Acupuncture involves stimulating specific parts of the skin, often through the use of thin needles. The practice has existed for thousands of years in Asian countries and is part of traditional Chinese medicine, per the National Center for Complementary and Integrative Health. More recently, Western medicine has been trying to understand how it might be helpful for their patients.

Studies suggest it’s effective at reducing nausea and pain in cancer patients, according to the National Cancer Institute, which raises questions about whether it’s useful for other forms of pain, such as migraine.

So, should you throw away your headache medicine? Not quite.

Does acupuncture help migraines?

The short answer is maybe. “We do not have enough evidence for me to strongly say acupuncture is helpful or hurtful,” Mason Dyess, DO, a general neurology and headache medicine physician at Ochsner Medical Center in New Orleans, tells Health. There are, however, a number of smaller studies and a few decent-sized systematic reviews that speak to its effectiveness.

Specifically, Dr. Dyess points to a 2019 systematic review in the journal Headache. It included seven clinical trials, for a total of 1,430 participants, comparing acupuncture to standard pharmacological treatments for migraine. Several of these studies individually suggest that acupuncture could be more effective than standard treatment; however, it’s not possible to look at all of their results as a whole because their methods of testing were so different from each other.

So for the time being, it’s still an open question about whether acupuncture definitively improves migraines. But “acupuncture (and acupressure) are both tools we have in our toolbox,” says Robert Cowan, MD, professor of neurology and chief of the division of headache medicine at Stanford University.

What Causes Chronic Migraines? 12 Things That Can Trigger These Headaches

What are the benefits of acupuncture for migraines?

While many studies suggest that acupuncture is safe and effective, large-scale randomized controlled trials are still needed to verify its clinical value, per a 2020 review in Neurology and Therapy. Based on the evidence to date, the review authors highlight one potential benefit: a reduction in the frequency and duration of migraines.

A systematic review from 2016, for example, saw headache frequency drop by 50% after six months in more than half of patients who received acupuncture treatments, reports the American Migraine Foundation.

"I've had mixed results with my own patients," says Dr. Dyess. "I've seen patients have an overall mild or just modest reduction in overall headache frequency. Likewise, I've had patients have a modest reduction in average headache intensity as well. Then I've had some people that had no relief at all from acupuncture."

Still, it can take a while for any migraine treatment to work, and not all of them will. "That can be said for any of the preventive or acute medicines," he adds.

The Acupuncture Benefits You Should Know About Before Your First Session

What are the risks of acupuncture for migraines?

Acupuncture is low-risk for most people, particularly if you’re going to a skilled practitioner, according to the Mayo Clinic. While there’s some potential infection risk by piercing the skin, standard practice is now to use single-use disposable needles, which greatly reduces the chance of that happening. You may feel some soreness or experience mild bleeding or bruising.

However, there are a few people who might need to avoid acupuncture:

• People with bleeding disorders or who are on blood thinners, because this may increase your risk of bleeding or bruising from the needles.
• People with pacemakers need to avoid any form of acupuncture that uses electrical pulses, which can compromise a pacemaker's functioning.
• Pregnant people should be careful, as some forms of acupuncture are thought to stimulate labor.

What Are Chronic Migraines? Neurologists Describe the Causes and Treatments

What to know before you try acupuncture for migraines

Dr. Cowan was quick to emphasize that acupuncture shouldn't be thought of as a singular medical practice, but part of a larger mode of treatment. "Acupuncture is one part of traditional Chinese medicine, along with moxibustion, herbs, and so forth," he says. In the same way you wouldn't go to a doctor who is only familiar with antibiotics, you don't want your acupuncturist to only have training in acupuncture.

"Pick your provider carefully and trust them to select the best treatment, whether it is Western or traditional Chinese, Ayurvedic, or whichever," he says.

He also advises that you don't seek out a provider for a specific treatment. "Go for advice, recommendations, help," he says, rather than expecting they'll prescribe a particular treatment.

If you're working within Western medicine, Dr. Dyess recommends continuing any treatments you're already using to manage migraines. Research shows that preventive medicines are effective, he says. "Acupuncture should be used as an add-on therapy to that."

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When the pounding in your head starts to interrupt your life, it's time to talk to a healthcare professional about what your options are. Treatment for chronic migraines can be split into three categories: preventative treatments, acute (also called "abortive") treatments, and complementary treatments.

“Most people with chronic migraines are taking both a preventive medication and have an acute medication to use as needed,” according to Mason Dyess, DO, a general neurology and headache medicine physician at Ochsner Medical Center.

Medications To Prevent Chronic Migraine

Preventive medicines are “medicines that you would take scheduled on a daily basis or injections on a monthly basis,” Dr. Dyess explained. “Whatever your regimen is, it’s helping you actually prevent headaches from occurring.”

Blood Pressure Medications

Blood pressure medications, like beta-blockers, can be "very effective" at preventing migraines, Dr. Dyess said. "We typically start out at doses lower than a typical patient would use for actual blood pressure," Dr. Dyess explained. As far as why they work, Dr. Dyess said there's a concept called cortical spreading depression (CSD)—a wave of activity across the surface of the brain—and healthcare professionals think these medicines can interrupt the spreading process of a migraine.

Antidepressants

Amitriptyline is often used to prevent migraines, but side effects like nightmares, dry mouth, and extreme sleepiness mean it’s not a good fit for everyone, according to MedlinePlus. Another option is venlafaxine (Effexor), a different type of antidepressant. Each is considered “probably effective” in migraine prevention, according to a statement from the American Headache Society published in 2021 in the The Journal of Head and Face Pain.

Anti-seizure Drugs

Anticonvulsants, such as topiramate or gabapentin, may be tried as preventative migraine therapy, according to the American Migraine Foundation. “We think that part of the issue with migraines is that your nerves become hyperexcitable, meaning that they fire more easily and become more irritated easily,” Dr. Dyess said. “We think that these anticonvulsants help calm the nerves and prevent them from being activated and causing more pain.” But side effects include skin rash, weight changes, and sedation.

Botox Injections

Botox injections are approved specifically for chronic migraine sufferers, according to Johns Hopkins. On a basic level, botox “decreases sensory input around the face and neck,” said Robert Cowan, MD, professor of neurology and chief of the division of headache medicine at Stanford University. But there may be more to it than that. “We also think that chemically Botox helps dial down inflammation,” Dr. Dyess added.

Calcitonin Gene-related Peptide (CGRP) Inhibitors

Studies show that blood levels of calcitonin gene-related peptide (CGRP), a chemical messenger, are elevated during a migraine attack, according to a 2017 review in the Journal of Headache and Pain. That observation has led to two classes of CGRP blockers.

Monoclonal antibodies. Drugs like Aimovig, Ajovy, and Emgality block the effects of CGRP, according to the US Food and Drug Administration (FDA). Injected on a monthly or quarterly basis, the effects of these medicines can last for months, and they’re well-tolerated by most people—the most common side effect is pain at the injection site, per the American Migraine Foundation. Another monoclonal antibody, Vyepti, was approved in 2020 as the first intravenous (IV) treatment for migraine prevention, according to the American Headache Society.

CGRP receptor antagonists. These oral medicines work by stopping the inflammation that leads up to a migraine, Dr. Dyess explained. Nurtec ODT is a CGRP receptor antagonist that is the only one approved both as a preventive and acute medicine, according to the American Headache Society. Common side effects include nausea, stomach pain, and indigestion.

What Are Chronic Migraines? Neurologists Describe the Causes and Treatments

Medications To Treat Chronic Migraine

There are a few options for knocking out a migraine when you're in pain. "The acute medications are supposed to be employed at the very first sign of migraine. So you start having pain, you take the medicine," Dr. Dyess explained. "It, in theory, will help to eliminate the headache in a timely fashion so that you can go about your day."

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Many NSAIDs like aspirin, ibuprofen, and acetaminophen are available over the counter, which makes them a convenient option, according to the American Migraine Foundation. NSAIDs are typically used for mild headaches and can irritate the stomach and cause digestive issues like ulcers and gastrointestinal bleeding.

Triptans

Triptans are one of the main headache-specific drugs recommended by healthcare professionals for chronic migraine, according to the American Migraine Foundation. Common brands include Imitrex (sumatriptan) and Maxalt (rizatriptan). Triptans work by stimulating serotonin, reducing inflammation, and constricting blood vessels, according to the National Headache Foundation. They’re most effective when taken early on in a migraine attack.

Dihydroergotamine

Dihydroergotamine (sold under the brand name Migranal) is available as a nasal spray or an injection, and it’s most effective when taken at the very start of a migraine that would otherwise last longer than 24 hours, according to MedlinePlus. Dihydroergotamine tightens the blood vessels in the brain and prevents the release of certain substances in the brain that cause swelling. Side effects include tingling or pain in the nose and throat, nosebleed, nausea, vomiting, and more.

CGRP Receptor Antagonists

Another CGRP receptor antagonist that is approved for the acute treatment of migraine is Ubrelvy (ubrogepant), according to the FDA. In drug trials, CGRP receptor antagonists have been shown to reduce pain, nausea, and light sensitivity within two hours. Ubrelvy’s side effects include nausea, dry mouth, and excessive sleepiness.

Ditans

For people who haven’t found success with triptans, ditans may be an option. These drugs are believed to work by targeting a certain type of serotonin receptor on nerves that transmit headache pain, according to Harvard Health Publishing.

Reyvow (lasmiditan) is the first drug in its class. In clinical trials, substantially more people experienced migraine symptom relief within two hours versus those who took a placebo. Common side effects include dizziness and sleepiness.

Anti-nausea Medicines

“Nausea is a very common migraine complaint,” Dr. Dyess said. “So having a nausea medicine is very helpful.” But these medicines might help beyond reducing nausea, Dr. Dyess said. The way these drugs work may also help “shut down the migraine,” Dr. Dyess said. Options include metoclopramide and prochlorperazine, according to a 2018 review in American Family Physician.

Complementary and Alternative Treatments

If you've had chronic migraines for long enough, you've likely been recommended a host of different supplements. Unfortunately, most are ineffective at best. "If you were to Google supplements for migraine, the vast majority of those supplements do not have significant amounts of research behind them," Dr. Dyess said.

But complementary treatments are a viable option for some people. "The challenge is that these require active engagement on the part of the patient, and results are not typically immediate as they can be with some of the pharmaceuticals," Dr. Cowan said. "A lot of this hinges on patient preference."

Magnesium

Magnesium is among the few complementary treatments for chronic migraines that have shown promise. “It’s been proven safe in a variety of settings for headache,” Dr. Dyess said. It seems to help people who have migraines with aura in particular, and people with menstrual-related migraines, according to the American Migraine Foundation. It’s also safe for use in pregnant people, which is not true for some migraine medications.

B Vitamins

There’s some evidence that high doses of riboflavin (B-2) reduces the number of migraines by about two migraines a month, according to MedlinePlus. Additionally, if you take riboflavin with other vitamins and minerals, this may reduce the amount of pain a migraine can cause.

Coenzyme Q10 (CoQ10)

A review and analysis of six small studies from 2020 in BMJ Open found no significant reduction in migraine severity with CoQ10 supplementation. But the compound may have other benefits. The duration and frequency of migraines with CoQ10 was significantly reduced compared with a control group.

Remote Electrical Neurostimulation (REN)

Nerivio, a wearable REN device, delivers electrical pulses to nerves in the upper arm. It’s believed that the brain responds to those signals by activating the body’s own ability to squelch pain in another part of the body, according to a study from 2021 published in Pain Reports. This non-pharmaceutical treatment may be a viable alternative for people with chronic migraine. The American Headache Society found that REN may reduce medication-overuse headaches.

Mindfulness, Biofeedback, and Other Awareness Techniques

“Migraines are very stressful when they’re happening. They’re very stressful on your family and your family dynamics that take a huge toll in your life,” Dr. Dyess said. Cognitive behavioral therapy, mindfulness, and even biofeedback (which teaches patients to monitor and control their heart rate) can help people manage stress and deal with the effects of migraine. “A lot of people use it as a way of dealing with the pain in real-time,” Dr. Dyess said.

Bottom line: Stay in conversation with a healthcare professional when it comes to complementary techniques. "I'm always open to trying whatever works to control their pain and control their migraines as long as it's safe," Dr. Dyess said.

A Quick Review

The pain of a migraine is typically something that can't be ignored. There are preventative, acute and complementary treatments available, all depending on the severity and frequency of your migraines. These medications may not be right for every person. Talk to a healthcare professional about your options to treat your migraine symptoms.

Everything is loud, bright, and your head is pulsating with pain. You might even feel as though a vice grip is clenching your skull. Migraine sufferers know what it's like to have an entire day sidelined because of an irresistible urge to hide in a cool, dark room.

But one migraine is bad enough. Imagine having several every month. Chronic migraines differ from typical migraines in part by how often they happen but also because most chronic migraine sufferers have several non-migraine headaches the rest of the month.

“Very often I’ll ask a patient, how many migraines do you have a month? And they’ll say, ‘oh, maybe two a week,'” says Robert Cowan, MD, professor of neurology and chief of the division of headache medicine at Stanford University. But when he asks if they’re headache-free the other 22 days of the month, they’re quick to correct themselves. “They say, ‘No, no, I have my regular headaches, those are every day—but I only seem to have migraines about twice a week.”

Chronic migraine is defined as “a patient that has headache more than 15 days per month, of which eight or more have migrainous features,” Dr. Cowan explains. That’s based on the International Classification of Headache Disorders.

What are chronic migraine symptoms?

For migraine sufferers, their migraines often feature "a mostly one-sided headache with either nausea or a combination of light and sound sensitivity, worsened by exercise, and is moderate to severe," Dr. Cowan explains.

Per the American Migraine Foundation, symptoms for a typical migraine include:

• Moderate to severe pain on one side of the head, although it sometimes happens on both sides
• Throbbing or pulsing pain
• Sensitivity to light
• Sensitivity to sound
• Sensitivity to smell
• Sensitivity to touch
• Nausea and vomiting
• Dizziness
• Pain that gets worse with exercise

But, as mentioned, chronic migraines also feature general “headache” days. Headaches come in different forms, according to the Cleveland Clinic, but generally, their symptoms include:

• Consistent, mild-to-moderate pain without throbbing
• Pain on both sides of the head
• Pain that decreases or subsides with over-the-counter treatments

A Neurologist Explains Everything You Need to Know About Migraines—and How to Avoid Them

What causes chronic migraines?

"The main cause is poor parental selection," says Dr. Cowan—that is, your genetics play a big role in how susceptible you'll be to migraines. If a family member has migraines, you're much more likely to experience them.

Migraines are more common in women and tend to start in adolescents, though they can begin at any age. They’re usually the worst in your 30s and begin to lessen as time goes on, according to the Mayo Clinic.

As far as the exact mechanism that causes migraines, it's not entirely clear. It may have to do with changes in the brainstem, or possibly an imbalance in brain chemicals, as the Mayo Clinic explains.

Risk factors that make chronic migraines more likely include obesity, overusing medications, asthma, and poor sleep habits, Dr. Cowan says. A doctor should be looking at health conditions you have, because managing other illnesses may help reduce the frequency of migraines, he explains.

Certain things can trigger migraines. Dr. Cowan says the biggest triggers are a change in sleep, particularly not sleeping well, a change in eating routine or amount, and a big increase in physical activity relative to how active you usually are.

Other triggers include hormonal changes (like those around menstruation), drinking alcohol or caffeine, bright lights, strong smells, and loud sounds, along with certain foods, according to the Mayo Clinic.

But the important thing to understand about triggers is that they build on each other, which can make them hard to identify. For example, a patient who gets a migraine after eating blueberries they may blame the berries, Dr. Cowan explains. But often that person got a poor night's sleep and had a stressful day, and then had blueberry pie. The migraine wasn't triggered by blueberries alone.

Actively managing your migraines may make your triggers less impactful, says Mason Dyess, DO, a general neurology and headache medicine physician at Ochsner Medical Center in New Orleans. “People tend to have more triggers and are more susceptible to their triggers when their migraines are uncontrolled,” he explained. But until you’ve found a regimen that works for you, “if you know something’s going to give you a migraine, avoid it,” he says.

The 14 Different Kinds of Headaches You Can Get—And How to Treat Each One

How are chronic migraines diagnosed?

You’re unlikely to have any imaging done with a migraine. “Ninety-five percent of your diagnosis in headache patients comes from the history,” Dr. Cowan explains. The more information you have about your experience with headache and migraine, the better your doctor will be able to diagnose you. Try making a note each day you have a headache or migraine before your appointment.

That’s important, explains the American Migraine Foundation, because chronic migraine is diagnosed based on the number of headache days you have, not on how disabling the condition may be.

Your doctor may also do a physical exam to check your neck range of motion and touch the back of the head and around your temples and eyes to check on certain nerves. "That can tell me a lot about how to treat the patient," Dr. Cowan says.

If you're having frequent headaches, your doctor will want to rule out other potential causes, such as an underlying health condition or a different type of headache, notes the American Migraine Foundation.

'I Tried CGRP Inhibitors for My Chronic Migraines After Other Treatments Failed—Here's What Happened'

How do you get rid of chronic migraines?

Treatments for chronic migraines can be broken into two categories: preventive medications that help reduce the number of migraines every month and acute medications for when you actively sense a migraine coming on.

"Most patients take both if they have chronic migraine," Dr. Dyess says.

But it's important to know when to take them. "The acute medications are supposed to be employed at the very first sign of migraine," Dr. Dyess explains. That means as soon as you feel any pain. Acute medicines include over-the-counter medications like ibuprofen or aspirin and headache-specific medicines called triptans, such as sumatriptan and rizatriptan.

Preventive medications include oral medications, like beta blockers, antidepressants, and seizure medications. They might also include injectables, like Botox or calcitonin gene-related peptide (CGRP) inhibitors.

There are also newer CGRP blockers in pill form, which are approved as both acute and preventive medicine. This category includes Nurtec (rimegepant) and Ubrelvy (ubrogepant). "We probably get the most questions about them right now," says Dr. Dyess, because they've been popularized by several celebrities. "Those work to fundamentally help the inflammatory pathway, to stop the inflammation that leads up to a migraine."

You may also take other medications that help with migraine side effects, such as Zofran (ondansetron) for nausea.

The important point is this: if you're struggling with migraines, talk to your doctor—especially if your headaches or migraines have been increasing. "I'm more concerned about a patient who's gone from two headache days a month to six or eight headache days a month. That person is still going to be defined as episodic, but that's a patient that's in trouble or headed for trouble," says Dr. Cowan. "That patient's on their way to being disabled by their headaches if you don't intervene."

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Yep, I suffer from the bad timing (and all-around bummer) of vacation headaches—and I'm definitely not alone. Headaches can, unfortunately, happen at any time, and getting laid up with a migraine on your precious PTO isn't as uncommon as you might think.

So what's the deal with head pain that hits just when you're hoping to relax? Here are some of the precipitating factors for vacation headaches, according to experts—and what you can do to keep them from ruining your time off.

RELATED: The 14 Different Kinds Of Headaches You Can Get—And How To Treat Each One

You have a let-down headache

Picture this: You've just settled into a beach chair with an umbrella-topped drink when—ugh—in the midst of this tranquil scene, you feel a migraine coming on. That, friends, is what's known as a "let-down headache."

"A let-down headache is a headache which occurs when there has been a drop in stress levels," Deena Kuruvilla, MD, neurologist, headache specialist, and director of the Westport Headache Institute, tells Health. "Many patients with chronic or episodic migraine tell me that their headache frequency has been really well controlled on preventive migraine treatments, but then boom, they go on vacation and experience an attack!"

According to research from the journal Neurology, headaches, for some people, don't get triggered from stress, but when stress is released, though it's not exactly clear why. "While we do not know the exact cause of let-down migraine, one possibility that has been proposed is a fluctuation in our stress hormone levels," says Dr. Kuruvilla. "These stress hormones increase during times of stress and then decline when we are relaxed." 

Fortunately, to keep your relaxation from backfiring into a headache, you do have options. The National Migraine Foundation advises stabilizing stress levels by getting enough sleep, managing time commitments, and spending quality time with a partner or friend. Especially prior to leaving for vacation, these and other stress management activities can help avoid the spike-and-drop pattern that might trigger a migraine.

Lots of smaller stressors added up

The truth is, not every aspect of vacation is stress-free bliss. From last-minute packing woes to the difficult in-laws you may be visiting, there are any number of reasons why you might need a vacation from your vacation. All of these can add up to headaches—literally and figuratively.

Again, self-care strategies for de-stressing are your best bet for prevention. Try downloading a guided meditation to listen to in the car, practicing deep breathing exercises in the airport terminal, and giving yourself quiet, unscheduled breaks throughout your trip. 

RELATED: What Is a 'Stress' Headache and How Can You Treat It?

You’re off your typical sleep schedule

When you're away from your own bed, sleep doesn't always come easily. "Migraine and sleep run hand in hand," says Dr. Kuruvilla. "Traveling across time zones can throw off a person's circadian rhythm, which contributes to sleep disruption and migraine attacks." 

For better shuteye on vacation, practice healthy sleep hygiene by discontinuing the use of devices before turning in, keeping a cool, dark bedroom, and sticking to your usual bedtime routine as much as possible. While you're at it, tuck some melatonin in along with your toiletries. "Melatonin is a hormone which helps regulate the circadian rhythm. Research studies have shown it can be helpful for the prevention of migraine," says Dr. Kuruvilla. 

You’re dehydrated

It's hard to overstate the importance of staying hydrated to prevent head pain. "Even 1-2% body water loss can increase your chances of developing headaches," dietitian Maryann Walsh, MFN, RD, CDE, tells Health. "So it's critical to get adequate water."

But while air travel alone can be dehydrating, the low humidity in a plane cabin isn't the only factor that can lead to vacation dehydration. Simply switching environments can bump us out of our usual healthy habits. "Being out of your normal routine can lead to not hydrating as you normally would, especially if you are on a road trip or flight and you'd rather not have to stop or get up to use the restroom every hour," says Walsh.

Then there's that ubiquitous vacation frenemy: alcohol. "Because alcohol acts as a diuretic, it can further cause us to be dehydrated," says Walsh. "If we aren't drinking enough water before, in between, and after a day or night of cocktails, this can lead not only to a dreaded hangover, but also headaches."

Want to get ahead of head pain from dehydration? Always stash a bottle of H2O in your travel bag, and keep the water flowing alongside any alcoholic drinks you consume.

RELATED: 18 Signs You're Having a Migraine

Your diet changed up

Could that dinner you enjoyed at a five-star restaurant send you loading up on Ibuprofen the next day? It's possible. For some people, foods high in substances like tyramine, nitrates, sulfites, and artificial ingredients can be a trigger for head pain, according to the Cleveland Clinic. Common culprits include aged cheeses, cured and processed meats, pickled foods, and alcohol—all of which you'll frequently encounter in restaurant dining.

Meanwhile, travel can disrupt other individual diet choices you might normally make to live pain-free. "Some of us may have dietary headache triggers that we usually avoid in our daily lives, but may not be able to avoid if there are sneaky ingredients we are consuming out at restaurants," says Walsh. 

And don't forget the impact of caffeine. Fluctuations in caffeine intake are known for tripping the headache wire. If vacation mode has you chilling out sans coffee—when you'd normally drink several cups a day—a headache can result. Rather than drastically deviate from your norm, try keeping your caffeine intake consistent.

You’re at a higher altitude

As you make your way up winding roads for a mountain getaway, you're likely looking forward to fresh air and cooler temps—but altitude change can be a hidden cause of headaches.

According to the American Migraine Foundation, altitude-related headaches occur most often over 8,500 feet. Still, you don't have to be scaling Everest for altitude to mess with your head; even smaller elevation changes may lead to discomfort. "Studies have confirmed that all migraine associated symptoms, headache frequency and headache severity tend to worsen with increasing altitude," confirms Kuruvilla. "One of the proposed mechanisms is a loss of oxygenation to the brain as a result of being at an increased altitude."

If altitude-related headaches put a damper on your mountain retreats, do your best to stay hydrated and take frequent breaks as you travel upward. Or ask your doctor if a prescription medication could be right for you. And, if all else fails, consider swapping the cabin in the Rockies for a trip to the beach. 

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I thought I had tried everything-Advil, beta-blockers, Topamax-but none of them gave me the results I was looking for. Then a few years ago, my neurologist suggested I try Botox to manage my migraines. I knew about the drug's wrinkle-reducing effects (I watch the Real Housewives franchises and Keeping Up With the Kardashians, after all), but I didn't know that the same drug is a well-regarded preventative treatment for chronic migraine.

Admittedly I was hesitant about getting dozens of shots injected into my head, neck, and shoulders on a regular basis, but my misery made me open to trying it. Despite my initial concerns, Botox shots have completely changed how I control my migraine attacks. Though I'm still good for one or two migraines each month, Botox has drastically reduced the frequency of these attacks.

Getting Botox for my chronic migraines changed my life. What you need to know.

First: What exactly is a migraine?

Most people believe a migraine is just a bad headache, but it can be more than that. According to the American Migraine Foundation (AMF), a migraine (sometimes just referred to as "migraine") is a "disabling neurological disease with different symptoms and different treatment approaches compared to other headache disorders."

It's also important to note that, while some headaches can be the cause of underlying conditions (those are known as secondary headaches), migraines are usually their own thing. "Migraine is the most common primary headache disorder, which means that it's not happening because of a tumor or an infection. It's just how your brain is wired," Umer Najib, MD, a board-certified neurologist and the director of the headache medicine fellowship program at West Virginia University, tells Health.

"Pain is often the predominant symptom, though many patients have other symptoms that can actually be more bothersome than the pain itself," says Dr. Najib. Ferhad Bashir, MD, a neurologist with Mischer Neuroscience Center at Memorial Hermann The Woodlands Medical Center in Texas, goes a step further: "It's a state of misery," he tells Health. "During that time period, you're not yourself. If you're at work, you can't produce at your optimum level. If you're a parent, you can't enjoy time with your kids."

Those additional symptoms, aside from often disabling pain, include:

• Sensitivity to light, sound, or strong smells
• Nausea
• Vomiting
• Excessive Fatigue
• Language, speech, or balance problems
• Visual disturbances, like seeing zig zags, flashes of light, or blind spots.

It's not entirely clear what causes migraine, though researchers believe that there's a genetic component to the neurological condition, according to the US National Library of Medicine's MedlinePlus resource. But the condition-which affects more than 37 million people in the US alone-is thought to have quite a few triggers, including stress, anxiety, caffeine (or caffeine withdrawal), and certain medications.

Migraine is also about three times more common in women, per the AMF, which points to a possible connection to fluctuating hormones. "For a lot of women with migraine, menses can trigger an attack," Megan Donnelly, DO, a board-certified headache specialist and neurologist, and the director of headache and women's neurology at Novant Health in Charlotte, North Carolina, tells Health. "We also have changes in migraine frequency in pregnancy and postpartum, as well as related to perimenopause."

There's no cure for migraines, per MedlinePlus. Instead, treatment mainly focuses on relieving symptoms and preventing or lessening future attacks through a combination of medications and lifestyle changes. This, in some cases, is where Botox-aka Onabotulinumtoxin A or Botox A-comes into play.

RELATED: 5 Women on What It Really Feels Like to Have a Migraine

How does Botox for help migraine?

Botox is a preventative therapy for migraine, meaning that it can reduce the frequency of migraine, but it won't stop one once it's begun. Though Botox has been an FDA-approved treatment for chronic migraine for more than a decade, per the AMF, the science behind how it battles the disease is still a bit of a mystery.

Technically speaking, the AMF says that Botox is injected into the pain fibers in the head, neck, and back that are involved in headaches. That Botox then blocks the release of chemicals involved in pain transmission, which then prevents activation of pain networks the brain.

Why Botox works in this way, however, is still not well understood. "We have animal data that shows that Botox causes a change in a certain type of calcium channel in the meninges, which is the covering of the brain as well as the critical part of the migraine process," says Dr. Najib. "We think that's how it suppresses migraine."

Despite Botox's efficacy (patients reported that two rounds of shots reduced their headache days by roughly 50 percent, per the AMF), Dr. Najib notes that the drug isn't a cure-all. "As long as the disease is still active, you'll have breakthrough headaches," he says.

Because of that, some patients find that they need another preventative treatment, like an oral medication, in addition to their shots. It's also common to need a rescue drug, and the risk of drug interaction is minimal.

Choosing a treatment of preventative method for migraine is a highly personal choice that should be done in close contact with your doctor. Here's more of what I learned about Botox and migraine during my own journey-and what I want those considering the treatment to know.

RELATED: This Explains Why You Want to Crawl Into a Dark Closet When You Have a Migraine

It’s only approved for chronic migraine

Botox is FDA-approved to treat chronic migraine in adults, which is defined as more than 15 migraine days per month. It's not approved for other kinds of headaches, like tension or cluster, nor is it approved for children or adolescents (if it's used for them, it's considered "off-label use").

You’ll have to get dozens of shots

Though migraine symptoms vary from person to person, Botox for migraine is standardized. Every three months you'll receive 31 shots (yes, you read that correctly) totaling up to 155 units of Botox. This includes injections in specific spots in the forehead, temples, back of the head, neck, upper back, and shoulders.

If you've got a particular concern, like muscle spasticity or tightness in the shoulders, your provider may adjust the shot pattern to tackle that specific issue.

If Botox is working for you, there's no known health risk associated with staying on it indefinitely, though it's not approved for people who are pregnant or breastfeeding because of minimal studies in these groups.

The risk of side effects is low

"Botox injections can occasionally trigger a headache, muscle weakness and neck pain, but this is rare," Kerry Knievel, DO, director of the Jan & Tom Lewis Migraine Treatment Program at Barrow Neurological Institute in Phoenix, Arizona, tells Health. "Eyelid and eyebrow asymmetry and droop can happen, but to prevent this we recommend that patients refrain from rubbing their foreheads or wearing a hat for 24 hours after their injections to prevent the Botox from spreading from the area we intend for it to be."

In fact, Botox's limited side effects are part of its appeal. "It's not addicting. You don't have to take a pill every day. It doesn't work for everyone, but it does work for a significant amount of people. That's why Botox is amazing," says Dr. Bashir.

Your insurance may or may not cover it

Because it's an FDA-approved treatment, your health insurance may cover all or most of the cost of Botox, though this depends on your specific plan. The drug manufacturer also offers a savings program that can help offset some of the expense.

To get approval, your insurance company may want to see that you've "failed" on two or three oral preventatives first. You may also need to keep a headache diary (I track mine in a note on my phone) that shows you're having 15 or more headache days per month.

Once you've started the shots, your insurance will probably require documentation of improvement to continue paying for the treatment. Depending on your plan, you may also need to come for a follow-up visit between shots.

Note, however, that if Botox is used as an off-label treatment (meaning it's used in a way not approved by the FDA, like in children or adolescents), insurance companies may not cover it, per the AMF.

It can take several months to see results

If you don't experience relief from migraine right away, don't swear off the treatment immediately. Dr. Najib recommends trying two rounds of Botox before making a decision about whether it's working for you. Even if the treatment ends up helping after the first round, he says results typically take two to four weeks to kick in. There's no taper required to discontinue the treatment.

It’s a little different than the Botox you receive from your esthetician

Though the same drug is used for both migraine prevention and cosmetic purposes, the amount and placement of Botox varies depending on your goals.

You may find some level of relief when you get Botox for cosmetic purposes. However, when you receive Botox from an esthetician, you're not getting injections in the same spots as you would in a doctor's office. This means you'll miss the drug's full migraine-busting effect.

You can technically get Botox for migraine and for cosmetic reasons at the same time-but you may not want to

This is where it gets a little murky, and opinions vary depending on who you ask. The manufacturer of Botox recommends not exceeding 400 units in a three-month span. Since your neurologist will administer 155 units, technically you have wiggle room if you want to visit an esthetician for Botox, too. However, this can be problematic.

"There is a theoretical risk of developing antibodies to Botox if it's given more frequently," explains Dr. Donnelly. If you'd like to do both, it's best to check with your provider before booking an appointment with your esthetician.

Overall, if you're finding yourself planning your life around your migraines, you may want to make it a point to chat with your doctor about using this multitasking drug to reduce the frequency of the attacks. I know doing so has drastically changed my life-and it might help you, too.

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Most of us found ourselves addicted to watching the news in 2020, crazy as it was, and celebrities are no exception. Karamo Brown, 40, one of the fab five of the Netflix show Queer Eye, also got caught in the trap of the never-ending updates. "There was a lot of moments where I caught myself watching the news, constantly on this news cycle," Brown tells Health.

Staying glued to headlines 24/7 isn't necessarily healthy for anyone, but it was especially damaging to Brown because of a chronic health condition he lives with. "I suffer from migraine, and migraine is brought on a lot by stress. [The news] would just be bringing out so much stress to me, which was triggering my migraine," Brown explains.

RELATED: YouTube Star Lilly Singh Explains How Quarantine Taught Her What a Work-Life Balance Looks Like

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I was about two years into my migraine journey at that point. After years of sporadic migraine, I had progressed to high-frequency episodic migraine—headache activity 10 to 14 days per month, with more than a few episodes severe enough to send me to bed until my medications kicked in. Given my severe symptoms, my neurologist said injections were my best option for relief, and I had two choices: Botox injections administered in-office every three months, or giving myself anti-calcitonin gene-related peptide (anti-CGRP) injections once a month at home.

RELATED: A Neurologist Explains Everything You Need to Know About Migraines—and How to Avoid Them

Of course, I still had reservations. CGRP inhibitors were only recently approved by the US Food and Drug Administration (FDA) in 2018, and the thought of taking a brand-new drug made me nervous. The injections also aren't meant for everyone—according to Stewart Tepper, MD, a professor of neurology at Dartmouth Geisel School of Medicine in an interview with the American Migraine Foundation, people who have multiple medication failures (like me) are the best candidates for the drug. But the fear of getting on yet another ineffective (and potentially harmful) treatment outweighed any fear of trying something new.

With my sample injection pens in hand—the first month includes an extra loading dose, FYI—I left my doctor's office and went home cautiously optimistic. After my history of daily pills, dosage adjustments, and medication interactions, could this—a 10-second injection once a month—finally give me some much overdue relief? I was ready to give this a try—at least during the car ride home.

Once there, I opened everything up and read the directions. My neurologist had walked me through the steps on how to administer the medication in her office, so I was somewhat familiar with the procedure (for my blind spots, there was also an instructional YouTube video, which made the process look incredibly easy). But, dose in hand, I started spiraling: Had the testing on the medication been rigorous enough? Could I possibly inject myself the wrong way? If I did suffer side effects, how long would they last?

At this point, the anxiety rabbit hole had been opened and couldn’t simply be closed back up again. Before I took the literal plunge and pressed down on the injection button, I needed to know more about what I was getting myself into, so I did something you're not supposed to do: I played Dr. Google. I checked in on my favorite migraine resource groups on Facebook—a rookie mistake. The comment sections were split down the middle, with people who benefitted greatly from CGRP inhibitors, and those who did not, and they didn't help my decision process.

RELATED: 5 Women on What It Really Feels Like to Have a Migraine

My fears about taking the drug didn't completely stem from the unknown—I was also terrified of revisiting an all too familiar past with migraine medications. Each time I tried a new treatment that ended up not working, my fears about living with migraine grew bigger. I worried they'd continue getting worse; that I'd have chronic migraine forever; that I'd miss out on my family's important events, stuck at home in the dark with a lightning storm raging in my head. I wasn't sure I could handle another failed treatment.

Feeling anxious and dejected, I set aside the injections. When my husband came home from work, I reeled off a mile-long list of concerns, worries, and what-ifs. "What if this doesn't work?" I asked him.

My reasonable, rational, level-headed husband responded with, “Okay, but what if it does?”

He was right. I had no idea whether the injections would help me or not (and truthfully, I also didn't know if Botox injections would've helped, either). I was already uncomfortable, in pain, and missing out on large chunks of my life thanks to the effects of chronic migraine. I could get better on this new medication, or I could get worse, though not by much—I didn’t really have a lot to lose.

My husband came back into the bathroom with me and offered to give me the injections, but I wanted to do them myself. It’s recommended that you inject yourself in the upper leg, stomach, or buttock, and my leg seemed like the least easiest place. It took me a minute or two to work up the nerve to press down on the injection button over my thigh, and when I did, it hurt much more than I expected it would, but it lifted a weight off my chest, too. There was no going back.

RELATED: Scientists Have Developed a Promising New Migraine Medication—Here's What You Should Know

I’ve given myself six more rounds of injections since that first injection, and so far CGRP inhibitors have been a positive experience for me. I’ve had almost no side effects, except for injection site irritation (I have sensitive skin, so I end up with moderate swelling and itching for 48 hours after the injection; annoying, but manageable). I’ve also noticed an improvement in the frequency, severity, and duration of my migraine.

CGRP injections aren’t a cure; they’re not designed to make chronic migraine disappear. But I’ve been able to manage my migraine better in the last several months, which is more than I can say about any other treatment I’ve tried. But I also know that this treatment may not last. I could suddenly develop side effects or acclimate to the medication, making it useless.

In any situation, the future is always scary for people with migraine. It's often an evolving health condition, changing with seasons, diets, hormones, sleep, age, and a number of other factors. Treating migraine isn’t a matter of finding something that works and sticking with it forever. Feeling better can be fleeting—but so can feeling worse, if I’m remembering to be optimistic.

Ultimately, I can’t predict what lies in my migraine future. My episodes are tied to my hormones, so maybe when I go through menopause I’ll notice an improvement (a girl can dream, right?). For now, every 28 days, I do the only thing I can do: I take a chance this therapy will work. I say yes. I press down on the button and hope for the best. And when the voice inside my head says “What if this doesn’t work?” I force myself to ask the opposite question: “What if it does?”

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Headaches in particular are often brought about by increased stress levels, but while "stress headaches" may be a good description of what's going on in your body, it's not an entirely accurate diagnosis. Here's what you need to know about headaches triggered by stress, and how to help relieve the pain. 

What is a “stress” headache?

Stress headaches aren’t an official classification of headaches in the International Classification of Headache Disorders (ICHD-3), but are more accurately known as “tension-type” or tension headaches, Ellen Drexler, MD, a board-certified neurologist based in New York, tells Health.

“Tension-type headaches are defined by the absence of migraine features, so they tend to appear on both sides of the head, feeling like a pressure pain, without the usual migraine accompaniments of nausea, sensitivity to light and sound, and worsened by head movement,” says Dr. Drexler. “They'd be the sort of run-of-the-mill pressure in the front of your head kind of headache of mild to moderate severity.”

RELATED: 11 Surprising Headache Triggers

According to the US National Library of Medicine's MedlinePlus database, tension headaches are the most common type of headache and are described as pain or discomfort in the head, scalp, or neck, often associated with muscle tightness. Tension headaches affect roughly 70% of people, and can last for 30 minutes to 72 hours, Susan Broner, MD, assistant professor of clinical neurology at Weill Cornell Medical College, tells Health, and in order to be properly diagnosed with tension headaches, you need to have a history of them. “To make the diagnosis, you've had to have had at least 10 of these [headaches]," Dr. Broner says. 

Stress, of course, plays a key role in triggering tension headaches. "The exact mechanisms aren't clear, but it's theorized that when people are exhibiting stress, physiological changes occur in the body,” Dr. Broner says. “Increased cortisol levels and our fight-or-flight response gets revved up, triggering a migraine or tension-type headache.” Aside from stress, other triggers of tension headaches, according to MedlinePlus, include: alcohol use, caffeine, illnesses (colds, the flu, etc.), dental problems, eye strain, excessive smoking, and fatigue or overexertion.

RELATED: The 14 Different Kinds Of Headaches You Can Get—And How To Treat Each One

How can you treat “stress” headaches—and when should you see a doctor?

Depending on the severity and length of your stress headache, it can go away on its own by simply taking a break from whatever activity is causing you stress, Dr. Wexler says. Lying down, meditating, or doing some light yoga are all great options. 

However, if the pain is really bothersome, most stress headaches can be treated with over-the-counter analgesics like ibuprofen or naproxen, Dr. Broner says—but be wary of the frequency with which you’re taking medications. “If you find that you're taking [medications] more than once a week on a regular basis, that's a sign that you're getting increased headache frequency and you should speak to your doctor about what's causing your headaches,” Dr. Broner says. 

RELATED: 12 Ways to Get Rid of a Headache, Besides Taking Ibuprofen

Dr. Wexler also recommends that if headaches aren’t the norm for you, especially if you’re over the age of 50, you should consider speaking to a neurologist or headache specialist, since this could signal that something else more serious is going on. Some other warning signs to pay attention to, according to Dr. Wexler, include: “headaches that consistently get worse or more frequent over time, accompanied by any neurological conditions such as double vision, numbness, tingling, paralysis, loss of vision, or accompanied by a fever.” 

Despite a stress headache or two being normal, Dr. Broner encourages you not to let them become a regular part of your life you have to adjust to. “It's a very difficult time for so many people so be kind to yourself and relax even when you're under stress,” Dr. Broner says. “If stress is interfering with your sleep and your mood, get help to learn how to deal with it.”

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According to the American College of Allergy, Asthma & Immunology (ACAAI), two different types of headaches are linked to allergies: sinus headaches, which typically feel like facial pain and pressure; and migraines, which can cause moderate to severe pain that can feel like throbbing and can be accompanied by nausea. The triggers of those headaches often include nasal or sinus congestion, stress, certain foods, or smoke, per the ACAAI.

But before you definitively start blaming your headaches on allergy season, it's important to note that allergy headaches in general are controversial in the medical community. "A true allergy headache is probably very rare," Ronald Purcell, MD, an allergist at Cleveland Clinic tells Health. That's because some experts believe that what people call allergy headaches may actually be a different type of headache—like a migraine or tension headaches—independent of a person's allergies.

RELATED: Scientists Have Developed a Promising New Migraine Medication—Here's What You Should Know

The National Headache Foundation (NHF) also highlights the controversial connection between allergies and headaches, sharing that, while many people with migraines may attribute them to reactions to certain foods, that's often not the case (they note the difference between headache-triggering chemicals, which are bodily reactions but not allergic reactions). The NHF adds that respiratory issues or seasonal allergies can contribute to or cause sinus headaches (and in some cases, migraines), and patients who experience those issues should be evaluated by a medical professional for a proper diagnosis.

Regardless of the controversy—and whether you're suffering from a true allergy headache or just a headache triggered by allergies—the pain is real. "Most commonly, what people will describe is a sense of pressure in the face," says Dr. Purcell. That pain is typically caused by inflammation in the sinuses, or the hollow air spaces behind the eyes, cheekbones, forehead, and nose (though Dr. Purcell notes that sinus pain may also be due to a sinus infection rather than allergies).

RELATED: What Is a Sinus Headache, Anyway? Doctors Explain How They're Treated and Prevented

The treatment for a headache possibly caused by allergies is pretty simple: You treat the allergies to make the headache or facial pain go away. Allergies can be treated with over-the-counter or prescription medications, as well as allergy shots. But other than treating your allergies, there’s no specific treatment for allergy headaches.

The ACAAI also recommends avoiding the headache or allergy triggers as much as possible. That means limiting outdoor exposure when pollen counts are high, avoiding fans that can draw air from outside into your home, and wearing sunglasses that limit allergen exposure to your eyes, washing your hands after petting any animals you're allergic to, and keeping the humidity in your home at low levels to limit exposure to mold, among other things.

And if you keep getting headaches even after you’ve gotten your allergies under control, your head pain may be due to something else, says Dr. Purcell. Remember: There are loads of different types of headaches, so if the pain persists, don’t hesitate to see a headache specialist to get some relief and make sure further testing doesn’t need to be done.

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It's cleary a sinus headache, right? Not so fast: Before you make a hasty decision and decide to self-treat, it's important to know that migraines are actually often misdiagnosed as sinus headaches—largely because they come with many of the same symptoms (yes, even run-of-the-mill nasal congestion).

So how do you know for sure if your headache is sinus-related or something a little more serious? Health spoke to doctors to find out what you need to know about sinus headaches, how to diagnose them, and what you can do to treat and prevent future ones.

RELATED: The 14 Different Kinds Of Headaches You Can Get—And How To Treat Each One

What is a sinus headache, and what causes them?

Most often, a true sinus headache stems from a viral infection or a condition called sinusitis, says Clifford Bassett, MD, a New York-based allergist and spokesperson for the Asthma and Allergy Foundation of America. Sinusitis is a result of inflammation in the tissue that lines your sinuses, which are air-filled cavities in your forehead, cheekbones, and behind the bridge of your nose. Pain in those areas is essentially what is labeled as a "sinus headache."

But here's the thing: Migraines are actually frequently misdiagnosed as sinus headaches, says Isaac Namdar, MD, an otolaryngologist at Mount Sinai West in New York—which means the only true way determine whether or not you have a sinus headache or a migraine is to get checked out by a doctor, specifically an allergist or an otolaryngologist. This can happen through a physical exam or doctors can also get a look at your sinuses through a nasal endoscopy.

Another misconception: Sinus headaches are often associated with allergies, and they shouldn’t be, says Dr. Bassett. “It is not a symptom in general due to seasonal and/or year-round allergies.”

RELATED: Scientists Have Developed a Promising New Migraine Medication—Here's What You Should Know

If you don't have a runny nose, fever, bad breath (or a change in how your breath usually smells), you're likely suffering from a migraine rather than a sinus headache, per the American Migraine Foundation. (The foundation warns that "self-diagnosed" sinus headaches are actually migraines a whopping 90% of the time. So if you suffer from frequent headaches and you're unsure of what's causing them, it's probably best to talk to a doctor about your symptoms.)

RELATED: 11 Surprising Headache Triggers

How are sinus headaches treated—and how are they prevented?

Once a doctor concludes that you’re suffering from a sinus headache, specifically, treatment options vary. Dr. Namdar says using nasal saline rinses, such as the Neti Pot, can help. He adds, “Some people use anti-inflammatory [medications, such as] Flonase.” Additionally, picking up an air purifier for your home can help you if you suffer from sinus headaches, and if a sinus headache is stemming from a bacterial infection, a course of antibiotics can be used to treat the problem.

As for the pain element, which is the real point of this article, Dr. Namdar says patients can take over-the-counter pain medications like ibuprofen and acetaminophen for the headache part of their sinus headaches.

While you can't necessarily prevent a sinus headache if you have sinusitis, you can do your best to prevent viral infections in the first place. Washing your hands with soap and water thoroughly and often is a good start, along with trying not to touch your nose, mouth, and eyes when your hands are unclean. Eating enough vegetables and getting enough sleep can also strengthen your immune system, which means you’re less likely to get sick.

But the main point here: Definitely get to the doctor if you suspect you have a sinus headache—only a medical professional can diagnose one, or let you know that something else (like chronic migraines) might be going on and recommend next steps to take in getting that checked out, as well.

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