Living well with migraines is a first line of defense to help headache patients achieve better headache  control and improve quality of life. There are a number of lifestyle factors that may have influence in managing headaches.  Some of these factors, for individual patients, may be as important as many of the medical or other therapeutic approaches employed for headache control.   This brief discussion will focus upon those lifestyle changes that may positively influence headache frequency in patients with migraine.

SLEEP:

The human body does not function well when it is sleep deprived.  In the 21st Century this has become a common problem for many.  The literature suggests that teenagers require a minimum of 9 hours of sleep for proper restorative function.  Adults require 71/2 hours. During healthy restorative sleep the brain goes through a series of stages of sleep from very light to very deep sleep and include the active dream stages of sleep as occur during REM (Rapid Eye Movement).  Many medications, including “sleep medications” which are referred to as “ hypnotics” may disrupt these healthy stages of sleep. Alcohol, nicotine and caffeine are notorious for being disruptive to quality sleep.

If possible, it is best for patients with migraine to attempt going to bed approximately the same time each night and plan to awaken as the same time each morning.  In those susceptible migraineurs sleeping in on days off and on vacations may disrupt the brain’s inherent sleep-wake rhythms and contribute to migraine headaches. Thus, over sleeping or under sleeping could be a trigger for migraine occurrence.  Brief daytime naps are not an issue if they do not cause headaches or contribute to insomnia.

Having chronic recurrent headache pain may contribute to insomnia, just as having insomnia contributes to headaches.  Addressing the issues together may be beneficial and improve overall outcomes.

 

ORAL INTAKE/DIET:

Everyone is unique but there are categories of foods that are more likely to be triggers for migraine that others. People with migraine vary in their sensitivity to specific foods.  Some foods contain naturally occurring amino acids as tyramine, phenylethylamine and dopamine. These amino acids, even in patients without headaches, may provoke brief significant increases in blood pressure when taken in sufficient amounts.  Specific patients with headache may lack the ability to rapidly metabolize these amino acids which may have prolonged effects on blood vessel tone as a possible cause of headaches. Others may have an inheritable condition in which they are unable to breakdown glutens in the intestines and this disorder has been linked not only to severe gastrointestinal and nutritional problems but also to a number of neurological issues including headache.

Food additives may sensitize some migraineurs to an attack.  The most common of these is MSG (monosodium glutamate) and aspartame (an artificial sweetener).  Both of these compounds are derived from or are transformed to amino acids essential for life. These compounds play a role in the brain as stimulating neurotransmitters (chemical messengers).  When used in excessive amounts they may cause migraine in susceptible individuals. Recent trends with bottled waters (some promoted as being nutritional) contain the B vitamin niacin which in some people promotes excessive dilation of the blood vessels and with this, headache.

Nutritional supplements such as minerals and vitamins are not needed for most people who eat well balanced food choices, including adequate sources of meats, fish, dairy, vegetables and fruits.  Those who have less than optimal diets may need to use multi-vitamin supplements. If there are dietary issues, patients are advised to consult with their primary care physicians for advice and guidance.  In some migraine patients a magnesium supplement may be recommended. Since magnesium deficiency may be within the brain cells and not necessarily within the blood stream, laboratory testing for magnesium deficiency in migraine may result in variable outcomes.  Therefore accurate hematologic testing for magnesium deficiency in migraine may not be a reliable indicator since the deficiency is within the neurons and not systemic. For this reason, in some migraineurs with specific type of migraine, magnesium supplements may be prescribed empirically.

 

ORAL LIQUID INTAKE:

Children, adolescents, and many adults may be prone to headaches from being relatively dehydrated.  General guidelines suggest that 8 eight ounce glasses of water per day should be consumed by adults.  However most healthy people can stay hydrated by drinking water and other fluids when they feel thirsty.  For some people fewer that eight glasses of water daily may be enough. Physical activities including active play by children and adolescents should be accompanied by an increase in fluid consumption.  Special brands of water or bottled waters in general are not needed.

There is also much individual variation in sensitivity to caffeine and some people do best by completely avoiding caffeine.  But caffeine has become almost ubiquitous in our diets. Part of this may be related to the stimulating effect it has that may counterattack the fatigue that occurs from not getting adequate sleep.  Caffeine is found in coffee, tea, soft drinks, chocolate, energy drinks and many over the counter and some prescription pain relievers. In some individuals, the ingestion of caffeine may precipitate migraine while in others missing a daily dose of caffeine may precipitate the headache.  The following are the amounts of caffeine in different ingested products:

. A typical dose of over the counter medication contains

 an average of 130 mg of caffeine

. A medium sized chocolate bar contains 50 mg of caffeine

.  A 12 oz. can of soda may contain between 50-100 mg of caffeine

.  A 6 oz. cup of coffee contains an average of 100 mg of caffeine

.  A 6 oz. cup of tea contains an average of 20-60 mg of caffeine

.  6 oz. of decaffeinated coffee contains an average of 2 mg. of caffeine

 

There are also a number of foods that can trigger migraines.  If a migraineur identifies a particular food that is associated with their migraines, that food should be eliminated from their diet.  Some examples of different foods that can be triggers for migraine include:

   

.  Caffeine as above.  It is recommended patients with migraine should

        limit their caffeine intake to less than 200 mg of caffeine per day

.  Chocolate

.  Alcohol – Some migraineurs are especially sensitive to wine.  Red wine is notorious as a headache trigger.  This appears to be related to a specific chemical substance in red wine.  White wine, tap beer, and the distilled clear liquors are less likely to provoke a migraine

.  Foods containing sulfates which is a type of preservative

.  Raw onions

.  Monosodium Glutamate and Aspartame as discussed above

.  Oranges, grapefruit and other citrus fruits

.  Nitrates and nitrites which are added to foods as preservatives

 

EXERCISE:

 

Aerobic exercise for 20 minutes four times a week may exert significant benefits on the brain’s pain regulating system and with that reduce the severity of headaches.  Hoverer, some individuals may experience the onset of or worsening of headache related to exercise. While it is important to determine that there is no serious underlying cause for this, it may be a matter of the form of exercise one does.  High impact aerobics, running and weight lifting are the forms most likely to contribute to or cause headache. In those with sensitivity to these forms of activity, other exercises as swimming or bicycling may be a better alternative.

 

STRESS:

 

In these times it would be truly an exceptional person who does not experience stress.  There are many different definitions of emotional stress. But common within all the different definitions of stress are the physical, emotional and psychological strain secondary to the precipitating factors.  Stress as a condition or feeling is a state experienced when a person perceives that the demands exceed the personal and social resources that the individual is able to mobilize. Stress as an emotional and pathophysiological state can trigger the body’s response resulting in the release of different hormones, including adrenalin and cortisol.  Tachycardia, alterations in the digestive system, shunting of blood flow to major muscle groups and changing of the various other autonomic system functions are just a few of the physiological changes that can occur as a byproduct of stress. Stress can also be a trigger for migraine. Between 50% and 70% of people with migraine can connect their symptoms to situations induced by a stressful event or even daily stress.  Migraine may occur with either the buildup or the let down from a significant stressful situation. Thus, stress management with appropriate behavioral cognitive therapy in tandem with behavior modification training are also important mechanisms in the control and management of both episodic and chronic migraine.

 

Migraine can be different from person to person or even from one migraine to the next.  This brief review is focused upon “triggers”, a tern healthcare provider’s use for those internal or external factors that can precipitate a migraine in susceptible individuals.  Migraine triggers might be different from one person to another but common migraine triggers are factors to consider in developing a migraine prevention plan.