As a healthcare provider, my role is to listen to what you are telling me about your life and priorities. I’m not there to recite a laundry list of recommendations, I’m there to collaborate with you and help develop strategies that are meaningful and realistic for the context of your life.
Many of my patients are reluctant to start a daily medication to prevent migraines. I can’t say that I blame them. A lot of the medications we use to help prevent migraines aren’t specific to managing migraines. This means that they are borrowed from other families of medication, such as antidepressants, blood pressure medications, and anti-seizure medications. This also means that there is a potential for unwanted side effects that migraineurs find intolerable.
Before I get to the discussion about medications, I like to share all the non-pharmacological (non-medication) ways that you can use to manage or reduce attacks. These changes can be much harder to stick with than simply taking a medication. BUT, if you can make these positive changes first, or along with a medication, then there is more likely to be a better overall outcome in the long run.
In taking on lifestyle and behaviour changes, pick one thing to work on at a time. It’s hard to change your diet, start a new exercise program, and overhaul your sleep all in one go. If you try to take on everything then you’re more likely to end up feeling bad about every slip up and abandon the change all together.
When I’m talking to patients about making any lifestyle changes I always ask:
“what’s something you’re interested in doing better with?” and
“what change is realistic for you at this time in your life?”
A new mom may not be able to do anything about their interrupted sleep at this time but perhaps she can drink more water.
You likely have some idea of a positive lifestyle change that you would like to make. We all have things that we can optimize related to self care. If I can share practical tips that are based in research and evidence, then there is a better chance that these changes are sustained. Then we can add a new goal at the next follow up visit.
Here are some of the basic lifestyle factors that I discuss in my first few visits.
Remember - just start with one or two at a t
Keep a balanced diet. A good selection of diverse nutritious foods with minimal artificial colours, sweeteners, and preservatives is the best approach. Some migraine sufferers notice that certain foods trigger their migraines (commonly wine, old cheese, or preserved meats). However, many migraine sufferers do not note any food triggers. I do not recommend any extreme elimination diets.
Eat breakfast with protein. Incorporate at least 12 grams of protein. Ideally within 30-60 minutes of waking. Easy sources of protein are nut/seed butters, protein in smoothies, eggs, Greek yogurt, trail mix. It doesn’t have to be a complicated breakfast.
Avoid skipping meals. Keep some healthy snacks on hand for times that are challenging (i.e. the midday stretch between lunch and dinner).
Avoid the sugar. That midday slump often makes us reach for that plate of cookies sitting in the breakroom but that can trigger a migraine. Pair your carbs or sugars with some protein and try to keep it to healthier choices.
Stay hydrated. Set some goals for your water consumption (i.e. 1 litre by lunch, another by dinner). Keep a water bottle nearby. Keep it exciting with some fresh lime or cucumber. A total of 2 litres of fluid per day is an ideal target.
Moderate caffeine intake. Many migraineurs benefit from some caffeine but too much can trigger migraines. Around 200mg per day (1 cup of brewed coffee) is reasonable although some frequent migraine sufferers may do better with less. Keep your caffeine to earlier in the day so that it doesn’t disrupt your sleep.
Consider food triggers. Not all migraineurs have food triggers. I usually recommend focusing on the other lifestyle factors and over time food triggers may become apparent (keep an eye out for an upcoming post on triggers).
Exercise! This is something we all strive to fit into our lives. But the benefits of exercise extend to better sleep, better mood, and have been captured in research as a reduction in headache days for migraine sufferers (Varkey et al., 2011 Cephalagia). Speak to your healthcare provider before starting any new exercise routines.
Improve sleep. Aim for a regular sleep and wake time as much as possible, including weekends. Turn off screens an hour before bed. Try switching to something audio based like a guided sleep story or meditation. Avoid caffeine after around 2:00 pm. Incorporate relaxation strategies before bed. Speak to your healthcare provider if you have sleep challenges and need more support.
Reduce stress. Easier said than done, right?! There are number of strategies and finding the right one is a personal choice. Meditation, mindfulness, exercise, relaxation training, and cognitive behaviour therapy are all great places to start. I really like using apps such as Calm or Headspace for meditation at home. Stress is probably the most common trigger that patients tell me about and a topic we revisit at every appointment. (I'll discuss this in a future post).
An important thing is to have realistic goals during this process. Migraines are a biological condition. We’re aiming to improve your function. This can look like shorter migraine episodes, a reduction in the number of headache days, or less severe episodes (a 50% reduction in any of these is considered a success!). We’re not expecting to “turn off” your migraines. A more reasonable aim is to get good control over them. Even with perfect adherence to all the strategies above there will be things like weather changes and hormonal fluctuations that are out of our control. So approach these changes with realistic expectations and know that they are certainly going to benefit your health without unwanted side effects!
There’s a good clinician resources on non-medication based therapies from the American Headache Society: https://americanheadachesociety.org/wp-content/uploads/2018/05/Behavioral-and-Other-Nonpharmacologic-Treatments-for-Headache-May-2014.pdf
Varkey E, Cider A, Carlsson J, Linde M. Exercise as migraine prophylaxis: a randomized study using relaxation and topiramate as controls. Cephalalgia. 2011;31(14):1428–1438. doi:10.1177/0333102411419681