Ask Doctor K: Avoid triggers, seek preventive treatment for migraines

DEAR DOCTOR K: I suffer from excruciating migraine headaches. What can I do to prevent them?

DEAR READER: Migraines are severe, throbbing, often debilitating headaches. They can be accompanied by nausea or vomiting. It’s no wonder that anyone who suffers from migraines would do anything to avoid them.

Migraines can be triggered by certain activities, foods, smells or emotions. Common migraine triggers include:

• Caffeine (either too much or cutting back on regular use).

• Certain foods and beverages. These include foods and drinks that contain tyramine (aged cheeses and meats, fermented beverages), sulfites (preserved foods, wines) and monosodium glutamate (MSG).

• Stress or the opposite: relaxing after a stressful day or week.

• Hormone levels.

• Lack of sleep.

• Changes in weather or altitude.

• Overuse of pain-relieving medications.

If you can identify a trigger, try to avoid it. Some people also find that alternative treatments help. These include biofeedback, yoga, acupuncture and massage.

But some people get frequent and severe migraines no matter how well they avoid triggers. If your migraine attacks are severe, do not respond to treatment or occur more than four times a month, look into the following preventive treatments:

• Transcutaneous electrical nerve stimulation (TENS). The FDA approved the first TENS device for migraine prevention in 2014. Placed on the forehead, it applies an electrical current that stimulates nerves in the brain that process pain.

• Preventive medications. Several types of medications are used to reduce the frequency of migraine headaches.

There are some studies that suggest taking low-dose aspirin every day may reduce the frequency of migraines.

• Botox injections. If you experience more than 14 migraines per month, botulinum toxin (Botox) injections may help.