Everyone has a headache threshold, and given a sufficient stimulus, anyone can suffer a headache attack symptomatically identical to migraine. Individuals who are said to have migraine appear to have a relatively low biologic threshold for headache; their headaches occur spontaneously or in response to internal and external stimuli (e.g., menstruation, weather changes, ingestion of alcohol) at a greater frequency than would be expected for the general population. This lowering of the headache threshold may be inherited, may be acquired (e.g., following head trauma), or may occur spontaneously in the absence of any family history of migraine. While we remain uncertain as to what precise physiologic and anatomic factors work together to cause migraine, it is clear that the brains of migraineurs may be especially sensitive and that transient changes in brain blood vessels occur in many patients during an attack.

Acute (abortive) treatment for migraine involves an attempt to halt and reverse acutely the biologic process that is causing the headache. Preventative (prophylactic) treatment for migraine involves an attempt to raise the individual's headache threshold and thus render him or her less susceptible to attacks.

What You Can Do
Start by recognizing triggers, or patterns which are headache producing. For example, can you count on getting a headache if you are sleep deprived or oversleep? if you drink wine? if you smoke a cigarette? if you are emotionally upset? On your first day off after a hard week at work? When you menstruate? These and other factors commonly aggravate migraine and keeping a headache diary may help you identify which of them regularly contribute to your particular headaches. For some people, merely avoiding such triggers may reduce or eliminate the majority of the problem.

For everyone who suffers from migraine, an important point to emphasize regarding treatment is consistency of lifestyle. Many inpatient units designed for the control of headache utilize a very regimented schedule, and to some extent, it may be worth trying this on your own. For example, eat at regular intervals; attempt to go to sleep and awaken at the same time each day; avoid foods that seem to have provoked headaches in the past; begin a regular aerobic exercise program; and take any medications prescribed at consistent and appropriate intervals.

The effect of diet on migraine is controversial and varies widely from individual to individual. A complete diet list has been prepared by the National Headache Foundation and may be obtained by contacting that organization. Dietary suggestions for headache prevention include:

1. Be wary of alcohol: Aromatic alcoholic beverages (red wine, champagne, liqueurs, brandy, scotch) are particularly prone to cause headaches; vodka appears to be somewhat less likely to provoke an attack.

2. Be wary of aged or "strong" cheese.

3. Use monosodium glutamate (MSG) sparingly.

4. Be wary of cured meats (such as hot dogs or salami).

5. Use caffeine sparingly. Chronic, extensive ingestion of caffeine (in coffee, tea, soft drinks, and certain medications) may worsen migraine overall, and even short periods of caffeine withdrawal may provoke a severe migraine attack.

6. Avoid skipping meals, prolonged fasting, or excessive ingestion of sweets.

There are many great reasons not to smoke. For one, smoking may aggravate migraine.

A relationship exists between migraine and emotional stress. An acute migraine headache is certainly stress producing, and stress usually worsens the intensity or frequency of migraine attacks. While migraine is not "just nerves" or strictly psychosomatic, many patients will have a headache during or immediately after a stressful period. Stress is often impossible to avoid, but you can learn ways to recognize and deal with stress more effectively as it arises. This may include such simple measures as getting up from your desk from time to time to stretch your neck and legs, employing a babysitter one afternoon a week or exercising on a regular basis to relieve frustration, relax musculature, and improve cardiovascular tone. Exercise can be anything from a ten minute daily walk to much more strenuous activity. What is important is that it suits your lifestyle and promotes your sense of physical and emotional well being.

In some people, feelings of anxiety, anger, or impatience seem to be linked to their migraine. You must decide how true this is for you. Your headaches may be telling you that you need to alter certain circumstances or interactions with people in your life. Easy enough to say! This is clearly a lifelong process.

If your problems with headache are frustrating to you, it is probably safe to assume that those close to you also are frustrated. It may be helpful for you to discuss with them what you have learned about your headaches preferably not when you are having one. They also may gain reassurance (and a measure of compassion) from speaking with your physician and being informed of the treatment plan.

There are a variety of resources available to help you understand and cope more effectively with your headaches. If you have heard about and would like to try exercise regimens, stress management courses, biofeedback training, acupuncture, dietary changes, or psychological counseling for help with your headache control, please ask your physician for assistance. For certain patients these can be quite useful and may have a place in your treatment program. One cautionary note in selecting such programs: beware of those that promise a cure for headaches.

Another obvious treatment for migraine involves use of medications, either prescription or over the counter. Avoid both over treatment and under treatment of your headaches. Many medications prescribed for migraine can actually cause headache if taken too frequently or if taken at inappropriate times. On the other hand, if you are given a medication to abort attacks, do not wait to take it until your headache has become so severe that nothing is likely to help. A sufficient dose of aspirin taken early may go a lot further towards providing relief than narcotics given too late.

During a migraine attack, take whatever medication your doctor has prescribed. If possible, lie down in a quiet dark room with your head slightly raised. If you can take fluids, try caffeinated coffee, tea, or soft drinks. Some people find relief by pressing on the affected part of the head or by applying ice packs. After the acute attack has subsided, try to remain in bed or at least relax for a while longer. Keep a record of your acute headache attacks. This information should be communicated to your doctor, as it may assist in designing an optimal treatment program.