Maybe you've taken your meds, rested in a dark room, loaded up on water ... and you're still stuck with a migraine attack that's not going away. It's so frustrating! We've been there.
Migraine is a finicky disease. Just when you think you've figured out your triggers, symptoms, or coping techniques, the disease can morph and you're stuck in a bad health rut yet again.
It is incredibly draining — physically and emotionally — to deal with stubborn migraine attacks that won't go away, especially those lasting more than a day. Pounding pain, nausea, stiff neck, and other symptoms take a toll on your body, your job, and your relationships. The longer you're in pain, the harder it can be to think strategically and creatively.
The editorial team at Migraine Again has five decades of migraine experience to draw on, so we put our heads together to come up with the best research-backed strategies for breaking out of a migraine rut. We hope these practical tips will relieve symptoms and bring needed relief.
Migraines Not Going Away? 17 Ways to Get Unstuck
1. Track Your Attacks
Don't underestimate the power of data. Keeping a detailed diary of your migraine attacks, symptoms, and potential triggers can help you communicate more effectively with your doctor and identify headache patterns. A diary can also help you quickly see if your treatments are working, so you'll know sooner when it's time to try something new.
2. Mix Up Your Meds
If you reach for the same bottle of pills every time you have an attack, there is a chance those meds are adding more fuel to the pain fire. Persistent attacks can potentially lead to medication overuse headaches (MOH), also known as rebound headaches. The American Migraine Foundation defines medication overuse headaches as "a chronic daily headache and a secondary disorder in which acute medications used excessively causes headache in a headache-prone patient."
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The specific thresholds for each medication class to cause rebound headaches are:
- Use of simple analgesic pain relievers, including over the counter nonsteroidal anti-inflammatory drugs (NSAIDs), on 15 or more days per month
- Use of triptans, ergot alkaloids, and combination analgesics, on 10 or more days per month
- Use of opioids on 8 or more days per month
- Use of barbiturate-containing analgesics such as Fioricet (butalbital, aspirin and caffeine) on 5 or more days per month
If you're using any medication more than these guidelines, it's time to talk to your doctor about the best way to mix up your migraine treatment plan. Your doctor can also help you come up with a preventive strategy to help stop attacks before they happen.
3. Focus on Prevention
"An ounce of prevention is worth a pound of cure," Ben Franklin famously said. Talk to your doctor about your best options for preventing migraine attacks.
Harvard Health. Are the new migraine medications working? October 2019.
Botox is approved by the U.S. Food and Drug Administration for preventing chronic migraine attacks. And new migraine preventive medications have come on the market in recent years, including Aimovig, Ajovy, Emgality, Vyepti, Nurtec, and Qulipta. It's a better time than ever to find the prevention plan that works for you.
Prevention is a little more involved than just popping a pill, but it's an essential part of managing frequent attacks.
4. Get a Second Opinion
Furthermore, there are hundreds of different headache disorders and it is possible to have more than one type of headache. Tension-type headache, occipital neuralgia, and new daily persistent headache are all separate diagnoses with symptoms very similar to migraine. Consider getting a second opinion from a qualified headache specialist to rule out other disorders.
5. Track Your Actual Water Intake
Don't dismiss this idea — even our founder, Paula Dumas, found she wasn't drinking enough water. How do you know how much water you're actually drinking? Count the number of glasses you drink every day for a few days; you need half your body weight in ounces each day, more if it's hot outside or you're flying in an airplane. Staying hydrated can be an easy fix for preventing migraine attacks, but it's easier said than done. Tracking your exact water intake will make it easy to see if you're subconsciously setting yourself up for a dehydration attack.
6. Consider Complementary Therapy
Managing migraine often requires more than a pill — or even a handful of pills. Complementary therapies are alternative, mostly natural options that you can adopt alongside your current treatments.
Acupuncture and acupressure, nutritional supplements like magnesium and riboflavin, and physical therapy are just a few of the many complementary therapies worth considering and talking to your doctor about. Do a little research beforehand and don't be surprised if your doctor isn't an expert: Complementary therapies tend to fall outside of traditional doctors' experience.
7. Don't Let Stress Creep Up
Migraine attacks love to show up during and after stressful events. We call it the letdown effect: The stress leaves and a migraine attack takes its place.
According to psychologist Dawn C. Buse, PhD, clinical professor of Neurology at Albert Einstein College of Medicine, "One theory we have may be that during times of stress, glucocorticoids are released, which are steroid hormones, basically, that occur naturally in our body. While we’re in that time of stress, the body is in a fight or flight response, and those corticosteroid hormones maybe protected against pain. Then when the stressor is over, the body relaxes, and as that protective level lowers, there’s an increased chance for a migraine attack."
You can't really avoid stress, but you can affect how your body reacts to it. Schedule breath breaks during the day, especially busy days, so you periodically release some of that stress before it builds up.
Buse says, "During a stressful period you probably have limited time, so you'll want to find anything that you personally find soothing, calming, or relaxing. We know that 60 seconds of watching a funny video can release oxytocin and other calming hormones. We also know that anything that increases activity, like exercise, can be really beneficial.
Simply walking up and down a couple of flights of stairs, while it may sound activating, actually helps combat the stress hormones. Or you might want to do a mini guided visual imagery–type of relaxation."
8. Consider Mind-Body Work
It is completely natural to react to a migraine attack by tensing up and feeling angry, scared, or sad. This internal stress can feed the attack, though, and make it more difficult for your mind and body to recover.
While no amount of positive thinking will cure your migraine disease, adopting some kind of mind-body work is essential for coping with frequent migraine attacks. Cognitive behavioral therapy, biofeedback, relaxation techniques, and mindfulness are a few examples of mind-body practices that can help you remain calm and at peace.
9. Treat Your Whole Person (Including Other Conditions)
These comorbid conditions often interact with migraine, triggering attacks or making attacks worse. The best way to make progress with migraine is to treat comorbid conditions with it.
10. Consult the Experts
There aren't nearly enough headache specialists to treat the millions of people living with migraine — only one for every 85,000 people with migraine. Even if you're lucky to get a qualified doctor, you may have to travel to see him or her, or wait months between appointment times.
Luckily, you can learn from the top migraine experts without leaving your house. All you need is an internet connection and a ticket to the Migraine World Summit, and you can be a fly on the wall during one-on-one interviews with more than 30 leading minds in headache medicine.
11. Take a Timeout
If you're really feeling stuck with migraines not going away, it may be time to shake things up by taking a break. In the United States, your job is protected if you need to take a break for your health. The Family and Medical Leave Act (FMLA) allows you to take up to 12 weeks of unpaid time off work. If you're struggling with your daily routine, talk to your boss or HR about your FMLA options.
Going on an extended vacation or taking a restorative sabbatical are other options for taking a timeout. Sometimes you need to get out of your routine and deliberately focus on your health to get a new perspective.
12. Find Your Migraine BFF
Dealing with persistent pain is draining physically, spiritually, and emotionally. While science and medicine are incredibly helpful, your doctor is not going to be there to hold your hand during a terrible night or listen to your fears about missing out.
Support from someone who understands, whether in person or online, is so important for thriving in the face of chronic pain. Join an online community, start a migraine Twitter account, or call up an old friend. Migraine affects 1 in 5 women and 1 in 10 men; you are NOT alone. And you don't have to suffer alone.
13. Try Neuromodulation Devices
If you feel like you've tried most of the medication treatment options, you might want to consider neuromodulation. Do a little research on the various FDA-approved devices:
- Nerivio for acute and preventive use
- Cefaly for acute and preventive use
- Transcranial magnetic stimulation SAVI dual for acute and preventive use
- Relivion for acute use
- Vagus nerve stimulator gammaCore for acute and preventive use
You'll need to consult with your doctor and get a prescription for all devices except Cefaly, which is available over the counter in the United States. Prepare for a battle with insurance, though. These devices are all based on new technology and are rarely covered by insurance companies.
14. Explore New Treatments With Your Doctor
Are you ready to try a new treatment but don't want to find a new provider? Do a little research on our “New Treatments” page for fresh ideas to incorporate into your migraine treatment plan.
If you find yourself with an acute attack that lasts longer than 72 hours, however, it’s important to consult your healthcare provider or urgent care. Some of the acute treatments for status migrainosus, defined as an attack lasting longer than 3 days, include:
- Triptans
- Ditans
- Gepants
- Peripheral (e.g., occipital) nerve blocks
- Steroids (like Dexamethasone)
- NSAIDs
- Anti-nausea meds (metoclopramide and prochlorperazine)
15. Try a New Diet
There are so many different diets that claim to help migraine. We like to keep it simple with 3 rules to remember, but if you're dealing with migraines not going away, it's not a bad idea to try a new diet.
Folks in the migraine community have gotten better control over their attacks by cutting down on salt intake, watching out for high-glycemic foods, cutting out gluten, and even doing a full ketogenic diet.
Even if you don't want to overhaul your diet, you should consider boosting your intake of omega-3 fatty acids. The first of its kind, a 2021 study from the National Institute on Aging and the University of North Carolina found that people with migraine whose diet was rich in omega-3s, like those found in fatty fish, experienced less frequent and less intense migraine attacks.
It may take some trial and error, but it's worth it to find a diet that helps your body stay healthy.
16. Take Sleep Seriously
American Migraine Foundation. Sleep Disorders and Migraine.
It's possible that you have a sleep disorder like sleep apnea that is triggering those morning migraine attacks. If that it is the case, you can prevent some of your migraine attacks by ensuring you get enough sleep.
17. Level Out Hormone Swings
Many women are hit with migraine attacks before their menstrual period. Researchers are pretty sure it's the drop in estrogen before a monthly period that sets women up for attacks.
Track your head pain and other symptoms along with your cycle to see if there is a hormonal pattern. If there is, talk to both your headache doctor and gynecologist about your options for leveling out those hormone swings. If changing estrogen levels are a migraine trigger for you, stabilizing your hormones could help prevent those hormonal attacks.
When to Worry
Most headaches are nothing to worry about, but there are a few instances when you should get medical help. According to Harvard Health, you should see immediate medical attention if you experience:
- A sudden, severe headache
- A severe headache along with a fever, nausea, vomiting, shortness of breath, weakness anywhere in your body, confusion, double vision, or a stiff neck
- The "worst" headache you've ever had
- A severe headache if you rarely get headaches
- A headache that starts after a head injury.
Never Give Up
The big takeaway: You have options. Living well with a chronic disease like migraine is a marathon, not a sprint. You will always have more options to try and more people in the community to connect with.
Research and technology only continue to improve, with new migraine treatments coming on the scene this year. Take care of yourself the best you can, both during and between migraine attacks, and never, ever give up.
