Just a sip of cabernet, a whiff of cigarette smoke, a flickering fluorescent light or a sudden rainstorm can be enough to send many women straight home to bed for hours or days with throbbing, debilitating pain.
Although migraines are the most common severe headache disorder, afflicting some 27 million American women, researchers still don't fully understand what causes themor how to make them completely stop. "Preventive medications help 50 percent of patients by about 50 percent," says Sheena Aurora, MD, of Stanford University's headache program. Even if the drugs work like magicwhich they do for many migraine sufferersoveruse of certain pills (particularly barbiturates, triptans and opiates) can cause rebound headaches.
To land on the right remedy, sufferers usually slog through a process of trial and error, and it often takes more than one type of treatment to find relief. "We really don't know why some things work for some people and not others," admits neurologist Jack Schim, MD, co-director of the Headache Center of Southern California. "There are enormous genetic differences from person to person, which may affect how we absorb and metabolize medications." That's where alternative therapies come inwhich can be used in tandem with drugs or by themselvesas part of a migraine-relief plan.
Here are three of the most promising less traditional remedies, with feedback from both headache specialists and women who've used them to contain the pain.
The fix: A migraine-fighting gizmo
Imagine if you could wear a band across your forehead that electrically stimulated the trigeminal nerve, heading off migraine attacks. Sounds like sci-fi, but an FDA-approved device called Cefaly does just that. You wear it at home for 20 minutes a day, even if you aren't having a migraine. In a study published in the journal Neurology last year, Cefaly was shown to reduce monthly migraine days by 30 percent.
The tester says
"I started having migraines at 16. I got three to five a week, especially around my period. I've seen pain specialists, headache specialists and neurologists. I've been hospitalized. I tried all the different medications, and my headaches just became worse.
Five or six years ago, my neurologist put me on preventive migraine medication. It worked a little, but the side effects were terrible: I forgot things; I thought I had dementia. I would be driving in my own neighborhood and not remember how to get where I was going. I'd just pull over and cry.
When my dad forwarded me an article about Cefaly, I immediately got a prescription from my pain specialist and bought the device, which looked really space-agey. The day it was delivered, I started to get a migraine. I put it on, and the migraine never fully developed. In the four months I've been using CefalyI relax with it at night before bedI've had only two migraines, and they were less intense than I'm used to. I do have some sinus issues, and I still get a small aura (where I see flashes of light) in the morning, but that has gotten less severe, too. Overall, I no longer have pain and brain fog all the time!" Tracey Goodman, San Diego
The expert verdict
It's worth a try for anyone who "doesn't want to take medication and is interested in something techy," Dr. Aurora says. Although Cefaly hasn't yet been tested on pregnant women, experts believe that it is safe for them. (Most migraine medications are classified as schedule C, which means it's unknown whether they're OK to use during pregnancy.) She notes that those who have success with the device typically notice an improvement in about a month, and some people see a dramatic change.
You'll need a prescription to get your hands on the device, so talk to a doctor, ideally a neurologist or headache specialist, if you want to go the tech route. (There's also another headache-easing gizmo coming to the market soonsee Zap Away the Pain, above.) Cefaly costs around $325, and at this point most insurance companies don't cover it; order the gadget at cefaly.us.
The fix: Elimination diet
Turns out, certain foods activate an inflammation response that triggers migraines in people who are prone to them. Top offenders include red wine, aged cheese, cured meats (like hot dogs and cold cuts), monosodium glutamate (MSG), dairy, artificial sweeteners, chocolate and gluten. Typically, headache clinics recommend cutting out these foods for six weeks, then adding them back in individually to see if any bring on your head pain.
The tester says
"My migraines were bad since age 10. By the time I was in high school, I was getting them constantlyoften for weeks. I missed almost half of my junior and senior years, going in and out of the hospital. Getting acupuncture regularly and changing my medication improved things in college, but during law school, my headaches kicked in again.
I mentioned to a friend that I often had stomachaches after I ate, and she said, 'That's not normal.' I started researching to see if my stomach problems and migraines were related and found articles about celiac disease. I was shocked to see how many of the symptoms I had and to learn about the link between migraines and gluten for many people with celiac disease.
I decided to try going gluten-free on my own, and within a few weeks not only did my stomachaches disappear but my migraines let up, too. But I found it hard to believe that gluten had been causing so many problems for so long, and one night I foolishly decided to eat gluten to see what would happen. I ordered pizza and, sure enough, had a terrible stomachache and the beginnings of a migraine within 30 minutes of eating it.
Eliminating gluten from my diet was life-changing. Although I haven't been formally diagnosed with celiac disease, I know how important it is for me to avoid gluten. I've learned my lesson, and I don't cheat at allit's not worth it!" Stephanie T., Chicago
The expert verdict
"If a food is a problem, you're going to figure that out pretty quickly if you try an elimination diet," says Merle Diamond, MD, managing director of the Diamond Headache Clinic in Chicago and clinical assistant professor in the department of medicine at Rosalind Franklin University of Medicine and Science. And there's good evidence that gluten can be a culprita 2013 study from Columbia University found that people with celiac disease suffered from more migraines than those without it.
Perhaps the biggest food suspect, however, is tyramine, a compound that occurs naturally in aged and fermented foods, including cured meats, aged cheese, smoked fish and some beer. A 2010 study of migraine sufferers said hot dogs and cheese were among the most common culprits, and Dr. Diamond has seen great results with low-tyramine diets. Not all migraine sufferers have food sensitivities, but for those who do, eliminating a problem food can cut headaches by 50 to 60 percent. "Within a month," she says, "it has changed people's lives."
To test for food triggers, it's best to work with a doctor. Insurance will cover a visit to an MD to talk about recommended dietary tweaks as part of your medical care. Reach out to a migraine and headache specialist (visit americanheadachesociety.org or headaches.org to find one), as not all neurologists specialize in migraine treatment.
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The fix: Botox injections
The same toxin that relaxes facial muscles to smooth wrinkles can also dull the transmission of pain messages to the brain. In a 2010 study, Botox injections (to seven key areas on the head and necka total of 31 jabs) cut migraine headache days in half within six months for about 50 percent of those treated.
The tester says
"The first time I got a migraine, when I was 17, I freaked out because I thought I was having a stroke. I was nauseous and vomiting, and I had these black flashes in my eyes, like pictures were being takenin other words, an aura. I ended up getting triptans, which helped for about two years. Then in college, I started having migraines all the time: For two weeks each month I couldn't do anything but lie in a dark room. At one point I was hospitalized; it was a nightmare. On top of that, the MDs put me on this other medication that made me feel totally wacked-out, like I was high. I had to stop taking them.
My mother, who also suffers from migraines, suggested Botox. She was getting the treatment and it was really helping, so I went to see her neurologist. I'll admit: I was a little leery about the needles, but at that point I was desperate. I felt like I was becoming an invalid.
The injections didn't hurt that muchkind of like getting your eyebrows tweezedthough I did have some neck stiffness. After about a week and a half, I noticed that I was getting fewer auras, and then I didn't have a migraine at all for three to four months. The Botox started wearing off after that (each treatment lasts for about three months), and the migraines came back. I was having a full-on migraine during the second treatment, and it lifted after a week and a half.
It's been a year since my last treatment. As far as going back for more, the doctor told me to feel it out. But I haven't been getting severe migraines, and maybe that's thanks to the Botox. I've heard the effects can improve over time with repeated treatmentswhatever the reason, I'm grateful to be feeling better." Hannah Campbell, New York City
The expert verdict
"I've been injecting Botox for difficult-to-treat medical conditions for 25 years, since it was first approved for rare eye-muscle disorders in 1989," Dr. Schim says. "For treatment of chronic migraine, I've seen some real home runs." A number of patients notice a benefit within a week or two; others need two or three treatments. What's more, he adds, results can improve over time for many patients, as likely happened with Hannah. But take note: There can be potential side effects with Botox, like bruising or neck pain.
Go to a neurologist who is board-certified in headache treatment (again, americanheadachesociety.org and headaches.org are good search tools). Insurance should cover Botox for chronic migraine, which is defined as 15 or more headache days a month. With any luck, your migraine days will soon be numbered.