Reducing migraine frequency and severity comes down to a combination of trigger management, consistent daily habits, and the right treatment plan when attacks do hit. Most people with migraine can cut their monthly attack days significantly by layering several strategies together rather than relying on any single fix.
Know Your Triggers
Migraine triggers vary from person to person, but dietary and lifestyle factors are the most controllable. Common food triggers include aged cheeses (cheddar, brie, parmesan, gouda), processed and cured meats (hot dogs, pepperoni, salami, jerky), chocolate, alcohol (especially red wine and dark beers), and foods containing MSG or “natural flavoring.” Caffeine is a double-edged trigger: it can help abort a mild attack, but inconsistent intake, either too much or sudden withdrawal, reliably provokes one. If you drink coffee, keep it to no more than two servings per day at the same time each day.
Fresh yeast breads, sourdough, certain beans and legumes, avocados, citrus fruits, and artificial sweeteners like aspartame also appear on UC Davis Health’s migraine avoidance list. You don’t need to eliminate everything at once. A headache diary tracking what you ate, how you slept, and your stress level in the 24 hours before each attack is the fastest way to identify which triggers actually matter for you.
Build a Consistent Sleep Routine
The migraine brain is unusually sensitive to change, and irregular sleep is one of the most reliable attack triggers. The American Migraine Foundation recommends seven to eight hours per night with strict bedtimes and wake times, including weekends. Sleeping in on Saturday morning feels like a reward, but the shift in schedule alone can set off an attack. If you’re sleeping six hours on weeknights and nine on weekends, that inconsistency is likely contributing to your migraine burden more than the sleep deficit itself.
Stay Well Hydrated
Research published in the Journal of Clinical Neuroscience found that people who drank more water had significantly lower migraine frequency, shorter attack duration, and less severe pain. Drinking at least 1.5 liters (about six cups) of water daily improved quality of life in migraine patients. Spread your intake throughout the day rather than catching up in the evening, and increase it during exercise, heat, or illness.
Supplements That Have Evidence
Three supplements have enough clinical support to be worth considering for migraine prevention. Magnesium is the strongest of the three. The American Academy of Neurology and the American Headache Society concluded that magnesium is “probably effective” for migraine prevention. The typical preventive dose is 300 mg taken twice daily (600 mg total), based on multiple placebo-controlled trials showing modest reductions in attack frequency. Because this dose exceeds the recommended upper limit for supplemental magnesium, it’s worth discussing with your doctor, and magnesium citrate or glycinate tend to cause less digestive upset than magnesium oxide.
Riboflavin (vitamin B2) at 400 mg daily and CoQ10 at 100 to 300 mg daily are the other two commonly recommended supplements. These take two to three months of consistent use before you can judge whether they’re helping.
Behavioral Therapies
Cognitive behavioral therapy (CBT) and biofeedback are both backed by clinical evidence for migraine prevention. A review of 10 trials by the Agency for Healthcare Research and Quality found that CBT-based interventions reduced migraine frequency by about one day per month. Biofeedback, which teaches you to control physiological stress responses like muscle tension and skin temperature, showed a reduction of about two migraine days per month in one trial, outperforming combined CBT and relaxation training.
For children and adolescents, a combined approach using CBT, biofeedback, and relaxation training reduced attacks by about 1.6 days per month and meaningfully lowered migraine-related disability. These techniques work best when practiced regularly, not just during attacks.
Avoid Medication Overuse
One of the most counterintuitive causes of worsening migraine is the very medication you take to treat it. Using over-the-counter painkillers like ibuprofen or acetaminophen more than 14 days a month, or triptans and combination painkillers more than 9 days a month, can cause rebound headaches that trap you in a cycle of daily or near-daily pain. The Mayo Clinic notes that risk increases sharply at 10 or more days per month for triptans, combination analgesics, and opioids, and at 15 or more days for simple painkillers. If you’re approaching these thresholds, that’s a signal you need a preventive strategy rather than more acute medication.
Preventive Medications
If you’re experiencing four or more migraine days per month, preventive medication can reduce that number substantially. Traditional options include certain blood pressure medications, antidepressants, and anti-seizure drugs repurposed for migraine prevention. These work for many people but come with side effects like fatigue, weight changes, or cognitive dulling.
A newer class of preventive treatments targets a protein called CGRP, which plays a central role in triggering migraine attacks. These come as monthly or quarterly injections or as daily oral pills. The American Headache Society now considers them a first-line option, meaning you shouldn’t have to fail other medications before trying them. They work by blocking the signaling cascade that drives migraine pain and inflammation without the blood vessel constriction that makes older treatments risky for people with heart disease.
Treating Attacks When They Happen
Triptans remain the most widely prescribed acute migraine treatment and work well for many people, but they constrict blood vessels in the head and heart, which rules them out if you have cardiovascular risk factors. A newer class of acute treatments called gepants blocks the same CGRP pathway used in prevention. In clinical trials, gepants provided pain relief within two hours in 65 to 68 percent of treated attacks, with complete pain freedom in about 23 to 25 percent. Their side effects are mild: the most common are upper respiratory symptoms, nausea, and nasal discomfort (for the nasal spray version). Importantly, they don’t carry cardiovascular restrictions.
Some gepants can serve double duty for both prevention and acute treatment, which simplifies things if you need both.
Neuromodulation Devices
Several FDA-cleared wearable devices offer drug-free options for both preventing and treating migraine attacks. The Cefaly device stimulates the trigeminal nerve through a patch on the forehead and is cleared for both acute and preventive use. In trials, it improved two-hour pain freedom during attacks and showed higher rates of 50 percent or greater reduction in monthly migraine days compared to a sham device.
A single-pulse magnetic stimulation device (SAVI Dual) is cleared for people 12 and older. In a large UK study, it reduced monthly migraine days, decreased acute medication use, and dropped the rate of medication overuse headache from 52 percent of participants at the start to just 8 percent after 12 months. A vagus nerve stimulator (gammaCore), worn on the neck, is also cleared for acute and preventive use, though its clinical trial results were more mixed.
These devices work best as part of a broader plan rather than a standalone solution, and they appeal most to people who want to minimize medication use or who haven’t responded well to drugs.
Botox for Chronic Migraine
If you experience 15 or more headache days per month, with headaches lasting four or more hours per day, you meet the FDA criteria for chronic migraine and may be a candidate for Botox injections. The standard protocol involves 31 injections across seven muscle areas in the head and neck, including the forehead, temples, back of the head, neck, and upper shoulders. Treatments are repeated every 12 weeks. Most people notice improvement after the second or third round rather than immediately. The injections take about 15 to 20 minutes, and the most common side effects are neck pain and temporary discomfort at the injection sites.