Regularity and consistency are key in maintaining the brain’s happy medium, especially for individuals who experience migraine. If there is less consistency in a variety of lifestyle factors, you may be more susceptible to migraine attacks occurring.
Realistically, some people will benefit more than others from the advice that follows, as lifestyle factors are only one part of how migraines occur. A degree of flexibility is encouraged, as rigidly following a restricted lifestyle may be anxiety-provoking and counterproductive.
It is sensible to avoid using the bed/bedroom for activities that could be done elsewhere (such as using electronics, watching TV, studying). Try to avoid staying in bed if you are wide-awake. This approach helps to maximise the mind’s association of the bedroom primarily with rest and sleep. Avoid smoking if possible as nicotine has a stimulating effect on the brain and also suppresses melatonin levels. Avoiding caffeine in the evening is recommended, as this can affect both the time taken to get to sleep and the quality of it. Bear in mind that as well as the obvious culprits such as tea and coffee, many soft drinks and certain chocolates can be high in caffeine. Be mindful that alcohol may also reduce the quality of sleep.
Consistency of sleep can be more difficult to achieve with long-distance travel, but improving other factors, such as those described below, may help to at least partly compensate for this. Listening to relaxing music or meditation audio before going to bed may be very helpful for some people. There is a growing evidence base for the use of cognitive behavioural therapy for insomnia (CBTi). https://freecbti.com is a freely accessible option. The NHS inform ‘Sleep problems and insomnia’ online guide is also recommended.
Fasting or having significant variation in calorie intake on different days of the week, as certain diet approaches advocate, may trigger migraines for some. It is commonly believed that certain foods, such as cheese or chocolate, or even environmental factors such as bright light, trigger migraines. Research in this area actually points away from these being triggers and instead being part of the warning phase of migraine, before the headache starts, with a craving for a particular food and light sensitivity being a symptom.
- Riboflavin (Vitamin B2) 400mg once daily
- CoEnzyme Q10 (a Vitamin-like substance) 150mg daily
Although there is no evidence that these treatments cause developmental problems it is recommended that these supplements are not used during pregnancy, or when trying to conceive.
It is also worth highlighting that the use of any painkiller, on too many days per month over a number of months, may cause migraine control to be worse, and for migraines to be poorly responsive to what may otherwise be effective preventatives. Advice around this can be found on the NHS Forth Valley headache diary.
Unfortunately, as topiramate use during pregnancy is known to increase the risk of developmental abnormalities in the developing foetus, very careful precautions are required in females with childbearing potential. Potential developmental abnormalities include cleft lip and palate, as well as growth restriction. Rates of developmental abnormality increase seven-fold in babies born to mothers taking topiramate.
Topiramate decreases the effectiveness of some contraceptives
Topiramate may also reduce the effectiveness of some contraceptives. As such, the use of topiramate is not recommended if the only acceptable method of contraception for a patient is the combined oral contraceptive pill (COCP), the progesterone only pill (POP, “the mini-pill”), or the progesterone only implant (e.g. Nexplanon®, “the implant”).
Suitable contraceptives when taking topiramate
Topiramate can be used by women using the intrauterine (coil-type) methods of contraception, which are not weakened by topiramate. Coil-type contraception methods (e.g. Mirena, copper coil), with a failure rate of less than 1% with typical use, are regarded as being ‘highly effective’. Topiramate may also be used by women who have previously undergone sterilisation, or who have a male partner with a confirmed successful vasectomy.
The Depot Medroxyprogesteone Acetate (Depo) jag is also a contraceptive available. Brand names for this method include Depo-Provera® and Sayana-Press®. This contraceptive option is also not affected by the weakening effect of topiramate, however, the failure rate is around 6% and as such it is not considered a ‘highly effective’ contraceptive method. Depo used alongside condoms could be considered in certain circumstances, after discussion with a clinician. As barrier methods, such as condoms, are not ‘highly effective’, they cannot be used as the only contraceptive approach alongside topiramate.
Referral to Neurology for an alternative migraine treatment will be required if there are no other suitable migraine preventatives.
A PDF version of this advice is also available. Advice due to be reviewed 10/08/2025.