Patient handout · Pain & Hypermobility
Chronic migraine is one of the most treatable neurological conditions there is, and yet many people spend years cycling through the same over-the-counter painkillers without ever being offered a real plan. This page walks through how migraine is actually treated today, from stopping individual attacks to preventing them altogether, and where care fits for people living in Victoria and Burnaby.
The single most important idea is this: good migraine care is a plan, not a product. Botox, a pill, or an injection is never the whole answer on its own. The goal is to fit the right combination of tools to your particular headache pattern, and that starts with understanding what kind of migraine you have.
Doctors separate migraine into two broad patterns because they are managed differently. Episodic migraine means fewer than 15 headache days a month. Chronic migraine means 15 or more headache days a month, for more than three months, with migraine features on at least 8 of those days. Chronic migraine is the pattern that most often benefits from dedicated preventive treatment, and it is the pattern for which several of the newer therapies are specifically approved.
If you are not sure which describes you, a simple headache diary is the fastest way to find out. Even rough notes on your phone - how many days you had a headache, how bad it was, and what you took - give a clearer picture than memory alone, and it is the first thing a good assessment looks at.
Almost every migraine plan has two sides. Acute treatment is what you reach for when an attack is starting, to stop it. Preventive treatment is taken regularly, whether or not you have a headache that day, to make attacks less frequent and less severe. Most people who are struggling need attention to both halves, and getting the preventive side right is often what finally changes things.
Acute options range from simple anti-inflammatories to migraine-specific medications called triptans, and newer classes such as the gepants and ditans that work on the migraine pathway directly. Anti-nausea medications are sometimes added because they help both the symptom and the absorption of other treatments.
One caution matters here: using acute medication too often can quietly make headaches worse, a pattern called medication-overuse headache. If you find yourself taking something for pain more days than not, that is itself a sign that the preventive side of your plan needs attention rather than more painkillers.
Preventive treatment is worth considering when migraines are frequent, disabling, or not well controlled by acute medication alone. There is no single best preventive - the right choice depends on your pattern, your other health conditions, what you have already tried, and your preferences.
Oral preventives are often the starting point. Several familiar medications - certain blood pressure medications, some antidepressants used at low doses for their nerve-calming effect, and particular anti-seizure medications - have long track records in migraine prevention. They are chosen carefully, because the best one for you often depends on what else is going on with your health.
One of the most significant developments in migraine care is a group of treatments that target a molecule called CGRP, which plays a central role in migraine attacks. These come as regular injections you can give yourself, and as tablets, and they were designed specifically for migraine rather than borrowed from another condition. As a physician, Dr. Baldwin prescribes and monitors these therapies, which widens the options well beyond what is available over the counter.
OnabotulinumtoxinA, commonly known as Botox, is Health Canada approved specifically for chronic migraine and has been used for this purpose for over two decades. It is a preventive treatment: a series of small injections given roughly every twelve weeks, following a standardized protocol, meant to reduce how often migraines happen rather than to stop one that is already underway. It tends to suit people whose pattern is genuinely chronic. You can read more on the dedicated migraine Botox page, including what an appointment involves and how coverage works.
For many people, tight muscles in the neck and shoulders feed the headache pattern, and treating those muscles directly can be part of the plan. Trigger point injections target the specific knots that refer pain up into the head. This is especially relevant when neck tension and jaw clenching are part of the picture, which they often are.
The unglamorous parts of migraine care are also some of the most powerful. Irregular sleep, skipped meals, dehydration, and unmanaged stress are common contributors, and steady routines genuinely reduce attack frequency for a lot of people. Identifying your own triggers through a diary, rather than guessing, is what makes this practical rather than a list of vague advice.
Migraine turns up more often in people who are hypermobile or who have Ehlers-Danlos syndromes, alongside jaw pain and neck tension, and these connections are not coincidences. If that describes you, treatment is planned with that context in mind. There is more on this in our article on how jaw pain, migraine, and hypermobility connect.
Because the right combination is individual, migraine care starts with an assessment rather than a fixed protocol. Dr. Baldwin sees patients at Hillside Medical Clinic in Victoria and Kensington Medical Clinic in Burnaby, and manages migraine comprehensively - reviewing your acute medications, considering oral and CGRP-targeted preventives, offering therapeutic Botox and trigger point injections where they fit, and working through the triggers and habits that shape your pattern. The assessment figures out which of these belong in your plan.
If migraines are running your calendar, the most useful next step is a proper assessment where the whole picture gets looked at together, rather than one more painkiller.
Consultations for TMJ, migraine, and hyperhidrosis are available at Hillside Medical Clinic in Victoria and Kensington Medical Clinic in Burnaby.