Neurologist shares 5 migraine mistakes that could make attacks worse
Early treatment can help control migraine attacks.
Migraine is often dismissed as ‘just a bad headache’, but for millions of people, it is a complex neurological disorder that can disrupt work, sleep, relationships, and overall quality of life. While medication can help manage attacks, everyday habits also play a significant role in determining how severe or long-lasting a migraine episode becomes.
Highlighting this, neurologist Dr Rahul Chawla recently shared five common mistakes that people with migraines should avoid. On taking medicines, he said, “Migraine medicines work best when taken at the very beginning of the attack. Waiting until the pain becomes severe makes the headache much harder to control.” He also warned that delaying treatment can sometimes allow a headache to persist for two to three days, leading people to require more painkillers.
Dr Chawla also cautioned against excessive use of pain-relieving medicines, noting, “Overusing painkillers can actually lead to Medication Overuse Headache (MOH), where the medicine itself starts causing more headaches.” He further warned that long-term overuse may increase the risk of stomach ulcers and kidney damage. Sleep, too, is an important factor. “It’s not just sleeping less that triggers migraine,” he explained. “Sleeping less than six hours, staying up late, or even oversleeping on weekends can trigger an attack.”
According to Dr Chawla, identifying individual migraine triggers is equally important because they vary from person to person. “Skipping breakfast, dehydration, weather changes, perfumes, chocolate, and even certain foods can trigger migraines in some people,” he said. He also added, “Evidence shows that maintaining a headache diary to identify triggers and monitor your response to treatment can reduce migraine frequency over time.” Finally, he emphasised that migraine should never be underestimated: “Migraine is a neurological disorder and affects your quality of life. Along with headache, it can cause vomiting, sensitivity to light and sound, brain fog, vertigo and, in rare cases, even paralysis.”
But how well do these recommendations align with current medical evidence, and what should people with migraine actually prioritise?
When should migraine medication be taken?
Dr Jagdish Chattnalli, senior minimal invasive brain and spine surgeon, Bengaluru West Clinics, HCG Hospitals Bengaluru, tells indianexpress.com, “Evidence consistently shows that acute migraine medications are most effective when taken early in the attack, ideally when the headache is still mild. Delaying treatment allows the pain pathways to become more sensitised, making the attack harder to control and increasing the likelihood of prolonged symptoms.”
At the same time, Dr Chattnalli advises that patients should avoid relying on painkillers too frequently, as excessive use can itself lead to medication overuse headache. A good balance is to treat genuine migraine attacks promptly while limiting the use of acute medications to the recommended number of days each month. Those experiencing frequent migraines should consult a neurologist about preventive treatment rather than repeatedly using pain-relieving medicines.
How can you identify migraine triggers?
Migraine triggers are highly individual, and not every commonly reported trigger affects every person. Instead of eliminating multiple foods or activities at once, patients should observe patterns over time and identify triggers that are consistently associated with attacks.
Dr Chattnalli states that a headache diary is one of the most effective tools for this purpose, as it helps track headache episodes alongside factors such as sleep, meals, hydration, stress, menstrual cycles and environmental exposures. “This allows patients and clinicians to identify meaningful patterns rather than making assumptions. The goal is targeted lifestyle modification instead of unnecessary restrictions that may add stress without reducing migraine frequency.”
What are the biggest misconceptions about migraine?
One of the biggest misconceptions is that migraine is simply a severe headache. In reality, it is a complex neurological disorder that can affect vision, balance, cognition and sensory processing, significantly interfering with daily life.
Dr Chattnalli mentions, “While most migraines are not life-threatening, urgent medical evaluation is essential if a person experiences a sudden explosive headache, new neurological deficits such as weakness or difficulty speaking, seizures, loss of consciousness, persistent confusion, or a headache that is different from their usual migraine pattern. Long-term management focuses on consistency. Maintaining regular sleep, staying well hydrated, eating balanced meals without prolonged fasting, managing stress, exercising regularly and adhering to prescribed preventive therapy when indicated can substantially reduce both the frequency and severity of migraine attacks.”