Combination Therapy for Migraine & Headache: What’s in your toolbox?

June 28, 2021/Chloë King

The Migraine Combination Therapy Toolbox

The complexity of migraine and headache diseases makes them hard to treat. With no cure, patients need to pursue management. There are many different tools people can add to their combination therapy toolbox.

Preventative medication is recommended if a person has 4 or more headache days per month; attacks significantly interfere with daily routine despite acute treatment; contraindication to acute medication; or patient preference.¹
Abortive medications are critical, so a patient can stop an attack.
Medical device options are not new. But in the past few years there are more options available for both prevention and to abort attacks.

While all the above options are great to discuss with your doctor, remember there are other toolbox options to discuss with your health care provider:

Supplements
Over-the-counter tools such as heat, ice packs, migraine glasses
Alternative treatments such as acupuncture, mindfulness, massage, yoga or physical therapy
Lifestyle changes such as diet, sleep habits and stress management

We are two migraine advocates, and we’re sharing each of our toolbox approach to migraine management!

Darcy’s Combination Therapy Toolbox

I have a big tool box! It’s portable on wheels too. Our toolboxes can be cleaned out and restocked at any time. My toolbox looks different from everyone else’s toolbox. In 6 months, I may do a clean up and take some things out and add something else. The important thing is to keep it updated, and keep working on it. Don’t get discouraged. We are all a work in progress.

Treatments
I have 2 preventative treatments and the option of 4 different abortives for when a migraine strikes. Fortunately, I do not have a lot of side effects from my medications other than fatigue. I use these over-the-counter tools: vitamins, massages, a great pillow, blackout curtains, a soft eye mask, good sunglasses, numerous ice packs and heating pads.
Self Care
I take time for myself to recharge and care for me. As an introvert, it is important to have quiet time to myself. My hobbies include: advocacy, reading, computer word games, watching tv shows, light gardening, walking and playing with my dog — and naps! My goal is to find something joyful in every day.
Self Advocacy
This is often overlooked. It is easy to give up when we don’t feel good. Along with migraine, I experience severe neck pain and stiffness. Physical therapy on my neck provides a little relief from the pain and stiffness, and it also helps with my migraine. When I start to get a migraine, one of the first things I do is neck exercises. Staying on top of my medications, doctors, insurance and all care issues is difficult. It’s hard for me because I am deaf, and phone calls can be stressful! However, if I don’t advocate for myself, no one else will.
New Diagnosis, New Tool: I have a long history of vertigo and dizziness. I was recently diagnosed with Meniere’s disease. Vestibular rehabilitation is difficult because my vertigo is almost daily, and the rehab exacerbates it. Sometimes we have to push ourselves to do something hard to try and get better. I know this won’t cure me, but it may help.

Anna’s Combination Therapy Toolbox

I spent years gliding with my migraine management medications, surviving with one preventative and an abortive medication. Everything changed in 2017. At first, I had new symptoms, which led to a new diagnosis. Before I knew it, my preventative was no longer effective, then I experienced new side effects from my abortive. Within a few months, I went from having two simple tools to none. I gained two more diagnoses: trigeminal neuralgia and chronic cluster disease. The next year was spent learning about my diagnoses and symptoms. My new doctor helped me build a new toolbox, but it wasn’t a quick or easy process. Since rebuilding my toolbox, I feel better and am able to add more tools. I eat more fresh ingredients, take more walks, am more focused on the present and give myself permission to relax, set boundaries and be kind to me.

Treatments
Late 2018, my health care provider prescribed a new preventative. Thankfully I could tolerate it, and it was about 50% effective. For migraine attacks, I waited for new abortive treatments to gain FDA approval; fortunately, one worked for me. For cluster attacks, I successfully went through all the steps to obtain oxygen.
Over-the-Counter Tools & Supplements
During my journey, I began picking up lifestyle changes. I found ice packs for my cluster attacks and heat packs for my trigeminal nerve pain. I learned that my B12 and D3 vitamin levels were low. B12 helps my trigeminal nerve pain. D3 is more complex to supplement because of the cofactors; however, my numbers increased to a more normal level.
Lifestyle Changes
I felt the connection of my body feeling stress and the increase in pain. I started trying to reduce stress and set those boundaries, keeping stressful events from crossing over.

What’s In Your Toolbox?

There are many options available to build your personal migraine toolbox. One step is to work with a knowledgeable health care provider to find treatment options. However, that is just one puzzle piece. The complex and incurable nature of migraine requires ongoing management. Things frequently shift and change with this disease, and we need to always be on the lookout for new tools. What tools do you have in your toolbox? Do you need to take an inventory and talk with your doctor about adding some options that might work for you?

Visit Migraine Meanderings for a comprehensive list of migraine treatments.