A migraine attack is like a power outage in the brain: Everything was just bright and functional – suddenly it goes dark, sounds are too loud, light is blinding, and productivity collapses. The good news: Modern, evidence-based strategies help restore the network faster – and lower the rate of outages in the long term.

Migraine is a neurological disorder characterized by recurring, usually unilateral headaches, often accompanied by nausea, and sensitivity to light and noise. Some sufferers experience an Auratransient neurological symptoms such as flashing lights, visual field deficits, or tingling. Behind the attacks lies a sensitive Trigeminovascular Systempain pathway in the facial-skull area and disrupted neuronal excitability regulation. Triggers like dehydration, sleep deprivation, irregular meals, or certain additives increase susceptibility to attacks, while preventive measures raise the threshold for stimuli and stabilize the system. The goal of modern therapy is twofold: to shorten acute attacks – and significantly reduce the number of migraine days through prophylaxis.

Migraines impact performance, quality of life, and ultimately healthy lifespan. Those who frequently turn to painkillers risk a medication-overuse headacherebound headache due to excessive use, where occasional attacks become almost daily pain – especially with butalbital and opioid preparations. The solution is to break the cycle of overuse with clear limits and a preventive strategy ^{[1] [2] [3]}. Lifestyle factors also have a measurable impact: Low fluid intake correlates with more frequent, longer, and more intense headaches; consuming more water is associated with a lower pain burden ^{[4] [5]}. Certain food additives are relevant triggers: monosodium glutamate (MSG) and nitrates can promote headache-like and migraine-like symptoms – preclinical data indicate activation of peripheral NMDA receptors and vasodilatory effects on the meninges, which stimulate the pain pathway ^{[6] [7]}. Irregular meals and high-fat, low-carbohydrate patterns are associated with more migraine days – more stable glucose supply seems to offer protection ^[8].

Acupuncture has long moved out of the “maybe” zone: randomized studies show a reduction in migraine days and fewer side effects compared to traditional prophylaxis. In an open RCT, the number of migraine days after 12 weeks of acupuncture decreased significantly more than in the waitlist; after six months, 81% of those treated had at least a 50% reduction compared to 36% in the control group ^[9]. Meta-analyses demonstrate a small but consistent advantage over medications in terms of migraine days, better response rates, and fewer treatment dropouts – effects persist in follow-up ^[10]; further RCTs confirm non-inferiority to Western pharmacotherapy with fewer side effects ^[11]. Additionally, the evidence for micronutrients presents a practical profile: Magnesium, riboflavin (Vitamin B2), and coenzyme Q10 reduce pain intensity and disease burden in studies; combination preparations show clinically relevant improvements, sometimes with a trend toward fewer migraine days ^[12], while observational data with magnesium combinations report significant decreases in migraine days and better quality of life ^[13]. For riboflavin alone, pediatric data suggest safe, moderate efficacy, especially without other headache comorbidities ^[14]. Relaxation techniques such as progressive muscle relaxation measurably normalize cortical hyperexcitability and have efficacy comparable to some medication options – provided they are practiced regularly ^[15]; reviews emphasize the effectiveness of relaxation, endurance exercise, biofeedback, and cognitive behavioral therapy, especially in combination with pharmacotherapy ^[16].

- Smart use of magnesium: Test 300–400 mg of elemental magnesium daily, preferably as citrate or bisglycinate, for 8–12 weeks. Combining it with riboflavin (200–400 mg/day) and CoQ10 may enhance the effect; studies show less pain intensity and lower disease burden, with some trend towards fewer migraine days ^[12]. Observational data with magnesium combinations report notable decreases in migraine days and better quality of life ^[13].
- Targeted dosing of riboflavin: 200–400 mg/day for adults for at least 3 months; for children, low doses under medical supervision are safe and moderately effective, particularly without other headache types ^[14].
- Daily relaxation as “neural training”: Progressive muscle relaxation for 10–20 minutes daily or meditation. It works when it becomes routine: PMR can normalize cortical hyperexcitability and reduce migraine frequency; reviews confirm the effectiveness of relaxation, biofeedback, and endurance training, preferably combined with medications ^{[15] [16]}. For children, TM, hypnotherapy, and PMR are equally effective and safe – choose what suits you ^[17].
- Acupuncture as an add-on or alternative: 6–12 sessions over 6–12 weeks. RCTs and meta-analyses show fewer migraine days, lower pain intensity, and fewer side effects compared to many prophylactic medications; effects persist in follow-up ^{[9] [10] [11]}.
- Trigger management with high-performance basics:
- Hydration: Aim for 2–3 liters of water daily, plus 0.5–1 liter with exercise/heat. More water correlates with fewer, shorter, and milder attacks ^{[4] [5]}.
- Regular meals: Eat every 3–5 hours, including proteins + complex carbohydrates. Irregularity and high-fat patterns favor attacks; stable glucose offers protection ^[8].
- Avoid additives: Try 4 weeks without MSG and nitrate-rich processed products (e.g., some ready-to-eat snacks, cured meats). Preclinical evidence supports the trigger mechanism ^{[6] [7]}.
- Use acute medications strategically: A maximum of 8–10 days/month (depending on the active ingredient) and avoid rebound; plan a prophylaxis with a doctor if acute use is high ^{[1] [2] [3]}.

Migraines can be systematically defused: Hydration and regular meals stabilize, daily relaxation trains the nervous system, micronutrients and acupuncture reduce the attack burden – all supported by solid evidence. The next step: create a 12-week plan (water target, PMR routine, magnesium/riboflavin, acupuncture appointments) and maintain a trigger diary to find the personal effective combination.