4. Migraine patients are commonly instructed to identify and to avoid their so-called "trigger" factors. (14)(15) This advice is not supported by any evidence whatsoever. Some experts advise against avoidance behaviors, since they tend to make things worse rather than better. Avoidance attitudes are associated with pain chronification.
5. Also, scientific evidence suggests that episodic migraine attacks are not usually "triggered." Instead, they were found to mainly occur at a certain rate as the result of a gradual buildup. Changes in electrical brain activity can be detected several days in advance.
6. In 8% of cases, the episodic migraine transforms into chronic migraine, with headaches on more days than not. In chronic migraine, the brain tends to over-interpret normal stimuli as aversive and hurtful and to respond with the generation of headaches. The main risk factor for the progression to chronic migraine is the frequent use of migraine medication. Patients with limited mental flexibility and poor comprehension are at a particularly high risk.
7. Despite frequent repetition, Migraine is not a genetically predetermined condition. Although migraine tends to run in families, the genetic heritability of migraine is actually much lower than that of obesity. While roughly half the population have inherited the genetic talent for migraine, the majority of them do not ever develop migraine in their lives.
8. The abundant media coverage of "Botox for migraines" distorts the scientific evidence for its low efficacy. For episodic migraine, Botox was found to be so ineffective that it isn't even registered. After a series of failed attempts, a custom-designed drug trial finally managed to present Botox as marginally better than salt water for chronic migraine. That — and a $600 million payment by the manufacturer — sparked an approval by the FDA. A later review confirmed only "small to modest benefits" for chronic migraineurs.
9. Many patients are unaware of the influence that the pharmaceutical industry has on medical education, research, organizations, treatment guidelines and doctors, as well as on public and social media. Drug companies invest many billions of dollars on overt and covert sales-promotional activities. Their obligation is to look after the interests of their shareholders by increasing drug sales, and they're known to use every trick in the book. By 2014, the global market for pharmaceuticals is expected to reach $1.1 trillion. Patients with migraine episodes who don't watch out for themselves can easily end up paying a very high price: a life ruined by chronic migraine.
10. Patients with episodic migraine are advised to look after themselves and not to rely on drugs only. A healthy lifestyle with regular aerobic workouts, relaxation exercises, breathing-retraining and individualized herbs and nutraceuticals can go a long way. Cognitive Behavioral Therapy, biofeedback-based training and other behavioral therapies can help to cope with life in general and to bring the attack rate down. The strongest migraine therapies are neurofeedback-based methods, which can renormalize deviant brain activity with unmatched success rates. In cases of frequent or severe attacks, as well as for chronic migraine, a comprehensive rehabilitation program is advisable, as outlined in the patient guide, "The Migraine Revolution: We can End the Tyranny!"