When you're halfway through your day, and you feel it coming – that familiar, unwelcome sensation that signals a migraine attack is on its way. Whether it’s the light sensitivity, the throbbing pain, or the wave of nausea, each sign is as daunting as the last. When you are unprepared, migraine attacks can disrupt your entire day or even several days.

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This is where your acute toolkit comes into play. Think of it as your personal emergency kit, uniquely tailored to provide relief and support when you need it most.

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Why is an acute toolkit for migraine necessary?
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Migraine attacks can escalate quickly. Having a toolkit means you can act fast at the first sign of an attack, potentially reducing its severity and duration.

• Every person experiences migraine differently. Your toolkit allows you to tailor your response to your specific triggers,symptoms, and preferences, ensuring you have the right tools on hand when you need them most.
  
  
• A toolkit puts you in the driver's seat of your migraine management. Instead of feeling helpless, you'll have a plan and the resources to take control of your health.
  
  
• Knowing you're prepared for a migraine attack can alleviate anxiety and stress, which are known to worsen migraine symptoms.
  
  

When you effectively manage your migraine attacks, you can participate in activities you love without the constant fear of debilitating pain. Imagine attending that concert, enjoying a family outing, or simply getting through your workday without interruption.

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What are the different components of a migraine toolkit?

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A migraine toolkit can contain a variety of components, tailored to your migraine experience (including type), specific needs and preferences. Here's a breakdown of the different categories:

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1. Medications

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Migraine management involves a variety of medications targeting different aspects of the condition:

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• Gepants (e.g., ubrogepant, rimegepant) - Block CGRP receptors, suitable for those who cannot use triptans.
• Triptans (e.g., sumatriptan, rizatriptan) - Effective for early signs of a migraine attack.
• NSAIDs (e.g., ibuprofen, naproxen) - Reduces inflammation and pain.
• Acetaminophen - Alternative pain relief option.
• Anti-nausea medications (e.g., metoclopramide, ondansetron) - Controls nausea and vomiting.
• Ergotamines (e.g., ergotamine, dihydroergotamine) - Used for severe or prolonged attacks.
• Ditans (e.g., lasmiditan) - Does not cause vasoconstriction, safer for those with heart issues.
• Benadryl (Diphenhydramine) - Helps manage nausea and aids sleep during attacks.
• Intramuscular shots (e.g., sumatriptan injection) - Provides fast relief when oral medications aren’t effective.
• Nasal Sprays (e.g., sumatriptan nasal spray, zolmitriptan nasal spray) - Quick absorption, useful when gastrointestinal symptoms are present.
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2. Non-medication rescue therapies
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a. Neuromodulation devices
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• Cefaly: This hands-free device sends gentle electrical impulses to your forehead, stimulating the trigeminal nerve to reduce migraine pain and frequency.
• gammaCore: A handheld device that stimulates the vagus nerve in your neck, potentially offering relief during a migraine attack.
• Savi Dual: This device uses single-pulse transcranial magnetic stimulation (sTMS) to target the brain's visual cortex, potentially stopping a migraine with aura in its tracks.
• Relivion: This device combines non-invasive nerve stimulation with an app to track and manage migraine attacks.
• Nerivio: This armband-like device is worn on the upper arm and uses remote electrical neuromodulation (REN) to activate natural pain pathways, potentially reducing migraine pain and associated symptoms.
• TENS Unit: This versatile device delivers low-voltage electrical currents to the skin, potentially blocking pain signals and providing relief.
  
  

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b. Topical analgesics

• Lidocaine patches or sprays: Lidocaine is a numbing agent that can be applied directly to the skin to alleviate localized pain. If you have a prescription or over-the-counter lidocaine product, it might help reduce pain in specific areas like the temples or neck.
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• Non-lidocaine creams: Prescription analgesics containing diclofenac, cyclobenzaprine & gabapentin to apply on temples or neck.
  
  
• Salonpas patches: Apply to temples, forehead, or neck for cooling relief.
  
  
• Peppermint oil: Dilute a few drops in a carrier oil (like coconut oil) and apply to temples.
  
  
• Tiger Balm or other menthol-based creams: Can provide a cooling and distracting sensation.
  
  

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c. Self-administered acupressure/massage tools

• Acupressure mats and pillows: These are covered in small spikes that stimulate pressure points when you lie or stand on them. They can help release muscle tension, promote relaxation, and potentially reduce migraine pain.
  
  
• Acupressure bands or wraps: These wearable bands apply pressure to specific acupressure points, such as the LI4 point between the thumb and index finger or around the head.
  
  
• Sea-bands: These wristbands apply pressure to the P6 point and are often used for motion sickness, but can also be helpful for migraine-related nausea.
  
  
• Massager: An electric neck massager or a shiatsu tool can help relieve trigger point pain or soothe your muscles during an attack.
  
  

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d. Hot/cold therapy

• Headache hat: A wearable device that wraps around the head, providing cooling relief. It covers critical areas like the forehead, temples, and neck.
  
  
• Gel ice packs or refillable ice packs: You can also use a frozen bag of peas or stash ice packs in your freezer to use when you need it. They’re basic but helpful.
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• Non-medicated adhesive cooling patches: BeKool and similar products use a hydrogel layer that contains a high percentage of water. This water evaporates when the patch is applied to the skin, creating a cooling effect. Some patches also contain menthol, a natural compound known for its cooling and soothing properties.
  
  

• Ice roller: A handheld tool that can be kept in the freezer and rolled over the face and temples. It's great for a soothing massage and inflammation reduction.
  
  

• Heating pad: Apply to tense muscles in the neck and shoulders.
  
  
• Microwaveable heat packs: You can DIY or purchase buckwheat-filled heating packs that can offer some soothing relief to sore muscles.
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3. Sensory management
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Migraine attacks often come with heightened sensitivity to light, sound, and smell, along with nausea and discomfort. Sensory management and comfort tools can significantly alleviate these symptoms, creating a more bearable experience.

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• Comfortable clothing: To minimize more sensory overwhelm and calm your body especially if you have allodynia.
  
  
• Eye mask: A soft, comfortable eye mask can effectively block out all light and provide immediate relief. Consider one with a contoured shape to avoid pressure on the eyes.
  
  
• Earplugs or noise-canceling headphones: Minimize noise if it exacerbates your pain.
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• Green light therapy: Research suggests that green light may have a calming effect on the brain, potentially reducing the severity of migraine pain and associated symptoms like nausea and light sensitivity. An Allay Lamp or Norb Relief light bulb could help alleviate some discomfort.
  
  
• Weighted blanket: The gentle pressure can be calming and help with pain.
  
  
• Blackout curtains: If you're at home, closing blackout curtains can quickly darken the room and provide relief. You can also try portable blackout tents that you can place on the bed or even at work for a quick down-time.
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• Sunglasses (for outdoors only): While not as effective as a complete blackout, sunglasses with polarized lenses can help reduce glare and light intensity, especially if you need to move around. Please note that wearing sunglasses for long periods could exacerbate light sensitivity. Avoid indoor use.
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• FL-41 tinted or pink-tinted glasses (indoors and outdoors): These can be particularly helpful as they filter out specific wavelengths of light that can worsen migraine attacks. They do not exacerbate light sensitivity like sunglasses. FL-41s are not recommended for use while driving.
  
  

• Head-wrap or scarf: Especially if an eye mask isn't available.
  
  
• Neck pillow: For trigger point pain relief or to soothe sore neck muscles.
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• Neck brace: Can be worn to provide temporary neck pain relief (ten minutes/day).
  
  

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Distraction and relaxation
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When pain and sensory overload strike, distraction can be a powerful tool. Engaging your mind in activities that shift your focus away from the discomfort can help reduce the intensity of the experience.

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Many distraction tools also incorporate elements of mindfulness. Mindfulness involves paying attention to the present moment without judgment, which can help you observe your pain and other sensations without getting overwhelmed by them. This awareness can lead to a greater sense of control and reduced suffering during a migraine attack. This can be personal based on what you can tolerate, and what you enjoy. For example, some patients report cooking as a useful distraction tool because it helps them stay grounded in the moment. Some prefer listening to wave sounds. Here are a few more:

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• (Audio)books
• Soothing sounds like rain, tibetan singing bowl, etc.
• Guided meditations
• Creative outlets like coloring, drawing, or writing‍
• Deep breathing exercises
• Progressive muscle relaxation (PMR)
• Gentle yoga or stretching
• Warm baths or showers
• Puzzles
• Crafting or knitting

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Nourishment and hydration

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It’s crucial to have easy-to-access food and drinks prepared beforehand. The debilitating pain and sensitivity can make it extremely difficult to prepare meals. Here are some suggestions on how to be prepared:

• Stock Up on easy-to-digest foods: Keep your pantry and fridge stocked with bland, non-triggering foods that are easy to digest and require minimal preparation. Some options include:
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  • Crackers
  • Plain toast or bread
  • Applesauce
  • Bananas
  • Rice cakes
  • Broth
  • Frozen fruits and vegetables
  • Frozen smoothies
  • Frozen meals
    
    
• Pre-portion snacks: Prepare small, grab-and-go snacks in advance. Store them in easily accessible containers so you can quickly reach them.
  
  
• Hydration: Dehydration can worsen migraine attacks, so have plenty of water or electrolyte drinks readily available.

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What are polytherapy and combination therapy?

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It's important to treat an attack at its onset, so, if you have chronic migraine with 20+ attack days/month, work with your specialist to have several acute medications, including a gepant; NSAID, triptan or ditan; and anti-nausea medication so that you don't feel like you have to save medications for a possibly worse attack.

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Since NSAIDs and triptans need to be limited each month in order to avoid medication adaptation headache, having gepants and a triptan/ditan/NSAID option will allow you to limit your triptan/NSAID while still acutely treating attacks.

Polytherapy refers to the use of multiple medications from different drug classes simultaneously to treat a single condition, in this case, an acute migraine attack.

Combination therapy involves using a fixed-dose combination medication, which contains two or more active ingredients in a single pill or formulation, to address the migraine attack.
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Migraine is a complex neurological disorder with multiple underlying mechanisms. A single medication may not effectively target all of these pathways. Polytherapy and combination therapy offer several potential advantages:

• Increased efficacy: By targeting different mechanisms simultaneously, these approaches may lead to better pain relief and resolution of other migraine symptoms compared to using a single drug.
  
  
• Reduced side effects: Using lower doses of each individual medication in polytherapy may help minimize side effects while still achieving effective pain relief. It may also help prevent medication adaptation headache.
  
  
• Personalized treatment: This approach allows for tailoring treatment to the specific needs and sensitivities of the individual patient.
  
  

Commonly used combinations in acute migraine management:

• Triptan + NSAID: This combination is often more effective than either medication alone.
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• Triptan + Antiemetic: This pairing addresses both the headache pain and the associated nausea/vomiting.
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• Triptan + Caffeine: Caffeine can enhance the absorption and effectiveness of triptans.
  
  

It's important to be aware of potential drug interactions when using multiple medications. Consulting with a healthcare professional is crucial to ensure safe and effective treatment.

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How your Neura care team can assist you

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Your provider and care coach will conduct a thorough assessment of your migraine history, triggers, symptoms, and current treatment approaches. This helps them understand your unique needs and preferences.

1. Personalized toolkit creation: Based on your assessment, they'll collaborate with you to develop a customized acute toolkit.
   
   
2. Situation-specific kits: Neura recognizes that different situations call for different approaches. Your provider and care coach can help you create specialized kits for:
   
   
   • Travel: This might include travel-sized medications, earplugs for noise sensitivity, eye masks for light sensitivity, and calming essential oils.
     
     
   • Work: Your office kit could contain medications, a comfortable eye mask for resting during an attack, and a note explaining your need for accommodations during a migraine episode.
     
     
3. Education and Support: Your provider and care coach will educate you about your migraine attacks, treatment options, and potential side effects. They'll also provide ongoing support and guidance as you navigate your migraine journey.
   
   

The more comprehensive your toolkit, the more you have to mix and combine to address each attack depending on symptoms and severity.

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