plan must begin with the correct diagnosis step to the plan.

Treatment strategy

A good treatment strategy should have three parts, rescue or acute treatment, prevention and lifestyle modification, usually the cornerstone of a rescue or acute treatment is medication but it is also important to have a strategy in place to hand off your responsibilities, to have a safe quiet dark place to go and so forth without these predetermined processes. Your mind will constantly cycle back to loose ends and other stressors making your medication less effective and your recovery slower. The second component of your treatment plan is prevention, prevention is made up of strategies you put in place to decrease your sensitivity to the environmental stressors that can trigger your headache again, medication often plays a role in prevention and the selection of your preventive steps is one of the most important functions your physician can perform, there’s no one-size-fits-all preventive behavioral strategies such as biofeedback physical therapy, stress management, integrated medicine and other strategies are essential to good outcomes for many patients. The third and final component of a treatment plan is lifestyle modification, this is often the most important and most beneficial by the same token, it’s often the first to fall by the way, once headaches are under control, if change in the environment can trigger a headache, that follows that providing your body with predictable orderly life will be to some degree protective against migraine thus the goals and lifestyle modification are to maintain consistent sleep patterns, eating patterns and exercise patterns. It is these three behaviors that influence changes in your body’s hormonal cycles. By maintaining consistency in these cycles, your body is better able to anticipate and adapt without spiraling out of control and into migraine.

Not every headache is our fault, to be sure we can do some things knowing full well we will probably get a headache and that’s okay, we have free will and sometimes that day at the beach or that Barry Manilow concert is worth the price but we are genetically hardwired to get headache under some circumstances so we need a plan to deal with headaches when they happen and the better we are at managing them, the fewer headache days we’ll have.

In addition, a healthy, balanced diet and regular mealtimes can help keep migraines at bay. Some people find that smaller, more frequent meals can be even better at managing symptoms.

Regular exercise, especially if it’s outside, can regulate your sleep and eating rhythms, and it seems to be another key part of managing migraine headaches. Shoot for 30 minutes on most days of the week.

It’s a good idea to try to maintain a healthy body weight, because obesity raises your risk for chronic daily headaches. A healthy diet, exercise, and sleep routine will help get you on the right track.

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