Back to Basics with Migraine Management

People who come and see me about their migraine have often tried many different treatments and strategies to manage these troublesome and debilitating headache attacks. One of the main things I do is to go back to basics in understanding what is going on and how you can help yourself to limit and reduce the number and frequency of migraine attacks.

Eating and Sleeping Regularly

Think about your daily routine of waking, eating and bedtimes. Lots of people tell us that they commonly wake up with the headache already present.

As a migraine sufferer, you have inherited a tendency for your brain to be more irritable and sensitive to changes –this tendency is present even when you don’t have a headache. For example, you may be the one who always wants the music turned down or doesn’t like the glaring of sunshine or headlights.  If too many things add together to irritate your brain, a migraine may result.

One of the most irritating things for your brain is not having a steady supply of fuel. Missing meals, exercising without eating, and having a long night’s sleep and then no breakfast are all potent triggers for a migraine to develop.

I recommend that you try to eat something within an hour of waking up. Then it’s important to eat every 3-4 hours during the day. The final time is just before bed when a snack of slow release food can keep you going through the night and prevent that wake up head pain.

Try and keep to the same bedtime and wake times or at the least the same number of hours of sleep too. Short nights or having a lie-in can also irritate your brain! Keeping hydrated is important too.

What foods should I eat?

There are no absolute rules but I usually say try to avoid intensely sugary, sweet foods and fast release carbohydrates like white bread and white rice. Protein and fat give slower release energy. So snacks or meals containing nuts, seeds, eggs, meat, dairy products, avocados and berries are preferable to those containing high concentrations of sugar e.g. sweets, cakes, biscuits and too much dried fruit. Obviously avoid any foods which always trigger your headaches although this true food trigger problem is less common than many people think.

Other Changes

Anything that changes in your body can irritate the brain so fluctuations in stress, excitement and hormones are all powerful irritants. Be aware that the changes happen over the 24 hours before you become aware of the migraine. By beginning to realise what adds together to trigger your headaches, you can then start to plan forward. For example, if you are getting up in the middle of the night to catch a plane to go on holiday, you will definitely need to eat regularly and keep well hydrated to minimise the chances of a holiday headache.

Treat early, treat hard

The other concept to think about is the way that migraine develops over an attack. I like to think of it as a rolling snowball gathering size. As the migraine rolls on and gathers momentum, it becomes much harder to treat effectively and get rid of the pain completely. Many people are rightly concerned about over-using pain relieving medication (See the leaflet about Medication Overuse Headache on the National Migraine Centre website). Unfortunately, by delaying taking painkillers too long, you are more likely to get a migraine that has settled in for the duration! Hitting it again the next day and the day after results in a drip, drip, drip of pain killers that can lead to medication overuse headache.

It is better to take repeated doses of your pain killers, preferably with an anti-nausea tablet to enhance their absorption, on Day One of your migraine attack. Treat it fast with high doses (talk to us or your GP for advice about which medications and doses are safe and right for you) and then take them again if it hasn’t been fully “squashed”. This strategy can shorten your attacks and the fewer you have the calmer your brain gets.

Come for a consultation for a personalised plan of how you can best manage your particular migraine.

By Dr Katy Munro