How to Manage Migraine

Why does an ENT treat migraine?

Migraine is one of the most common reasons people come to an ENT with symptoms that seem to start in the ears or sinuses:

• Dizziness and vertigo. Vestibular migraine causes spells of dizziness or vertigo, with or without a headache, often with sensitivity to light, sound or motion. It is one of the most common causes of repeated dizzy spells. Dizziness that comes with hearing that changes, ringing or a full feeling in one ear needs a hearing test and an exam, because other inner ear conditions, such as Ménière’s disease, can look the same.
• “Sinus headaches.” Most headaches people think of as sinus headaches turn out to be migraine. You can also have both migraine and a true sinus problem.
• Ear pressure and ringing can also come with migraine.

If you have “sinus headaches” or dizzy spells that have not been explained, ask us whether migraine could be the cause.

Taking care of yourself in ways that lower the chance of an attack is sometimes called migraine hygiene. The steps below help both the headaches and the dizziness.

What daily habits help?

• Keep a regular sleep schedule. Aim for at least 7 hours a night, and go to bed and get up at the same time every day, weekends included. On weekends, do not sleep in more than about an hour past your usual time.
• Eat regular meals. Do not skip meals. Eat within an hour of waking and about every 4 to 5 hours while you are awake, and carry a snack for days when a meal may be late.
• Exercise regularly, for example 30 minutes of brisk walking, cycling or swimming at least 3 times a week. Keep it up when your routine changes, such as when you travel.
• Make time to relax for 10 to 20 minutes every day, with slow, deep breathing, a guided relaxation recording, soft light and quiet sound, or focusing on a calm image. Done daily, this helps many people have fewer attacks.
• Keep caffeine steady. You do not have to give it up. If you have caffeine, keep it to no more than 2 servings a day (an 8-ounce cup of coffee, a 6-ounce cup of tea or a 12-ounce can of soda each count as one), at about the same times every day, weekends included. More than that can set off an attack, and so can missing your usual amount. To cut back, lower it slowly over 1 to 2 weeks.
• Treat attacks early with the medicine plan you and your doctor made. Early treatment can keep an attack from becoming severe.

What can trigger a migraine?

Triggers do not cause migraine, but they can set off an attack in someone who is prone to it. Triggers differ from person to person, and the same trigger may not cause an attack every time. A migraine diary, a note of each attack with what you ate, how you slept and what was going on, helps you find your own triggers so you can avoid them. Keep it for at least 3 months, or for 3 menstrual cycles if your attacks may be linked to your period.

Can supplements help?

These supplements may make migraine attacks less frequent. Take them every day for at least 3 months before you judge whether they help. Magnesium and riboflavin have the most evidence behind them.

Check with your doctor before starting a supplement if you are pregnant, have kidney disease or take other medicines.

What about headache medicines?

For many people, an over-the-counter anti-inflammatory pain reliever helps an attack when taken at the first sign of it, while the pain is still mild: ibuprofen 400 mg (two 200 mg tablets), or naproxen 440 mg (two Aleve tablets, as the label allows for a first dose). Using pain relievers or other headache medicines on many days a month can itself lead to more frequent headaches. If you need them more than 2 days a week, talk with us or your doctor. If attacks are frequent or hard to control, prescription medicines can prevent or stop them; your primary care doctor or a neurologist can help.

When should I call?