As a neurologist specializing in headaches and migraine, and as someone who experiences migraine personally, I often tell my patients that in the field of medicine, migraine is like Rodney Dangerfield: it doesn’t get always get the respect it deserves. People tend to not understand migraine is a neurological brain disorder that can significantly affect quality of life. It’s not “just a headache.” Many people have had migraine for quite some time and just accept it as part of their lives. They don’t always realize there are ways to manage migraine using treatment approaches and lifestyle modifications. And while we can’t cure migraine, we can drastically cut down on the frequency, severity, and duration of attacks. After 15 years of working as a headache and migraine specialist, I’ve learned a lot about the condition and how it impacts my patients’ lives. Here’s what I want them to know. 1. Keep a diary or log to better understand your bouts of migraine. I advise all of my patients to carefully record different details about their day in order to gain insight into their attacks of migraine. Trying to manage migraine without this information is like throwing darts at a dartboard blindfolded. If you write down daily notes about your symptoms, diet, exercise, environment, stressors, and sleep, you’ll soon be able to identify certain patterns and possible triggers. When you experience a migraine attack, always note the time, duration, and severity. Keep track of your treatments—when you take them, how much you take, and how well they worked. Female patients should also record their menstrual cycles, as there’s often a relationship between hormones and migraine. Keeping a diary helps you and your doctor better understand the context around your attacks of migraine. Often, these diaries empower patients to realize the actual frequency of migraine attacks, because most people have recall bias; they’ll recall the bouts of migraine that are moderate to severe, but discount the more mild ones. Without a log, patients can underestimate the impact migraine has on their quality of life. And their doctor’s treatment recommendations will be different depending on what the overall picture really looks like. 2. Know your triggers. After a while, your diary will most likely reveal if there are specific triggers leading to your attacks of migraine—the more information you have, the more likely you’ll be able to narrow down the culprits. Think about your environment: what’s the lighting like at your home and work? What scents are often around you? Do you use an ergonomic chair? Is your work schedule sporadic or routine? Are your bouts of migraine worse or better when it’s hot or cold outside? When it comes to diet, don’t just record the foods you ate in a day; also note if you ate earlier or later than usual, if you felt dehydrated, if you were more or less active than usual, and if you ate at a restaurant or at home. Once you’ve got some data to analyze, notice if your attacks of migraine are correlated with eating specific food items or specific types of foods—are you experiencing symptoms after eating processed foods or artificial sweeteners? Do your bouts of migraine seem to come on when you eat a late lunch? Does lack of sleep or too much sleep trigger a migraine? Finding the answers to these questions will allow you to identify and avoid your triggers, which can help significantly in managing your migraine. 3. Keep in mind: it’s a marathon, not a sprint. Getting control of migraine can be a slow process with lots of ups and downs. You and your doctor will determine whether you’ll benefit primarily from acute medications that treat attacks of migraine as they occur, or if preventive drugs are necessary. You’ll try different treatments to see what works and what doesn’t. And you’ll also make lifestyle changes to stay away from triggers and keep your body healthy. This can seem like a lot of change all at once, but know it’s a marathon, not a sprint. These changes will happen slowly, bit by bit. Most people can’t tackle multiple changes at the same time; it’s just human nature. That’s why it’s crucial to set realistic expectations and trust you’ll learn to manage your bouts of migraine step by step. 4. Stay hydrated. One of the most common triggers of migraine is dehydration. While there’s no magic amount of water that will keep bouts of migraine away, we can all pay attention to our bodies to determine how much water we need. If you exercise a lot, you’ll need more water to stay hydrated. If you’re a big coffee or tea drinker, it’s important to know caffeine is a diuretic and makes people urinate more. And if you take regular medications, check if they’re known to cause dehydration. Understanding your relationship with water (with the help of your migraine diary) and making sure to stay hydrated is a key way to manage your migraine headaches. 5. Prioritize sleep. Sleep is important for everyone, especially those with migraine. Getting a good night’s sleep can greatly improve migraine symptoms, just like sleeping poorly can increase the frequency and severity of migraine. I always tell my patients the bed should be used for only two things: sleep and sex. Sticking to this rule helps your body develop cues for when it’s time to sleep. Try to avoid using smart phones, computers, tablets, or watching television right before bed and keep a regular sleep routine—go to bed around the same time each night and wake up around the same time each morning. Treating migraine is not like treating a sinus infection, for example; you can’t just take an antibiotic and be cured. Much of managing migraine is building on incremental gains. But I encourage my patients to stay positive, because by working with your headache specialist and focusing on taking it step by step, you can find the right treatment, make beneficial lifestyle changes, and take control of your migraine headaches.