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The question

I get migraines frequently and suddenly. Nothing seems to help: what's your advice?

The answer

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My initial advice? If your migraines are changing in frequency and intensity, visit your doctor to make sure these are still migraines and not something more serious.

The next step is to understand what you have been using to treat your migraines. One of the most common reasons for increased frequency of migraines is the overuse of medications.

If you are needing to use pain medication such as acetominophen (tylenol) or ibuprofen (advil) more than twice a week, your migraines may be due to the rebound effect when your body withdraws from the medication. If this sounds familiar, your doctor may help you to taper these medications safely to avoid rebound and worsening of the pain.

If these headaches are confirmed migraines and they are not responding to previously used medications, I go through a step-wise approach with my patients to help them to regain control over the migraines:

Step 1: Recognition and avoidance of triggers

Migraines are commonly triggered by specific changes in the environment or from the intake of certain food or drink. Common food triggers include: alcohol, aged cheese, caffeine, chocolate, red wine and monosodium glutamate (MSG).

Other triggers can include change in sleep patterns, stress, loud noises, a change in weather or barometric pressure and hormonal changes like those that occur in pregnancy or with menstrual cycles. Medications can also increase migraine frequency, the most common culprit being the oral contraceptive pill due it's influence on hormones. If this is the case, you may want to discuss non-hormonal options with your doctor for contraception.

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If you can't identify specific triggers, keep a diary of your headaches, record the intensity and see if there is an identifiable pattern.

Step 2: Try lifestyle and non-medicinal options:

Certain healthy lifestyle changes have been found to be helpful at decreasing frequency of migraines by reducing stress and increasing general health. A few changes that may be helpful are regular exercise, getting a proper amount of sleep, and relaxation techniques such as meditation or yoga. Some clinical trials have shown that acupuncture has been found to be helpful for frequent headache pain and some people find massage therapy and relaxation techniques help to decrease muscle tension and pain.

If you feel a migraine coming on, try resting in a dark quiet space and place a cool cloth over your forehead or back of your neck.

Step 3: Medication

If you are still having frequent migraines despite trying the strategies of avoiding triggers and healthy lifestyle changes, consider visiting your doctor to see if there are medication options that may help.

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Beyond general painkillers such as acetominophen and ibuprofen, specific medications called triptans are designed to treat migraines and common symptoms of pain, nausea and the increased sensitivity to light and sound. These medications can be expensive, but if taken at the first sign of a migraine have been found to be very effective.

If you have tried these medications and you are still suffering from frequent headaches, consider regular preventative medication.

There are a variety of preventative medication options including antidepressants or medications used to treat blood pressure or seizures which also seem to help control migraines. These are generally taken on a regular basis and can reduce the duration, frequency, and severity of migraines. Depending on your specific pattern of migraines, your doctor may recommend that you take preventive medications daily, or only when a predictable trigger, such as menstruation, is approaching.

Step 4: Referral to pain specialist/neurologist

If all of the previous options have not sufficiently helped to control your migraines, your doctor may opt to do some investigations such as imaging studies and may refer you for specialist care. Some other options at this stage may include botox injections which have been found to be helpful to treat chronic headaches.

Send family doctor Sheila Wijayasinghe your questions at She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

Read more Q&As from Dr. Wijayasinghe.

Click here to see Q&As from all of our health experts.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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