Managing your migraine: Why not everyone needs CGRPs

By: Dr Kay Kennis, GP with a special interest in headache

7th December 2021

For some people with severe migraine CGRP monoclonal antibodies can be life-changing, but we should not forget about self-help and non-pharmacological preventive treatments

Monoclonal antibodies against the calcitonin gene related peptide (GCRP) or its receptor are arguably the most exciting development in migraine management for years. I have been uplifted by the number of my patients with disabling migraine who have been able to return to work or education, re-engage with their families and recommence long missed social activities. We are indebted to the many scientists and research teams who made this possible.

Unfortunately, this new therapy is not effective for all migraine due to the multiple mechanisms involved. Research continues to improve our understanding of these mechanisms so that one day we may be able to find effective treatment for all sufferers and perhaps even a cure.

Whether it is effective for you or not, self-care can play an important role in helping you manage your migraine.

Self-care for migraine is something that many readers will be familiar with but for those at the start of their journey, or even for those who have learned to live with severe migraine over many years, here is a short checklist of things to make sure you have optimised. You never know, sometimes the smallest changes can make the difference between feeling in control or feeling powerless against the condition. You may be able to prevent yourself needing strong medications, or developing chronic migraine.

Here are tips for managing your migraine:

  • Have a regular routine – try to get up and go to bed at the same time each day, even when you’re not having to work. Sometimes a ‘lie-in’ can trigger a migraine.
  • If you struggle to sleep, ask for help – many areas have sleep courses run by psychological therapy teams now. There is an app called sleepio, but this is not funded on the NHS in many areas of the UK. Sometimes sleep can be unrefreshing due to intermittent obstruction of the airway in the night (a condition called obstructive sleep apnoea), and the resulting lower oxygen levels can be a cause for headache. See your doctor to discuss this if you think you may be affected.
  • Eat regularly (at least three times / day) – the brain likes a regular supply of glucose to function well. Eat healthily since obesity is linked with worsening migraine.
  • Drink plenty of fluids – aim for two litres / day, and try to avoid caffeine, fizzy drinks or too much alcohol (some people have to avoid alcohol completely if it triggers their migraine).
  • Exercise for 30 minutes on five occasions each week – try to do this at a speed where you could talk to a friend, but not sing a song, then you know you are working hard enough!
  • Think about stopping smoking if you are a smoker – many of the chemicals in cigarettes trigger migraine. You can get plenty of help from your GP surgery if you want to quit.
  • Consider if you are under any stress. If you think you are, make time to actively manage this. Are there things you control which you can change? Could you benefit from relaxation therapies, Pilates, yoga or mindfulness? There are various apps which can help e.g., Calm. There is a free online information leaflet on manging stress available from Northumberland mental health here.
  • Consider if you might have clinical depression or anxiety. These are known to be much more common in people with migraine. Signs of clinical depression include poor sleep, poor appetite, loss of motivation or thoughts of worthlessness. Signs of anxiety include a feeling of restlessness, a sense that something awful is about to happen, or physical symptoms like intermittent butterflies, palpitations or shortness of breath when you’re thinking about your worries. If you think you have any of these ask your GP for further help and support. The NHS website Every Mind Matters also has some great resources to help you manage stress, poor sleep, depression and anxiety.
  • Think about whether your other medical conditions are controlled properly. If there is something else in the body that isn’t right then often migraine is harder to control. Musculoskeletal neck and shoulder problems are a particularly common cause for exacerbation, so get checked out by a physiotherapist if you think this may be affecting you. Some people grind their teeth at night and wake up with head pain. If you’re experiencing this, visit your dentist as they may be able to give you a special mouth plate to help you stop grinding your teeth.
  • Note down how many days each month you take painkillers. If it tots up to more than 10 days each month ask for help from your GP and try to leave off painkillers for 8 weeks. This is challenging since headaches may initially worsen, and some people may need a sick note as they can’t work during the washout period. People living with chronic pain from other conditions can find this particularly challenging. If there is a clinic for people living with chronic pain in your area ask your GP to refer you. They can help you find other ways to manage the chronic pain, so you can stop the regular painkillers.
  • If you are trialling a preventer treatment which isn’t working, ask your prescriber if it is at the highest dose. If not, and you are not getting side effects it should be increased gradually until you have tried the top dose for at least 2-3 months. After this time if it doesn’t help, then it is time to try something different, so see your doctor.
  • Make sure you have your rescue medication with you at all times. It is most effective if you take it at the very start of your migraine attack. If you don’t have effective rescue medication speak to your doctor to see if there is something stronger you can try. Often people need a combination of two or three rescue medications e.g., a painkiller, an anti-sickness medication and a triptan.
  • Think if there are any other avoidable triggers for your migraine. You can learn more about different migraine triggers, how to identify them and how to manage them on our website here.
  • A helpful book written about living with migraine is also available for those wanting more in-depth information – Managing your Migraine – by Dr Katy Munro.