As someone who lives with chronic migraine, I’ll be the first to say that migraines can suck the life out of you. If you have experienced these debilitating headaches, you know what I’m talking about. (And I feel ya friend!) The good news is there’s been a lot of headway, (pun intended!) with more research and treatments being released all the time.
But migraines are no fun, there’s no doubt about it! Yet, getting armed with the right tips and tools can make a huge difference in migraine management.
I’ve learned a lot about this disease over the last 20+ years. Here are a few ideas you might find useful if you get migraines often, or just get pesky headaches once in a while…
My Migraine Story
Real quick, let me give some background. I’ve suffered from this condition since I hit puberty (thanks to Aunt Flo hitting the scene!) Back then, my family and doctors assumed I had bad sinus headaches so I was treated with Zyrtec and Allegra. As you might guess, I never had any relief and significant migraine episodes throughout my teenage years.
It wasn’t until I was in college that I was properly diagnosed with migraine attacks at a headache clinic in Ann Arbor, Michigan by a headache specialist. I was put on a medication protocol that included preventive treatments (medicine I would take daily) and acute medication (medicine I would take at the onset of migraine.)
While I still had an episodic migraine on occasion, I felt like I was finally getting my life back! And I did, for many years.
Fast forward to today, I’m suffering again but now it’s turned into chronic migraine – more than 15 days a month. I have some level of pain every.single.day.
But now, in the 2020’s there’s a lot more awareness, research, and state-of-the-art treatments for the migraine. Not to mention, I’ve personally learned A LOT along the way….
Ok, let’s get to my learnings for y’all!
What is a Migraine?
First of all, what’s a migraine exactly? You might be surprised to learn that migraines are the most common neurological disorders. (Not just a headache, as most suspect). Migraine attacks are throbbing, ick-pick type pain – often on one side of the head – and last a few hours, to several days! (I have had migraines that last weeks or more!) And the associated symptoms can be just as challenging as the pain itself.
Symptoms that often accompany migraine headaches are:
- Increased sensitivity to light and sound
- Nausea and stomach pain
- Tingling and numbness in limbs
- Visual disturbances
- Stiff neck & body pains
Also, some individuals may experience specific visual disturbances that appear like a flashing light or zig-zag image just before and during the migraine episode – this is known as an aura.
According to JamaNetwork, “Migraine affects an estimated more than 10% of people worldwide and occurs most often in people 20 to 50 years of age. It’s also about 3 times more common in women than in men. As a matter of fact, in a large US survey, 17.1% of women reported having migraine symptoms and only 5.6% of men.”
Women are more likely to have migraines due to the influence of fluctuating hormones… lucky us ladies! :-/
Additionally, according to the International Headache Society, migraine attack is among the top five leading causes of emergency department visits each year. (The pain is for real!)
Migraine Management – My Experience and Suggestions
While a lot remains a mystery to physicians on the exact cause of migraines, it’s thought that different triggers ‘over-excite’ and affect brain activity creating abnormalities to our nerve signals, blood vessels, and chemical messengers (neurotransmitters) that create the head pain.
You may have heard of these popular neurotransmitters: serotonin, dopamine, norepinephrine, GABA, acetylcholine, glutamate, and histamine. It’s thought when these neurotransmitters are disrupted it contributes – or may even be the primary cause of the migraine attack.
Therefore, a migraine brain is extremely sensitive to change, disruptions, and stressors – anything that could disrupt the balance in the chemical makeup of the brain.
There are 3 primary ways to address migraine headaches:
- Lifestyle and migraine triggers
- Acute migraine treatment (such as when the symptoms are acute or worsen)
- Preventive treatment (medicines and interventions designed to reduce the tendency or frequency of an attack)
In this article, I’m going to cover lifestyle and migraine triggers as that’s the best way we can manage our conditions without resorting to medical treatments – medications should be used as a last resort and for worst-case situations.
For example, reaching for acute migraine medications too frequently can result in what’s called medication overuse headaches. This occurs when you take acute treatment too often that you now get a migraine if you DON’T take it! I’ve been there and it sucks a big one! And it’s a terrible and PAINFUL pattern to get out.
Lifestyle Modification and Trigger Reduction
It’s sometimes difficult to identify triggers for severe headaches and migraines. Especially if it seems like EVERYTHING causes head pain, (I hear ya!) But lifestyle and trigger reduction is the best place to start because we can make adjustments ourselves. (While working with a migraine professional).
Nutrition – Maintain Meal Times & Stick to Whole Foods
The food you consume is the best lifestyle change to address, yet nutrition is often overlooked by a healthcare professional as part of treatment options. Starting to maintain regular eating habits is helpful to reduce migraine occurrences. My neurologist said fasting was not the best idea for migraineurs, and research confirms this.
By fasting we put ourselves at risk of low blood sugar, also called Hypoglycemia – which is a known headache and migraine trigger due to the fluctuations of the hormone insulin.
Also, research tells us that if you already suffer from headaches in general, you’re at a much greater risk of fasting headaches & migraines. So best to leave the intermittent fasting (IF) to others and stick to normal meals that keep energy and blood sugar as stable as possible. This also includes low GI foods and avoiding sugar/processed foods and when you do have meals to avoid blood sugar spikes.
It’s not just when you eat, but what you eat that plays a big role in migraine management.
A 2021 study in the Journal BMJ Case Reports revealed a case study of a man who suffered from chronic migraine headaches for more than 12 years who switch to a whole food, plant-based diet – the LIFE diet (Low Inflammatory Foods Every day) for two months and went from 18-24 migraines a month to one!
There is something to be said about eliminating processed food from one’s diet and focusing on magnesium-rich leafy greens!
Diets rich in magnesium and Omega 3’s are said to have a positive effect on migraine frequency. As a matter of fact, recent research notes diets with increased omega-3 fats (while reducing linoleic acid sources, like vegetable oil) help migraine sufferers reduce the number and intensity of headache days. So, even more, a reason to put down the Lay’s Potato chips and pick up some flaxseed Flackers instead!
Dehydration is a big trigger for migraineurs – even a slight dip can invoke a ‘run-away migraine’ that can cause several migraine days in a row as you try to catch up on hydration. This was a big problem for me when I was competing in triathlon! Treat migraines before they start by keeping a water bottle with you all day!
Photo by Bluewater Sweden on Unsplash
Routine Exercise & Physical Therapy
While it might be hard to have the energy and stamina to get in physical activity while battling chronic migraine, research shows it benefits migraine headache sufferers.
According to the American Migraine Foundation, “Exercise can help manage the symptoms and triggers of migraine in a few different ways. Exercise releases endorphins, which are the body’s natural painkillers. Endorphins also induce positive feelings and a sense of well-being which can be especially beneficial for those living with migraine, as they face an increased risk of anxiety and depression. Additionally, exercise can improve sleep quality and consistency and help relieve stress, which are common migraine triggers.”
I’ve found routine physical activity has been critical in reducing headache frequency and episodic and chronic migraine. Not to mention overall mood improvement and quality of life! I recommend everyone include exercise in their treatment plan.
Walking and yoga are great options that I love + physical therapy is often recommended by headache clinics to help with neck and body pains that are common in people with chronic migraine.
Note: Be careful to not overexert your effort or get your heart rate too high – perhaps get a heart rate monitor to gauge your effort. Working at max effort for too long can actually cause a migraine in sensitive individuals – it does for me! And don’t forget to ask your healthcare professional if you’re cleared to work out!
Photo by Arek Adeoye on Unsplash
Catch Your ZZZ’s
When healthcare professionals discuss common triggers the quality of our sleep is another that is often overlooked. But sleep is critically important when addressing chronic pain and health conditions – especially ones relating to the brain.
According to the National Headache Foundation, “Sleep is a fickle factor when it comes to headaches. While too much or too little sleep can often spark a migraine, napping can sometimes relieve unbearable head pain.”
Examples of sleep affecting episodic migraine and chronic triggers include:
- Sleeping in too late, known as the “weekend headache”
- This occurs most often in heavy coffee drinkers who miss their usual caffeine window by sleeping in causing withdrawal and therefore a rebound headache.
- It’s thought that the pain is caused by vasodilation or the expansion of the cranial arteries
- Lack of quality and quantity of sleep
- It’s critically important for people with frequent headaches and other migraine symptoms to get enough sleep since fatigue is one of the most common triggers of migraine.
- Ironically, according to a study published in the Journal of Headache, people with chronic headaches also have a high prevalence of insomnia (~66%) further suggesting that the quality of sleep is a risk factor in chronic headaches.
- Nap Strategically
- Napping can sometimes relieve pain that won’t go away on its own or with any abortive medications. (I do this a lot!!)
- However, for some individuals, acute medications are necessary before hitting the sack otherwise they can wake up with more severe pain than when they drifted off…
Photo by Vladislav Muslakov on Unsplash
Relaxation Techniques – Meditation, Yoga, Massage & Journaling
Dealing with the stress of chronic pain and migraine headache is the understatement of the century!! Believe me, I get it! But relaxation techniques to help de-stress have been shown to reduce migraine days significantly.
Peter Goadsby, M.D., Ph.D. shares in American Migraine Foundation, “The migraine brain is vulnerable to change such as sleep and stress, and is, therefore, best kept stable.”
To manage chronic migraine stress, start by protecting your time to allow for relaxation and downtime. Use your calendar and book time for self-care – it’s important! Even just 30 minutes can go a long way. A few ideas include:
- According to WebMD, “A 2020 study published in the medical journal Neurology found that people with migraine who did yoga for 3 months reported fewer and less intense headaches than those who just took medications. They were even able to cut back to about half their usual dose of migraine medicine.” Namaste~
- Even if you can’t get a professional massage, no worries! A study in Frontiers Neurology says you’ll see benefits with a just one-minute peppermint oil temple self-massage. (Pro-tip: Check out The Migraine Stick and/or BioFreeze for easy at-home options!)
- By getting our thoughts down, it can feel like ‘therapy on paper’ and help us get in touch with our feelings as we battle disease daily. There’s something cathartic about putting everything out there and leaving it …
Photo by processingly on Unsplash
Addressing Mental Health & Complementary Therapies
According to an American Migraine Prevalence and Prevention (AMPP) study referenced in American Migraine Foundation, those suffering from chronic migraine were more likely to have depression, anxiety, and other medical conditions than those with episodic migraine.
This further highlights mental health risk factors in migraine patients, especially chronic migraine-diagnosed patients.
As a matter of fact, tricyclic antidepressants are often prescribed as a preventive medication to address both neurotransmitter function AND depressive symptoms in chronic migraine.
The unpredictability and debilitating pain of chronic migraine can easily result in mood irregularities and add to negative symptoms.
However, many treatment options for anxiety and depression have a lot of crossover with migraine management such as cognitive behavioral therapy (CBT), psychotherapy, antidepressants, and relaxation therapy techniques.
If you’re like me, it can be scary and nerve-wracking to get help. “No, not another doctor” might run through your mind – that’s definitely what I thought! But getting started on some of these therapies can make a big difference on the battle of chronic migraines.
Each of us has individual triggers and keeping a headache diary or using a migraine app can help you identify your personal trends. (I’ve used MigraineBuddy which is great because it also shows weather and you can track your menstrual cycle). Yet, there are still triggers across the board that affects almost all migraineurs. We can bring down our risk factors by avoiding items.
Popular Migraine Triggers
- Stress is a trigger in migraine attacks in nearly 80% of individuals
- Shifts in female hormones estrogen (and progesterone) wreak havoc on headache-related chemicals in the brain and are actually known as the worse, most intense type of migraine
- Caffeine & alcohol
- Migraineurs often experience more headaches after drinking coffee (likely by serotonin effects or brain electrical activity.
- Regarding alcohol and migraine Dr. Sheena Aurora, a neurologist and adjunct clinical associate professor at Stanford University explains, “The [migraine] brain is hypersensitive” and therefore “dehydration and tannins can trigger migraine.”
- Red wine is noted as the worst alcoholic beverage among migraineurs
- Weather changes
- Many different weather changes affect migraine patients differently – but barometric pressure and humidity are among the worst offenders.
- Sometimes you can abort an attack simply by chugging some water!
- Dehydration affects our whole body at a cellular level – including our brain.
- Specific Foods
- Remove popular trigger foods such as; chocolate, cheeses, artificial sweeteners & colorings, histamine/MSG, aged meats, most citrus, processed foods high in sugars, etc.
- Avoid your personal triggers as well.
- Strong smells
- Candles, perfumes and even chemicals and gasoline can hit nerves in our nasal passages that can trigger a migraine, or make one worse!
- Bright or blinking lights
- Both bright light, fluorescent light, and even natural light can trigger or add to the pain of a current migraine attack. Light sensitivity is actually one of the distinct differences between migraine vs other headache disorders. (On bad days, I’ll wear my sunglasses in the house! )
- Loud noises
- According to MigraineBuddy, “With migraine attacks, there is usually higher sensitivity to sensory stimuli which means that at least one of the senses of hearing, touch, sight, taste, and/or smell becomes more sensitive!”
- Sound sensitivity is one of the most common symptoms experienced by the migraine community.
- A clock ticking, a vacuum running or a dog barking can feel like nails on a chalkboard!
- One study recognized 37% of individuals with allergies have migraines as well
- Migraine patients have a sensitive nervous system, so when they come in contact with allergens it quickly triggers their immune system to release histamine – a known migraine culprit.
- Additionally, allergens fuel inflammation throughout the body and brain creating pain and migraine.
Food Triggers! Photo by Cristiano Pinto on Unsplash
It’s still crazy to think that researchers still have such few answers on the mystery of migraines. But I must say, the community has made more advancements in the last two years than the last thirty! (Seriously!) I’ve tried almost everything that has come to market and like all medications (even neuromodulation devices) they’re not without side effects… or medication overuse risk.
So, I will continue to explore and share all the nutrition, lifestyle, and trigger-reducing strategies I can! My treatment plan for chronic migraine is a 360 degree approach… and a team effort! #teamsimon
I am not a doctor or healthcare professional – I recommend you visit with your doctor before starting any lifestyle or medical changes!