From Surviving to Thriving: Why Quality of Life Should Be a Primary Migraine Management Goal

Migraine is more than “just a headache.” Beyond the pain, nausea, and sensitivity to sound and light, migraine can quietly take over your life, disrupting your ability to work, think clearly, make plans, and show up for the people you care about. Over time, it can also take a real toll on your mental health and sense of independence.

“Quality of life is your perception of how you’re doing in life, relative to your goals and expectations,” says Jelena Pavlovic, MD, PhD, an assistant professor of neurology at Albert Einstein College of Medicine and the chief of neurology at Weiler Hospital in the Bronx, New York.

If migraine treatment is technically “working,” but you still find yourself planning your life around symptoms, it may be time to rethink what success in migraine management truly means for you.

Traditional metrics used to monitor migraine include headache days and pain ratings.

While assessing headache days and pain is important, it doesn’t fully capture the hidden burden of migraine. Invisible symptoms, such as anxiety, brain fog, and fatigue, which can carry on between migraine attacks (called the interictal phase) also often play a role.

• Relationships with your family, partner, children, or friends
• Ability to participate in social activities
• Career performance or stability
• Financial health
• Risk of mental health conditions, such as anxiety and depression
• Overall health

The unpredictability of migraine and anxiety over when an attack might occur can also cause you to miss out on life, says Dr. Pavlovic. “Many people who have a lot of migraine burden spend so much of their time in avoidance — avoiding amusement parks, avoiding bright lights, avoiding concerts, movies, or loud restaurants,” she says. “There’s even cases of cogniphobia, where people don’t want to think extra hard, for fear of getting a migraine.”

Evaluating the impact of these “hidden burdens” can be even more important than frequency or pain intensity when making treatment decisions. “It used to be that having four or more headache days a month would qualify you for preventive care,” says Pavlovic. “These days, it’s anyone who feels impacted sufficiently. Even if you have less frequent attacks, but they’re very burdensome, you can talk with your doctor about trying preventive options.” So it’s important to paint a full picture of how much migraine affects you.

• 50% reduction in days with a headache or migraine attack
• Improved response to acute treatment
• Significant decrease in attack duration
• Significant decrease in attack severity 
  

A well-rounded treatment plan should also take into account:

• Decreased psychological distress due to migraine
  
• Improvements in functioning in important areas of life
• Improvements in health-related quality of life
• Reduced migraine-related disability
  

You can assess these factors through self-reported outcomes that measure the impact of migraine on your life, such as:

• Migraine Disability Assessment Asks questions about how much migraine has disrupted household chores, school or work, and social or leisure activities over the past three months

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• Headache Impact Test-6 Measures fatigue, irritability, and how headache affects what you can and can’t do

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• Migraine-Specific Quality-of-Life Questionnaire, Version 2.1 Evaluates the emotional impact and restrictions on daily, social, and work activities.

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Other factors, such as sleep and stress, are also important considerations when assessing migraine’s effect on quality of life, says Pavlovic, who recommends asking yourself:

• How am I feeling?
• What have my headaches been like?
• What has my life with migraine been like?
• How is work?
• How is my family?

“You have to care about these other factors, more so than just headache frequency, because what you ultimately want is an optimized life,” says Pavlovic. Taking all of these factors into account will help you and your doctor develop a successful treatment plan that helps limit impairment during individual migraine attacks, so you can live your best, most productive life between attacks, she adds.

One of the most important steps in migraine care is having an open and honest conversation with your doctor about the symptoms you’re having and how they affect your day-to-day functioning. The more specific you can be, the easier it is for your care team to tailor treatment to you and what matters to you most.

These strategies can help guide those conversations.

Keep a Migraine Diary

Tracking migraine attacks can help reveal patterns and identify what’s working and what needs to change. Note how long each attack lasts, as well as the symptoms you experience, how severe they are, and how they affect your daily life. Review your diary with your doctor at each appointment to determine if any adjustments are needed.

Share Your Personal Goals

Talk with your doctor about what matters most to you, whether that’s getting through a workday, watching your child’s soccer game, or attending a wedding, says Pavlovic.

“These are the things that you really can’t miss, though sometimes that happens, and you need to know what plans to put into place,” she says. “Preventive medications and acute rescue plans can help. But then there’s the additional layer of how you would like to live your life, understanding that migraine is a chronic disorder.”

Prioritize Self-Care

• Eating a nutrient-rich diet
• Exercising
• Getting quality sleep
• Maintaining a healthy weight
• Managing stress
• Staying hydrated

Ask About Complementary Therapies

• Acupuncture
• Biofeedback
• Meditation
• Mindfulness
• Yoga

Review the Treatment Plan

Many treatments are available for migraine, including pain relievers, preventive medications, and neuromodulation therapy. Review the treatment plan regularly to see if it’s effectively helping you live the life you want or if it may be time to try something new.

• Traditional migraine metrics, such as headache days and pain intensity, don’t fully capture the many ways migraine can have an impact on quality of life.
• Invisible symptoms, such as fatigue, brain fog, and anxiety, can linger beyond individual migraine attacks, disrupting work performance, social plans, mental health, and daily functioning.
• Self-reported outcomes should be considered, along with clinical assessments, to help create a well-rounded, individualized migraine treatment plan.