Migraines For Dummies®


by Diane Stafford and Jennifer Shoquist, MD




About the Authors

Diane Stafford: The co-author of Migraines For Dummies, Diane Stafford knows the subject of migraines personally, having lived with headaches lifelong and having grown up in a family of migraine sufferers — sister, brother, and father. Her experiences provided helpful insight on the many challenges that migraineurs face at home, at work, and at play. In this book, she shares numerous ideas for headache management. Diane’s main reason for writing this book is the belief that it will help other migraine sufferers lead more fulfilling lives.

Despite migraines, Diane Stafford has been a high-energy writer and magazine editor for twenty-five years. She has served as editor-in-chief of Houston Health & Fitness Magazine, Dallas-Fort Worth Health & Fitness Magazine, Texas Woman Magazine, Houston Home & Garden, Dallas-Fort Worth Home & Garden, and Philanthropy in Texas. Also an entrepreneur, Stafford co-owned Health & Fitness and helped with startups of the magazine in New Orleans, Philadelphia, and Atlanta. She has written hundreds of articles. She now edits books for Arte Publico Press in Houston and writes books.

Stafford lives with her husband, David Garrett, in Houston, where she is a well-known writer and a community volunteer for Casa de Esperanza de los Ninos and the Emergency Aid Coalition Clothes Center.

Diane Stafford and Jennifer Shoquist (Stafford’s daughter) have also co-authored Potty Training For Dummies (Wiley Publishing), No More Panic Attacks: A 30-Day Plan for Conquering Anxiety (New Page Books), and The Encyclopedia of Sexually Transmitted Diseases (to be published by Facts on File, Inc. in 2003).

Jennifer Shoquist, MD: Evaluating and treating patients’ headaches is a staple of family practice doctors, and that has also been the case for Dr. Jennifer Shoquist, who teamed up with health writer Diane Stafford to write Migraines For Dummies — a book that ambitiously tackles every facet of migraine living, from choosing medications to understanding dietary and exercise triggers to handling people who think your headaches are “in your head.”

Jennifer’s interest in writing began when she was attending the High School for the Performing and Visual Arts, while also interning at Health & Fitness Magazine in Houston, Texas. Later, she completed her medical degree at the University of Texas Medical School at Houston, followed by family practice residency at Memorial Southwest Hospital.

Today, she writes books and serves as a health-issues resource for journalists. She and her husband, Robert San Luis, live in Houston with their son, Benjamin (born during the course of writing this book), and two shih-tzus, Lucy and Sophie.



To Allen, Camilla, and Clinton, who never let migraines slow them down. To migraine sufferers everywhere, our fondest wishes that you will find excellent relief from your headache pain. And, finally, we dedicate this book to the newest member of our clan: baby Ben.


Author’s Acknowledgments

This great project came our way thanks to the efforts of our incredible literary agent — Elizabeth Frost-Knappman of New England Publishing Associates.

Also, we appreciate the hard work and talent of our wonderful Project Editor, Kathleen Dobie, our capable Acquisitions Editor, Natasha Graf, and our copy editor, Greg Pearson, all at Wiley. We also owe thanks to Dr. Stephen Silberstein, who reviewed the book for technical accuracy. And a special thanks to Houston neurologist Dr. Brian Loftus (loftusmd.com).

Thanks to our wonderful friends and family: David Nordin, Gina and Curtis Bradley, Cameron Liem, Lindsay Liem, Camilla and Richard Pierce, Britt Pierce, Allen and Christina Shirley, Austin Shirley, Xanthe Shirley, Chris Fleming, Dana Chandler, Eddi Lee, Renee Somoza, Rachel Capote, Joanne Goldstein, Dinah Anderson, Donna Pate, Jami Exner.

From Diane: Deep appreciation goes to you, David, for support, friendship, and computer rescues. Loving thanks to my dear daughter Jenny — you’ve made my life wonderful by being sweet and kind and the love of my life. How fun that you’re a terrific co-author, too! And thanks to my son-in-law, Robert, who is always supportive and kind.

From Jennifer: Thank you, Robert, for being so truly great. Thank you, two-month-old Ben, for letting me finish this book. Thank you, Mom, for being the best mom I could imagine (and for being so easy to work with)! I also want to thank Martin and Sarah Shoquist, Dr. Leticia Carlos San Luis, Dr. Tom and Gina Cartwright, Lina Carlos, Wendy Corson, Kristina Holt, Shannon, John, and Jordan Mathis, Christy Waites, Shari Belmarez, my “brother” Austin Shirley, and Sophie and Lucy. To my friends and patients, I send best wishes for migraine-pain-free days.


Publisher’s Acknowledgments

We’re proud of this book; please send us your comments through our Dummies online registration form located at www.dummies.com/register/.

Some of the people who helped bring this book to market include the following:

Acquisitions, Editorial, and Media Development

Project Editor: Kathleen A. Dobie

Acquisitions Editor: Natasha Graf

Copy Editor: Greg Pearson

Technical Reviewer: Dr. Stephen Silberstein

Editorial Manager: Christine Meloy Beck

Editorial Assistants: Melissa Bennett, Elizabeth Rea

Cover Photos: © Bruce Ayres/Getty Images

Cartoons: Rich Tennant, www.the5thwave.com


Project Coordinator: Kristie Rees

Layout and Graphics: David Batholomew, Amanda Carter, Brian Drumm, Kelly Emkow, Clint Lahnen, Kristin McMullan, Tiffany Muth, Brent Savage, Jeremy Unger

Special Art: Kathryn Born

Proofreaders: John Greenough, Angel Perez, Rob Springer, TECHBOOKS Production Services

Indexer: TECHBOOKS Production Services

Special Help:

Patricia Yuu Pan

Publishing and Editorial for Consumer Dummies

Diane Graves Steele, Vice President and Publisher, Consumer Dummies

Joyce Pepple, Acquisitions Director, Consumer Dummies

Kristin A. Cocks, Product Development Director, Consumer Dummies

Michael Spring, Vice President and Publisher, Travel

Brice Gosnell, Publishing Director, Travel

Suzanne Jannetta, Editorial Director, Travel

Publishing for Technology Dummies

Andy Cummings, Vice President and Publisher, Dummies Technology/General User

Composition Services

Gerry Fahey, Vice President of Production Services

Debbie Stailey, Director of Composition Services




About This Book

Foolish Assumptions

How This Book Is Organized

Conventions and Icons Used in This Book

Where to Go from Here

Part I : Looking at the Big Picture: Migraines Demystified

Chapter 1: Knowing What You’re Dealing With: An Overview

Getting a Take on What Migraines Are and What They Aren’t

Tripping through the Types of Headaches

Looking at Some of the Reasons Why

Getting an Under-the-Hood Inspection and Tune Up

Handling Family and Work Issues

Exploring Options Galore

Chapter 2: Coping with the Symptoms

Taking on the Big Three: Auras, Sensory Sensitivity, and Stomach Problems

Encountering Other Migraine Signs

Using Quick Fixes as a Stopgap

Chapter 3: Knowing Your Foes

Keeping a Journal to Discover Reasons and Triggers

Understanding Inherited Migraines

Checking Your Environment for Allergens

Finding Dietary Villains

Zeroing in on Exercises that Make Your Head Hurt

Keying in on Other Migraine Triggers

Stopping Triggers in their Tracks

Part II : Getting Diagnosed

Chapter 4: Distinguishing a Migraine from Other Head Pain

Sorting Headache Types

Understanding What Makes a Migraine a Migraine

Identifying Variations on the Migraine Theme

Recoiling from Rebound Headaches

Defusing the Myths

Chapter 5: Finding a Good Migraine Doctor

Seeing Your Everyday Doc

Discovering Whether Your Physician Understands Migraines

Turning to a Headache Specialist

Preparing for the Headache Specialist

Chapter 6: Having Your Head Examined and Coming Up with a Plan

Huddling with Your Doctor

Taking the Tests

Hunkering Down to Come up with a Migraine-Busting Plan

Part III : Giving Migraines a Knockout Punch

Chapter 7: Spelling Relief without a Prescription

Counting on Over-the-Counter Medications

Sidestepping the Side Effects of Too Many OTC Drugs

Using Vitamin and Herbal Supplements

Chapter 8: Taking Care of Pain with Prescription Drugs

Looking for Relief in All the Right Places

Finding Out What to Expect and How You React

Fighting Back: Abortive Medications for Migraines Underway

Stopping Migraines Upfront: Prophylactics

Trying Newer Treatments

Choosing a Delivery Method

Calling on Superhero Medications

Getting Nausea Relief

Chapter 9: Sampling Alternative Remedies

Sampling Mind-Body Methods

Working with Behavioral Headache Bashers

Pursuing Alternative Physical Treatments

Micromanaging Your Own Treatment Program

Chapter 10: Making Medical Decisions Even When You’re Migraine-Hazy

Making Good Choices Despite the Migraine Haze

Negotiating the Emergency Room

Part IV : Committing to Lifestyle Changes

Chapter 11: Catching and Rejecting Food Triggers

Tracking Down Dietary Triggers

Pulling the Plug on Migraine Foods

Chapter 12: Getting Physical with Your Migraines

Loosening Migraine’s Grip with Movement

Avoiding Exercise that Induces Migraines

Chapter 13: Eyeballing Environmental Enemies

Investigating Your Environment

Kicking Troublemakers Out of Your Home

Checking Your Surroundings

Preparing a Personal Oasis

Chapter 14: Looking at the Link between Migraines and Sleep

Waking Up to Your Sleep Patterns

Defining and Treating Sleep Disorders

Benefiting by Changing Your Behavior

Part V : Staying Connected to the People in Your Life

Chapter 15: Living the Good Life Despite Migraines

Singing the Why-Me Migraine Blues

Feeling Free to Get Pain-Free

Deciding Whether to Go Out and About or Hunker Down at Home

Joining in the Social Whirl

Keeping It Real When Migraine-Free People Think You’re Faking It

Chapter 16: Managing Migraines at Work

Minimizing Migraine’s Impact at Work

Coping with Attitude and Agony

Staying in a Positive Self-Image Place on Migraine Days

Working with Periods of Disability

Chapter 17: Handling Your Home Life

Giving Cues to Loved Ones

Making Your Mate an Advocate

Being Realistic about Your Children’s Reactions

Handling the Negative Attitudes of Family Members

Part VI : Managing Special-Situation Migraines

Chapter 18: Spotting the Dangerous Headache

Paying Attention to First-Ever or Worst-Ever Headaches

Spotting ER-Worthy Red Flags

Getting Thee to the ER on Time

Chapter 19: Let’s Hear It for the Girls: Hormonal Migraines

Discovering Why So Many Women Are Plagued by Migraines

Combating Menstrual Migraines

Spelling Relief or Trouble: Oral Contraceptives and Migraines

Tackling Migraines While You’re Pregnant — and Afterward

Ditching the Migraines of Menopause

Chapter 20: Helping a Child with Migraines

Recognizing the Signs

Hunting Down and Disarming the Causes and Triggers

Seeking Treatment

Managing the Emotional Side Effects

Chapter 21: Holding Off the Sex Migraine

Laying Out Sex-Related Headaches

Having a Candid Chat with Your Doctor

Doing It without Getting Done In

Chapter 22: Sideswiping Migraines Caused by Stress

Mastering Techniques for Calming Your Mind

Rearranging Priorities to Scuttle Some Stressors

Chapter 23: The Senioring Effect: Aging and Migraines

Losing Migraine Pain along with Your Hair

Gaining Wisdom and Migraines

Seeing Your Doctor for Help

Looking Out for Eye Problems and Atypical Head Pain

Part VII : The Part of Tens

Chapter 24: Ten Tips for Dealing with Folks Who Don’t Get Migraines

Express Your Envy (At Least to Yourself)

Shrug Off Unhelpful Advice

Keep a Sense of Perspective

Steel Yourself for the Very Irritating

Try to Love Even the Headache-Free

Be Matter-of-Fact about Having to Miss Engagements

Warn People Up Front

Don’t Let Anyone Guilt-Trip You

Help Your Hosts Accommodate Your Triggers

Express Your Disappointment at Missing Important Events

Chapter 25: Ten Things You Can Do for the Migraine Sufferer You Love

Be On Call

Stay Cheerful

Crank Up Your Compassion

Resist the Urge to Cajole

Serve as a Social Secretary

Take Charge of the Kids

Make Necessary Work-Related Phone Calls

Call the Doc if the Headache Worsens

Be Thoughtful

Ask What You Can Do

Chapter 26: Eleven Ways NOT to Treat a Migraine

Go Off Your Program

Take Too Many Drugs

Ignore Dosage Recommendations

Believe Crazy Claims

Keep Taking a Drug that Doesn’t Work

Try to Gut it Out and Go Out

Stuff Yourself with Tons of Food

Try the Sun-and-Activity Remedy


Foster a Sick-Person Reputation

Become an ER Junkie


A bout 28 million Americans have migraine headaches. And, if you’re one of them, you know all too well that it’s hard to predict what a day will hold. Any morning, afternoon, or evening, you may find yourself in the throes of mind-boggling pain, not to mention nausea, vomiting, and sensitivity to loud noises.

So, you’ve gotten fairly expert at composing migraine metaphors:

My head’s getting pounded by unfriendly fire.

Contortionists are busting a move in my skull.

Descriptive words just pop out, borne of disbelief that you could actually be hurting so badly.

As a matter of fact, migraines have been driving people nuts forever. Ancient “caregivers” bored holes in people’s heads to try to relieve headache pain. Egyptians tied an herb-stuffed clay crocodile to an aching head.

Yet despite a history of being guinea pigs and a yen for spicy metaphors, migraine sufferers remain optimistic. Migraines hurt and can be very disabling, so bring on the remedies!

Knowledge is a powerful weapon in any fight and, in this book, we aim to arm you with the tools you need to whip your migraines into submission.

About This Book

Serving as a reference book for people who want to transition from being hamstrung by headaches to developing high-level pain-busting savvy, Migraines For Dummies has parts that are set up as freestanding units. You can peruse each one separately, and feel no urgency about reading chapters or parts in order. After scanning the Table of Contents, zero in on those topics that interest you most, and later, you can turn back to the others.

To tame the migraine beast, you must acknowledge the formidable creature. Denying what you are dealing with does not help. Migraines For Dummies provides headache information that helps you understand what you’re up against — and a list of remedies effective enough to merit high-roller status in any migraine circle in the world.

Migraines For Dummies offers hope, with a focused, fleshed-out program that works in the real world. Headache medications have their place in the picture, but you absolutely can do more.

The quest for answers — and the pilgrimage to a better health place — is at the core of this book. Essentially, Migraines for Dummies will benefit people who want to improve their lives. If you have migraines regularly, you know how devastating they can be. Sometimes, just the thought of making plans seems pointless — what if you get a headache? Friends may think that you’re just making excuses to get out of going somewhere. Better not take a chance. So you grow afraid to venture too far from the safety of home base.

In Migraines For Dummies, we look at the whole spectrum of the problem, from dealing with the number-one issue of pain relief to handling peripheral problems: absences from work, skepticism from friends, and impact on family. The authors also investigate women’s hormonal headaches, stress- as-a-factor in headaches, children’s migraines, seniors’ head troubles, sex headaches, and sleep-habit demons.

Questions answered

The migraine mob needs health advocates. And we, the authors of Migraines For Dummies, fill that role, offering valuable tips on ways to eliminate the fisticuffs going on inside your head in the wacky world of managed health care. Migraines For Dummies hands you a gilded invitation to join a proactive group of migraine-busters. Via this book, we provide answers to the following pressing questions:

bullet How can you know that you have migraines and not some other kind of headache?

bullet Can your headaches be migraines if you don’t have the visual disturbances you’ve heard are the benchmark sign of a migraine?

bullet Who’s the right doctor for diagnosing and treating your headaches?

bullet Is there any way to get rid of a migraine once it moves in and sets up camp?

bullet Do remedies like biofeedback or hypnosis really help the pain?

bullet How can you find the medication that will provide full-fledged pain relief?

bullet How can you deal with family and work issues when people really don’t understand how debilitating migraines can be?

Truly, because of its complexity, migraine-busting must be considered an extreme sport. You need a concrete headache-management plan, and you need it pronto.

Solutions offered

Check out the many things that Migraines For Dummies can do for you:

bullet Help you take charge of your headache fate: You don’t have to be at the mercy of migraines. You can pave the way to a more headache-free existence. We show you how.

bullet Foster a team approach: You can get your mate and children on board, fill in your work supervisor, and cope ably with all of those in your universe whose support can be invaluable during headache episodes.

bullet Separate fact from fiction: No, migraines aren’t fantasies; they’re located in your head, all right, but they’re not “all in your head,” as some unsympathetic folks may tell you. We sort through the myths and misconceptions.

bullet Steer your pain-shedding and migraine-handling: You’ll master the technique of warding off a headache, if possible; if not, you’ll bash it after it gets going. You’ll figure out what to do — and, just as important, what not to do.

bullet Show you how to stay on message: We get you feeling powerful about conquering migraines and keep you on track by providing answers.

bullet Prepare you for all scenarios: From finding out how to function during a migraine haze, to handling health insurance questions, to deciding whether to go to work or school with a headache, we address common problems that migraineurs face.

Caution given

This book contains our opinions and ideas. We intend to provide helpful information on migraines, but we don’t offer professional medical, health, or any other kind of personal services via the book.


This is a supplement, not a replacement, for medical advice from your personal healthcare provider. In no way does reading this book replace the need for an evaluation by a physician.

If you want or need personal advice or guidance, please consult a medical, health, or other competent professional — especially if you have a condition that may require medical diagnosis or attention — before adopting any of the suggestions in the book or drawing inferences from the information given.

Foolish Assumptions

Because you picked up this book, we assume a few things about you:

bullet You think that you have migraines, know that you have migraines, or live with, and love, someone with migraines.

You’re familiar with the debilitating factor, and you’re looking for ideas that will be inspiring, instructive, and winning. You’re putting your migraine history and its frustrations behind you. Now you want to venture into the new and promising era of Migraines For Dummies. You’re saying, “Hit me with your best shot, ’cause I’ve got nowhere to go but up!”

bullet You may have yet to find a remedy that gets rid of your head pain.

bullet You find the entire migraine problem and its related issues (work, family, public skepticism) somewhat daunting. This idea alone, not to mention the incredible pain, may have inspired you to pick up this book.

bullet You’re baffled, unsure of what to do and when to do it — when to take an over-the counter remedy, when to resort to a prescription drug, or whether to try alternative or complementary treatments.

bullet We half-assume that you inherited the migraine tendency, because these headaches run in families.

If you grew up with a parent who had migraines, you’re all too familiar with how this ‘disability’ can alter family plans and dynamics (can you say Bleak House?).

bullet Our biggest assumption is that you’re itching to discover ways to get rid of migraine pain, and we think that you can definitely find what you need in this book. We present clear and comprehensive information about all aspects of migraines, along with tips, encouragement, and reassurance.

How This Book Is Organized

This guide to understanding and handling migraines is divided into 7 parts and 26 chapters. You can read the parts randomly — without having to read what came before. If a section requires prior knowledge, we refer you to the chapter number so that you can flip to those pages and get the skinny. Here, we give you a rundown of each part and what’s in store for you.

Part I: Looking at the Big Picture: Migraines Demystified

In these chapters, we expose the headaches that perplex and vex you. You get an overview of the things you can do to get rid of them (ideally) or to cope more effectively. We guide you through the maze of reality versus rumor, and we give you a heads-up on the physiology of a headache — and tell you how your family history may have set you up for head pain (in other words, you inherited the migraine proclivity).

We look at recurring headaches that aren’t disease-based — as well as at the more ominous sort, characterized by the very important words new onset or worst-ever. (The latter can sometimes stem from anything from a stroke to a brain hemorrhage to meningitis.)

Also in Part I, we address how to avoid rebound headaches and subdue migraine-associated nausea and vomiting.

You can also take a look at potential headache instigators that can make your head hurt and use the handy headache journal to keep track of your triggers.

Part II: Getting Diagnosed

Part II investigates headaches that sometimes impersonate migraines — cluster and tension-type — and pinpoints the markers of headaches caused by disease.

To reach a conclusion on your headache type (if that’s still up in the air), you must enlist a good doctor (Chapter 6), who can evaluate and diagnose your problem or refer you to a headache specialist. You then huddle with your doctor to draw up a battle plan.

We brief you on tests that may be required to determine what’s wrong and walk you though designing a treatment plan.

Part III: Giving Migraines a Knockout Punch

Part III ushers you into the “taking care of pain” realm — over-the-counter (OTC) remedies and prescription drugs. This section features a compendium of medications and discusses the good, the bad, and the ugly of each one. We review how abortives work — the meds you take when a migraine’s in place — and how prophylactics can be used to stave off trouble.

You can check out complementary and alternative migraine remedies, such as visualization, relaxation techniques, biofeedback, acupuncture, hypnotism, and more. Plus, we tell you how to handle decision-making when you’re in a migraine haze and how to negotiate the ER wisely.

Part IV: Committing to Lifestyle Changes

You probably can’t live exactly the way you used to and still manage to decrease the number and severity of your migraines — that’s the hard, cold fact of it.

The chapters in this part deal with table truths for migraineurs — the do’s and don’ts of food and beverage. We list workouts that can help migraine sufferers, and the kinds of movement that tend to spur migraines. We give you tips for checking out your environment for migraine-causing culprits and advice on examining the migraine and sleep-habit link.

Part V: Staying Connected to the People in Your Life

We bring you productive ways to deal with those who think migraine pain is “all in your head.” We tell you how to recruit friends and family for your support staff and how to make your mate a staunch ally instead of a grumbler who’s tired of hearing “Not tonight, honey — I have a headache.”

We give you tips on handling your boss and colleagues — and yourself — in the workplace.

Part VI: Managing Special-Situation Migraines

Part VI cautions you to stay vigilant for signs that big trouble is brewing inside your head. You need to know when the hammering isn’t “just a migraine” but a symptom of disease.

Knowing that hormonal swings throw up headache roadblocks for women, we discuss femme migraine details (Chapter 19). Chapter 20 focuses on children’s migraines. In the chapter on sex migraines, we separate the serious from the benign (but obnoxious). Chapter 22 examines stress-related migraines, while Chapter 23 talks about seniors and their headaches.

Part VII: The Part of Tens

Here, you get a hodgepodge of good ideas: effective ways to deal compassionately with the migraine-free around you, ways NOT to treat migraines, and terrific tips for support-folks who love migraineurs.

Conventions and Icons Used in This Book

To avoid the “he or she” rigmarole, we solved the pronoun problem by using male pronouns in even-numbered chapters and female pronouns in the odd-numbered chapters.

For Dummies books use snazzy pictures in the margins to draw your attention to specific bits of text. In this book, the pictures we use are


Tack this tidbit on your bulletin board!


Cautions you about practices and procedures you should talk to a doctor about and tells you when you should head for the emergency room.


The dry medical info that you may or may not be interested in is highlighted with this icon. You can skip it if you like.


This icon says: “Here’s a valuable morsel you may want to read several times.”


This icon alerts you to danger signs and practices to avoid.

Anecdote(Pub Speak)

Stories about how other migraineurs have coped have this icon beside them.

Where to Go from Here

With the intros tucked away, we usher you into the meat of the book. Look for the parts you need first, and flag others for a look later.

bullet If your headaches haven’t been diagnosed, start with Parts I and II, which acquaint you with the different types of headaches and give you tips on what your doctor will need from you to make a firm diagnosis.

bullet Check out Parts III, IV, and V to find out how to deal with your migraines medically, practically, and socially.

bullet If you’re a parent, friend, mate, or employer of a migraineur, and you’re searching for ways to help and understand, start with Part VII, and then go to Parts III, IV, and V.

As you find parts that help you, flag them for rereading. This book is packed with options, and you have an excellent forecast for getting your headache-future in tow. So let’s get started!

Part I

Looking at the Big Picture: Migraines Demystified

In this part . . .

P art I pitches a tent and lights the campfire, preparing you for an upfront briefing on the Rules of Migraines. You find out quickly that even though these headaches are as common to the populace as s’mores are to summer camp, the wacky things still remain shrouded in mystery. And if you don’t understand migraine-criteria, you’re left lurking on the fringes of the circle, uncertain whether you belong.

So the job of Part I is to shed some light on migraines for cranial-headache campers, providing a rundown on migraine symptoms, the hereditary factor, and rebound caveats. Having an overview of these dastardly headaches, you stand poised and ready to sing your many merit-badge-worthy migraine-managing achievements.