Flashing spots in your vision, sudden stiffness in your neck—sometimes you know a migraine headache is coming long before it hits.
What’s even worse: a migraine that sneaks up on you at a moment when you can’t drop what you’re doing, pop the relevant pills, and crawl under the covers until further notice.
Maybe you’re mid-escalator at the mall with three heavy shopping bags dangling from each arm. Maybe you’re at the office with a difficult boss and tricky commute standing between you and your bed.
Maybe you’re busy navigating a foreign city. Wherever migraine pain catches you off guard, step one is to stay calm—freaking out can only make the situation worse.
“It’s important to have an action plan you can turn to as soon as symptoms come on,” says neurologist Jessica Ailani, director of the MedStar Georgetown Headache Center at Georgetown University.
“This will keep your stress and anxiety down during an attack.”
Put down your phone.
Although your first instinct might be to text your best friend for much-needed moral support, it’s best to disconnect from electronic devices when you feel a migraine headache coming on, Ailani says.
They can intensify your symptoms because of the light they give off and the way they strain the eyes and require focus.
Avoid looking at yours more than is truly necessary (i.e., it’s fine to text someone to see if they can come pick you up, but don’t scroll through your Instagram feed in search of distraction).
“Walking away from devices also helps you refocus and take deeper breaths,” Ailani says.
Take your meds A.S.A.P.
If you use prescription migraine medication, keep doses in labeled ziplock bags in your purse at all times (include the expiration dates), so you won’t have to delay taking them if pain hits without warning.
“Many of the drugs used to treat migraines, especially the class of medications called triptans, work best if they are taken within the first 40 minutes of migraine headache onset,” explains neurologist Lawrence C. Newman, M.D., director of the headache division at NYU Langone Medical Center.
“Delaying more than that results in less-than-optimal pain relief and a greater likelihood that the headache may come back later that day or the next day.”
The only exception: Don’t take a medication that will make you drowsy or otherwise hinder your ability to get home safely. “It’s important to always try a prescription medication at home first to see how it makes you feel,” Ailani says. “If you don’t feel tired or out of it, you can go ahead and use it while out.”
If it does make you woozy, ask your doctor to recommend a secondary option you can turn to when you need to remain alert.
“I might advise a patient to take an over-the-counter medication while out and then follow it up with her prescription medication at home,” Ailani says.
Find peace and quiet.
Do your best to escape noise and bright light. If you’re out and about, Google Map your way to the nearest library or bookstore; a calm, dim coffee shop is a good second choice.
If you’re in an office filled with loud phone talkers, chatty coworkers, and glaring fluorescent bulbs, seek solace in a quiet hallway, empty conference room, or bathroom.
“Sit down and take deep breaths for five minutes with your eyes closed,” Ailani says.
Watch out for odors too, as they can trigger symptoms; if you work next to a dude who marinates himself in cologne each morning, it’s time to temporarily relocate (maybe that lucky coworker whose office has an actual door will kindly lend you her space).
If your company has a sick room, take advantage: Shut off the lights, lie down, and apply a hot or cold compress.