my Chronic Migraine!”

Guide to living well with
I “ took
control of
my Chronic
Migraine!”
Former CNN journalist
Yasmina Ykelenstam
persevered until she found
her path to relief
Don’t put
up with
migraines—
prevent
them!
37 ways
to take
charge!
£ ID your triggers
£ Tune into
symptoms ASAP
£ Treat promptly
£ Be prepared

Guide to living well with
Migraine
headaches
Good communication with
her care team was key for
Kate McCombs to conquer
her migraines.
10
18
“It worked! I was so happy!”
says ex-CNN journalist
Yasmina Ykelenstam of a
treatment that helps prevent
her Chronic Migraine.
New hope
3 Live your best life—
even with migraine!
Why your chances of getting rid of
migraine pain are better than ever
The basics
4 What’s causing your head pain?
Learn the different types of headache
5 The four stages of migraine
6 Steer clear of your triggers
You & your care team
7 Your weekly journal
Track your symptoms to learn your triggers
8 Your healthcare team
9 How medications can help
Real inspiration
10 “I’m conquering Chronic Migraine!”
Former CNN journalist Yasmina Ykelenstam
refused to stop looking for a solution to
near constant distress
16 ”What I’ve learned about migraine”
Celebs share how they stop the pain
18 “How I took control...”
How migraine sufferers make every day easier
Feel your best
21 Q&A
Your questions answered by a migraine expert
22 Migraine-proof your home
Make your home a safe zone!
24 Questions for your next exam
24 Resources you need now
>> Find these articles and more at
HealthMonitor.com/Migraine
Reviewed by
Health Monitor’s
migraine experts:
Roger K. Cady, MD—
founder and medical director
of the Headache Care Center in
Springfield, MO. He is the
Associate Executive Chairman of the
National Headache Foundation.
Stephen D. Silberstein, MD—
professor of neurology and director
of the Jefferson Headache Center
at Thomas Jefferson University in
Philadelphia. He is a Fellow of the
American Headache Society and the
American Academy of Neurology.
Editor-in-Chief, Maria Lissandrello
Project Editor, Lindsay Bosslett
Creative Director, John Angelini
Art Director, Jennifer Webber
Production and Project
Management Director,
Kimberly H. Vivas
Account Executive,
Christina Nelson
Alliances and Partnerships
Director, Marc Jensen
Vice President, Human Resources
and Customer Service,
Renee Mormando
Chief Financial Officer,
Ding Yu
Senior Vice President,
Dave Dolton
Senior Vice President,
New Products, Technology
and Strategy, Alex Dong
President, Kenneth Freirich
Chief Executive Officer,
Eric Jensen
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©2015 Data Centrum Communications, Inc.
This publication is not intended to provide
advice on personal medical matters or to
substitute for consultation with a physician.
The NHF aims to raise awareness
of headache; support research; and
educate the public about it.
The AHMA
exists to E.A.S.E.
the burden of
Migraine and other
Headache Disorders through Education,
Awareness, Support and Engagement.
The editorial content of this publication has been
reviewed for accuracy by the National Headache
Foundation (NHF) and the American Headache &
Migraine Association (AHMA). This review does
not constitute an endorsement or expression of
opinion by NHF, AHMA or the reviewing healthcare
provider(s) regarding any advertised product or
service or point of view mentioned or advertised.
t
hese days, Patrice R.
Valentine spends time
having fun with friends
and pursues her passions,
including launching a new business.
But it wasn’t always like that. “At
my worst, I would have a migraine
that would last for days. Often,
I’d get them two or three times a
month. It was keeping me from
doing my job and living my
life.” How did she find relief? “I
refused to give up!” she says. “My
doctor and I tried everything, and
finally a treatment came out that
made all the difference.” Patrice
even experienced a silver lining:
“By tracking my symptoms I also
learned that stress was a trigger for
me—so I quit my job to pursue my
own business. Migraines actually
changed my life for the better!”
Focus on prevention
With today’s treatments, days spent
lying down in dark rooms may be a
thing of the past. Whether you suffer
from episodic migraines (the kind
that occur on fewer than 15 days per
month) or Chronic Migraine (which
strikes on 15 or more days per month
for at least three months), partnering
with your healthcare team like Patrice
did is key. It’s the best way to take
advantage of the latest learning.
For example, the newest emphasis
is on preventing migraines. In fact the
American Academy of Neurology
has identified nearly a dozen effective
medications that can help do just that.
What’s more, nearly 40% of
patients could benefit from such
preventive therapies, says Stephen D.
Silberstein, MD, professor of
neurology and director of the
Jefferson Headache Center at Thomas
Jefferson University in Philadelphia.
Experts also have a deeper understanding
of what triggers migraines
and how to find faster relief. A pivotal
finding: Treating a migraine quickly
helps the medication work better.
What you can do
If you’re one of the nearly 30
million Americans who suffer from
migraine, it’s time to take a stand.
Start by learning about your
headaches—what type you have
and what triggers them—and
new hope
Live your best life—
even with migraines!
exploring all your treatment
options. That’s where this guide
comes in handy. Get comfortable in
your favorite armchair and read on.
You’ll get tips and real-life
inspiration, which will help you
turn the tables on migraine, just
like Patrice. “I definitely encourage
people to work closely with their
doctors,” she says. “You never
know what options might be out
there—or what might be causing
your migraines without your realizing
it. You don’t have to just accept
the pain and discomfort as a part
of your life—get out there and do
something about it!”
HealthMonitor 3

the basiCS
What’s causing
your headache?
The
the basiCS
4 stages of migraine
If you have migraines you’re familiar with the pain, the nausea and the vomiting. But that
describes only the headache stage of migraine. There are three others, and tuning into them
can help you get more effective treatment. Consider: Treating at the very first sign can help
stave off a full-blown migraine or limit your symptoms. To learn more, read on.
ot really sure? You’re
not alone. Many people
mistake migraines for
sinus infections; it’s easy to confuse
tension and cluster headaches;
and you may not realize there’s a
difference between episodic and
Chronic Migraine. Yet it’s important
to get to the bottom of your head
pain. That’s because identifying the
type of headache you have can help
your healthcare provider pinpoint
the best treatment for you. To find
out exactly what’s ailing you, read on.
Tension-type: The most
common headache, tension-type
headaches usually cause only mild
to moderate pain. The discomfort
typically begins in the forehead,
temples or the back of your head
or neck. It creates a band-like
sensation around your head, or
a feeling of pressure in head and
neck muscles. The headaches
often occur after feeling stressed,
anxious, fatigued or angry.
Sinus: A study found that 86%
of people who thought they were
having a sinus headache were
actually suffering a migraine—so it’s
important to know the difference.
Sinus headaches typically cause
throbbing pain and a feeling of
pressure around your eyes, cheeks
and forehead. The pain will usually
worsen if you bend or lie down.
They develop when your sinuses
become swollen, usually due to
4 HealthMonitor
Migraine or chronic migraine?
Migraine: Migraine often
begins as a dull ache that develops
into a throbbing and pulsating pain,
often near the temples, as well as the
front or back of one or both sides of
the head. The pain is often accompanied
by nausea, vomiting, and/or
sensitivity to light and noise. Some
may see “aura” (see page 5 to learn
more) before the headache strikes.
Migraine checklist
Many of the symptoms of a
migraine are unique to that type of
headache. If you’re experiencing
at least two of the symptoms at
right—either before or during your
headache—let your healthcare
provider know.
allergies or a sinus infection. Your
sinuses will often be blocked, so
you may not be able to breathe well
through your nose, and your sense of
taste or smell may be diminished. If
the cause is an infection, you’ll likely
have a low fever, and may have green
or yellow nasal discharge, a sore
throat, soreness in your jaw or teeth,
a cough, and/or fatigue.
Rebound: This type of
headache occurs if you take acute
pain relievers too often (twice a week
or more for several weeks) or use
more than the recommended dosage.
Typically, as soon as the medication
Chronic Migraine:
With Chronic Migraine, you can feel
as though you’re never free from your
headaches at all, and while pain medications
may lessen your symptoms,
they never go away completely. Your
care team may diagnose you with
Chronic Migraine if you have 15 or
more migraine days a month, each
episode lasting four hours or more.
◦ Blurred vision
◦ Dizziness
◦ Fatigue/
sleepiness
◦ Nausea
◦ Sensitivity to
light
◦ Sensitivity to
sound
◦ Vomiting
◦ Lightheadedness/
feeling faint
◦ Sweating or
cold hands
◦ Diarrhea
◦ Other:
____________
wears off, the headache comes back.
You may also experience neck pain,
irritability, difficulty concentrating and
depression.
Cluster: Cluster headaches come
in groups and typically strike without
warning. The head pain, which is
severe, often occurs on only one side of
the head, and may cause the eye to tear
and turn bloodshot, and your nose to
run on the same side. They often begin
in the middle of the night and may last
for weeks or months. Their cause is
not completely known, but researchers
believe they may be the result of a
chemical reaction in the brain.
1 Prodromal (early warning)
• When it happens: Several hours to up to two days
in advance.
• Frequency: About 60% of those with migraines will
experience this phase.
• Possible symptoms: Anxiety, unexplained energy or
feelings of euphoria, irritability, difficulty concentrating,
food cravings, sensitivity to smells or noise, fatigue
with frequent yawning
• What to do: Take the pain reliever your doctor
recommended or prescribed. Doing so right now can
help you avoid a full-on migraine. This is also a good
time to think about possible triggers—for example,
ask yourself what you’ve eaten or had to drink, how
stressed you are and how much sleep you’ve had.
2
Aura phase
(pre-migraine)
• When it happens: About an hour before to right
when the headache strikes.
• Frequency: About 20% of those with migraines
experience this phase, but not necessarily every time.
• Possible symptoms: Changes in vision, such as
flickering, shimmering or flashing lights, tunnel vision,
difficulty focusing, spots of vision loss or zigzag lines
that cross your line of sight; skin sensations, such as
numbness in your extremities or feelings of tingling or
“pins and needles” in the face or hands; trouble speaking,
writing or understanding words; muscle weakness
• What to do: Immediately take a pain reliever or the
medication you’ve been prescribed for your migraine.
Make sure you have your migraine tool kit (see page
23) handy and avoid any triggers.
4
3
1
2
Phases of a migraine
1. Prodromal: 24-48 hours
2. Aura phase: 1 hour
3. Headache phase: 4-72 hours
4. Postdromal: 24-48 hours
3
4
Headache phase (during migraine)
• When it happens: This is when the actual headache
strikes; it can last for hours up to several days.
• Frequency: 100% if the migraine is untreated.
• Possible symptoms: Throbbing or pulsing
pain ranging from mild to severe, often on one side
but sometimes both sides of the head; sensitivity
to light, sounds and sometimes smells; nausea
and vomiting; blurred vision; light-headedness
and/or fainting
• What to do: Immediately take a pain reliever or
medication you’ve been prescribed for your migraine.
Relax in a cool, dark, quiet setting.
Postdromal
(after headache)
• When it happens: After the attack phase has subsided,
and lasting for a few hours up to two days.
• Frequency: Most people who experience the attack
phase will experience some form of postdromal phase.
• Possible symptoms: Extreme fatigue,
sluggishness, confusion, irritability, head pain if
you move too quickly or bend over
• What to do: If you’ve been taking acute pain relievers,
start to cut back so you avoid a rebound headache. Continue
to rest and avoid stress or other common triggers.
HealthMonitor 5

the basiCS
you & your care team
Steer clear of
your triggers!
one of the best ways to rein in
your migraines? Avoid
having them in the first
place! One strategy: Zeroing in
on—and avoiding—your triggers,
the culprits that spark the chemical
reactions resulting in migraine. The
thing is, triggers are different for
everyone, and sometimes a combination
is to blame. To learn what sets
off your migraines, see the list below,
and use the journal on the next page
to track your migraines.
Food/food additives.
While food triggers tend to be
unique for each individual, there are
some that are more common. Here
are some of the more likely ones,
according to the National Headache
Foundation and American
Headache Society:
• Aged cheeses (such as blue cheese
and Cheddar)
• Processed meats with nitrates or
nitrites (such as bacon and hot dogs)
• Monosodium glutamate (MSG)
(often found in soy sauce, meat
tenderizers and seasoned salts)
• Artificial sweeteners
• Alcohol (particularly red wine)
• Coffee, tea and other sources
of caffeine
Eyestrain. Particularly from
staring too long at a computer screen,
or attempting to read too-small text or
reading in low light.
Dehydration. Thirst can spark a
migraine; stay hydrated by drinking
plenty of water throughout the day.
Odors. Perfume and/or certain
scented cleaning products can
trigger a headache.
Food temperature. Very hot
(such as hot soup or coffee) and very
cold (such as ice cream) foods can
trigger a migraine in some.
Skipping a meal. Migraine
sufferers’ bodies crave predictability.
Glare. Nearly 90% of migraine
sufferers are sensitive to light. In
a study in Nature Neuroscience,
researchers found a pathway in the
brain that links the visual system to
that which produces head pain.
Changes in your routine.
Migraine sufferers are sensitive to
schedule changes, such as sleeping
too much or too little.
Hormone changes. Sixty
percent of women who suffer
from migraines do so when
estrogen levels drop (such as
before menstruation).
Stress. Everyday hassles like
running late for an appointment
or working long hours to meet a
deadline can cause nerve irritation
and inflammation. Experiencing
“letdown” after stress can have the
same effect. “[The migraine] doesn’t
happen when you finish your
deadline, but it can happen the next
day,” says Stephen D. Silberstein,
MD, professor of neurology and
director of the Jefferson Headache
Center at Thomas Jefferson
University in Philadelphia.
Intense exercise. It sparks
the release of nitric oxide—a
chemical that can cause nerve
irritation—into the bloodstream.
Cigarette smoke. It can
cause nerve irritation.
A change in
temperature.
Going from either
warm air to cold (such
as being out on a warm
summer day and going
into an air conditioned
room) or vice versa, can
spark a migraine.
A change in
pressure. Changes in barometric
pressure can alter your body’s
chemical balance.
Use this diary to pinpoint your
triggers—and find out how well
your treatments are working.
Your weekly migraine journal
SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY
DATES
What I ate before
my headache
How much I slept the
night before
What activities I did that day
What the weather was like
(include temperature, humidity
and barometric pressure)
Rate the severity of your pain
(0 = no pain, 10 = severe pain)
Describe the type of pain
(throbbing, band-like) and its
location (in the temples, etc.)
Note any other symptoms
(nausea, aura, etc.)
Treatments (and doses)
Note how long it took
for you to get relief
6 Guide to Living Well with Migraine Headaches
HealthMonitor 7

you & your care team
Your healthcare team
As challenging as it may be to battle migraine, remember that you’re not alone. There’s a
whole team of healthcare providers in your corner. Here is a look at the experts who can
help you develop the best strategy for overcoming your pain:
• A neurologist specializes in
disorders of the brain and nervous
system. Look for one who is boardcertified
in pain or headache medicine.
• A board-certified internist
or family physician with a
background in pain management
and/or headache medicine can
diagnose and treat migraine.
• A physical therapist can teach
exercises to reduce neck tension, which
is common among migraine patients.
He or she may also teach or recommend
other physical activities, such as yoga,
that have been proven to ease symptoms.
We can change
the course of
We can change
this the disorder course of
this disorder
so little can do so much
so little can do so much
• A nurse practitioner (NP)
or physician assistant (PA)
can diagnose and treat migraine.
• A psychologist or
neuropsychologist can help
you learn to better manage stress,
which often triggers migraine,
and can teach you biofeedback
methods. A psychologist can also
help you cope with depression
and/or anxiety.
• A sleep disorder specialist
can diagnose sleeping conditions,
such as sleep apnea, that may be
contributing to your migraines.
After 7,000 years of enduring and searching for relief from migraine, there’s still
no cure. Still worse, for the 3rd most common disorder on the planet and the 4th
most disabling among women worldwide, we’ve had only one class of medication
developed and approved for the treatment of migraine over the last half-century!
While we know more today than ever before about the brain chemistry and circuits
involved, we are still far from safer and more effective treatments.
Yet we have the brain trust – so many talented doctors and scientists across the United
After States 7,000 and years around of enduring the world and searching – who know for relief the path from migraine, forward and there’s know still how to get this
no done. cure. Still What’s worse, missing for the 3rd is enough most common money disorder to do the on the job. planet and the 4th
most disabling among women worldwide, we’ve had only one class of medication
developed and approved for the treatment of migraine over the last half-century!
As a nation, we allocate a pittance to migraine research – less than 1/20th of 1% of
While we know more today than ever before about the brain chemistry and circuits
involved, the budget we are still of the far from National safer and Institutes more effective of Health treatments. – or about $16 million a year. Given
the prevalence and magnitude of migraine, $260 million would be right. Industry and
Yet the we have voluntary the brain sector trust – simply so many cannot talented make doctors up and the scientists difference. across the The United task before us now
States needs and a around kick-start! the world – who know the path forward and know how to get this
done. What’s missing is enough money to do the job.
As a That’s nation, why we the allocate American a pittance Migraine to migraine Foundation research and – less Mrs. than Cindy 1/20th McCain of 1% of are partnering
the in budget 2013 of to the launch National the Institutes 36 of MILLION Health – or MIGRAINE about $16 million CAMPAIGN, a year. Given a national public
the mobilization prevalence and and magnitude education of migraine, campaign $260 to million increase would our be right. nation’s Industry research and investment in
the migraine voluntary sector and raise simply public cannot visibility make up for the this difference. enormously The task disabling before us disorder now that affects
needs
more
a kick-start!
than 36 million Americans.
That’s why the American Migraine Foundation and Mrs. Cindy McCain are partnering
in 2013 to launch the 36 MILLION MIGRAINE CAMPAIGN, a national public
mobilization and education campaign to increase our nation’s research investment in
migraine and raise public visibility for this enormously disabling disorder that affects
more than 36 million Americans.
Join us and make the difference
us and make the difference
Join us and make the difference
To learn more, visit us at www.AmericanMigraineFoundation.org
How medications
can help
Great news: Your chances of getting life-changing
relief from migraines are better than ever, thanks to
a growing number of treatment options, including
proven ways to prevent migraines, according to the latest
guidelines from the American Academy of Neurology.
preventive
acute
Preventive therapies calm your hypersensitive nervous
system so you experience fewer flare-ups. When
a migraine does occur, it is usually less intense. Of
course, during an episode, you can still turn to acute
medications to help ease the pain quickly. Ask your
healthcare provider about the medications in the chart
below to find the right approach for you.
Medication How it is given How it works
Antiepileptic (divalproex sodium,
sodium valproate, topiramate)
Antidepressant
(amitriptyline, venlafaxine)
Beta-blocker
(metoprolol, propranolol, timolol)
Nonsteroidal anti-inflammatory
drug (NSAID) (fenoprofen,
ibuprofen, ketoprofen, naproxen)
Onabotulinum toxin A
(a purified organic product;
for Chronic Migraine only)
Triptan
(frovatriptan for short-term
prevention of menstrual migraines)
Antinausea (metoclopramide,
prochlorperazine)
Dihydroergotamine
(DHE)
Nonsteroidal anti-inflammatory
drug (NSAID) (acetaminophen,
diclofenac, ibuprofen, naproxen)
Triptan/NSAID combination
(sumatriptan and naproxen sodium)
Triptan (almotriptan, frovatriptan,
naratriptan, sumatriptan)
Pill or syrup
Pill
Pill or injection
Pill, oral solution,
injection
Injection
(in a few locations)
Injection, nasal spray,
pill
Pill, liquid,
suppository
Injection or nasal spray
Pill, oral solution,
injection
Pill
Injection, nasal spray, pill
Stabilizes nerve cells in the brain, making
them less easily activated
Boosts levels of the brain chemical serotonin,
which helps calm the nervous system
Blocks the release of stress hormones like adrenaline
and epinephrine, which can trigger migraines
Relieves inflammation and pain. These
medications are often prescribed on a short-term
basis to women with menstrual migraines and
patients who are suffering from other types of
pain, such as back and/or neck
Quiets hyperactive nerve cells; blocks muscle
contractions in the head, neck and face; and blocks
the release of inflammatory chemicals associated
with migraine pain
Prevents nerves on the surface of the brain
from transmitting pain signals, reduces
inflammation and shrinks swollen blood vessels
Relieves nausea and migraine pain
Blocks pain, reduces inflammation and
shrinks swollen blood vessels
Relieves inflammation and pain
you & your care team
Relieves inflammation, blocks pain and shrinks
swollen blood vessels
Prevents nerves on the surface of the brain
from transmitting pain signals, reduces
inflammation and shrinks swollen blood vessels
HealthMonitor 9

eal inspiration
“I’m conquering
Chronic Migraine!”
When faced with a seemingly insurmountable problem—say,
managing Chronic Migraine in the middle of a war zone—
former CNN journalist Yasmina Ykelenstam knows she has
what it takes to prevail. by Lindsay Bosslett
there is no ‘can’t’ in my
vocabulary,” says Yasmina
Ykelenstam, currently
Yasmina covering a
on one of her nowfrequent
lengthy trips abroad. “Be it
story in downtown
Beirut in 2008.
chartering private helicopters to airlift
equipment, bribing ship captains to
stow us away or finagling team visas to Libya on two
hours’ notice during the Gaddafi years—I’ve done it all.”
However, her can-do attitude doesn’t mean finding
her path to migraine relief was easy.
“When they were at their worst I found myself
banging my head against a wall to try and alleviate
the incredible pain,” she remembers.
“I explored all my options”
Yasmina was first diagnosed with migraines by “Dr.
Mom,” and a headache specialist confirmed it. Then
began the journey to find relief.
“I have tried every migraine medication on the
market: prescription NSAIDs, acetaminophen,
triptans, biofeedback therapy, homeopathic remedies,
meditation, stress reduction, physiotherapy—you
name it.” Some would work only for a short time,
some had terrible side effects and none could seem to
really slow down the migraine onslaught.
“The migraines progressed over time. They were
daily at times, or lasted for weeks, in some cases
months,” she says. “Eventually my doctor told me I didn’t
just have migraines—I had Chronic Migraine [defined
by 15 or more migraine days a month, each lasting four
hours or more]. You truly haven’t experienced hell until
you’ve had a migraine last for six months. It felt like I
was never not in pain.”
The migraines became so bad, eventually Yasmina
was afraid to leave her house—let alone travel the
globe to cover news stories. “I was scared in case I
began a migraine and wasn’t able to make it home to
somewhere dark,” she says. “And there’s little worse in
life than bouncing around in a Humvee or a military
helicopter while flying though hostile territory in war
zones in that kind of condition.”
“My answer was out there!”
Yasmina eventually left her job at CNN to concentrate
on her health. After finding a headache specialist she
could really connect with, she told him how many
treatments she had tried and failed to find relief with. He
convinced her to try an injectable medication that would
prevent her head pain. “It worked! I was so happy,” she
says. But as a journalist, Yasmina still felt she needed to
investigate the cause of her migraines.
Yasmina decided to try to see if anything she ate
sparked a migraine. She wrote down any offender foods
and shared the list with her doctor, who finally gave her
an answer: Yasmina had a histamine intolerance.
Histamine is produced by the immune system in
response to foreign invaders entering the body. But in
Yasmina, her histamine response was being triggered
by different foods and cosmetics, causing constant
body-wide inflammation and Chronic Migraine.
“Now I had a treatment and I knew my trigger,” she
says. “Thanks to that, for the first time in my life I was
finally free of migraines—I couldn’t believe it!”
Now Yasmina devotes her time to educating others
with migraines to pursue treatment and learn their
triggers. She’s even started her own food blog—
thelowhistaminechef.com—where she features low
,
10 Guide to Living Well with Migraine Headaches
HealthMonitor 11

eal inspiration
histamine–reactive recipes and other products.
“I have more than 60,000 readers monthly, so I know
I’m really reaching people,” Yasmina says. “I’m just glad
I can help others like I was to finally find relief!”
Here are some other ways Yasmina learned to control
her Chronic Migraine—maybe they can work for you!
Give new treatments a fair shake. “Follow what your
doctor says and don’t give up [on a new treatment] if
it doesn’t work right away,” Yasmina says, adding that
with treatments like the injections and even dietary
changes, it can take weeks to see relief.
Keep a food journal! “Start a food diary right away!”
Yasmina emphasizes. “Write down a list of all potential
triggers, then cross them off once you encounter them
and don’t get a migraine.” Yasmina used her food diary
to learn she had to eliminate fermented foods, smoked
meats and fish, most alcohols, most vinegars and any
packaged foods with dye and preservatives.
Stay upbeat! “My positive outlook remained because
I knew one day, if I kept trying, I’d take control,”
Yasmina says. “You have to have faith in yourself, and
don’t feel guilty or like you failed if you need to take
medication.”
Find others who understand. “Sharing what I have
learned on my blog has inspired readers to share
their own stories of recovery with me,” Yasmina says.
“Above all, I’m thankful for that and finding this
community of people. We all can help each other, and
there’s no better motivator than helping others.”
Are you a candidate for
preventive therapies?
It’s possible to short-circuit migraines
before they start with preventive therapies.
These medications are designed to reduce
the frequency and severity of attacks. You
might benefit if you fall into any of the
following categories:
• You aren’t getting relief from acute
medications or you can’t tolerate them.
• Your migraines strike more than once a week
or you need to take headache-relieving
meds more than a few times per week.
• You’re getting complicated forms of
migraine (with aura).
• Your migraines are interfering with your
daily routine.
IMPORTANT SAFETY INFORMATION (Continued)
Do not take BOTOX ® (onabotulinumtoxinA) if you:
are allergic to any of the ingredients in BOTOX ® (see
Medication Guide for ingredients); had an allergic reaction
to any other botulinum toxin product such as Myobloc ®
(rimabotulinumtoxinB), Dysport ® (abobotulinumtoxinA), or
Xeomin ® (incobotulinumtoxinA); have a skin infection at the
planned injection site.
The dose of BOTOX ® is not the same as, or comparable to,
another botulinum toxin product.
Serious and/or immediate allergic reactions have been
reported. These reactions include itching, rash, red itchy
welts, wheezing, asthma symptoms, or dizziness or feeling
faint. Tell your doctor or get medical help right away if you
experience any such symptoms; further injection of BOTOX ®
should be discontinued.
Tell your doctor about all your muscle or nerve conditions
such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s
disease), myasthenia gravis, or Lambert-Eaton syndrome,
as you may be at increased risk of serious side effects
including severe dysphagia (difficulty swallowing) and
respiratory compromise (difficulty breathing) from typical
doses of BOTOX ® .
Tell your doctor about all your medical conditions,
including if you: have or have had bleeding problems; have
plans to have surgery; had surgery on your face; weakness
of forehead muscles, such as trouble raising your eyebrows;
drooping eyelids; any other abnormal facial change; are
pregnant or plan to become pregnant (it is not known if
BOTOX ® can harm your unborn baby); are breastfeeding or
plan to breastfeed (it is not known if BOTOX ® passes into
breast milk).
Tell your doctor about all the medicines you take, including
prescription and non-prescription medicines, vitamins, and
herbal products. Using BOTOX ® with certain other
medicines may cause serious side effects. Do not start any
new medicines until you have told your doctor that you
have received BOTOX ® in the past.
Especially tell your doctor if you: have received any other
botulinum toxin product in the last 4 months; have received
injections of botulinum toxin such as Myobloc ® , Dysport ® ,
or Xeomin ® in the past (be sure your doctor knows exactly
which product you received); have recently received an
antibiotic by injection; take muscle relaxants; take an allergy
or cold medicine; take a sleep medicine; take anti-platelets
(aspirin-like products) or anti-coagulants (blood thinners).
Other side effects of BOTOX ® include: dry mouth, discomfort
or pain at the injection site, tiredness, headache, neck pain,
and eye problems: double vision, blurred vision, decreased
eyesight, drooping eyelids, swelling of your eyelids, and
dry eyes.
For more information refer to the Medication Guide or talk
with your doctor.
You are encouraged to report negative side effects of
prescription drugs to the FDA. Visit www.fda.gov/medwatch or
call 1-800-FDA-1088.
Please refer to full Medication Guide including Boxed
Warning on the following pages.
For adults with Chronic Migraine,
15 or more headache days a month,
each lasting 4 hours or more,
BOTOX ® is the first and only preventive treatment
proven to reduce headache days every month.
BOTOX ® is the only FDA-approved, preventive treatment that is
injected by a doctor every 3 months for people with Chronic Migraine.
BOTOX ® prevents up to 9 headache days a month, versus up to 7 days
for placebo. BOTOX ® is not approved for adults with migraine who
have 14 or fewer headache days a month.
IMPORTANT SAFETY INFORMATION
BOTOX ® may cause serious side effects that can be life
threatening. Call your doctor or get medical help right away if
you have any of these problems any time (hours to weeks) after
injection of BOTOX ® :
• Problems swallowing, speaking, or breathing, due to weakening
of associated muscles, can be severe and result in loss of life. You
are at the highest risk if these problems are pre-existing before
injection. Swallowing problems may last for several months.
FOR ADULTS WITH
CHRONIC MIGRAINE
injection
Find a headache specialist near you at
BotoxChronicMigraine.com
BOTOX ® is a prescription medicine that is injected to prevent headaches in adults with Chronic Migraine who have 15 or more days
each month with headache lasting 4 or more hours each day in people 18 years or older. It is not known whether BOTOX ® is safe
or effective to prevent headaches in patients with migraine who have 14 or fewer headache days each month (episodic migraine).
• Spread of toxin effects. The effect of botulinum toxin may affect
areas away from the injection site and cause serious symptoms
including: loss of strength and all-over muscle weakness, double
vision, blurred vision and drooping eyelids, hoarseness or change
or loss of voice (dysphonia), trouble saying words clearly
(dysarthria), loss of bladder control, trouble breathing, trouble
swallowing. If this happens, do not drive a car, operate
machinery, or do other dangerous activities.
There has not been a confirmed serious case of spread of toxin
effect away from the injection site when BOTOX ® has been used at
the recommended dose to treat Chronic Migraine.
Please see additional Important Safety Information on adjacent page.
12 Guide to Living Well with Migraine Headaches
injection
© 2014 Allergan, Inc., Irvine, CA 92612. ® marks owned by Allergan, Inc. Dysport is a registered trademark of Ipsen Biopharm Limited Company.
Myobloc is a registered trademark of Solstice Neurosciences, Inc. Xeomin is a registered trademark of Merz Pharma GmbH & Co KGaA. APC43DI14

MEDICATION GUIDE
BOTOX ®
BOTOX ® Cosmetic
(Boe-tox)
(onabotulinumtoxinA)
for Injection
Read the Medication Guide that comes
with BOTOX or BOTOX Cosmetic before
you start using it and each time it is given
to you. There may be new information.
This information does not take the place of
talking with your doctor about your medical
condition or your treatment. You should
share this information with your family
members and caregivers.
What is the most important information
I should know about BOTOX and
BOTOX Cosmetic?
BOTOX and BOTOX Cosmetic may cause
serious side effects that can be life
threatening, including:
• Problems breathing or swallowing
• Spread of toxin effects
These problems can happen hours, days,
to weeks after an injection of BOTOX or
BOTOX Cosmetic. Call your doctor or get
medical help right away if you have any of
these problems after treatment with BOTOX
or BOTOX Cosmetic:
1. Problems swallowing, speaking, or
breathing. These problems can happen
hours, days, to weeks after an injection of
BOTOX or BOTOX Cosmetic usually because
the muscles that you use to breathe and
swallow can become weak after the injection.
Death can happen as a complication if you
have severe problems with swallowing or
breathing after treatment with BOTOX or
BOTOX Cosmetic.
• People with certain breathing problems may
need to use muscles in their neck to help
them breathe. These people may be at greater
risk for serious breathing problems with
BOTOX or BOTOX Cosmetic.
• Swallowing problems may last for several
months. People who cannot swallow well
may need a feeding tube to receive food and
water. If swallowing problems are severe,
food or liquids may go into your lungs.
People who already have swallowing or
breathing problems before receiving BOTOX
or BOTOX Cosmetic have the highest risk of
getting these problems.
2. Spread of toxin effects. In some cases,
the effect of botulinum toxin may affect areas
of the body away from the injection site and
cause symptoms of a serious condition called
botulism. The symptoms of botulism include:
• loss of strength and muscle weakness
all over the body
• double vision
• blurred vision and drooping eyelids
• hoarseness or change or loss of voice
(dysphonia)
• trouble saying words clearly (dysarthria)
• loss of bladder control
• trouble breathing
• trouble swallowing
These symptoms can happen hours, days, to
weeks after you receive an injection of BOTOX
or BOTOX Cosmetic.
These problems could make it unsafe for you
to drive a car or do other dangerous activities.
See “What should I avoid while receiving
BOTOX or BOTOX Cosmetic?”
There has not been a confirmed serious case
of spread of toxin effect away from
the injection site when BOTOX has been
used at the recommended dose to treat
chronic migraine, severe underarm sweating,
blepharospasm, or strabismus, or when
BOTOX Cosmetic has been used at the
recommended dose to treat frown lines and/
or crow’s feet lines.
What are BOTOX and BOTOX Cosmetic?
BOTOX is a prescription medicine that is
injected into muscles and used:
• to treat overactive bladder symptoms such
as a strong need to urinate with leaking or
wetting accidents (urge urinary incontinence),
a strong need to urinate right away
(urgency), and urinating often (frequency)
in adults when another type of medicine
(anticholinergic) does not work well enough
or cannot be taken.
• to treat leakage of urine (incontinence)
in adults with overactive bladder due to
neurologic disease when another type of
medicine (anticholinergic) does not work well
enough or cannot be taken.
• to prevent headaches in adults with chronic
migraine who have 15 or more days each
month with headache lasting 4 or more hours
each day.
• to treat increased muscle stiffness in elbow,
wrist, and finger muscles in adults with upper
limb spasticity.
• to treat the abnormal head position and
neck pain that happens with cervical dystonia
(CD) in adults.
• to treat certain types of eye muscle
problems (strabismus) or abnormal
spasm of the eyelids (blepharospasm)
in people 12 years and older.
BOTOX is also injected into the skin to treat
the symptoms of severe underarm sweating
(severe primary axillary hyperhidrosis) when
medicines used on the skin (topical) do not
work well enough.
BOTOX Cosmetic is a prescription medicine
that is injected into muscles and used to
improve the look of moderate to severe
frown lines between the eyebrows (glabellar
lines) in adults for a short period of time
(temporary).
BOTOX Cosmetic is a prescription medicine
that is injected into the area around the side
of the eyes to improve the look of crow’s
feet lines in adults for a short period of time
(temporary).
You may receive treatment for frown lines and
crow’s feet lines at the same time.
It is not known whether BOTOX is safe or
effective in people younger than:
• 18 years of age for treatment of urinary
incontinence
• 18 years of age for treatment of chronic
migraine
• 18 years of age for treatment of spasticity
• 16 years of age for treatment of cervical
dystonia
• 18 years of age for treatment of
hyperhidrosis
• 12 years of age for treatment of strabismus
or blepharospasm
BOTOX Cosmetic is not recommended for
use in children younger than 18 years of age.
It is not known whether BOTOX and
BOTOX Cosmetic are safe or effective to
prevent headaches in people with migraine
who have 14 or fewer headache days each
month (episodic migraine).
It is not known whether BOTOX and
BOTOX Cosmetic are safe or effective for
other types of muscle spasms or for severe
sweating anywhere other than your armpits.
Who should not take BOTOX or
BOTOX Cosmetic?
Do not take BOTOX or BOTOX Cosmetic
if you:
• are allergic to any of the ingredients in
BOTOX or BOTOX Cosmetic. See the end of
this Medication Guide for a list of ingredients
in BOTOX and BOTOX Cosmetic.
• had an allergic reaction to any other
botulinum toxin product such as Myobloc ® ,
Dysport ® , or Xeomin ®
• have a skin infection at the planned injection
site
• are being treated for urinary incontinence
and have a urinary tract infection (UTI)
• are being treated for urinary incontinence
and find that you cannot empty your bladder
on your own (only applies to people who are
not routinely catheterizing)
What should I tell my doctor before taking
BOTOX or BOTOX Cosmetic?
Tell your doctor about all your medical
conditions, including if you:
• have a disease that affects your muscles and
nerves (such as amyotrophic lateral sclerosis
[ALS or Lou Gehrig’s disease], myasthenia
gravis or Lambert-Eaton syndrome). See
“What is the most important information I
should know about BOTOX and
BOTOX Cosmetic?”
• have allergies to any botulinum toxin
product
• had any side effect from any botulinum
toxin product in the past
• have or have had a breathing problem,
such as asthma or emphysema
• have or have had swallowing problems
• have or have had bleeding problems
• have plans to have surgery
• had surgery on your face
• have weakness of your forehead
muscles, such as trouble raising your
eyebrows
• have drooping eyelids
• have any other change in the way your
face normally looks
• have symptoms of a urinary tract
infection (UTI) and are being treated for
urinary incontinence. Symptoms of a
urinary tract infection may include pain or
burning with urination, frequent urination,
or fever.
• have problems emptying your bladder
on your own and are being treated for
urinary incontinence
• are pregnant or plan to become
pregnant. It is not known if BOTOX or
BOTOX Cosmetic can harm your unborn
baby.
• are breast-feeding or plan to breastfeed.
It is not known if BOTOX or BOTOX
Cosmetic passes into breast milk.
Tell your doctor about all the medicines
you take, including prescription and
nonprescription medicines, vitamins
and herbal products. Using BOTOX or
BOTOX Cosmetic with certain other
medicines may cause serious side effects.
Do not start any new medicines until
you have told your doctor that you have
received BOTOX or BOTOX Cosmetic in
the past.
Especially tell your doctor if you:
• have received any other botulinum toxin
product in the last four months
• have received injections of
botulinum toxin, such as Myobloc ®
(rimabotulinumtoxinB), Dysport ®
(abobotulinumtoxinA), or Xeomin ®
(incobotulinumtoxinA) in the past. Be sure
your doctor knows exactly which product
you received.
• have recently received an antibiotic by
injection
• take muscle relaxants
• take an allergy or cold medicine
• take a sleep medicine
• take anti-platelets (aspirin-like products)
and/or anti-coagulants (blood thinners)
Ask your doctor if you are not sure if your
medicine is one that is listed above.
Know the medicines you take. Keep a list
of your medicines with you to show your
doctor and pharmacist each time you get
a new medicine.
How should I take BOTOX or
BOTOX Cosmetic?
• BOTOX or BOTOX Cosmetic is an
injection that your doctor will give you.
• BOTOX is injected into your affected
muscles, skin, or bladder.
• BOTOX Cosmetic is injected into your
affected muscles.
• Your doctor may change your dose of
BOTOX or BOTOX Cosmetic, until you and
your doctor find the best dose for you.
• Your doctor will tell you how often
you will receive your dose of BOTOX
or BOTOX Cosmetic injections.
What should I avoid while taking BOTOX
or BOTOX Cosmetic?
BOTOX and BOTOX Cosmetic may
cause loss of strength or general muscle
weakness, or vision problems within
hours to weeks of taking BOTOX or
BOTOX Cosmetic. If this happens, do not
drive a car, operate machinery, or
do other dangerous activities. See
“What is the most important information
I should know about BOTOX and
BOTOX Cosmetic?”
What are the possible side effects of
BOTOX and BOTOX Cosmetic?
BOTOX and BOTOX Cosmetic can cause
serious side effects. See “What is the
most important information I should know
about BOTOX and BOTOX Cosmetic?”
Other side effects of BOTOX and BOTOX
Cosmetic include:
• dry mouth
• discomfort or pain at the injection site
• tiredness
• headache
• neck pain
• eye problems: double vision, blurred
vision, decreased eyesight, drooping
eyelids, swelling of your eyelids, and dry
eyes.
• urinary tract infection in people being
treated for urinary incontinence
• painful urination in people being treated
for urinary incontinence
• inability to empty your bladder on your
own and are being treated for urinary
incontinence. If you have difficulty fully
emptying your bladder after getting
BOTOX, you may need to use disposable
self-catheters to empty your bladder up to
a few times each day until your bladder is
able to start emptying again.
• allergic reactions. Symptoms of an
allergic reaction to BOTOX or BOTOX
Cosmetic may include: itching, rash, red
itchy welts, wheezing, asthma symptoms,
or dizziness or feeling faint. Tell your
doctor or get medical help right away
if you are wheezing or have asthma
symptoms, or if you become dizzy or faint.
Tell your doctor if you have any side effect
that bothers you or that does not go away.
These are not all the possible side effects
of BOTOX and BOTOX Cosmetic. For
more information, ask your doctor or
pharmacist.
Call your doctor for medical advice about
side effects. You may report side effects to
FDA at 1-800-FDA-1088.
General information about BOTOX and
BOTOX Cosmetic:
Medicines are sometimes prescribed
for purposes other than those listed in a
Medication Guide.
This Medication Guide summarizes the
most important information about BOTOX
and BOTOX Cosmetic. If you would like
more information, talk with your doctor.
You can ask your doctor or pharmacist
for information about BOTOX and BOTOX
Cosmetic that is written for healthcare
professionals.
What are the ingredients in BOTOX and
BOTOX Cosmetic?
Active ingredient: botulinum toxin type A
Inactive ingredients: human albumin and
sodium chloride
Revised: 08/2015
This Medication Guide has been approved
by the U.S. Food and Drug Administration.
Manufactured by: Allergan
Pharmaceuticals Ireland a subsidiary of:
Allergan, Inc.
2525 Dupont Dr.
Irvine, CA 92612
© 2015 Allergan, Inc. All rights reserved.
®
marks owned by Allergan, Inc.
Patented. See: www.allergan.com/
products/patent_notices
Myobloc ® is a registered trademark of
Solstice Neurosciences, Inc.
Dysport ® is a registered trademark of Ipsen
Biopharm Limited Company.
Xeomin ® is a registered trademark of Merz
Pharma GmbH & Co KGaA.
®
Based on 72511US14
APC25LG15

eal inspiration
“What I’ve learned
about migraine”
Fight back!
“Migraines are the worst! … [I tell
my migraine] ‘We are about to go
to blows! #IWin’”
—Tweeted by reality star Khloé
Kardashian, who eventually
learned her migraines were
triggered by stress.
Treat quickly!
“[When a migraine is about
to strike] I’m nauseated…I get
this light disruption thing.”
—Comedian and actor Russell
Brand, who was interrupted
in the middle of a standup
routine by signs of a migraine,
but was able to continue
after taking medication.
Enlist friends!
“[Migraines] once made me pass
out on stage. Fortunately, the
boys in my band have learned to
tell when it’s coming. They just
take me by the elbow and help
me sit until it passes.”
—Loretta Lynn, as written in her
memoir Coal Miner’s Daughter.
Get back in
the game!
“Once I decided to seek
professional help for my
migraine attacks, I learned
that there are effective
treatments that enable me
to ‘get back in the game,’
and I now want to help other
sufferers do the same.”
—Terrell Davis, player for the
NFL’s Denver Broncos

eal inspiration
“ How I took control
of my migraines...”
These five patients feared they’d never find relief from their
debilitating headaches. Today, they’re working closely with
their healthcare providers and thriving. Here are their tips for
taking back control from migraine. by Lindsay Bosslett
“Managing migraines isn’t about finding one big
answer—it’s a bunch of tiny pieces,” says Kate.
“But as long as you keep communicating with
your care team, you won’t have to feel lost.”
Be patient.
“It is going to take time to find
what works for you,” says Kate
McCombs, 30, from New York
City. “Managing migraines isn’t
about finding one big answer—it’s a
bunch of tiny pieces. You may have
many triggers and may have to find
many different ways to avoid them.
You may need more than one
medication or to switch meds at
one point like I did. You may need
to visit more than one doctor. But
as long as you keep trying and keep
finding a way to communicate, you
won’t have to feel lost.”
Become nutritional
label savvy.
“Once I learned I was allergic to MSG
[monosodium glutamate] and that
it was likely triggering migraines for
me, I was able to cut it out of my diet,”
says Lisa Rosen, 47, Little Falls, NJ,
who has had migraines since her early
teens. “But sometimes it was in food
and I didn’t even know.” Food labels
can have some sneaky names for
MSG on labels. If it’s a trigger for you,
avoid anything with the following
listed in its ingredients: the words
Are you doing
all you can to …
PREVENT MIGRAINES?
Today’s treatments can help
fend off migraines—in fact, up
to 40% of migraine sufferers
can benefit from preventive
treatment, studies show. Ask if
you are a candidate.
nip THEM IN THE BUD?
Preventive treatment not right
for you? Then try to identify
your body’s earliest warning
signs of migraine—the sooner
you take an acute medication,
the better it can work to halt
or lessen symptoms.
“Once I discovered MSG was causing my migraines I was finally able to cut it
out of my diet,” Lisa says. “I realized sometimes it hides under different names,
too. But I learned what to avoid, and now I rarely get migraines at all!”
glutamic or glutamate; textured or
hydrolyzed proteins; yeast extract;
anything labeled as protein-fortified,
ultra-pasteurized, fermented or
enzyme-modified; ajinomoto.
Make sleep
a priority.
“I noticed that I tended to get
migraines on Tuesdays and
Saturdays,” says Andrea Stephenson,
46, from Solon, OH, who started
getting migraines six years ago. “I
realized that Tuesdays were after two
nights of going to bed late and getting
up early, and on Saturdays I tended
to sleep in to make up for what I lost
during the week. When I started
getting seven to eight hours sleep
regularly, that helped a lot.”
Learn your triggers.
“We all have different triggers for
migraines, so just avoiding the
things commonly listed may not
work for you,” says Sarah Farver,
48, from Fort Worth, TX, whose
migraines became chronic while
she was in college. “I make sure
to write down when something
uncommon—like lifting a 50-lb.
bag of dog food—triggers one for
me. If I know them, I can avoid
them. Or at least be prepared to
treat very early if I know I’ll be
forced to encounter one.”
Plan ahead.
“Planning ahead can help avoid
unpleasant surprises and scheduling
messes that trigger migraines,”
says life-long migraine sufferer
Teri Robert, 60, from Washington,
WV, author of Living Well with
Migraine Disease and Headaches
and chairperson at the American
Headache Migraine Association.
“Make lists—the last thing you need
is for a migraine to be coming on
as you’re getting ready to travel and
end up forgetting half of what you
need.” Teri also recommends making
a migraine kit and keeping it handy
in the car or plane—see page 23 for
what to include.
18 Guide to Living Well with Migraine Headaches

eal inspiration
“I know now I have to make sleep a priority,”
says Andrea. “Sticking to a regular schedule
is essential.”
Develop your
voice. Kate credits her ability to
communicate clearly with helping her
find relief for her migraines. “The fact
that I can talk openly and honestly
with my husband has been a key in
our marriage while managing this
condition,” she says. “It’s important
for me to be able to ask my friends
to accommodate my needs without
alienating them, and to tell my
doctors what I’m going through
and have them take me seriously.
Migraines are so individual—you
have to be able to say what’s going on
with you specifically. My voice has
been my most important ally.”
Learn your
symptoms. “My migraines
often start with a dull ache in my
forehead that moves backward,”
Andrea says. “I often become irritable
and sometimes smells and sounds will
bother me. A sure sign is when I start
20 Guide to Living Well with Migraine Headaches
to feel nauseated. The key is taking
my medication as soon as I notice
these early symptoms—the earlier the
better, and sometimes I can fend off a
migraine all together.”
Choose happiness.
“I think everyone has aspects of their
lives that they have to deal with and
work around,” Sarah says. “For me,
migraines are just one of those things.
But because of them, I chose to
pursue a fabulous job where I can
work from home now and spend
more time with my kids. Happiness
is a choice and choosing to be
thankful for every breath we’re given
is not something to take lightly.”
Give acupuncture
a try. “My migraines have been
much more rare ever since trying
acupuncture a few years ago,” Lisa
says. Acupuncture involves placing
thin, painless needles in different
parts of the body that are associated
with acupoints. And a recent study
published in the Archives of Internal
Medicine did find acupuncture to be
helpful in chronic pain conditions—
just be sure to visit a certified
practitioner; find one at nccaom.org.
Be open to change.
“My migraines started around when I
hit puberty,” Kate says. “Because they
were related to my menstrual cycle,
they were pretty regular and easier
to plan for. I was able to be treated
by my regular doctor for years.” All
that changed about a year ago, when
without explanation the migraines
began coming more frequently and
lasting longer. “I knew I needed to try
something different—even though
my old treatments had worked for
a long time. That’s when I went to
see a neurologist. He prescribed
an injectable medication, as well as
something I can take daily. It’s
made it so I can work again.”
Dump the guilt!
“Always take care of yourself,” Teri
emphasizes. “We all tend to try to
adapt our schedules to fit with those
of others. If it’s going to trigger a
migraine, just don’t do it—and don’t
feel guilty!”
“I choose happiness,”
Sarah says. “Everyone
deals with something;
at least migraines I
can manage!”
QA &
AM I HAVING CHRONIC MIGRAINE?
I seem to have headaches all the time—I feel
Q like I’m taking pain meds every day, and the pain
never stops. Could I be having Chronic Migraine?
A
Possibly. You could have Chronic Migraine if
you suffer 15 or more headaches a month, each
lasting four hours or more. However, taking too many acute
painkillers—medications used to treat the sudden onset of
pain—can also have a rebound effect. Once the medication
wears off, the headache will return. This can happen if you
take more than the recommended dosage, or if you take
the drug too often. Luckily, you don’t have to go off painkillers
cold turkey. If frequent migraines see you turning
to acute painkillers too often, ask your doctor if preventive
medications might be an option for you.
a world without headachE
Our expert:
Stephen D. Silberstein,
MD—professor of neurology
and director of the Jefferson
Headache Center at Thomas Jefferson
University in Philadelphia
AURA—EXPLAINED!
Q
Why do I get aura before a migraine?
Do they mean I get worse migraines than
other people?
A
Auras—which are known to occur in only about
20% of migraines—can include flashes of light,
blind spots, wavy lines or tingling in your hands or face.
Experts suspect the cause is an electrical or chemical
wave that crosses the part of your brain that controls
your sense of vision. In any case, experiencing an aura
has no effect at all on the severity of your migraine. If
anything, consider it a warning that gives you a chance
to take action: Take your meds and find your way to a
cool, dark, quiet place to help fend off or at least lessen
the impact of the headache.
(CAQ)
The National Headache Foundation’s
Certificate of Added Qualification
1 2 3 4 5
Establish Stimulate Serve enhance
a credentialing body physicians’ interest in as an alternative or the ability of patients
for physicians treating headache and its addition to board to identify those
headache and thus management
certification in
physicians with
facilitate patient care.
headache medicine expertise and interest
from the United in headache.
Council of Subspecialties
(UCNS) certification
which requires a
1-year fellowship in
headache medicine
at a qualified center.
Recognize
physicians with an
advanced level of
experience in headache
management.
For more information
[ ]
visit headaches.org/CAQ
[ ]
call (888) NHF-5552

feel your best
Migraine-proof your home
Just a few simple changes can turn your
home into a fortress against migraines—and
a refuge to rest in, in case one does strike!
IN THE BEDROOM
Go for thick curtains. Your bedroom can be the
ideal migraine retreat. Thick or “black-out” curtains on the
windows will help keep the room dark and cool, and can even
help dampen outside sounds.
Get an air purifier. Dust and dander can be a
trigger for many. You can find free-standing air purifiers for as
low as $40 in home-improvement and electronics stores. Be sure
to change the filter in your furnace, as well, and have your vents
and ducts professionally cleaned once every 3-5 years.
Consider a humidifier or dehumidifier.
Aim for a healthy 35% to 50% humidity inside at all times—that
can mean using a humidifier in winter and a dehumidifier in
summer. Bonus: Maintaining a normal humidity level has been
shown to reduce your likelihood of getting sick!
IN THE KITCHEN
Stop drawers from slamming. When you’re in the midst of a migraine, any noise can
cause a bolt of pain. Pick up little rubber drawer stoppers (or you can make your own by cutting up pencil
erasers!) at a hardware store—they attach to the inside of drawers or cabinet doors and muffle the noise made
when closing them.
Take care with cleaning products. Scented products are a huge migraine trigger for
some. Look for products labeled “perfume-free” or “fragrance-free,” and be wary of ones that say “all-natural,”
as these still might have scents that can cause problems. It’s also best to avoid scented detergents, body
products, candles and air fresheners.
Deactivate your fridge light. In the midst of a migraine, you’ll still need to eat and drink
(it’s especially important to stay hydrated!). But the fridge light can exacerbate your migraine. Solution? Simply
remove the bulb and keep a small flashlight nearby—the smaller light beam will help you find the food you
need, and won’t be as problematic for your migraine.
22 Guide to Living Well with Migraine Headaches
Your migraine tool kit
If you suffer from
migraines, create
a personalized
migraine kit, which
can come to your
aid if a severe
headache strikes
unexpectedly.
Here’s a list of
what it could
include:
A cold
compress or
pack, which
can help your
throbbing head.
THROUGHOUT
Seal up windows and doors.
A sudden shift in temperature—like you’d experience near
a drafty window—can spark a migraine. Closing up drafts
(either with caulk, insulation or draft guards) will not only
keep the temperature in your house more steady, it will
also help lower your heating and cooling bill.
Change to these light bulbs... Lowwattage
incandescent bulbs, which produce a warm, steady
stream of light. Bright and/or flickering lights—such as
from halogen or fluorescent bulbs—are more likely to
trigger a migraine.
Decorate with care. Paints and carpets that
contain “volatile organic compounds” (VOCs) can trigger
or worsen migraines. The compounds get released into the
air over time, and can cause irritation and inflammation
throughout your body. Look for paints that are VOC-free,
such as Benjamin Moore Natura or Low & Zero, and
carpet manufacturers rated as “Green Label” by The
Carpet and Rug Institute at carpet-rug.org.
An eye mask
to shield your
eyes from light.
A bottle
of water
Dehydration
can lead to
headaches.
You’ll also
need water
to take your
migraine
medication.
A small
pillow, which
could come in
handy for
resting.
Medication
can treat a
headache ASAP.

you & your care team
9 questions
Good communication is the key to
effective treatment for your migraine.
Get started by asking these questions.
for your next exam
1. Could my headache be a migraine?________________________________________________________________________
2. Could I have Chronic Migraine?____________________________________________________________________________
3. What’s the best way to identify my triggers?_________________________________________________________________
4. What are my treatment options?___________________________________________________________________________
5. Could I benefit from preventive therapies?__________________________________________________________________
6. How long should I wait to assess if the preventive therapy is working to stop my headaches?______________________
7. Should I expect any side effects from my treatment(s)? _______________________________________________________
8. How can I tell when a migraine is coming on, and at what point should I start taking acute medication?____________
________________________________________________________________________________________________________
9. When should I come back to see you?_______________________________________________________________________
Resources you need... Looking for more info on migraines? Hoping to connect
with others who understand you? These organizations offer the answers you want and the support you need,
and you can visit them all with a click by logging on to HealthMonitor.com/MigraineResources
This anonymous online health
community is a safe, comforting
place to join and meet others with migraine headaches like
you.. You can share, learn and help others, while keeping your
identity completely confidential. Join the conversation at
HealthKeep.com and download the app in the iTunes Store.
If you have Chronic Migraine,
don’t live a maybe life. Visit
MyChronicMigraine.com to learn
about treatment options, get inspired by real-life stories,
track your headaches/migraines and find a Headache
Specialist near you.
The AHMA exists to E.A.S.E. the
burden of Migraine and other Headache
Disorders through Education, Awareness,
Support, and Engagement.
The National Headache Foundation
enhances the health of those with
migraine by providing educational and
informational resources, supporting headache research
and advocating for the understanding of headache as a
legitimate neurobiological disease.
The American Migraine
Foundation (AMF) supports
innovative research and education that will lead to
improvement in the lives of those who suffer from migraine
and other related disorders.
The American Chronic Pain
Association (ACPA) facilitates
peer support and education for people with chronic
pain and their families so that they may live a fuller life.
ACPA also raises awareness of issues associated with
chronic pain.
NATIONAL FIBROMYALGIA & CHRONIC
PAIN ASSOCIATION. Migraines and
chronic pain are a challenge to manage.
Join the National Fibromyalgia & Chronic Pain Association
(NFMCPA) at FMCPaware.org for education, research
information and important advocacy programs to improve
your healthcare and protect your access to care.
24 Guide to Living Well with Migraine Headaches