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Migraines: what are they?
Of all the primary headache disorders, migraines are one of the most common [1]. A migraine is a “chronic neurologic disease that varies in its frequency, severity, and impact on patient's quality of life” [2], and that causes “unilateral, pulsatile, or throbbing sensations in the head” [1]. Migraines can affect those of all ages, resulting in lifestyle complications. Oftentimes, patients who suffer from migraines do not get recognized, as the disorder is often undertreated. Some common symptoms of migraines include “nausea, vomiting, or sensitivity to light, sound, or movement” [3]. Usually, these migraines can last from “4 to 72 hours” [3]. Headaches, a lighter form of migraines, can be a bit more docile, allowing you to carry on daily activities. Migraines can be more severe, getting in the way of a person's ability to finish daily tasks, and/or causing a person to be completely bedridden from the pain.
Migraine Prevention
Migraines can be caused by a considerable number of triggers, some including “stress, food, fasting, sleep deprivation, and change in weather conditions” [1].
Some essential lifestyle modifications can be made in order to prevent migraines from developing, such as “SEEDS (sleep, exercise, eat, diary, and stress)” [4]. The Cleveland Clinic Journal of Medicine goes into depth about how improving each factor can support migraine prevention.
Poor sleep habits have been shown to contribute to the development of migraines. Sometimes it’s hard to recognize bad sleep habits, especially with the rise of technology. Using your tablet, TV, or phone while in bed triggers your brain to stay awake longer, affecting the amount of sleep a person can get. It’s easy to do tasks in bed that aren't sleeping, such as reading a book, watching tv, or surfing social media, but this can actually change the brain's perception of your bed. This means the brain can be manipulated to believe that your bed is not necessarily for just sleep, and it will stop triggering the hormones that make you sleepy. In order to prevent this, it is recommended to only be in bed if you are planning to sleep. Also, it can be helpful to keep the room dark, cool, and quiet. If these steps don’t help, there are plenty of bedtime relaxation routines that can help you to unwind before bedtime.
Exercise is not too often associated with helping migraines, but as exercise can help maintain health, it can also help with migraine prevention. Oftentimes, “low levels of physical activity and a sedentary lifestyle are associated with migraines” [4]. There is some data that proves “exercise may also reduce migraine duration and severity as well as the need for abortive medication” [4]. This amount of exercise will look like “ 30 to 50 minutes 3 to 5 times a week” [4], but it doesn’t have to be this much. Even exercising for less than 20 minutes can show benefits to the body. Exercising helps the body to feel more fatigued at night, allowing you to fall asleep easier. Exercise can also help to alleviate stress and increase your appetite.
Next is eating. Some claim that certain foods can trigger migraine attacks, such as alcohol and caffeine. It is important to note that there is no such thing as a “migraine diet” that will completely prevent migraines. However, what you put into your stomach is important. Busy lifestyles can lead to meal skipping, and having no food in your stomach can definitely trigger migraines. A way to combat this would be to eat “well-balanced meals at least 3 times a day” [4]. It is also important to stay hydrated, as drinking plenty of water has shown benefits for those who suffer from migraines. Last, it can be beneficial to cut out or reduce any/all forms of caffeine, as it can trigger migraines.
Keeping a diary for migraines may seem like a silly idea, but it can be recommended as “headache management and may enhance the accuracy of diagnosis and assist in treatment modifications” [4]. Noting changes in your everyday diet, life, etc. can help you to identify any odd things that may have contributed to a migraine. This can also help you to log how consistently you get migraines, as well as how intense the migraine is. The stoplight method is just one way that you can monitor pain levels. Red days are labeled as very bad days (characterized by the inability to get out of bed), yellow can be moderately bad (stopping your ability to do regular tasks), and green days can be when you’re still able to do daily tasks despite having a headache/migraine. If there’s no migraine that day, no need for any color!
Finally, the last ‘S’ of SEEDS is for stress (and anxiety). Stress can often be associated with migraines, whether that’s from the stress itself, or any effects of having stress. For example, stress can garner bad habits such as “medication overuse, smoking, sedentary habits, and obesity” [4]. These can all contribute to the development of migraines. Migraines are a genetic disorder, and stress can make them worse. Some techniques that can improve the effects of stress and decrease the risk of migraines include cognitive behavioral therapy, mindfulness, biofeedback, and other relaxation techniques.
Outside of these treatments are prescriptions, over-the-counter drugs, and drug therapy. A doctor should be consulted so you know which drugs to take, as they will most likely be prescribed. The important thing to do when starting drug therapy is to “start the chosen drug at a low dose and increase it slowly until therapeutic effects develop, the ceiling dose is reached, or adverse events become intolerable” [2]. If the patient has previous illnesses or is comorbid, they should take this into account before starting drug therapy, as this can produce side effects. What is important, however, is for the patients to “tolerate the early adverse events that may develop when a new medication is started” [2]. This type of therapy takes time, first for the drug to take effect, and then for the patient to feel and monitor the lasting effects.
According to United States, Canadian, and European guidelines, preventive treatment should be used if the following symptoms are seen:
● Migraine attacks that are recurring, and interfere with a person’s ability to complete regular, daily tasks.
● Headaches that occur more than four or more times a month
● Side effects from medications
● The presence of migraine conditions including hemiplegic migraines, basilar migraines, or “frequent, prolonged, or uncomfortable aura symptoms; or migrainous infarction” [2].
Preventive migraine therapy can and should be stopped if the patient develops intolerable reactions to drugs, or if the patient shows significant benefits for at least 6 months.
With all these techniques being listed, it is important to know that small modifications can make a big difference. By practicing healthy lifestyle habits, it will become easier to avoid developing migraines and all the symptoms that come with them. However, if you are in a position where your migraines are affecting your daily routine frequently and causing you immense pain, it is important to consult a doctor.
References:
1. Vasudha, M. S., Manjunath, N. K., & Nagendra, H. R. (2019). Lifestyle - A Common
Denominator for the Onset and Management of Migraine Headache: Complementing Traditional Approaches with Scientific Evidence. International journal of yoga, 12(2), 146–152. https://doi.org/10.4103/ijoy.IJOY_59_18
2. Silberstein S. D. (2015). Preventive Migraine Treatment. Continuum (Minneapolis, Minn.), 21(4 Headache), 973–989. https://doi.org/10.1212/CON.0000000000000199
3. Goadsby, P. J., Lipton, R. B., & Ferrari, M. D. (2002). Migraine — Current Understanding
and Treatment. New England Journal of Medicine, 346(4), 257-270. https://doi.org/10.1056/NEJMra010917
4. Robble, J., Starling, A. J. (2019). SEEDS for success: Lifestyle management in migraine.
Cleveland Clinic Journal of Medicine, 86(11), 741-749. SEEDS for success: Lifestyle management in migraine (ccjm.org)
Contributors:
Author: Kayjah Taylor
Editor: Liam Lynch
Health scientist: Catherine Sarwat
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