May-June 2017: Its a Headache having a Migraine! How can Diet & Lifestyle help?

Do you even get a severe throbbing pain or a pulsing sensation, usually on just one side of the head? Is it often accompanied by nausea, vomiting, and extreme sensitivity to light and sound? Do you sometimes see flashes of light, blind spots, or tingling on one side of the face or in your arm or leg. Then you are more likely to be experiencing a migraine than a headache. Migraine attacks can cause significant pain for hours to days and can be so severe that the pain is disabling and often so debilitating that it prevents you from work and play. 

So, what can one do? Medications can help prevent some migraines and make them less intense, but the severe, often long-term side effects might override the medical benefits. In short, the right medicines can provide relieve but self-help remedies and lifestyle changes may provide the long-term preventive relief you seek, with few if any side effects.

Below are some suggested diet and lifestyle strategies that can help you deal with migraines. 

1. Foods to have or not to have. 

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  • Foods to eat regularly: these foods have seldom if ever triggered migraines: Rice, especially brown rice, cooked green vegetables, such as broccoli, kale, spinach, Swiss chard, or collards, cooked orange vegetables, such as carrots or sweet potatoes, cooked yellow vegetables, such as summer squash, and cooked or dried non-citrus fruits: cherries, cranberries, pears, prunes (be a bit cautious with citrus fruits such as apples, bananas, peaches, and  tomatoes). In addition, stick to modest amounts of salt, maple syrup, and vanilla extract that are usually well-tolerated (PCRM, Mayo Clinic, WebMD).
  • Healthy fats: adding certain kinds of fats into your diet may help reduce inflammation, which is thought to exacerbate migraine pain. Omega-3 fatty acids, which are most concentrated in fatty fish and also in vegetarian sources like chia seeds, flaxseeds, hempseeds and their oils, and in soy and walnuts, and the monounsaturated fats found in olive oil have both been shown to reduce the frequency, duration, and severity of headaches and migraines. 
 Vegetarian sources of Omega-3 fatty acids

Vegetarian sources of Omega-3 fatty acids

  • Water is actually a nutrient, essential for your body’s proper functioning, and dehydration is a common migraine trigger. Migraine sufferers need to stay vigilant about the amount of fluid they drink and should aim to preempt thirst. I recommend at least nine cups of liquid a day for women and 13 cups a day for men. 
  • Foods to avoid. Aged cheeses, salty foods and processed foods may trigger migraines.  Dairy, chocolate and eggs are some very common migraine triggers (PCRM). Wheat and certain types of nuts have been known to trigger migraines in some people. Anywhere between 20 and 50 percent of adults experience a reduction or elimination of their headaches when common trigger foods are avoided.
  • Food additives. The sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods, may trigger migraines.
  • Drinks. Alcohol, especially red wine, and highly caffeinated beverages may trigger migraines. However, coffee and tea in small amounts might actually help with migraine pain.

2. Supplements that might help to prevent migraines

 Key supplements to support not replace food sources of these nutrients.

Key supplements to support not replace food sources of these nutrients.

  • Feverfew: 250 milligrams per day or two to three fresh leaves. Exercise caution if pregnant or lactating.
  • Ginger: 1/2 to 1 teaspoon (1 to 2 grams) of fresh crushed ginger by itself or with tea every day.
  • Magnesium: 400 to 700 milligrams per day total (foods plus supplements, if used) or 200 milligrams per day as elemental supplement alone. The best food sources for magnesium are: spinach, sweet potatoes, swiss chard, amaranth, quinoa, brown rice, sunflower seeds.
  • Riboflavin — also called vitamin B2 — is necessary for the body’s production of energy at the level of the cell. Although it is difficult to get enough riboflavin to prevent migraines from food sources alone, I recommend adding some riboflavin-rich foods to your diet; good choices are whole-grain fortified cereal, mushrooms, broccoli, and spinach. As a supplement, a daily dose of 400 mg or a combination product that includes riboflavin and other potentially beneficial supplements can be taken.
  • Calcium: Reduce calcium losses by avoiding animal protein, coffee, tobacco, and excess sodium and sugar. If you wish, you can take 1,000 to 2,000 milligrams per day of elemental calcium, with 200 IU (5 micrograms) of vitamin D. Regular physical activity, especially doing some weight-bearing exercises, will keep calcium in your bones where it belongs.

2. Lifestyle Habits to prevent and reduce recurrence

  • Skipping meals or fasting has been known to trigger migraine attacks.
  • Anxiety. Stress at work or home can cause migraines.
  • Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Strong smells — including perfume, paint thinner, secondhand smoke and others — can trigger migraines in some people.
  • Changes in wake-sleep pattern. Missing sleep or getting too much sleep may trigger migraines in some people, as can jet lag..
  • Changes in the environment. A change of weather or barometric pressure can prompt a migraine.
  • Medications. Oral contraceptives and vaso-dilators, such as nitroglycerin, can aggravate migraines.

3. Risk factors 

  • Family history. If you have a family member who tends to get migraines, then you may be more likely to develop them too, but diet and some specific lifestyle changes can help reduce migraine severity and frequency.
  • Age. Migraines can begin at any age, though the first often occurs during adolescence. Migraines tend to peak during your 30's, and gradually become less severe and less frequent in the following decades.
  • Sex. Women are three times more likely to have migraines than men. Headaches tend to affect boys more than girls during childhood, but by the time of puberty and beyond, more girls are affected.
  • Hormonal changes. If you are a woman who has migraines, you may find that your headaches begin just before or shortly after onset of menstruation. They may also change during pregnancy or menopause. Migraines generally improve after menopause. Some women report that migraine attacks begin during pregnancy, or their attacks worsen. For many, the attacks improved or didn't occur during later stages in the pregnancy.

One can argue that lifestyle changes and being able to identify triggers can go a long way in warding off migraines or minimizing their effects. So what can one do as a preventive measure?

  • Create a consistent daily schedule. Establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress with meditation and/or yoga. Even 5-7 minutes of deep breathing first thing in the morning and last thing at night can be helpful in managing stress and getting restful sleep.
  • Exercise regularly. Regular aerobic exercise releases endorphins, the "happy" hormone, reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including brisk walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches. Regular exercise can also help you lose or maintain a healthy body weight and body compositin, given that obesity is thought to be a factor in migraines. 
  • Reduce the effects of estrogen. If you are a woman who has migraines and estrogen seems to trigger or make your headaches worse, you may want to avoid or reduce the medications you take that contain estrogen (such as birth control pills and hormone replacement therapy).
  • Identify triggers. This can be key to preventing migraines. First, one can do a "Two-week Test" (see Ref. 4). Second, an elimination diet might help (see Ref 4). Third, foods that cause headaches are usually eaten within three to six hours of the attack. Be aware of what you eat prior to onset of a migraine, and make that part of an elimination diet. Fourth, the offending foods can be ones for which you have cravings. They may be the ones you might least suspect. Again, be aware of these craving triggers. Fifth, a person's tolerance to food triggers might be different at different times. For example, a woman might normally be able to eat half a box of chocolates with no problem, but as she approaches her period a single piece might trigger the migraine. The reason, presumably, is that the natural changes in hormones that occur over the month affect her sensitivity to certain foods. Thus, your triggers can change over time and over the course of your life cycle.

So what can you do once a migraine hits?  Here are some suggestions:

  • Try caffeine. Although caffeine can be a migraine trigger for some people, for others it works as a treatment. The dose is one to two cups of strong coffee at the first sign of an attack.t 
  • Starchy foods can help. Foods such as rice, potatoes, crackers, or bread might actually help unless you are gluten intolerant. But given their high glycemic load that can raise and cause substantial fluctuations in blood sugar/glucose levels, consume in moderation and only on occasion. Some people find that they actually crave starchy foods during migraines and that digging into toast, crackers, pasta, potatoes, or other starchy foods reduces the headache or nausea, and can even shorten the attack. Experience will tell you whether these foods help
  • Ginger it up! Fresh, crushed ginger, 500 to 600 milligrams (about 1/4 teaspoon), in a glass of water has been helpful in anecdotal reports. It can be repeated every few hours, up to about 2 grams per day.
  • Calcium might be able to treat migraines as well as prevent them. Researchers reported a case of a woman who was able to stop an early migraine by chewing 1,200 to 1,600 milligrams of elemental calcium. Again, avoid the temptation to get calcium from milk, yogurt, or any other animal source. 
  • Sleep it off in a dark room. Lie down in a quiet, dark room, and sleep if you can. Use hot or cold compresses, and massage the blood vessels at the temples.
  • Acupuncture has been shown to be beneficial for many people.

References

1. Millichap JG, Yee MM. The diet factor in pediatric and adolescent migraine. Pediatr Neurol. 2003; 28 (1):9-15.
2. Ernst E, Pittler MH. The efficacy and safety of feverfew (Tanacetum parthenium L.): an update of a systematic review. Public Health Nutr. 2000; 3(4A):509-514.
3. Johnson ES, Kadam NP, Hylands DM, Hylands PJ. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J. 1985; 291:569-573.
4. PCRM. Migraine Diet: A natural approach to Migraines. http://www.pcrm.org/health/health-topics/a-natural-approach-to-migraines.
5. Thys-Jacobs S. Alleviation of migraines with therapeutic vitamin D and calcium. Headache. 1994;34:590-592