I’m a Neurologist. Here’s What I Tell My Chronic Migraine Patients to Help Their Quality of Life

Written by Timothy Gower
Medically Reviewed by Zilpah Sheikh, MD on October 12, 2025
8 min read

Ella Akkerman, MD, is a neurologist who often treats women who are desperately seeking relief from chronic migraine, meaning they have headaches at least half of the days in a month.

“It completely disrupts women’s lives,” says Akkerman, of the Virginia Spine Institute in Reston, Virginia. “These are women who have so many roles to fulfill in everyday life…but they’re unable to keep up because migraine robs them of energy and time.”

Women under 45 have the highest risk of developing migraine headaches. A migraine attack can derail your day in no time. Akkerman knows this first hand. She, too, lives with chronic migraine. 

“I connect with my patients by explaining to them that I get it,” she says. When a migraine knocks Akkerman’s day off course, “it is very distressing.”

But Akkerman says that a healthy mindset plus simple, science-backed changes in your daily routine can help you feel measurably better.

 

“Sleep is the most important lifestyle issue," Akkerman says. She tells her patients that no matter what else they do for their migraine, “you’re going to be in much worse shape if you’re not getting restorative sleep regularly.” 

Getting too little sleep stresses your body and brain by increasing stress hormones such as cortisol, which in turn lowers your pain threshold and increases inflammation in your brain and body.

A study at the University of North Carolina that included 147 people with persistent migraine attacks found that those who practiced good sleep habits had fewer and less intense headaches. If you’re struggling with sleep, try adopting these habits:

  • Don’t eat for four hours before bedtime.
  • Limit fluids within two hours of bedtime.
  • Don’t take naps during the day.
  • Go to bed at the same time every night.
  • Aim for at least eight hours of sleep.
  • Don’t watch TV, read, or listen to music in bed.
  • Use visualization techniques, such as imagining yourself walking in a quiet forest, to help yourself fall asleep.

Akkerman suggests some other ways to improve your sleep hygiene: Watch your caffeine intake late in the day, don’t exercise or shower too close to bedtime, and avoid looking at screens (your phone or tablet, for example) before turning in. Use shades to keep your room dark.

“All types of exercise have a positive role in migraine prevention,” Akkerman says. In fact, a 2024 review in Current Pain and Headache Reports found that patients with migraine who exercise regularly have fewer attacks than others who don’t. A good workout, such as taking a brisk walk, jogging, or swimming laps, releases “feel-good” hormones called endorphins, Akkerman says. “Endorphins raise your pain threshold and help you to be more resilient in the face of stressors,” Akkerman says, adding that they also improve your sleep efficiency.

If you’ve been on the sidelines, Akkerman suggests some simple steps to start an exercise program:

  • Choose an activity you enjoy that gets you huffing and puffing.
  • Try to exercise for 30 minutes at least three times per week.
  • Aim to get your heart beating at a rate of at least 120 beats per minute — most smart watches can track your heart rate.
  • Use light weights or exercise bands a few times a week, too. Strength training is especially important when a woman hits her mid-30s and begins to lose muscle mass due to normal aging.

In a small number of people, exercise may trigger a migraine attack, though experts aren’t sure why. If this happens to you, it’s important to tell your doctor, who will rule out medical or neurological conditions (such as high blood pressure or brain issues) that may be related to migraine. Always check in with your doctor before you start a new exercise program.

Many people with migraine don’t drink alcohol because they believe they’ll pay for the buzz from a beer or glass of cabernet with a severe attack. In fact, about 1 in 3 people with migraine say alcohol triggers their headaches. But the link is not entirely clear, as some studies have failed to find any evidence that having a modest amount of alcohol will give you a migraine.

Yet in her practice, Akkerman says alcohol is clearly a trigger for some of her patients. “Especially red wine,” she says. Keeping a migraine diary can help you see if alcoholic beverages trigger your migraine. If you have no reason to think that’s true, Akkerman says, “but you still want to have a cocktail or glass of wine once in a while, it’s not a big deal.” However, she’s quick to add, “The latest research suggests that no amount of alcohol is good for your brain health.”

When it comes to caffeine and migraine, let’s just say this: It’s complicated. Studies suggest that having too much coffee or other sources of caffeine can increase the severity and frequency of migraines in some patients. But for some regular coffee drinkers, skipping their daily cup of joe can trigger an attack (known as a caffeine withdrawal headache). 

Akkerman asks her patients about their caffeine habits and whether they have noticed that they get migraine attacks after drinking coffee or tea. If so, you may want to avoid those drinks. If not, and you're a devoted coffee drinker, she recommends drinking it at the same time every day and limiting your intake to a maximum of two or three cups daily. “And if you want more, drink decaf,” Akkerman says.

Drinking plenty of fluids is good for all-around health and is a key habit for controlling migraine, Akkerman says. A 2020 study in the Journal of Clinical Neuroscience found that women aged 18-45 with migraine who drank the most fluids experienced less painful headaches and had fewer, briefer attacks than those who drank less. 

Dehydration causes various biological changes that can help trigger migraine attacks, Akkerman says. For instance, getting parched interferes with levels of important chemicals called electrolytes, which can irritate arteries in the brain and cause migraine attacks. She recommends consuming 2.5 to 3 liters of fluid a day, which is about 10 cups. Sounds like a lot, but that includes sources of liquid besides water, such as decaf coffee, caffeine-free tea, milk, and sugar-free beverages. Even soup or fruit with high water content (such as watermelon or grapefruit) counts. Don’t include sugary drinks, caffeinated beverages, or alcohol in your total.

About 50%-70% of people with migraine say stress triggers their headaches, according to the American Migraine Foundation. Akkerman says that busy women who juggle many tasks find it extra tough to deal with migraine. Her message to these women is simple: “Be a little more selfish.” She adds, “I know that may sound like a bad word, but when you are spread too thin and you are stressed because you’re running around like a chicken with your head cut off, you need to schedule time for just yourself.” 

If you don’t have a go-to relaxation method, try one of these, Akkerman suggests:

Use an app. There are many apps available that can help you relax. These apps can have many features, such as guided meditations and breathing exercises that can help you unwind.

Get a massage. Regular massages can help ease physical and psychological tension. And when you have a headache, giving your scalp a massage with your fingertips can also help, says Akkerman. 

Go to the local park. “Look at the green, beautiful trees and take deep breaths,” Akkerman says. “There are plenty of things that can relax you if you’re willing to give it a shot.”

If you have frequent migraine attacks, it’s important to keep a record of your migraines and show your doctor.

“That way, you have objective information showing the impact migraine has on your life,” Akkerman says. 

Use an app (such as Migraine Buddy) or notebook to record your migraine attacks and their effects. You can also find a preformatted diary from the National Headache Foundation here. 

Some information you might include in your migraine diary includes:

  • The date and time you had an attack
  • How long it lasted
  • The intensity and location of the pain (behind the eyes, for example)
  • How it felt (throbbing or pressure, for instance)
  • Aura symptoms (if any)
  • Related symptoms, such as nausea, vomiting, and light sensitivity
  • Common triggers, such as food, stress, or weather changes
  • Status of the menstrual cycle (for premenopausal women)
  • Number of migraine days per month

If you tried relaxation techniques and still struggle with migraine-related stress, such as worrying about your next headache, seeing a psychologist may help. A few approaches psychologists may apply include:

Cognitive-behavioral therapy (CBT). The Association of Migraine Disorders recommends CBT for breaking a vicious cycle that can affect many people: The pain and other symptoms of migraine cause stress and anxiety, which in turn worsen pain. CBT teaches you to spot unhelpful thoughts and negative responses that can worsen the pain. Studies show that CBT and other relaxation techniques can lessen headache symptoms by 30%-60%.

Biofeedback. This is a therapy that teaches you to control bodily functions such as heart rate, muscle tension, and breathing using real-time feedback from sensors. According to the American Migraine Foundation, biofeedback and other relaxation techniques have been well studied and can lower headache frequency and severity by 45%-60%.

 

Sometimes, simply sharing your fears and concerns about migraine with others who can understand may help you feel less anxious. Several organizations have support groups for people with migraine, including:

If you have migraine, one of the biggest mistakes you can make is to try and “tough it out” and dismiss an attack as “just a headache,” Akkerman says. “I say to my patients — if you want to feel better, you need to accept that you’re having migraines, you need to accept that you need an intervention, and you need to aim toward living as fulfilling a life as possible,” Akkerman says. “You’re not going to be cured, but you’re going to be better. We can work with you and find an approach to your migraine to allow you to live happily ever after. Don’t feel that you’re alone in this, and don’t lose hope. We’re here to help.”