Here is how to tell when a migraine attack is coming

By Madeline Holcombe, CNN

(CNN) — Wouldn’t it be helpful to have a sense of when a debilitating migraine may be on the way?

You may be able to do so, a new study has shown.

“The major finding from this study was that changes in sleep quality and energy on the prior day were related to incident headache in the next day,” said Dr. Kathleen Merikangas, principal investigator of the study that published Wednesday in the journal Neurology.

Migraines are nothing to shake your head at, and they certainly aren’t just nuisance headaches. Chronic migraines are the leading cause of disability in people younger than 50, according to a February 2018 study.

Merikangas, chief of the genetic epidemiology research branch in the Intramural Research Program at the National Institute of Mental Health, and her colleagues used electronic diaries to track the behaviors and symptoms of 477 people over a two-week period, according to the study.

The study team found that sleep quality and energy were important indicators of a migraine attack on the following day.

Those who had bad sleep quality and low energy one day were more likely to have migraines the next morning, the data showed. An increase in energy and greater-than-average stress usually foretold a migraine would appear later the next day.

“It’s a very exciting study because of how well done and how detailed and how large it is,” said Dr. Stewart Tepper, vice president of the New England Institute for Neurology and Headache in Stamford, Connecticut. Tepper was not involved in the research.

The differences point to the importance of your circadian rhythm — which regulates your cycles of sleep and wakefulness — in how headaches manifest. The findings may inform the treatment and prevention of migraine attacks.

Migraine prevention

Knowing when a migraine is coming can make all the difference — especially with growing interest in treating one before it starts, Tepper said.

“If we can identify things in the environment that people can change, then we’d like to be able to prevent the attack in the first place,” Merikangas said. “If we can do that with behavioral interventions … then they may be able to prevent it by either going to sleep to offset it or some other intervention that would prevent us from having to use medication to prevent the attack.”

Tepper, however, said he is not so sure if changes in behavior can always prevent a migraine attack.

A migraine attack isn’t just a headache. And warning signs such as fatigue, neck pain and sleep disturbance may be early symptoms of an attack — not only a trigger of one, he added.

Instead, Tepper advises intervening with medication before the head pain starts in hopes of warding off any pain at all.

How much is too much?

It makes sense that people might be conservative about using medication for migraine pain, Tepper said.

An older class of medications, called triptans, was associated with more migraines and a resulting chronic migraine condition if used more than 10 days in a month, he said.

But a newer option, rimegepant — sold as Nurtec — doesn’t seem to carry the same risk.

“There’s no downside because rimegepant has almost no side effects and is not associated with transformation into chronic migraine,” Tepper said.

What you can do about migraines

Your doctor can recommend pain medication to address your migraines, but it also helps to know the signs of an upcoming attack, Tepper said.

As well as monitoring sleep, exercise and diet, Merikangas suggests finding a way to monitor stress to be able to track the indicators of a migraine.

There are five typical signs of an oncoming migraine headache, Tepper said. Those are sensitivity to light, fatigue, neck pain, and sensitivity to noise and dizziness, he said.

Cognitive behavioral therapy is often useful to help manage the stress that can trigger migraine attacks. What’s more, taking vitamins and supplements, such as magnesium and riboflavin, can be effective in reducing migraine frequency, Kylie Petrarca, a nurse and education program director at the Association of Migraine Disorders, said in a previous CNN article.

It isn’t just about avoiding the pain, Merikangas said.

“It’s really important to think of the full context of our health,” she said. “By being able to characterize not just headaches, but also all these other systems, we might be able then to get a handle on causes of negative health events.”

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