How to Create a Comprehensive Migraine Management Plan for Your Teen

When I was in high school, I lived with undiagnosed and untreated chronic migraine. I normalized living in constant pain and hid my symptoms to keep up with my peers. But on the inside, I was struggling deeply. Without proper treatment and support, migraine disease can spiral out of control. By the time I was finally diagnosed at age 33, my migraine disease had progressed from episodic to chronic, to high frequency chronic, to chronic intractable, leading to a greater level of disability and a significant reduction in my quality of life. 

I often wonder how much better my teen and adult years could have been if my chronic migraine had been treated like the serious disease it was. Instead, I now live alongside a non-stop migraine attack that ebbs and flows in severity throughout the day. The good news is that with proper treatment, support, and accommodations, teens living with migraine can improve their disease outcomes and change the trajectory of their lives for the better.  

Understanding Migraine Disease

Migraine is a complex neurological disorder with a genetic predisposition. Migraine brains are sensitive and overreactive to so many factors that are beyond your teen’s control. They didn’t do anything to cause their attacks—they were born with a predisposition for migraine disease. It’s easy to fall down a rabbit hole searching for the “root cause” of migraine attacks, but migraine is a primary headache disorder, and “experts in the field will tell you that overwhelmingly, the root cause of migraine is genetics. I’ll say that again – the root cause of migraine is genetics. Migraine has dozens of genes associated with it. So, depending on your [teen’s] genes and the combination of the genetic variations that are in play, your [teen’s] migraine will behave and respond in a way that is unique to [them]” (Aberman, 2022).

It’s common to get lost in overthinking what “caused” every attack, which can lead to unnecessary and misplaced self-blame for those living with migraine. This mindset can even become a barrier to treatment if a person believes their attacks are caused by something they’re doing wrong. But triggers only exist in the first place because of migraine—the underlying cause of attacks is migraine disease itself. Migraine makes the brain more sensitive and reactive to triggers, setting off a biochemical reaction that leads to migraine pain and symptoms. Again, triggers are not the cause of migraine disease; they exist because of migraine. 

It’s also important to note that migraine isn’t an acute condition that comes and goes, only present during active attacks. Migraine is a chronic neurological disorder that the brain is constantly navigating, which is why it’s common to experience migraine symptoms like brain fog, fatigue, nausea, sensitivity to sensory stimuli and more, even between attacks. 

By understanding the migraine threshold theory—the idea that everyone living with migraine disease has a unique tipping point where triggers build up and spill over to cause an attack—you can begin developing a comprehensive, multi-layered management plan. Doing so can help raise your teen’s migraine threshold, making it less likely for them to experience debilitating symptoms. So how can you do this? Read on to learn more. 

Understanding the Migraine Threshold Theory 

The “migraine threshold theory states that a person with migraine typically has a threshold: a level of tolerance for migraine triggers that, when exceeded, results in a migraine attack. One trigger alone may not be enough, but multiple triggers in sequence can overwhelm the nervous system” (Kuruvilla, 2024).

It’s a common misconception that a single trigger, like a thunderstorm or menstruation, causes migraine attacks. In reality, it’s the accumulation of multiple triggers around the same time that causes a brain to reach its migraine threshold, resulting in an attack. Someone with episodic migraine has a higher migraine threshold than someone with chronic migraine, which is why a person with chronic migraine experiences more frequent migraine attacks. In contrast,  someone who doesn’t live with migraine disease can be exposed to many common migraine triggers without experiencing an attack because they don’t have this neurological disorder. Let’s compare this to another neurological disorder, epilepsy. I do not have epilepsy. I can be exposed to many things that might trigger a seizure in someone with epilepsy, but I won’t have one because I am not living with that neurological disorder. 

David Buchholz, the author of Heal Your Headache, puts migraine triggers into three categories: 

• Examples of Avoidable Triggers
• • Skipping meals
  • Dehydration
  • Sensory stimuli inside the home
    • Synthetic scents (e.g., air fresheners, laundry detergent, hair & body wash) 
    • Harsh, bright lighting 
    • Noise levels (e.g., loud sounds, constant background noise like music or T.V.)
  • Caffeine  (e.g., inconsistent amounts day to day or too much each day)
• Examples of Difficult to Avoid Triggers
• • Irregular sleep patterns 
  • Stress
  • Screen time 
• Examples of Unavoidable Triggers
• • Weather changes (e.g., barometric pressure changes, humidity, heat) 
  • Hormonal fluctuations (e.g., menstrual cycle, puberty)
  • Sensory stimuli outside the home (e.g., bright lights in a store, cigarette smoke in town, air fresheners in other people’s cars or homes)

It’s important to note that triggers vary from person to person and can change over time. In my disease progression, as my migraine spiraled out of control, I developed more triggers, and my brain became more reactive to existing triggers. This happened because I lived with undiagnosed and untreated chronic migraine for decades, constantly operating at or above my migraine threshold. Without treatment, the brain can become more sensitive and reactive over time. On the flip side, with an effective migraine management plan that raises your teen’s migraine threshold, their brain can become less reactive, leading to fewer attacks.

When managing migraine, one approach is to remove avoidable triggers. If you can identify and remove triggers to improve your teen’s overall trigger load, that is great. However, focusing only on avoiding triggers can increase fear and stress levels, further reinforcing self-blame. Additionally, trigger avoidance alone is not enough to prevent migraine attacks if your teen is consistently near their threshold or is affected by numerous unavoidable triggers. Instead, the most effective long-term approach is to develop a management plan that focuses on raising your teen’s migraine threshold. 

Elements of a Multi-Layered Management Plan Designed to Raise Migraine Threshold 

Below are different elements of a migraine management plan that can work together to help boost your teen’s migraine threshold. Remember, building an effective plan takes time. Introducing new elements gradually can help you see what works best for your teen. Keep in mind this list shares examples to get you started and is not exhaustive. Let’s dive in!

• Lifestyle Management 
• • • Pacing: Balancing activity with rest. 
    • Sleep hygiene: Maintaining a regular sleep schedule. 
    • Reduced screen time: Limiting screen time if it’s a trigger.
    • Regular exercise: 30-50 minutes of moderate-to-intense aerobic activity, three to five days a week, is recommended (Irby et al., 2016).
    • Triggering scents: Eliminating synthetic fragrances from your home if they are a trigger.

• FDA-Cleared Neuromodulation 

• Neuromodulation is a drug-free way to treat active migraine attacks and prevent future ones. The Nerivio REN wearable is a pill-free, needle-free, non-disruptive therapy that treats and prevents migraine. It is FDA-cleared for ages 12+ and designed with teens in mind. For me, using neuromodulation in my treatment plan has been a lifesaver. Living with chronic migraine, I couldn’t be without it. 

• Supplements 

• • • When it comes to teens with migraine, a neurologist may start with lifestyle modifications, neuromodulation, and/or clinically studied supplements for migraine, like magnesium and B2, before moving to medication management. 

• Medication Management

• • • Acute medications: To treat an active migraine attack.
    • Preventative medications: For high-frequency episodic or chronic migraine, to help raise migraine threshold. 

• Migraine Tools

• Tools like ice packs, heating pads, weighted eye masks & blankets, glasses designed for migraine to alleviate light sensitivity, noise reduction earplugs, hats, sunglasses, topical muscle pain relief, massage tools, acupressure mats and more can help manage migraine symptoms. 

• Mindset and Mental Health Strategies 

• • • Therapy: Talk therapy, such as Cognitive Behavioral Therapy has been studied for migraine prevention or somatic therapy.
    • Mindfulness & meditation  
    • Social Support 

• Accommodations at School

• • • Advocate for necessary school accommodations so your teen can succeed academically alongside migraine. 
      • For teens using Nerivio, make sure they have permission to keep their smartphones in class, to allow as needed for immediate acute treatment.

• Alternative therapies

• • Biofeedback
  • Green-light therapy 
  • Physical Therapy 
  • Acupuncture 
  • Rolfing 

After being diagnosed and developing my own multi-layered migraine management plan, I experienced a significant improvement in my quality of life. Taking a comprehensive approach has been key to raising my own migraine threshold and reducing the impact of my daily symptoms. Keep in mind that every person’s journey with migraine is unique, and what works for one might not work for another. If symptoms persist, it is never your teen’s fault. Be patient, explore different options, and encourage your teen to take an active role in their care. Together you can find a combination of strategies that best supports your teen’s well-being and helps them navigate life more comfortably alongside migraine. 

Use the Traffic Light Pain Scale

Communicating needs during a migraine attack can be difficult due to intense pain, brain fog, cognitive dysfunction, or other factors. This can make it hard for your teen to describe what they are feeling. Using an adapted version of the traffic light pain scale in your teen’s migraine management plan can be a valuable tool to help your teen express their needs and manage their symptoms more effectively. 

Green = Go

• For a teen with episodic migraine, green means no migraine symptoms and full functionality. For a teen with chronic migraine, it could mean baseline symptoms or a light migraine attack. They might be experiencing symptoms but can still function. 

Yellow = Proceed with Caution

• This is especially useful for teens who live with chronic or high-frequency episodic migraine and experience persistent attacks at different levels. Yellow represents moderate attack symptoms where they can continue to function with the help of treatment, pacing and accommodations. They might need to stop and rest if symptoms worsen. 

Red = Rest 

• Red means full stop because the symptoms are so debilitating that it is too hard to function. Teaching your teen to listen to their body and rest during a “red attack” can shorten the length of the attack and help improve overall outcomes. On the flip side, pushing through during a red attack can exacerbate symptoms in the moment and long term. 

It’s a great idea to talk with your teen and establish what green, yellow and red mean for them regarding their symptoms and functioning levels. Then, they can easily communicate with you about where they are at any given moment, and you can adjust as a family to swiftly support their needs.

Conclusion 

Migraine disease can exacerbate over time if not managed effectively. Early treatment is crucial to prevent a snowball effect, where more frequent attacks lead to more severe and regular symptoms. Watching your teen struggle with migraine attacks while juggling daily responsibilities can be overwhelming. As you navigate this, remember that building a comprehensive migraine management plan for your teen can take time but it is achievable. 

Collaborate with your teen, healthcare provider and school to create an effective plan and encourage your teen to take an active role in managing their condition. For more tips on supporting your teen with migraine, check out the rest of my Back to School Series with Nerivio. 

Disclaimer: The information provided in this article reflects personal experiences and should not be considered medical advice. Please consult with your healthcare provider about your personal migraine treatment plan and to see if Nerivio is right for you.

More Articles from my Back-to-School Series with Nerivio:

• Breaking Down Migraine Stigma to Access Better Care for Teens with Migraine
• Homework and Study Strategies for Teens with Migraine
• Unlocking Academic Success: A Guide to Accommodations for Students with Migraine

Author’s Bio:

Bernadette Gorczyca, Ed.M., is a certified educator with over 13 years of experience teaching in public, private, and international schools. Having lived with migraine since childhood and with chronic migraine since high school, she combines her personal and professional insights to advocate for students with migraine. Bernadette offers virtual tutoring services focused on improving academic outcomes and overall well-being for high school and college students managing migraine and other chronic conditions. Don’t miss out on her valuable migraine resources and support, available through her Instagram and TikTok accounts, @ChronicAccounts.

References:

Aberman, D. (2022, October 5). What is the Root Cause of Migraine?. Migraine Strong. https://www.migrainestrong.com/root-cause-of-migraine/#google_vignette  

Buchholz, D. (2002). Heal your headache. Workman. 

Irby, M. B., Bond, D. S., Lipton, R. B., Nicklas, B., Houle, T. T., & Penzien, D. B. (2016). Aerobic Exercise for Reducing Migraine Burden: Mechanisms, Markers, and Models of Change Processes. Headache, 56(2), 357–369. https://doi.org/10.1111/head.12738 

Kuruvilla, D. E. (2024, May 21). What is migraine threshold theory?. Cefaly. https://blog.cefaly.com/what-is-migraine-threshold-theory/