Doctor K: Preventing frequent migraines

DEAR DOCTOR K: I’m plagued by frequent migraines. I take medications to treat the migraines once they’ve started, but I’d rather prevent them in the first place. Any suggestions?

DEAR READER: Migraines can be debilitating. The severe, throbbing headaches are typically accompanied by nausea, vomiting or loss of appetite. Many migraine sufferers also develop blurry or distorted vision, or see pulsating lights or dark spots. Not all migraine headaches can be prevented. But if you can identify your headache triggers and avoid them, this may help reduce how often you have migraines and how badly they hurt.

Common migraine triggers include:

• Caffeine (either using too much or cutting back on regular use).

• Certain foods and drinks, including those that contain tyramine (aged cheeses and meats, fermented drinks); sulfites (preserved foods, wines); and monosodium glutamate (MSG), a common flavor enhancer.

• Stress, or relief from stress. (Some people get their migraines when they are home relaxing after a stressful day or week).

• Hormone levels (affected by menstrual cycles or hormone-containing medication such as birth control pills).

• Lack of sleep.

• Travel.

• Changes in weather or altitude.

• Overuse of pain medications.

Some other things to look into include biofeedback, yoga, acupuncture, massage and regular exercise.

I also recommend talking to your doctor about preventive medications. These are prescription drugs taken every day to prevent migraines. Different medicines are used to treat migraine attacks when they come.

You won’t find this recommendation from many authorities, but I have found low-dose aspirin to help in preventing migraines in some patients. This has not been proven in a large, randomized study. And you should check with your doctor before starting aspirin.