How to Break the Migraine Attack Cycle

“People with migraine are thought to already have a sensitive brain, if you will,” says Regina Krel, MD, director of the Headache Center at Hackensack University Medical Center in Paramus, New Jersey. “This makes them more susceptible to having a headache recurrence or rebound.”

Rebound attacks are also known as medication overuse migraine attacks. When you take pain medication repeatedly for migraine, your brain starts to expect — and rely on — the medication. “This can lower the threshold for another headache to come on and eventually make the medication less effective,” says Dr. Krel. “It triggers another headache on top of the underlying migraine disorder.”

As frustrating as rebound attacks are, understanding the cycle can be the first step in helping you break it.

Besides a reliance on medication, there are other factors that can lower the migraine threshold, setting you up for repeated attacks, including:

• Dehydration
• Hormonal changes, such as a woman’s menstrual cycle or menopausal transition
• Lingering inflammation

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• Poor sleep or sleeping too much
• Sensitization from previous attacks
• Shifts in the weather, leading to changes in barometric pressure
• Skipping meals
• Stress
• Trigger stacking, when multiple migraine triggers build up to cause an attack

Because a single migraine can go on for days, it can be hard to know if you’re experiencing one long migraine attack or multiple attacks. But this distinction matters, because both migraine duration and recurrence are key to planning your approach to preventive, acute, and rescue treatment.

“A typical migraine attack lasts between four to 72 hours,” says Krel. Signs of a continuous migraine attack are when:

• You take a rescue medication, and the migraine comes back within a few hours
• You go to sleep with a migraine attack and still have it when you wake up

In contrast, signs of repeated migraine attacks include:

• Clear breaks between episodes
• Predictable symptoms, such as nausea and throbbing
• Distinct phases, such as prodrome (early symptoms), aura, the attack, and postdrome (symptoms after the head pain ends), before the next attack starts

To lower the number of migraine attack days you experience, keep these strategies in mind:

1. Treat early and adequately. At the first sign of migraine pain, use rescue medication. “It’s important to get ahead of your pain, rather than chase it,” says Krel.
2. Keep rescue medication on hand. If you’re leaving the house, take rescue medication with you, and use it as soon as possible if a migraine attack strikes.
3. Have a “toolbox” approach. If the rescue medication fails, ask your doctor about other treatments or strategies to help find relief during an attack.
4. Treat your specific symptoms. Open up about exactly what you experience during an attack, because what works for one person with migraine may not work for another. For example, “You may benefit from a medication to help with nausea,” says Krel.
5. Consider your personal preferences. If you have trouble taking oral meds, for example, you may benefit from a nasal spray or injectable option, says Krel.
6. Stay hydrated. Dehydration is a common migraine trigger, so you may want to drink electrolyte water in addition to plain water to keep yourself hydrated.
7. Keep a regular sleep schedule. Migraine attacks can send you reeling from sleeping too little or too much. To manage migraine over time, it’s best to stick to a consistent sleep schedule (even on weekends) and get the same number of hours of sleep per night. “That can help with lowering migraine [attack] frequency,” says Krel.
8. Keep stress in check. Stress is a well-known trigger for migraine attacks. While some stress in life is inevitable, Krel suggests using meditation or relaxation techniques, such as yoga, to help lower the impact stress can have on migraine. Keeping up with friends and engaging in hobbies are good stress busters, too.
9. Stay active. Regular, moderate levels of exercise can help reduce anxiety and stress and even release natural painkiller hormones. Researchers suggest exercising in the morning for migraine management, as that helps align your circadian rhythm, which can otherwise be disrupted by migraine.

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10. Eat a balanced diet. Fasting can trigger a migraine attack. Eating fresh, whole foods at regular mealtimes, on the other hand, can help you feel your best. Research shows increasing your intake of omega-3 fatty acids and reducing omega-6 fatty acids can moderately reduce migraine attack frequency. That means eating plenty of flaxseed and fish and skipping processed foods and vegetable oils.

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If you’re struggling with frequent migraine attacks, it may be time to work with your doctor to tweak your treatment and management plan.

“This is where open and honest communication with your doctor is important,” says Krel. If you were previously doing well but are now having multiday attacks, it can be helpful to track the frequency and see if any patterns develop. “Preventive regimens should always be evaluated for efficacy,” she adds. “If every migraine attack is lasting multiple days, your doctor will want to discuss how effective your rescue plan is.”

• Once you have a migraine attack, you may be more susceptible to having another shortly after.
• It can be hard to know if you’re having one long migraine attack or back-to-back attacks, but the distinction matters for your treatment plan.
• By working with your doctor to adjust treatment and sticking to a healthy lifestyle, you can make a plan to lower the number of migraine attack days and reduce symptom severity.