Creating a Migraine Action Plan
Medically Reviewed By: Dr. Addie Peretz
Most people living with migraine know how to manage their condition and treat attacks. But what happens if your go-to treatments aren’t working? Or, what if you are traveling out of state or need emergency care? These are just a few scenarios where a migraine action plan can be useful.
What is a Migraine Action Plan?
A migraine action plan (MAP) is a personalized, documented strategy for treating your overall disease state, an individual attack, or an attack that’s not going away or responding to treatment at home.
You can work with your healthcare provider (or healthcare team) to develop a plan that best suits your specific needs. The plan should provide options for a variety of places or situations.
How or When Can a Migraine Action Plan Be Used?
A Migraine Action Plan (MAP) can be used in the following situations:
- At home: To guide how to manage and treat a migraine attack.
- When you need care outside your usual doctor’s office: For example, use a MAP if you need treatment at urgent care or the emergency room.
- While traveling: A MAP is helpful when traveling out of state or internationally.
- If you’re unable to communicate: For people with conditions like Hemiplegic Migraine, family and friends can use the MAP to help highlight potentially successful treatment strategies if you’re unable to talk.
- During pregnancy or planning pregnancy: If you require emergency care for your migraine attacks, your MAP can provide suggested treatments for your provider.
- Before or after surgery: A MAP specific to these situations can be used if an attack occurs before a procedure or during recovery. There may be medication contraindications associated with surgery, requiring an additional MAP.
What is Included in a Migraine Action Plan?
A migraine action plan should be tailored to your personal needs and migraine type.
It may include but is not limited to the following:
- Basic personal health information and headache history
- Include your name, age, allergies, headache diagnosis, relevant medical history, current acute and preventive medications, height, weight and emergency contact information.
- Typical attack presentation
- Describe the usual symptoms that occur with your attacks, such as aura, dizziness or numbness in one extremity.
- For those with Hemiplegic Migraine, it’s essential to describe your typical attack in detail to prevent unnecessary tests or treatments, such as CT scans or thrombolysis, due to stroke-like symptoms.
- At-home rescue treatment options and strategies
- Work with your doctor to decide which rescue/acute treatments to use during an attack.
- Outline which treatments are for mild-to-moderate attacks and which are for moderate-to-severe attacks. Additional treatment options should be listed if the pain persists despite using the first-line recommended treatments.
- Guidelines for when to seek treatment at urgent care or the ER
- With your doctor, establish when it’s necessary to seek urgent or emergency care. Your doctor should list recommended treatments, medications, and dosages for these situations.
- Include a list of the treatments you don’t tolerate well, that are ineffective, or that may worsen migraine (ex. opioids, butalbital-containing medications).
- Ultimately, the treating provider in urgent care or the ER will determine the best course of treatment for you, but it is helpful to provide a MAP with suggested treatments that may be more successful in treating the migraine attack.
- Preparation for travel or special events
- Having a backup treatment for status migrainosus (a migraine attack that lasts longer than 72 hours) is helpful, especially during holidays, stressful events, or when traveling internationally (ex. dexamethasone, olanzapine).
- Ensure the plan is signed with the neurologist/headache specialists contact information.
If you visit urgent care or the ER, record it in your migraine diary and inform your doctor at your next appointment. If frequent visits occur or if you are taking acute medications more than two times per week, talk to your healthcare provider to explore other treatment options.
How do I Create a Migraine Action Plan?
Work with your healthcare provider to determine what kind of MAP you need and what should be included. If you need some help getting started on a plan, the American Headache Society created a Migraine Action Plan template. It is important to note that this template was published in 2018. It does not include any mention of newer, migraine-specific treatment options like Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs), CGRP Inhibitors (Gepants), or neuromodulation devices. Additionally, the CACNA1A Foundation developed a Migraine Action Plan template for those living with Hemiplegic Migraine.
Creating a Migraine Action Plan for Kids and Teens
A pediatric migraine action plan can serve as a migraine management guide for parents, healthcare providers, caretakers, and school staff.
It can also help parents and schools create an effective 504 plan to help a child with migraine.
If you need some ideas on what to include, Migraine at School created this free, downloadable template for a migraine/headache health plan.
Migraine at School, an initiative of the Danielle Byron Henry Migraine Foundation, works to ensure young people with migraine are given every opportunity to succeed in school.
American Headache Society also has a free, downloadable Pediatric Migraine Action Plan template. AHS established guidelines and published the template in 2019.
References
- Peretz AM, Minen MT, Cowan R, Strauss LD. Introducing the Migraine Action Plan. Headache. 2018;58(2):195. doi:10.1111/head.13256
- Turner, S.B., Rende, E.K., Pezzuto, T., Weaver, S., Henderlong-Kropp, A., Greene, K.A., Bicknese, A.R., Dilts, J.J., Gautreaux, J.R., Victorio, M.C.C., Strauss, L.D., Lagman-Bartolome, A.M., Szperka, C.L., Yonker, M., Hershey, A.D. and Gelfand, A.A. (2019), Pediatric Migraine Action Plan (PedMAP). Headache: The Journal of Head and Face Pain, 59: 1871-1873. doi.org/10.1111/head.13681
Author
Molly O’Brien is a freelance Journalist and Communications Specialist originally hailing from the Seattle area. After graduating summa cum laude from Arizona State University with a degree in Broadcast Journalism, Molly traveled coast-to-coast working in local news. Molly was diagnosed with episodic migraine before the age of four, then turned chronic in her mid-twenties. Disease progression has severely impacted every facet of her life as she tries to balance migraine disease, a career, parenthood, and everyday life.
