One class of drugs has already found success in treating the painful, common attacks.
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Studies of migraine’s many triggers offer paths to new therapies
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I can relate to this. The number of hoops I had to jump through was ridiculous. And then your insurance changes and you have to switch to another version (after getting another prior authorization) because they get a better kickback from a different brand.
I've also had to switch because some didn't work, or started out working ok but lost efficacy with time.
This is interesting. I knew migraines were much more common in women, but I hadn't heard that CGRP antagonists might be less effective in men.
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My spouse suffers from multi-day migraines. They started trying Triptans and have not had anything worse than a light headache since then.
It’s a miracle drug and has completely changed their life.
It’s a miracle drug and has completely changed their life.
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I get headaches a lot - fortunately only a small percentage get bad enough to count as a migraine. And the worst the migraines usually get is light sensitivity and nausea. You can literally feel the blood pounding on the side of my head when it's bad.
Fortunately, most of the migraines respond to (generic) Excedrin Extra Strength (combo of acetaminophen, aspirin and caffeine).
From my experience weather can be a trigger, but from what I can tell (and talking with friends/family) it's usually pressure changes, rather than specific events.
Scents can definitely do it - Bath & Body Works can induce a headache just by walking too closely.
Fortunately, most of the migraines respond to (generic) Excedrin Extra Strength (combo of acetaminophen, aspirin and caffeine).
From my experience weather can be a trigger, but from what I can tell (and talking with friends/family) it's usually pressure changes, rather than specific events.
Scents can definitely do it - Bath & Body Works can induce a headache just by walking too closely.
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My mom had a similar experience. She got them infrequently enough that she could manage them with triptans. I remember growing up she had migraines all the time and nothing would really help. They started to be less frequent later, but they're still debilitating when they happen. Then she got triptans and she pretty much completely managed them with those alone. No more over the counter stuff. No more days of having to go lay in the dark. Pop a triptans and in 15 minutes or whatever you're feeling better.
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I get regular migraines, including pain, auras and occasional nausea. But I'm a anomaly -- 100% of the time, 400mg of ibuprofen disappears the headache and all its symptoms within about 40 minutes. I haven't met anyone else for whom ibuprofen works like this.
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Ibuprofen works wonders for 95% of my headaches - but I do find I have to break out the Excedrin equivalent when it hits actual migraine levels.
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That's crazy. The first thing I was ever prescribed was 500mg of naproxen. It didn't do dick.
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400mg of ibruprofen does nothing to mine. 600 or 800mg will push it back for about 3-4 hours, depending on how far it has progressed. 3 advil and a triptan will make it go away for a day or so, if I don't drive much, but I'll need a nap.
The high dose Aimovig was really effective for me, especially split dose (1 shot every 2 weeks instead of 2 every 4 before they switched to a single high dose pen) but lost it in an insurance change.
Had to stop donating platelets unless it was just before the CGRP shot was due... I'd get a spike of headaches for a week right afterward. Not sure if it was filtering out the meds in the apheresis or the anticoagulants.
</anecdata>
The high dose Aimovig was really effective for me, especially split dose (1 shot every 2 weeks instead of 2 every 4 before they switched to a single high dose pen) but lost it in an insurance change.
Had to stop donating platelets unless it was just before the CGRP shot was due... I'd get a spike of headaches for a week right afterward. Not sure if it was filtering out the meds in the apheresis or the anticoagulants.
</anecdata>
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I think that's one of the issues with migraines - there's no "one size fits all" medication (so far). And we apparently don't understand them well enough to design against the root cause.
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I started having migraines in 1966, long before modern treatments were introduced. I tried ergotamine and gave up on that after a few tries when I had rebound headaches that were as bad or worse than the original migraine.
Then, in 1988, I learned that one result of the long-term Framingham Heart Study was the observation that something like 80% of the migraine sufferers in the study experienced fewer and milder migraines when taking a daily aspirin. I started daily low-dose aspirin immediately and experienced less frequent and far more mild migraines, duplicating the experience of the Framingham results.
Then, in 2013, I had open-heart surgery to repair a defective valve and the surgeon closed the foramen ovale or opening between the atria of my heart, which normally closes by itself shortly after birth. When it remains open, it is called a Patent Foramen Ovale. Apparently, it has been noted in studies that PFOs are associated with migraines with aura.
Once my PFO was closed and healed, I have not had an old-school migraine. All that remains are occasional auras with no pain.
I am not suggesting running out to have open-heart surgery, but it is worth having a cardiac ultrasound scan if you have migraines.
Then, in 1988, I learned that one result of the long-term Framingham Heart Study was the observation that something like 80% of the migraine sufferers in the study experienced fewer and milder migraines when taking a daily aspirin. I started daily low-dose aspirin immediately and experienced less frequent and far more mild migraines, duplicating the experience of the Framingham results.
Then, in 2013, I had open-heart surgery to repair a defective valve and the surgeon closed the foramen ovale or opening between the atria of my heart, which normally closes by itself shortly after birth. When it remains open, it is called a Patent Foramen Ovale. Apparently, it has been noted in studies that PFOs are associated with migraines with aura.
Once my PFO was closed and healed, I have not had an old-school migraine. All that remains are occasional auras with no pain.
I am not suggesting running out to have open-heart surgery, but it is worth having a cardiac ultrasound scan if you have migraines.
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Wife used to suffer from migraines. Nothing helped. She tried chiropractors, acupuncture and lots of meds. She’d be down for 24-48 hours And throw up several times. She would ignore the early warning signs which didn’t help. If she skipped a month on her cycle, I knew to watch for a droopy right eye. From there her right shoulder and neck would tighten up. I’d grab the meds and encourage her to take them. It wouldn’t stop it but it would make it less painful and shorten the timeframe. Glad those days are over.
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I increasingly think that "migraine" needs to go as a classification. It's about as helpful or descriptive as "back pain" or "shin splints". It's no surprise that folks here (and in the article) are reporting wildly different results with different treatments. I don't think we are all talking about the same underlying causes, even if symptoms are similar.
As for me, I've tried the whole gamut. SSRIs, Tricyclics, Triptans, monoclonal antibodies... nothing. The one thing that has made a difference in frequency and duration for me is a relatively high dose of creatine. I started after reading that case study as a "why not?" and it's had a substantial, measurable impact. I hope there's more followup in the literature soon.
As for me, I've tried the whole gamut. SSRIs, Tricyclics, Triptans, monoclonal antibodies... nothing. The one thing that has made a difference in frequency and duration for me is a relatively high dose of creatine. I started after reading that case study as a "why not?" and it's had a substantial, measurable impact. I hope there's more followup in the literature soon.
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Definitely. It's a long, long process of throwing shit at the wall and seeing what sticks. I've been doing it for a decade and I still don't have a good solution. Until pretty recently, there weren't even meds actually targeting migraines. Just a lot of random shit someone must have noticed happened to help someone with migraines so they give it a shot. Basically anything that fucks with your brain, they'll try. Which is kinda scary. Some of those meds have some crazy side effects.
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I started having migraines in 1966, long before modern treatments were introduced. I tried ergotamine and gave up on that after a few tries when I had rebound headaches that were as bad or worse than the original migraine.
Then, in 1988, I learned that one result of the long-term Framingham Heart Study was the observation that something like 80% of the migraine sufferers in the study experienced fewer and milder migraines when taking a daily aspirin. I started daily low-dose aspirin immediately and experienced less frequent and far more mild migraines, duplicating the experience of the Framingham results.
Then, in 2013, I had open-heart surgery to repair a defective valve and the surgeon closed the foramen ovale or opening between the atria of my heart, which normally closes by itself shortly after birth. When it remains open, it is called a Patent Foramen Ovale. Apparently, it has been noted in studies that PFOs are associated with migraines with aura.
Once my PFO was closed and healed, I have not had an old-school migraine. All that remains are occasional auras with no pain.
I am not suggesting running out to have open-heart surgery, but it is worth having a cardiac ultrasound scan if you have migraines.
Then, in 1988, I learned that one result of the long-term Framingham Heart Study was the observation that something like 80% of the migraine sufferers in the study experienced fewer and milder migraines when taking a daily aspirin. I started daily low-dose aspirin immediately and experienced less frequent and far more mild migraines, duplicating the experience of the Framingham results.
Then, in 2013, I had open-heart surgery to repair a defective valve and the surgeon closed the foramen ovale or opening between the atria of my heart, which normally closes by itself shortly after birth. When it remains open, it is called a Patent Foramen Ovale. Apparently, it has been noted in studies that PFOs are associated with migraines with aura.
Once my PFO was closed and healed, I have not had an old-school migraine. All that remains are occasional auras with no pain.
I am not suggesting running out to have open-heart surgery, but it is worth having a cardiac ultrasound scan if you have migraines.
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CGRP inhibitors were a game-changer for my wife, whose migraines often caused visual auras and aphasia.
Unfortunately, she had to discontinue them when she was pregnant, as there wasn't a lot of safety data at the time. Fortunately, in spite of not starting up on the drugs again, she hasn't had a serious migraine since our kid was born.
Unfortunately, she had to discontinue them when she was pregnant, as there wasn't a lot of safety data at the time. Fortunately, in spite of not starting up on the drugs again, she hasn't had a serious migraine since our kid was born.
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Yeah, it's quite ridiculous what you have to go through. I'm currently in a situation where some drugs were approved last year after going back and forth and sending a letter from my doctor saying I had tried drugs x, y, and z and they didn't work. When we went to get it approved this year, they denied saying, "You have to try drugs x, y, and z first". Well guess what, I still have already tried drugs x, y, and z! It's just infuriating doing this back-and-forth.
It's interesting. I suspect that changes in testosterone in men are probably a trigger, too. I wasn't able to make the connection until I was older and started getting testosterone injections. Once I noticed it happened regularly, I was able to put it together.
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It's absolutely ridiculous that insurance can decide what treatment you're allowed to have. I've had them straight up lie to me as well. "Well after you try x, y, and z, we'll approve it." Then you do x, y, and z (with months in between each, because you usually have to give them 3 to 6 months to see if they do anything) and they come back with a "denied" anyway.
I've had insurance read my neurologist's notes that without medication I have headaches 30 out of 30 days with at least 20 of them meeting the criteria of migraines and turn around and tell me verbatim "you don't meet our criteria for a migraine diagnosis so we're denying your medication." Motherfucker, you've never even seen me. You can't diagnose me.
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An off-topic plea: can someone please point me to a spot to report bugs or interface issues with the new layout?
Much obliged. Back to your regular programming.
Much obliged. Back to your regular programming.
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Neutron Star reader mode feedback
Launching Neutron Star as a sub reading mode for the redesign was a bit of an experiment. Now that it's been live for a week+ (and the new more dense List view is live) we'd love to start gathering feedback from people on how it's working, and how it could be improved. One thing we're aware of...
arstechnica.com
That's specifically for the neutron star layout. I assume there's one for each. There's a link under the layout selector in the upper left, at least on my device.
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My migraine story is like others here. Multiple migraines per week, no aura, light sensitivity, nausea, complete inability to think straight (which does not help my coding at all). Fortunately, I eventually hit upon a combo of (generic) Fiorinol plus a sumatriptan. I take one each at the same time and, 99% of the time, the migraine is gone within the hour.
The thing is, "medication overuse headache" is a real thing for me. If I take those meds three days in a row, I will have a bad headache the following day, and I'm fairly sure it will be due to taking too many triptans. The solution? Why, my two-pill solution for migraines work great! Lather, rinse, repeat. Sometimes it is difficult to get off that hamster wheel.
My doctor wants me to try other meds, but the new ones presented in this article cost one bzillion dollars per month and insurance ... sucks. I may be forever threading the needle with triptans and overuse-induced headaches.
The thing is, "medication overuse headache" is a real thing for me. If I take those meds three days in a row, I will have a bad headache the following day, and I'm fairly sure it will be due to taking too many triptans. The solution? Why, my two-pill solution for migraines work great! Lather, rinse, repeat. Sometimes it is difficult to get off that hamster wheel.
My doctor wants me to try other meds, but the new ones presented in this article cost one bzillion dollars per month and insurance ... sucks. I may be forever threading the needle with triptans and overuse-induced headaches.
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The study of migraine issues is complicated by the fact that many, many people claim to have a "migraine" when what they really have is a bad headache. It's become a collquial term, rather than a medical one.
A migraine that hasn't been diagnosed by a medical professional is just as likely to not be a migraine at all. It's like saying calling any dark spot on your skin "melanoma."
A migraine that hasn't been diagnosed by a medical professional is just as likely to not be a migraine at all. It's like saying calling any dark spot on your skin "melanoma."
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Another example of our totally fucked up Health Industry. And it begs the question: what’s the proper role of insurance? Even if we had single payer (my favorite), surely the payor needs to look after expenses given so many fraud opportunities. As it stands, industry’s greedy little fingers are so far out of bounds that the sidelines aren’t even visible.
So, given the current nightmare, what’s a serious, conscientious lawmaker to do? Where is the art of the possible? I have no clue as I favor something like Medicare for all. Not possible.
But what is, even incrementally?
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Neutron Star reader mode feedback
Launching Neutron Star as a sub reading mode for the redesign was a bit of an experiment. Now that it's been live for a week+ (and the new more dense List view is live) we'd love to start gathering feedback from people on how it's working, and how it could be improved. One thing we're aware of...
That's specifically for the neutron star layout. I assume there's one for each. There's a link under the layout selector in the upper left, at least on my device.
A friendly hat tip. Thank you.
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Team Tardigrade
Ars Centurion
My wife had debilitating migraines lasting for days. She was in bed or barely functional for 3 weeks out of 4. CGRP inhibitors have given us her life back.
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I've been wondering if the U.S. diplomats in Cuba were suffering from migraines because of the stress at work not because of any Communist secret weapons. Anyone know information why this might be true / not true? Complete speculation based on a few of reports of symptoms.
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I can't read this article. Thinking about migraines is a risk for causing me a migraine. I'm serious.
I'm fortunate that I don't get them very often and the current drugs work reasonably well. It's less fortunate that I've passed the genes for them along to my daughter who gets them more often than I do.
I'm fortunate that I don't get them very often and the current drugs work reasonably well. It's less fortunate that I've passed the genes for them along to my daughter who gets them more often than I do.
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There are many pains can folks work through, a migraine just sucks the life out of you.
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I've never had a head migraine... but unfortunately I have suffered for about a decade with extreme abdominal migraines and cyclic vomiting syndrome brought on by the migraines. It's horrendous. I've got it under better control than I had it before but it still puts me in the hospital regularly.
My triggers are, number one, stress. Any kind. Bad stress, even good stress, like something really exciting or overwhelming. And food. I have to be very careful with what I eat. It's no fun that's for sure. Days in the hospital throwing up almost non-stop, no food or water for a week. Just IV fluids. It's pretty bad.
My triggers are, number one, stress. Any kind. Bad stress, even good stress, like something really exciting or overwhelming. And food. I have to be very careful with what I eat. It's no fun that's for sure. Days in the hospital throwing up almost non-stop, no food or water for a week. Just IV fluids. It's pretty bad.
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30-odd year old male who's had migraines since middle school, and last year they digivolved overnight and with no warning from 2 or 3 attacks a month to ongoing, constant vestibular migraines. I couldn't look at a screen without getting dizzy and developing a migraine headache within minutes. Finally managed to get on a CGRP agonist, and it was like night and day. The dizziness went away, and I was getting a fraction of as many headaches as before.
Unfortunately, it's 300-900/month, and also seems to be becoming less effective, though I'm really hoping that's just stress...
Unfortunately, it's 300-900/month, and also seems to be becoming less effective, though I'm really hoping that's just stress...
Same, I spent 6 months trying useless treatments that my neurologist knew would almost definitely not work, just so the insurance would authorize it, only to find out it's cheaper to self pay.
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After decades of "tension headaches" I ended up in the ER with a 10/10 headache for eight hours. After countless IV drugs and no improvement, the neurologist even did a lumbar puncture (spinal tap 
) to check for meningitis. Finally one of the drugs she tried broke through. Every migraine is different and they all respond to different things.
Soon after I got my diagnosis and a rizatriptan prescription. It has truly changed my life. Without it, a migraine is debilitating, searing, indescribable pain; with it, I'm recovering within an hour and fully myself by the next day. For me, it's a miracle drug, and I hope there are many more miracle drugs on the way until everybody has theirs.
(And the irony of those bright white images on this page in dark mode…)
) to check for meningitis. Finally one of the drugs she tried broke through. Every migraine is different and they all respond to different things.Soon after I got my diagnosis and a rizatriptan prescription. It has truly changed my life. Without it, a migraine is debilitating, searing, indescribable pain; with it, I'm recovering within an hour and fully myself by the next day. For me, it's a miracle drug, and I hope there are many more miracle drugs on the way until everybody has theirs.
(And the irony of those bright white images on this page in dark mode…)
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I have suffered from migraines since puberty. The severity and frequency increased as a function of age and medications all had unwanted side effects. Fast forward to the Covid years, I find myself working from home for the first time in my career and after the first six months my wife and I start to notice the frequency is dropping. A year passes and I decide to come off medications. Presently I have been off medications for three years. Yes, I still get migraines. However the frequency and severity have reduced by roughly a factor of 10. With time I realized that working from home I have full control of when I eat, the ambient sound, the smells, and the reduction of stress due to office dramas or whatever you call it. I would have never understood or believed this had I not experienced it firsthand.
I realize not everyone can work from home and hope that others can find effective treatments to improve this awful condition. For those that can work from home and haven’t tried it as a means of migraine treatment, I highly encourage you to try!
I realize not everyone can work from home and hope that others can find effective treatments to improve this awful condition. For those that can work from home and haven’t tried it as a means of migraine treatment, I highly encourage you to try!
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One of the three times I tried a triptan (sumatriptan) I ended up going to the ER over the pain and weird dizziness/confusion it induced.
I've ended eventually ended up on a daily combo of amitriptyline and topiramate and it's working fantastically.
This is after I had a huge uptick in migraine frequency/severity that started around the same time I was recovering from bad COVID fatigue. Now it's actually down well below my pre-COVID baseline.
I wonder how many subtypes of migraines actually exist, or why one treatment works on one person and not on another.
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I suffered from cluster headaches for decades before I got a doctor who believed what I was going through. The best thing I tried was high flow oxygen. If I could get on the oxygen before the headache was well established the O2 would shorten the duration. None of the other stuff I tried even put a nick in them.
I'm grateful that they tend to faid with age and mine have followed that norm.
I'm grateful that they tend to faid with age and mine have followed that norm.
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Ah, topiramate. Works great for many people, costs pennies. It was part of my regimen until it gave me kidney stones (happens to a small but notable percentage of people). You might want to get a renal ultrasound to check before you experience the life changing pain of passing one. They are inexpensive and usually covered by insurance.
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Have been having whats been diagnosed as migraines, and holy crap are they scary! Been to the hospital multiple times for them because I think I'm having a stroke, but testing shows no stroke. Been told by multiple doctors that migraines with an aura can mimic a stroke and do SO many things that you wouldn't think off the top of your head that they can do, for me I can have them multiple times per day, multiple times per week, or I can have good weeks where I feel completely fine the whole week, or weeks in fact.
It's hell, and its debilitating.
It's hell, and its debilitating.
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Chock another one up to fading with age, I had a series of those "medication induced headaches." No fun when every day a two-week stretch that your head feels like its gonna fall off. Oddly, a small daily dose of amitriptelene (sp?) made a huge difference for me. That and age.
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I've had headaches and migraines since I was a teenager (mid 40s now), usually head pounding and light/sound sensitivity. As I got older, I got less migraines and more just annoying headaches, usually 1 or 2 a week. Most can be "solved" with Excedrin and a half hour...but there is the occasional all-day headache/migraine that just suck (maybe once a month), no amount of Excedrin seems to help, but eventually sleep/time does.
Then June 2023 happened, and man that was intense, what started out as a regular headache turned into an all-day headache that lasted a couple days. That had never happened before, I was pushing the limits on how much you were supposed to take of Excedrin in a day. But after a couple days, they would reduce to an annoyance, but I had one every day and over the course of 2 weeks got more and more intense. I finally saw a doc since it hurt like hell (whole head just was pounding) and never had them last multiple days. She diagnosed me with the medication overuse headaches and prescribed some steroids that started strong and stepped down. She also suggested an ice pack, which I promptly found one that wraps around your head. The steroids worked for just over a day and then the headaches came back hard, it was described as like dealing with withdrawal, no matter what I couldn't take anything else. The ice pack really did help, wish I learned of that sooner, but it only worked for as long as I had worn it, once it was done and had to go back to the freezer, the pain would quickly return.
That last week was hell (couldn't really function or do anything, it was that bad), but slowly it started to improve to the point I finally had 2 days in a row without any headaches or migraines for the first time in a month and it was heavenly haha. Funny enough, I then went on to not have a single headache or migraine for over 2-3 weeks which I haven't had in who knows how long. Now I'm back to 1 or so a week, and rarely is it super intense and have been very grateful for that.
Then June 2023 happened, and man that was intense, what started out as a regular headache turned into an all-day headache that lasted a couple days. That had never happened before, I was pushing the limits on how much you were supposed to take of Excedrin in a day. But after a couple days, they would reduce to an annoyance, but I had one every day and over the course of 2 weeks got more and more intense. I finally saw a doc since it hurt like hell (whole head just was pounding) and never had them last multiple days. She diagnosed me with the medication overuse headaches and prescribed some steroids that started strong and stepped down. She also suggested an ice pack, which I promptly found one that wraps around your head. The steroids worked for just over a day and then the headaches came back hard, it was described as like dealing with withdrawal, no matter what I couldn't take anything else. The ice pack really did help, wish I learned of that sooner, but it only worked for as long as I had worn it, once it was done and had to go back to the freezer, the pain would quickly return.
That last week was hell (couldn't really function or do anything, it was that bad), but slowly it started to improve to the point I finally had 2 days in a row without any headaches or migraines for the first time in a month and it was heavenly haha. Funny enough, I then went on to not have a single headache or migraine for over 2-3 weeks which I haven't had in who knows how long. Now I'm back to 1 or so a week, and rarely is it super intense and have been very grateful for that.
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Myself, I started getting migraines after high school. Blinding pain, sensitivity to light and sound. And all the next day I feel hungover (without having touched any alcohol). 600mg-1000mg of ibuprofen (the latter while being supervised by an ER nurse) at initial onset can blunt or deflect the episode; but after it starts no effect. Doctor gave me rizatriptan: at onset or 15min into mister migraine it really takes the edge off. But I still get to go lie down in a dark room for 4 hours.
And then the doctor got me on blood pressure meds, and it was night and day; went from an episode every 4-6 weeks to one a year. Along the way learned some of my triggers - dehydration and lack of caffeine. I count myself lucky: I have few triggers, can still eat cheese and chocolate, and only get a "mild" migraine that lasts hours and leaves me hungover, which is nothing compared to stories from others.
But the plural of anecdote is not data. I agree with some other commenters that there probably isn't a single "migraine", but a family of related and unrelated issues, with overlapping and contradicting symptoms and overlapping and contradicting cures.
.. Stay Hydrated kids.
And then the doctor got me on blood pressure meds, and it was night and day; went from an episode every 4-6 weeks to one a year. Along the way learned some of my triggers - dehydration and lack of caffeine. I count myself lucky: I have few triggers, can still eat cheese and chocolate, and only get a "mild" migraine that lasts hours and leaves me hungover, which is nothing compared to stories from others.
But the plural of anecdote is not data. I agree with some other commenters that there probably isn't a single "migraine", but a family of related and unrelated issues, with overlapping and contradicting symptoms and overlapping and contradicting cures.
.. Stay Hydrated kids.
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It's interesting you say this. I mentioned my migraines being "cured" by Ibuprofen, but I hadn't thought about what else I was doing when I took it. I always drank two cups of water and ate a banana (or more) to protect my stomach. I wonder if those also help alleviate my migraine symptoms.
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