In this blog, we answer six of the most common questions we get asked via The Migraine Trust helpline.

What treatment can I use to help my migraine?

Preventives are very useful to get control and reduce both the severity and the overall number of migraine attacks. We have a list of recommended preventive medications with doses, which aim to make you less sensitive to triggers and less likely to have attacks develop. You can discuss the options with your doctor.

For the acute medications, treating early in the pain stage and with sufficient doses preferably on that first day, helps to shorten and get rid of an attack fully. You can check with your doctor if triptans, soluble paracetamol and NSAIDs (e.g. aspirin, naproxen, ibuprofen) are safe for you.

How can I get support from my employer?

Trying to speak to your employers and give them guidance on what would be helpful/what you need is the best first step to take. Once employers have a better understanding of migraine they are usually better placed to provide you with support.

For some people their migraine may be classed as a disability under the Equality Act 2010 which means they’re entitled to reasonable adjustments to support them. These vary from person to person but can include changes to work pattern, flexible breaks, adjustments to equipment etc. Where possible, it’s helpful to have a review with Occupational Health as they can give a view on whether the migraine is covered under the Equality Act and they can suggest adjustments to your employers. You can ask your line manager for details about occupational health and to make a referral for you. It can also be helpful to get a letter from your GP explaining how your migraine impacts you and that you’d benefit from reasonable adjustments. We have more information about your rights at work in our ‘Migraine: Help at work’ toolkit.

I have exhausted all of the medications my GP can give me, what’s next?

If (once tried for long enough at an effective dose) preventive treatments do not work or aren’t suitable (e.g. side effects) the next step is to be referred to either a neurologist or a headache specialist.

A specialist should review the impact of your migraine, your symptoms and the treatments you’ve already tried and suggest other treatments that may help. There are different treatments available depending on your situation but they can include:

• Other medications e.g. flunarizine (usually this would depend on your symptoms and medical history)
• Botox
• A Greater Occipital Nerve block (often used to provide relief while waiting for other treatments to work)
• CGRP mAbs

My migraine has got worse since my Covid vaccine, is this common?

It seems likely that people with migraine may be more sensitive to the side effect of prolonged headache, although there is no conclusive evidence to show that’s the case. From what we know generally, there’s no conclusive evidence that the vaccine should make migraine or headache worse in the long-term. It’s still very early days in terms of the effect of the vaccines, and there hasn’t yet been any research looking at the effect they have on people with migraine. However, from the anecdotal evidence it seems some people with migraine are sensitive to the impact of the vaccine and are experiencing a temporary worsening of/increase in migraine attacks after the vaccine.

Generally, even with the latest data and updates the consensus is the benefits of the vaccine outweigh the risks of side effects.

I do not want to take prescription medications, what else can I do to help my migraine?

Some people try supplements such as riboflavin (B2) at a dose of 400mg a day, magnesium (400mg a day) or co-enzyme Q10 (150mg a day). These provide relief for some people. Similar to preventive treatments, it can take around six to eight weeks to see a benefit and three months to see the full impact. Some people choose to take all three supplements together or try each one individually – it’s often down to personal preference. Some people also report that acupuncture can be helpful. There is also a range of medical devices which may be beneficial for headache or migraine symptoms.

I have chronic migraine and I find it very difficult to treat, what can be done to help me?

Treating chronic migraine can be a challenge, and a lot of people find that they need to try a range of different treatments to help get it under control. It’s also difficult because an effective preventive treatment is around a 50 percent reduction in the frequency and severity of migraine, however, when you have chronic migraine this can still mean a lot of days with migraine.

The standard approach to treating chronic migraine usually involves trying different oral preventives to try and reduce how often you have attacks, and how severe they are. If (once tried for long enough at an effective dose) these don’t work or aren’t suitable (e.g. side effects) the next step is to be referred to either a neurologist or a headache specialist.

If you have further questions about your migraine or are in need of support, you can speak to us via our free helpline on 0808 802 0066 or via our online contact form.

Read about tips for managing your migraine here. For more information on chronic migraine and other types of migraine, click here.