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Avoidance of Triggers is Best for Migraine: Results of Patient Study Comparing 180 Treatments

For the live-updated, interactive version of this infographic, click here.

Migraine: a beast I’ve been through myself. At CureTogether, 3,455 people who experience the pain of migraine came together to rate 180 treatments. Here are the current results of this ongoing study.

Our migraine survey has by far the most treatments reported by patients – even the dense scattering of points on the chart shows how many treatments people with migraine go through to find something that works. A few of our members have tried over 100 different treatments, which suggests that migraine pain is not well handled with the current state of medical knowledge.

Patients rate avoidance of triggers like smoke, MSG, red wine, and light as most effective at dealing with migraines (see the top of the green part of the chart), and alcohol and birth control pills as making their migraines worse. (see the red part of the chart above.)

The top 20 overall treatments reported for migraine are, as a list:

1. Dark room and NO NOISE!
2. Avoid red wine
3. Avoid MSG
4. Avoid smoky situations
5. Sleep
6. Sleep with ice packs wrapped in a dry dish towel
7. Passage of time
8. Wearing sunglasses with the smallest amount of sunshine
9. Wrap ice bandage around head
10. Wrap cold towel around head and put pressure on side of neck and head that hurts most
11. Cooling headbands
12. Ice
13. Imitrex (Sumatriptan)
14. Avoid aspartame/phenylalanine
15. Wear a sleep mask
16. Intravenous DHE
17. Treximet (Sumatriptan and Naproxen)
18. Avoid Spenda/sucralose
19. Imitrex (Sumtriptan) injection
20. Oxygen

The rest of the results are in the graph above, which is divided into four squares…

- Top right: the most popular and effective treatments (including avoiding smoke, Imitrex, and sleep)

- Top left: effective treatments that not many people have tried, so they may be options to think about (including cold towel around head)

- Lower right: very popular but not very effective (including birth control pills)

- Lower left: neither popular nor effective (including alcohol)

Where did this data come from? This is the result of a 3-year CureTogether study on MigraineTo thank everyone for participating, we’re publishing this study openly and freely.

This is part of our regular series of research findings. Of course, with each of these findings, there is a potential bias in patient self-selection and recall. We present these findings as just what they are – patient-reported data – to stimulate discussion and generate new insights for further research.

Please tweet, blog, or pass this along to anyone who can benefit or is interested in Migraine. Thank you!

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15 Responses to “Avoidance of Triggers is Best for Migraine: Results of Patient Study Comparing 180 Treatments”

  1. Thanks Alex! Still coping with them here too….
    It would be interesting to see a chart like this for more of the longer-term treatments/prevention (some of them listed above), but minus the short-term pain-relievers. Maybe some kind of combination of deeper causes and more permanent treatments… ways people could potentially eliminate them forever! (wishful thinking I know =)

  2. Annettte Baker Says:

    Since being diagnosed in March with Gluten Intolerance and going gluten-free (foods, drugs/supplements, cosmetics & cleaning products), I’ve only had two migraines.

    I have Hashimoto’s Thyroiditis and many with this condition are Gluten Intolerant or have Celiac Disease.

    I use Advil. Since I’ve had a stroke and have hypertension, I can’t use Imitrix.

  3. I’ve suffered fron migraine for the last 28 yrs. I used to get only one bad attack once a week. But then,when i started taking meds to abort my attacks it became a daily affair,what is called rebound headaches.. If anyone is doing that,its better to stop taking meds to abort daily attacks,and suffer just one bad attack in a week. Beacuse, i then had to take pain meds daily to abort attacks,which i did and was happy until they affected my stomach lining and now my stomach is so weak it cannot even tolerate paracetamol and i am on daily PPI ,to prevent gastritis even when i don’t take meds,which again is not good for you. Fortunately i have now reached menopause which miraculously stopped the daily headaches and now i get migraines only when i eat something that triggers it for me,which by the way a lot of foods do! Still i’m thankful for the reprieve,since now i feel my life is more under my control.Anyone who suffers migraine will understand that. By the way i still use feverfew tablets,which is the first herbal med to give me relief many years ago. The only problem with it is ,that if you stop it suddenly,you will get horrendous migraines! So,as long as you can continue taking it ,its fine to use it. I still don’t have the courage to try stopping it after i had a bad experience some years back. Another herbal med called PETADOLEX too really helped my headaches and you can try it .Only thing is its a little expensive,otherwise it really does help. Feverfew on the other hand is not expensive,so its worth a try. My sole intention in writing this is to help fellow sufferers like myself to cope with this painful condition. I am not endorsing any product or company. Hope this helps..God bless.. There is hope..menopause! Just hang in there till then! :)

  4. Here’s a list of foods which usually trigger migraines and does for me.. CHEESE,CHOCOLATE,ALCOHOL,WINE,MSG WHICH IS MOSTLY USED IN CHINESE FOODS BUT ARE ALSO THERE IN PKT SOUPS,CHIPS ETC,,CURED MEATSLIKE SAUSAGES ETC, RED MEAT,SPINACH,NUTS,PULSES,FISH,FERMENTED FOOD,YEAST. Also sunlight so sungasses a must! Try to eat fresh meat and veggies and avoid constipation which is a bad trigger. Keep well hydrated by drinking enough water and yes get enough sleep.. Hope this helps..:)

  5. I agree with Faren. This chart is comparing apples with hand grenades. It would be more useful to have people rate what works to prevent migraines from happening at all, and separately to rate what works to stop a migraine once you have one. For me, Topamax has been very good at preventing them, and Imitrex usually works to stop them once they have started. But I have to watch my triggers as well (being sleep-deprived, missing breakfast, maple syrup, glare, etc.).

    If you could separate the charts it would be greatly appreciated.

  6. I had a headache to hit me the otherday and was forced to go the ER. Thinking I was going to be able to get thru without any problems boy was I in for a big surprise. I got a newly graduated doctor who insisted that my usual treatment of Demerol and Phenegan was a bit much even though I’ve got a grocery list of allergies and seeing a neurologist on a regular basis. The first thing he did was have me hooked up to a drip then had me given Decadron. When I questioned as to why a steroid all I was told that it was a better treatment. Some 30 mins later and no better with a pain level still at 10+ I was given Reglan. After 55 mins later and still no relief I was finally given the Demerol but not in my usual dosage. When I questioned if my neurologist was called at all I was told emphatically no. Interesting how every other physician I’ve ever seen at that particular ER has called but this one. If I didn’t know any better I’d swear he was intimidated.

  7. After undergoing radio frequency neurotomies at C5/C6 mid-year with still no relief except my neck feels a bit better, I tried the only thing left to me – botox. Three weeks later and it’s like a miracle, no more daily background headache and two weeks without a major migraine. The botox had the effect of improving my eyesight, which my GP said means I’ve had a squint/strabismus all these years, which may have been the cause of my migraines all along (I have to read a computer all day for work), even though I get my eyes tested regularly because they are always sore and achy. My advice is get your eyes tested who knows how to look for strabismus and give botox and least one try.

  8. jay: I hung on until menopause, and when it finally happened…. my migraines got worse! sorry for the bad news :(

  9. I agree with Faren & Betti. I use Topamax for prevention and Zomig when I get a migraine, and that usually does the trick. For me, though, I still have to avoid a lot of triggers, like stress (ha!), red wine, preservatives, and sleep deprivation. Having the separate charts would be nice, but this is still very interesting and much appreciated research.

  10. 2 Comments: A cause of daily headaches could be sleep apnea. Headache sufferers should talk to their doctors to see if a sleep study should be ordered. We just found this out on my husband who has had daily headaches for years. a recent sleep study showed severe sleep apnea.
    Second Since there are so many different combinations of medications that can be used daily to prevent headaches the treating neurologist should keep working with the patient to find something that works. I’m back taking something that stopped being effective a few years ago and now it is effective again.

  11. My new neurologist has recently put me on daily 400mg dose of Vitamin B2 (riboflavin) for prevention of migraines. I have had only one short (one day) migraine since starting this just over 2 weeks ago. I have many triggers, some of which are unavoidable in real life. this approach has thus far been the most successful thing I have tried. I have had migraines for over 35 years. My neurologist says this works for about 30% of his patients.

  12. If you are trying to figure out your triggers, be careful because if you have more than one trigger its really hard to figure out what they are! Stopping one might lead you to believe that its not a trigger, cause you are still getting migraines and in reality the other trigger is still in your diet… You need to stop all things that are suspect and add them back in 1 at a time. Mine were Caffeine and MSG. MSG is in alot of foods read the label! Salad dressings, snacks, soups, gravies…

  13. I take a STRICT regimine of preventatives. The most important one is a drug called Namenda. It is actually a drug to treat Alzheimer’s disease. It is not FDA approved for this purpose but there has been a lot of research done on it and it has been proven to help a lot of people.
    If you are having a lot of headaches that are not responding to treatment you may want to look into being tested for something called “pseudotumor cerebri” AKA “IIH Idiopathic Intracranial Hypertension” – it is most often seen in women in childbearing age who are obese. It can cause severe headaches as well as swelling in your optic nerves.
    A cheap, natural preventative my doctor has me on is Magnesium 400 mg daily. It’s worth a try.

    If you aren’t getting anywhere with your docs I would strongly suggest that you find a Headache Clinic/Specialist. They are doctors who only treat headaches. Usually at teaching hospitals (those affiliated with medical schools) will have a headache clinic. I treat at the Cleveland Clinic and have had wonderful success after treating at another clinic for 2.5 years where I just kept getting worse.
    Good luck to everyone…I know how debilitating they can be.

  14. For those taking oxygen, how did you manage to get it prescribed to you? I can’t find a single study supporting the use of normobaric oxygen in migraine (unless I overlooked one), and no one is going to pay for hyberbaric oxygen (plus it would be too hard to arrange). So how does one access the oxygen?

    I would love to try it, but my neurologist is an evidence-based kind of guy.

  15. Thanks for doing this, very interesting numbers!

    Must of course be read with deep skepticism for several reasons:
    1) Many chemically related medicines mean their numbers are split into many fall far down on the list, while the general “Dark room” or “Avoid red wine” have no such issues and are known to everyone.
    2) No way to judge which _combinations_ of things that are most effective
    3) Illusory correlations and confirmation bias
    4) Self reported and much placebo expected

    But as long as such issues are kept in mind, this data is very interesting as a starting point, and should be studied by those who can try to identify potentially interesting findings, and test them properly through Randomized Controlled Trials. I hope you continue collecting, refining and developing.

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