I was compensated by Med-IQ through an educational grant from Lundbeck to write about the realities of migraine as a chronic disease. All opinions are my own. I decided to work with Med-IQ to help generate awareness around migraine prevention and treatment. Med-IQ is an accredited medical education company that provides an exceptional educational experience for physicians, nurses, pharmacists, and other healthcare professionals.
Migraine is a genetic neurological disorder. More than 100 different genetic mutations can make an individual vulnerable to migraine. Each person who has migraine has a different combination of genetic mutations. This is why migraine treatment is a process of trial and error, and each patient requires an individualized treatment.
Unfortunately, migraine has no cure. The purpose of effective migraine prevention is to reduce the frequency and duration of migraine attacks, thereby alleviating disability and suffering. Here are the most effective strategies for migraine prevention:
1. CONSULT A PHYSICIAN
Migraine is often a debilitating neurological disorder. Yet, a significant portion of migraine sufferers never consults a doctor for their symptoms.  A primary care physician, neurologist, or headache specialist can assist you in developing an individualized treatment for migraine prevention. Although 44 million Americans experience migraine, there are only 700 board-certified headache specialists in the United States. Dr. Amaal Starling, a neurologist and a headache specialist at Mayo Clinic, recommends patients have an initial conversation with their primary care provider about their symptoms and medications before seeing a specialist.
2. PRACTICE SEEDS
SEEDS an acronym created by Amaal Starling, M.D., stands for lifestyle changes that can help calm our overly sensitive brain.  The five letters stand for sleep, exercise, eating, diary, and stress.
SEEDS: S IS FOR SLEEP
The S of the SEEDS acronym stands for sleep hygiene. According to the American Migraine Foundation, people living with migraine are up to eight times more likely to have sleep problems than the general population.  Therefore, getting regular and adequate sleep is so vital for people with migraine.
Try keeping your bedroom dark, cool, and quiet to improve your sleep hygiene. Use a white noise machine, go to bed and wake up at the same time each day (even on the weekends), and avoid naps. Although it’s hard to change our habits regarding our phones, screens in the bedrooms may disrupt our sleeping patterns. 
SEEDS: E IS FOR EXERCISE
The first E of the SEEDS acronym stands for exercising regularly. Exercise or movement improves our overall health and helps us sleep better. Here are ways to make exercise and movement a part of your migraine prevention plan:
- Your exercise goal should be about 30-60 minutes 3-5 times a week;
- Start slowly, even if it’s 5 minutes once a week!
- Gradually increase exercise duration and frequency to make it a habit;
- Choose an activity you enjoy – walking, yoga, pilates, cycling, light weight lifting, ballet, swimming, etc. 
SEEDS: E IS FOR EATING
The second E of the SEEDS acronym stands for eating regular meals, as well as hydration. To improve your eating habits, make sure to eat at least three times a day, avoid skipping meals, stay hydrated (7-8 glasses of water per day) and limit your caffeine intake. 
SEEDS: D IS FOR DIARY
The D of the SEEDS acronym stands for migraine diary. Keeping a diary or a migraine tracker is an essential part of the migraine prevention plan. It allows us and our physicians to identify patterns, determine our triggers, and improve our treatments.
You may use a calendar, notepad, or a phone App. Make sure to bring your migraine tracker to your doctor for review during your appointments. If you have near-daily migraine attacks, consider doing a simple paper “spotlight diary.” Grab some colorful markers and color the calendar as follows: red days are when a patient is wholly debilitated in bed. Yellow days are when function at work, school, or daily activities are significantly limited by migraine. Green days are when the symptoms are present, but the function is not affected. Blank days mean you are 100% symptom-free. You can place a checkmark on the days when you need an acute medication to avoid rebound headaches. 
SEEDS: S IS FOR STRESS
The last “S” of the SEEDS acronym stands for stress management. Although stress does not cause migraine disorder, it is one of the significant migraine triggers which can exacerbate our symptoms. Therefore, stress management must be an essential part of our natural migraine prevention plan.
Here are some strategies to help manage and reduce stress: cognitive behavioral therapy, mindfulness, gratitude practice, positive mantras, guided meditation, biofeedback, and breathing techniques; .
3. TAKE MEDICATIONS IF NECESSARY
People with migraine who suffer from frequent attacks may need more aggressive prevention strategies that sometimes include medication. Approximately 38% of patients with episodic migraines would benefit from preventive therapy, but less than 13% take prophylactic medications. 
Preventive medications are medications that patients take daily to prevent migraine attacks from occurring. Medications used to prevent migraine attacks were initially created to control other conditions, such as seizures, depression, high blood pressure, or an irregular heartbeat. Most recently, new preventive medications designed specifically for migraine have been approved.
Other preventive migraine treatments include Botox, nerve block injections, and neuromodulation devices. CEFALY, Spring TMS or ENeura sTM, and GammaCore are devices that have been FDA cleared to prevent migraine.
4. TRY SUPPLEMENTS AND ALTERNATIVE TREATMENTS
Many people with migraine use supplements as a more natural approach or as a first step in migraine prevention. Certain supplements, such as magnesium, riboflavin (B2), and CoQ10, have studies that demonstrate their efficacy for migraine.
Consult your doctor before trying supplements. Supplements in the United States are considered food and are not regulated. Therefore, it is also important to purchase supplements from reputable brands.
5. RAISE YOUR MIGRAINE THRESHOLD
Since there are so many migraine triggers, it is challenging to identify your personal triggers. This is because there is rarely just one trigger that causes a migraine attack. A patient usually struggles with multiple triggers, which lead to migraine attacks. A more effective approach is to encourage patients to raise their migraine threshold. Migraine threshold can be raised with lifestyle modifications such as S.E.E.D.S., supplements, oral medications, or injectable medications. If a patient’s migraine threshold is successfully increased, the triggers are less likely to set off a migraine attack.
1 – Medical consultation for migraine: results from the American Migraine Study
2 – Cleveland Clinic Journal of Medicine November 2019, 86 (11) 741-749
3 – Sleep Disorders and Headache | American Migraine Foundation
4 – Migraine Headache Prophylaxis