Migraine prevention: practical steps that actually help

What if you could cut the number of migraine days each month? You can. Prevention isn’t magic — it’s a mix of small habits and the right treatments. Below are clear steps you can use now, whether your attacks come once a month or several times a week.

Start by tracking triggers and patterns

Keep a simple migraine diary for 6–8 weeks. Note when a headache starts, what you ate, how you slept, stress level, weather, and any meds you took. A pattern will usually show up: certain foods, missing sleep, skipping meals, or too much caffeine. Identifying triggers is the cheapest and easiest prevention step.

Also watch for medication overuse. Using triptans, NSAIDs, or opioids more than 10–15 days per month can make headaches worse. If your diary shows frequent acute med use, talk to your doctor about a prevention plan instead.

Simple daily habits that lower migraine risk

Sleep: aim for consistent bedtime and wake time. Too much or too little sleep can trigger attacks. Hydration: drink water regularly — even mild dehydration can spark a migraine. Meals: don’t skip meals; keep blood sugar stable with balanced snacks if needed. Exercise: moderate aerobic activity 3 times a week helps reduce frequency for many people. Stress: try brief, daily stress tools — breathing, short walks, or 10 minutes of guided relaxation.

Limit caffeine and alcohol. Caffeine helps some people, but overuse and sudden withdrawal are common triggers. If caffeine seems linked to your headaches, cut back slowly, not all at once.

Consider behavioral therapies. Cognitive behavioral therapy (CBT), biofeedback, and mindfulness have solid evidence for reducing migraine days. These work well alongside meds and are worth trying if you want fewer drug side effects.

When to consider preventive medicine

Talk to a doctor about preventive drugs if you have 4 or more migraine days a month, if attacks are severe or disabling, or if acute meds stop working. There are several options:

- Beta-blockers (propranolol, metoprolol): often first-line for many people, but not for those with asthma or low blood pressure.
- Antiepileptics (topiramate, divalproex/Depakote): effective but watch for cognitive effects (topiramate) and serious risks in pregnancy with Depakote.
- Tricyclic antidepressants (amitriptyline): good for sleep and pain in lower doses.
- CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) and gepants: newer options given monthly or quarterly with fewer systemic side effects for many people.
- Botox (onabotulinumtoxinA): an option for chronic migraine (15+ headache days/month) with a clear injection schedule.

All meds need time to work. Most need 2–3 months at a therapeutic dose before you judge whether they help. Track improvements and side effects so you and your provider can adjust the plan.

Prevention is personal. Start with tracking and basic habits, try behavioral tools, and add medicine if needed. Bring your diary to appointments — it helps your clinician pick the best option faster.