Identify and Avoid Triggers:

• Common triggers: stress, lack of sleep, certain foods (e.g., aged cheese, chocolate, alcohol), sensory stimuli (bright lights, strong odors).
• Rationale: Migraineurs often have heightened sensitivity to these factors, which can precipitate attacks.

• Lifestyle Modifications:
  • Regular sleep schedule (7–9 hours/night).
  • Consistent meal times; avoid skipping meals.
  • Hydration (2–3 L/day of water).
  • Rationale: Disruptions in circadian rhythms and dehydration are known migraine triggers.

• Stress Management:
  • Relaxation techniques (biofeedback, meditation, yoga).
  • Cognitive-behavioral therapy (CBT) for stress coping.
  • Rationale: Stress is a major trigger; CBT is evidence-based for migraine prevention (Level A evidence per AHS guidelines).

• Hormonal Considerations (for women):
  • Estrogen fluctuations (menstrual cycle, hormonal contraceptives) can trigger migraines.
  • Rationale: Hormonal changes are a well-documented trigger; consider non-hormonal contraception if migraines worsen.

• Sensory Stimuli Avoidance:
  • Limit exposure to bright lights, loud noises, strong odors.
  • Rationale: Sensory hypersensitivity is common in migraineurs; reducing stimuli can prevent attacks.

• Regular Exercise:
  • Aerobic exercise (e.g., walking, swimming) 3–4x/week.
  • Rationale: Exercise improves vascular health and reduces stress, but avoid overexertion (a potential trigger).

• Non-Pharmacologic Adjuncts:
  • Caffeine (100–200 mg/day) may help, but avoid excess (can trigger rebound headaches).
  • Rationale: Caffeine has mild analgesic effects but can worsen headaches if overused.

Key Reference: AHS/ANM guidelines emphasize non-pharmacologic strategies as first-line management for episodic migraine.