Table 7.

Migraine Management

Concept	# Interviews Coded	Definition	Example Quotes
Predictability / Control of migraine	63	Ability to feel that you have control over your life and circumstances, to predict how you will feel and function over a given period of time so that you can plan ahead	I make a lot of my decisions on an as-needed or morning basis, because there’s no way I’ve found to be able to predict what tomorrow’s going to bring. I’ve just had random ones that just come on, and I don’t know what even triggered it…I could be driving down the road and, boom, one hits me and I get to where I can’t even see. So I have to stop. I have to pull over. I already know that before my [menstrual] period, I should just plan to be sick…it’s almost like I feel in control, that I know when I’m going to be sick. So, when I’m surprised and I’m sick when I’m not supposed to be, then that feels like it impacts my life a lot more.
Cocooning	64	Practices of withdrawal and self-isolation during an attack	And for me what migraine looks like is kind of a dark room with no sounds and just being in bed for a long time. During a migraine, it all stops…I just have to retreat. I have to come back and close the curtains in my room, turn off all the lights.
Avoiding selected activities	21	Choosing to avoid activities because of the risk of triggering a migraine, withdrawing from participation during attacks	Sometimes you mentally remove yourself because it almost hurts to try and keep up with everything…I don’t talk. There are times when I just won’t participate in the conversation because I know I’m going to have problems. I avoid definitely long-term tablet or computer use…I love music, but I find myself listening to much less than I used to or even at lower volumes…I very much avoid stressful situations, confrontation of any sort, maybe avoid driving, because that’s sort of a stress.
Avoiding triggers	26	Avoiding specific known triggers, such as foods or environmental factors	I’ll try to not eat sugary things, especially in the morning, and then I’ll try to not stay out in the heat or humidity for too long and I’ll just try to de-stress as much as possible.
Lifestyle changes	11 (Study 2 only)	Choosing to adopt a lifestyle that minimizes risk of migraine attacks, builds health and well-being, or prioritizes one’s own health and welfare needs.	For me, what’s important is all the preventative stuff, right? Sleep, number one. Making sure I don’t do anything to disrupt my sleep, which is really easy to do. And I really hate - the doctors were right on this one - but exercise. So, regular exercise, which is really hard to do when you have an attack going.
Use of non-pharmaceutical therapies	12 (Study 2 only)	Use of therapies other than medication to manage migraine symptoms or to prevent attacks	I use peppermint aromatherapy cooling sticks - like, it just goes on my wrists - for the nausea…I have a whole bunch of different weighted masks and that kind of thing just to be more comfortable, you know. I have the ice hat. I do that. I meditate. I do stretches.
Pushing through	42	Choosing to continue functioning during a migraine attack despite symptoms or impairments	You know, every time you have an attack, you can’t just shut down. If it’s a milder one, you have to do things. And you don’t feel good doing them, but that's life. Sorry, bad luck. I will push through because that’s my responsibility as a mom.
Direct costs	21 (Study 2 only)	Comments about the direct costs of migraine, such as out-of-pocket medical costs or time spent obtaining medical care or dealing with insurance companies	At the beginning of the year, it cost, like, $400 for eight pills, and you’re like, “Oh. Great. Is this attack bad enough to take a pill?” You know? So it’s, like, rationing and figuring out, how bad is this attack?…I had a really forward-thinking doctor who wanted to try all these different procedures, but every time there was a procedure it was, like, a day off of work and then a day to recover, so this is two days I was taking off.
Self-sufficiency	21 (Study 2 only)	Ability to feel self-sufficient, have the sense that one can manage one’s health condition	I haven’t found the magical solution or the cure - that doesn’t really exist for migraine - but have learned by being very proactive and advocating for myself and my own management of migraine to find things that have allowed me to live a pretty controlled and pretty normal life around migraine. I actually built like a migraine emergency kit to deal with especially the depression because it’s kind of sudden and I wouldn’t know what to do, so I have a kit to help me with that…I have an anxiety workbook that has coloring and jokes in it…A cute little teddy bear thingy in there. And all the extra medicine stuff. Like portable heating pads and icy things. Like the medical stuff but also things to just make me happy.