4. Offer alternative options and supplements
In her clinic, Wohlgehagen offers alternative approaches for those who either wish to go without medication or who want to try additional treatments. She recommends migraine patients see a nutritionist, consider practicing yoga, and attend to their mental health with a psychiatrist or counselor as part of a larger lifestyle program to support overall health and reduce migraine triggers. She reinforces the importance of hydration and sleep, which patients often do not realize can be triggers.
In addition, she recommends a specific set of supplements that she finds especially helpful to migraine patients:
• Magnesium 500 mg daily
• Coenzyme Q10 300 mg daily
• Riboflavin 400 mg daily
Check vitamins D and B12 as well as thyroid. An improperly functioning thyroid can also contribute to migraines, so Wohlgehagen runs a blood panel if one hasn’t been done already. “We want to make sure there are not other things going on in the patient’s body that are easy to treat that might be increasing the burden of headache,” she says.
5. Don’t let young people fall through the cracks
Physicians should try to keep track of their younger patients with migraines, who often fall through the cracks or don’t get the treatments they need, only to suffer chronic migraines when they are older.
“Something happens in the transitional years from young adulthood to mid-thirties and people [disappear from] the clinic. Then they come to me in their thirties when their headaches are escalating. I feel we’re missing a great opportunity when people are still young to help them get their lifestyle in order.”
6. When to wean off medication
On the other end of the age spectrum, Wohlgehagen says that migraines tend to improve as people get older, especially after menopause in women. In these cases it may be worthwhile to try weaning patients off their medications to see if they can be managed with lifestyle modifications instead. And, of course, women who are or wish to become pregnant should be weaned off as quickly as possible.
Additionally, she says, some migraines are seasonal, so helping patients keep track of their occurrence can allow the physician to tailor a treatment approach that fits the migraine cycle.
Most importantly, Wohlgehagen urges physicians to remember that, “You can’t cure migraine but you can reduce the burden by lifestyle modifications.”