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If you get migraines frequently, I'd suggest going to your doctor and asking for a referral to a neurologist if they aren't too familiar with migraines (mine wasn't at all). I went to my family doctor and he put me on Imitrex. It worked well, until I discovered I was highly allergic. Since all the migraine drugs are part of that same class, chances are I'd be allergic to all of them, so my doctor sent me to a neurologist.
My neurologist had me keep a headache diary of how long I had them, how bad they were, and anything that could've possibly triggered each one (foods, weather, noise, smells, etc.). I realized I got them more often than I thought, and that some lasted a few days or more. At the same time as I was doing this, he put me on Fioricet for the pain, and those are pretty hardcore drugs (not narcotics, but still knock-you-on-your-butt if you're not careful). There were times when I'd take my daily dosage within the first 4 hours and still be in pain.
When he saw that wasn't working for me, my doctor put me on Atenolol (blood pressure medication). I joked about being geriatric, but the stuff worked - when my blood pressure was lowered, the headaches really couldn't begin in the first place. I've stopped taking it since I stopped taking Ortho Tri-Cyclen (I was on that for various hormonal reasons and I really think that's what made my headaches worse) - my blood pressure was already messed up enough from the Ortho and I got sick of feeling like I was going to pass out whenever I stood up. I'm sure my doc could've adjusted the dosage, but I went to a lower dose for a month and then went off it completely.
One thing you might want to check if you're trying to figure out a cause is the weather - I'm in Cleveland, so our weather changes at the drop of a hat. Whenever there were drastic pressure changes, I'd get headaches (sort of like people with arthritis feeling it in their joints). Another migraine tip: no matter what painkiller you use, take it as soon as you feel you might be getting a migraine (I'd usually take 3 Excedrin - the caffeine in it helps because it dilates the blood vessels and releases some of the pressure, according to my doc). If you don't catch it right away, you're usually in it for the long haul.
I also wouldn't recommend cutting caffeine completely to try to get rid of them. You might end up with headaches from the caffeine withdrawal instead, and those can be just as bad.
Good luck,
Liz
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