by Josh Turknett, MD
As mentioned in the last article, I’ve made it a personal goal to never take another triptan again (or any other migraine relief medication, for that matter). By that I don’t mean I never want to have another migraine again – though that’d be just fine, thank you very much – but because I know that gives me the best shot at never having another migraine again.
(RELATED: Click here to read more about how migraine meds trade short term relief for long term misery.)
Of course, having a goal like that also means that I need a plan.
Because while using the Migraine Miracle approach I currently enjoy protection against migraines I never before thought possible, I also know that the beast never truly rests, and that he loves nothing more than to sneak up when you least expect it.
So, in the event of said sneak attack, I must be prepared. Prepared to fend him off with something other than a drug. He wants me to pop a pill, after all, cause he knows that’s his Trojan Horse.
The Drug-Free Experiments
For the better part of this year, I’ve been experimenting with all manner of combinations of drug-free approaches. I’m able to reliably trigger a migraine, and have been doing so regularly in order to gather data on and refine these various strategies (my daughter says this makes me weird. She’s probably right).
This might sound absurd, but in all honesty it’s been completely worth it. As a result of these efforts, I now have an arsenal drug-free beast-slaying strategies — including one, which I’ll discuss below, that’s more effective than any of the drugs, including triptan. A method that utilizes my body’s own pain relieving mechanisms, and that removes the temptation to reach for an abortive medication and all the potential future consequences. This is huge.
Knowing I have a reliable, drug-free strategy for ending an attack gives me tremendous peace of mind.
Peace of mind in knowing I wanted be visited again by Massive Rebound Headache of Death. And had I never established this goal of zero meds, I’d have never done the work needed to discover that strategy.
11 Drug-Free Strategies For Ending A Migraine
The internet, as I’m sure you know, can be both blessing and curse. Google around a bit for migraine remedies and you’re sure to find a wide range of options.
Needless to say, it can be overwhelming.
The ones I present here represent the cream of the crop. They’ve been culled from over a decade of working with migraineurs, the people inside of our Migrai-Neverland and Migraine Miracle Facebook communities (via several polls, comments, etc.), along with my own (and Jenny’s) personal experience battling the beast for the better part of my life.
The goal here was not just to identify things that can work, but specifically those things that work for a majority of people (if standing on one leg and rubbing ginger ale on your earlobe only works for one person, it’s of little use to the rest of us… 🙂 )
With these drug-free migraine relief strategies, our goal is to activate, support, or amplify our body’s own natural ability to heal itself. We want to work with our body, not against it. So when it comes to migraine relief, there are a few different means by which we can do this, which is how we’ll be categorizing the strategies laid out here.
Category #1: Homeostatic Support
Those who’ve read the book may recall that in Chapter 4 of The Migraine Miracle, I outlined the evidence that points to the hypothalamus as the central generator of migraine, the place in the brain where it all begins. The first domino to fall in the awful cascade that is migraine.
The hypothalamus is a small but massively important brain structure, responsible for maintaining homeostasis, or stable conditions inside the body – arguably the single brain region most burdened by the evolutionarily inappropriate environment that is our modern world. The hypothalamus regulates things like temperature, heart rate, fluid and energy balance, mineral concentrations, pH, and so on.[RELATED: Those interested in learning more about “Migraines as the Hypothalamic Distress Signs” can view my talk on the topic at the 2014 Ancestral Health Symposium.]
One of the strongest pieces of evidence for the hypothalamus as the central migraine generator is that many of the most potent migraine triggers can also be viewed as homeostatic disruptors. In other words, things that make the hypothalamus’s job difficult are the same things that trigger migraines (which I don’t think is a coincidence).
And so, with this first category of remedies, our objective is to right the ship by assisting the hypothalamus in its efforts to respond to a homeostatic challenge.
Since these approaches are targeted towards the reversal of the effects of a primary trigger, they are not surprisingly more effective when performed earlier in the course of a migraine (which is why they’re listed here first). When they do work, the effect can often seem magical, sometimes causing the beast to retreat in a matter of minutes.
Method #1: Water and Minerals (salt)
Trigger: Dehydration and/or mineral losses
Homeostatic Correction: Stabilization of water and mineral losses.
Methods: There are several ways to go about this. If you’re trying to correct both fluid and mineral losses (i.e. sweating in the hot sun, diuresis induced by transition to low carb/keto, etc.) then a glass (or glasses) of water mixed with a pinch or two of salt is a simple way of doing so.
Personally, I’ll salt enough to notice that the water has a “flavor,” but not enough for it to taste salty. I also prefer Himalayan sea salt (but regular table salt is ok too in a “pinch”). Mineral waters with high mineral content can also work here, especially as a general means of hydration.
If you’re trying to primarily replace minerals, then options here include: a swig of pickle juice, electrolyte tablets, or a cup of bone broth (provided it was adequately salted).
Method #2: Cool Down
Trigger: Exposure to heat and humidity (especially if it’s an abrupt transition).
Homeostatic Correction: Body temperature regulation.
Method: Cool down rapidly. Move to a much cooler location if at all possible, or cool down using other means (ice pack, cold rag, etc.).
Method #3: Stress Hormone Reduction.
Trigger: Spike in stress hormones from activation of the sympathetic nervous system (with an array of physiologic effects).
Homeostatic Correction: Hormone stabilization (and related stabilization of downstream physiologic effects).
Method: Relaxation technique of choice (this requires you to have one! 🙂 ). Mindfulness practices, including mindfulness meditation, is one proven, highly effective means of doing so (both Headspace and Calm are easy ways to get started). Deep breathing (see below) may also work via this mechanism as well.
Also see the “Power of Thought” article for more on the importance of stress reduction, and the value of mindfulness practice, in migraine prevention.
Method #4: Deep Breathing
Trigger: Change in blood pH (presumptive), surge in stress hormones (or potentially expansion of cranial blood vessel diameter).
Homeostatic Correction: Blood pH, hormone stabilization, and possibly cerebral blood flow (though these effects are temporary).
Method: Deep breathing.
Ok, this is one of those areas where everyone and their grandmother has their own patented technique. Some needing a manual.
In reality, there’s no reason to overcomplicate this (unless you want to sell breathing manuals). There are basically two choices when it comes to deep breathing: either prolong the time of inhalation, or prolong the time of exhalation.
The former will lower blood carbon dioxide (CO2) concentration (and raise pH), while the latter will raise blood CO2 concentration (and lower pH). Changes in blood CO2 will also affect the diameter of cranial blood vessels.
The anecdotal data seems to indicate that prolonging the exhalation phase may work better for migraine relief.
Take a deep inhalation, then exhale very slowly (the exhale phase should take as long as possible). Repeat. Breathing in through one nostril or adopting a fancy yoga pose while doing so is optional. 🙂
Method #5: Sleep!
Trigger: Sleep deprivation.
Homeostatic Correction: Re-entrainment of circadian rhythms (sleep/wake cycle).
Method: Nothing fancy here. If you find a migraine starting after a poor night’s sleep (or multiple nights), a short power nap (15-30 min.) can often work wonders. Then try to make a concerted effort to ensure you good night’s rest the following night.
Also, if you’ve your sleep/wake cycle has be thrown out of whack for more than a couple days, consider a course of melatonin to reset the clock (3-5 mg, 1-2 hours prior to goal bedtime, for 4 weeks is the recommendation for a melatonin reset).
Method #6: Trigger Dilution
Trigger: Consumption of a known trigger food (or component).
Homeostatic Correction: Reduce the concentration of the substance in the bloodstream.
Method: Drink lots of water (generally, would recommend salting at least a little bit, that way you’ll cover #1 and 2). This is also an effective means of PREVENTING of migraine after eating a “cheat” meal.
How To Implement Category 1 Interventions
The targeted approach. If you have a pretty firm idea of what homeostatic disruption triggered your migraine (i.e. which homeostatic disruptor is responsible), then by all means target that one first. Give it roughly 10-20 minutes to assess your response. If things are improving, stay the course. If not, try the “kitchen sink” approach (see below).
The “Kitchen Sink” approach. If you have no real idea what brought on the attack but it’s still relatively early in the course of the migraine (up to a couple hours perhaps), then go for the “kitchen sink” approach and try the above interventions in succession. Again, give each one roughly 10-20 minutes and reassess. There’s little downside to this approach, and a major potential upside.
Category #2: Enhance “Endogenous” Pain Reduction
As discussed in the “Brain On Fire” article, our brain has its own intricate and sophisticated system for pain reduction. When we take meds for migraine relief, we’re oftentimes suppressing that system. Taking those meds may work in the short term, but can have disastrous effects over the long term.
Rather than outsource our migraine relief, the strategies in this category are intended to activate, support, or amplify or own systems of pain relief. Here we’re working with our body, not against it.
Method #1: Essential Oils
Method: Apply essential oil to temples and/or neck region (dilute the oil in a bit of water if you find the sensations overly intense).
Note: Peppermint and lavender oil appear to have the best track record in our community.
Method #2: Massage
Method: Massage of neck, shoulders, head, back, etc.
Note: While “tension” in the neck and shoulders is often blamed as the source of migraine, we likely have the cause and effect reversed here. Human touch, including massage, is another big booster of endorphin release.
The effects here are also likely mediated through the release of endorphins (the brain’s natural pain killer), rather than direct “relaxation” of muscles. No specific expertise or protocol is required (though avoid deep tissue, which leads to release of inflammatory mediators) – the key point is that you enjoy it.
I’m a big fan of the 4-pronged massage tools, which can turn any 6-year-old into an expert masseuse.
Method #3: Cold Packs
Method: Apply something cold to the area of pain.
Note: For many years, I wasn’t especially sophisticated with this approach, oftentimes just wetting a washcloth with some cold water and applying it to my head.
These days, there are various reusable cold packs made for just this situation that you can stick in the freezer and have at the ready. I’ve seen many different ones over the years, and the most clever and convenient solution has to be the Migraine Hat.
With the Migraine Hat, the icepack nestles inside of a cloth that can then be wrapped around the head, giving you hands-free head cooling, disguised as a fashion accessory.
Method #4: Laughter
Method: Any strategy that reliably makes you laugh!
Note: Don’t laugh (well, you know…)! This technique can be surprisingly effective, likely also via a significant boost in endorphin release (one of the brain’s natural painkillers).
Pay attention to the things that make you laugh out loud (memes, facebook and youtube vids, books, articles, etc.), and start maintaining your own personal laugh library (I have a comedy playlist in Spotify that I use for this). Even audio clips of people laughing can be enough to get you going.
Category #3: Attack the Beast!
Ok, this one is my absolute favorite. Why? Because it has WORKED. EVERY. TIME.
As mentioned in the beginning of this post, I’ve been on a mission this year to devise a foolproof strategy for migraine relief, one that could bring me peace of mind in knowing that, even if the beast manages a sneak attack, I have something besides an abortive medication I can reach for. That way I won’t have to risk sliding down the slippery slope to the miserable land of rebound.
Initial results with the following method were incredibly promising, but I wanted to exclude the possibility this was due to coincidence and chance. So I’ve replicated it over a dozen times since the beginning of the year.
With this strategy, we’re going after the beast directly by exploiting his biggest weakness. Which is that, to stay alive, he needs to eat.
The “Starve and Sink” Attack
There are really two arms to this strategy, what I’m calling the “starve” and the “sink.” The “starve” strategy I’ve alluded to before in the “How I Ended the Massive Rebound Headache of Death” article.
The “sink” strategy is a way of adding insult to injury.
Like all living things, the Beast needs to eat. Without food, he weakens. Deprive him long enough, and he dies. And just where does the Beast get his energy? From you.
Below is the Beast when you’re in the fed state. As you can see, there’s plenty of fuel (those big, delicious cupcakes he’s chowing down on) circulating in the bloodstream to keep him full. And he gets extra strong if that fuel is in the form of carbohydrate:
The Beast Chowing Down (you in fed state)
So once the beast arrives, I don’t eat again until he’s gone (I DO drink water, depending on the level of nausea and vomiting). Which means less fuel for him (his cupcakes are tiny now):
The Beast With Less Available Energy (you in fasted state)
Now it’s time to pour salt on his wounds, as it turns out you can accelerate the Beast’s demise with this second strategy: the “sink.”
In the fasted state, energy is a fixed resource, a zero sum game. With no energy entering the system, the Beast must share the available energy with the rest of your body.
More energy consumed by other parts of your body means less energy for him. So you want to create an energy “sink,” diverting energy stores away from the Beast. How do you create an energy sink?
Muscles store energy, and muscles use that energy during exercise. When those energy stores are depleted by exercise, they must then be refilled, which means that both during and after exercise, the muscles will be siphoning off more energy from the blood. In other words, exercise creates “hungry” muscles.
More food for the muscles means less for the Beast.
Essentially, any activity that gets the heart rate up will suffice, though the more large muscle groups that are involved, the more effective it will be. My preferred exercise is running, and I’ll generally aim for about 25 to 30 minutes of sustained activity (sometimes longer if the migraine is particularly intense).
Of course, how much you can tolerate will depend on your current level of fitness. If you’re unable to maintain activity for that period of time, simply do what you can, rest for a bit, and go again.
I know that exercising may be the last thing anyone wants to do while in the midst of a migraine. That’s how I felt about it for years, as well. Sometimes my headache would escalate during exercise, and so I’d worry I was making things worse (and I’ve found that sometimes the pain does increase in the first few minutes of exercise, but then it steadily declines as the workout continues).
But now I’ve done a full 180 degrees, after experiencing the effectiveness of this technique.
One important thing to remember here is that you want to keep the body in aerobic, not anaerobic, metabolism during the period of exercise. The best way to make sure you’re doing so is to monitor your heart rate, which works as an accurate surrogate for the aerobic (oxygen based) to anaerobic (not oxygen based) transition.
To find your own aerobic threshold, subtract your age from 180, and don’t let your heart rate get above that number (so, for example, a 50 year old wouldn’t want the heart rate to get above 130). I’ll discuss more on why this distinction matters for the migraineur in a future post.
So, here’s the situation the Beast finds himself in now after we’ve initiated the “sink.” Not only is less energy available, but it’s also now being diverted elsewhere. Without food, he ultimately starves to death:
The Beast Starving Because Energy Is Diverted Elsewhere (to exercised muscles)
One thing I’ve noted with the “starve and sink” technique is that my recovery from the migraine is VERY predictable (likely because I’ve eliminated the one thing, the food I’d eat, that used to vary quite a bit from one migraine to the next).
Both the intensity and the character of the pain changes in a predictable sequence, and the overall time course to recovery depends largely on the initial intensity level of the migraine. Not surprisingly, the ones that take the longest to get rid of are those I woke with, and that began early in the night (so have fully “matured” by morning).
Now, the downside to this approach is that it takes longer to work than a triptan – usually a few hours for a moderate headache, and the better part of a day for a fully mature one.
However, the upside – which I think far outweighs the down – is that the relapse rate is much, much lower. With this approach, I’m FAR less likely to experience more headaches down the line, over both the short and long term, compared to taking a drug for migraine relief. It’s a short term sacrifice for a massive long term gain, and so worth it in my opinion.