September 1-7 is Migraine Awareness Week
The purpose of Migraine Awareness Week is to improve understanding, and reduce stigma attached to this very common disorder.
Even though migraine is a complex, neurological disorder, with a genetic basis, we are not powerless to help. Just as there are things we can do to trigger migraines, there are also steps we can take to reduce their frequency and intensity. The migraine brain is sensitive to disturbances on many levels: blood chemistry, hormonal balance, and sensory input such as light, sound and smells. It follows that if we smooth out the peaks and troughs of brain activity, we stand a good chance of reducing the triggers of migraine.
What is the SEEDS approach to Migraines?
The SEEDS approach was developed by Dr Lawrence Newman, past president of the American Headache Society. It outlines simple lifestyle changes we can all make to reduce our migraines. Each day this week I will be discussing a different part of the approach.
S is for Sleep
Lack of sleep or disturbed sleep is one of the most common migraine triggers. The migraine brain likes consistency, so sticking to regular bedtimes and morning waking times will make your life easier. Unfortunately this means people who get migraines don’t make great party people!
We used to think that the brain rested at night. However recent research is showing that the brain is very active during sleep. It can be up to 10 times more active than during the day. Specifically, a part of the brain called the glymphatic system is busy clearing toxins and maladaptive proteins during the night.
Studies have shown that poor sleep increases our sensitivity to pain, and makes any migraines worse.
Almost all people with chronic migraine complain of bad sleep. Developing good sleeping habits can make a huge difference to someone’s migraines, sometimes more than medication.
Tips for better sleep
During the day:
- Avoid having a nice lie-in, or that afternoon nap, these can disrupt your sleep/wake cycle.
- Exercise outside, or take a walk during the morning, to help set your brain’s light/dark system.
- Reduce your caffeine intake, especially after 2:00pm, as the caffeine takes a while to leave your body.
In the evening:
- Exercise is great to improve sleep, but its best to avoid vigorous exercise in the evening. Try some gentle stretches or meditation instead.
- Reduce your exposure to bright lights: television, computer games and even reading devices. Light going directly onto the retina stimulates the brain and disrupts the sleep/wake cycle. It’s better to read a book, rather than a kindle, in the evening.
- Don’t eat a large meal too close to bedtime, and try to avoid foods that may give you indigestion.
- On the other hand, food that contains melatonin may help sleep. Try a handful of walnuts, almonds, tart cherries or a banana, close to bedtime.
- Make sure the bedroom is dark and cool, and try to keep the bed just for sleeping or making love.
E is for Exercise
People who get migraines tend to exercise less than other people. This is no great surprise, as activity tends to make migraines worse. Just walking up the stairs can be intolerable for some. However, exercise is one of the top healthy habits proven to help relieve migraine. It can be as powerful as medication in preventing migraine attacks.
As well as the general health benefits that we all know, exercise has several benefits for people who get migraines.
- Physical activity is great for the brain. It increases brain volume, it stimulates more connections between brain cells, and even promotes the creation of new brain cells.
- Exercise is a great way to manage stress, which is an important migraine trigger for some people.
- Regular exercise helps with the depression and anxiety that come along with migraine.
- One study found that over 3 months, doing 40 minutes of exercise three times a week can prevent migraine attacks.
What kind of exercise is best?
If your migraines are severe, and frequent, you should start with gentle aerobic exercise. As one activity that can boost your energy, burn calories and improve your mood, a brisk daily walk is hard to beat. Cycling or swimming are also good aerobic exercise. If people get dizziness or sensitivity to light then an indoor bike machine could be a safe, manageable alternative.
Yoga, pilates or Tai Chi are also good for relaxation, stress relief and developing a new relationship with your body.
How much exercise should I do?
Start small and gradually increase. In the early stages, just getting into the habit of activity is the main thing. People who get migraines should aim to do 30 minutes of exercise per day. This is so important that even if they can only manage 3 minutes in one go, then doing that 10 times a day would still bring great benefits.
E is for Eating.
Eat regular meals of real food, and have healthy snacks in between meals (e.g. a handful of nuts).
What about food triggers?
Many people who get migraines are aware of certain foods that trigger their attacks. Chocolate, blue cheese and red wine are commonly blamed. The scientific evidence for these is actually very limited. It is important to remember that a genuine trigger will lead to a migraine almost every time.
Some people over-react and try to eliminate their supposed food triggers so strictly that they end up with very little left to eat.
Avoid skipping meals
The most common food trigger is actually hunger. Dips in blood sugar place a stress on the brain, which may contribute to setting off a migraine. This is why people with migraines should eat regularly throughout the day. Up to 6 small meals per day has been recommended by Dr Amal Starling (Professor of neurology, Mayo Clinic).
Eat real food
Processed carbs, such as sugary food, white bread, pasta and rice have also been linked to attacks. These foods cause a spike in blood sugar, which then plummets as the body endeavours to take glucose out of the bloodstream. This drop in blood sugar may trigger a migraine. It is interesting that migraines have not been found in hunter gatherer societies. Some researchers have even described migraine as a “disease of civilisation” (Dr Josh Turknett, a neurologist in Atlanta).
D is for Drinking
Dehydration is a common trigger for migraines, and staying hydrated has been described as the “easiest, fastest treatment for migraine”.
Common causes of dehydration are not drinking enough water, sweating, vomiting and diarrhoea. People experiencing a migraine may avoid drinking because they feel nauseous. As well as thirst, signs to look out for include: darker urine, constipation, moodiness, tiredness and dry eyes or skin. It is interesting to note that dehydration is also a common thread among a number of common migraine triggers. These include exercise, caffeine, alcohol, air travel, heat, humidity, menstruation and menopause.
How much should you drink?
There is no magic number. Everyone is different and their requirements vary depending on their level of activity and the environment they’re in. Research suggests that simply drinking when you are thirsty is a reliable guide to staying hydrated. However the migraine brain is more sensitive to changes in blood chemistry. So it may be sensible to monitor how much fluid you need, and drink before you become thirsty.
As well as drinking regularly, fruit and vegetables are a good source of fluid. Apples, melons and cucumbers are particularly good, and they release fluid more gradually into your system.
S is for Stress, and stress management
Stress is regularly cited as a migraine trigger. However, it’s a tricky one to analyse because different people cope with stress in different ways, and everyone’s situation is unique.
Different triggers build up. People may be able to tolerate some stress in isolation, but if it happens on a day when they’ve not eaten or drunk enough, and didn’t sleep enough the previous night, then it may set off a migraine. There’s even a recognised pattern where people get a migraine at the start of the weekend, or a holiday. I knew one patient who called them a “Frigraine” because it happened every Friday evening. The correct term is a “let down headache”, and it occurs because the level of cortisol, a stress hormone, suddenly drops at the end of the working week. The migraine brain is sensitive to sudden changes in blood chemistry and this shift is enough to trigger an episode. The trick is to recognise your own causes of stress and work out how to manage them differently.
Try a headache diary
Keeping a headache diary can be a good way to see patterns and identify triggers over time. Once these have been identified the person can be equip themselves with strategies to cope better. My speciality is exercise and relaxation advice, but help can be found in any number of directions. Some people may benefit from relationship advice, financial counseling, time management courses, cognitive behavioural therapy or just getting some time to themselves once in a while.
At the end of the day, Migraine is a genetic neurobiological disorder, and sometimes it doesn’t matter what you do- you’ll still get an attack. The key is not to blame yourself. Experiment with stress management, develop your own coping strategies and watch the number of migraine days in your headache diary reduce over time.