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Ideally, you'd like to prevent a migraine from occurring in the first place. There is a lot you can do to help yourself. Identifying individual triggers--such as chocolate or fluorescent lights--and keeping away from them as much as possible is an obvious first step. You should also avoid relying too heavily on quick fixes. "People with severe migraine headaches can enter a cycle of taking medications on a daily or near daily basis," says Dr. Sonja Potrebic of the Pain Management Center at the University of California in San Francisco. "Initially it helps, but over time the headaches get worse." Painkillers that contain caffeine are the most common cause of such rebound headaches. Taking baby aspirin to prevent a heart attack does not seem to be a problem.
Many migraineurs swear by various nonpharmacological methods of keeping their headaches at bay, such as yoga, meditation and biofeedback. These techniques probably work best for patients whose headaches are triggered by stress or tense facial muscles. One of the surprises of the past couple of years is the effectiveness of botox, which is now being injected into facial muscles to temporarily erase wrinkles. Migraineurs have reported that botox seems to banish their headaches as well. Studies are under way to see if those observations hold up.
Lifestyle changes, however, are sometimes not enough to prevent migraines. In such cases, doctors may turn to beta-blockers, drugs that were designed to treat high blood pressure. Although these medications open up the blood vessels, which would seem counterproductive if you're trying to prevent a migraine, they also turn out to have a soothing effect on nerve cells.
Similarly, antidepressants have been used to help prevent migraines. "If antidepressants were discovered today and we didn't know they were antidepressants, we'd call them analgesics," says Dr. Seymour Diamond, director of the Diamond Headache Clinic in Chicago. Intriguingly, the pain-fighting effect of antidepressants takes just three to 10 days to kick in, less than half the time needed to alleviate depression. This suggests that depression and migraine are triggered by different, though related, neural pathways.
As helpful as beta-blockers, antidepressants and even anti-epilepsy drugs may be in preventing some migraines, they don't cure the condition. Eventually scientists hope to discover therapies that address the brain's overly sensitive circuits more directly. For what it's worth, getting older seems to soften the blow. Studies show that migraine attacks peak between the age of 35 and 45 and decline after that.
Meanwhile, it may be a process of trial and error for most migraineurs--and their physicians. Chances are, however, that more and more of them will, like Schipper, eventually hit on the combination of medications and lifestyle changes that works for them. In his case, careful attention to his triggers along with judicious use of a powerful painkiller has kept his headaches to a minimum. "It's a tricky thing to navigate a migraine," Schipper says. "You have to be adept at knowing your own patterns." But it can be done. And sometimes, knowing that relief is within reach is half the battle. --With reporting by Jeff Chu/London, Andrea Dorfman/New York, Harlene Ellin/Chicago and Jeffrey Ressner/Los Angeles