MANAGING MIGRAINES
Contributed by Heidi Roth, RDN, CHHC
If you’ve ever had a migraine or know a friend or loved one with migraines, you know they can be debilitating and are not just a “bad headache.” Recent estimates are that 40 million people in the US are affected by this disabling neurological disease, making it one of the most common yet under-diagnosed and under-treated conditions in the country. Each June, we observe Migraine Awareness Month to bring more understanding to this condition.
A migraine is a neurological disease with classic symptoms that include severe head pain, sensitivity to light, sound and smells, nausea, and brain fog. These symptoms can last hours to several days, and can significantly interfere with work, education, and family and social life. Even after a migraine attack subsides, symptoms can still linger for 1-2 days, often referred to as the “migraine hangover.”
Finding a doctor who specializes in migraines and can provide proper diagnosis and treatment is the essential first step. The American Migraine Foundation provides a free online tool to help you find a specialist near you.
In addition to medications to prevent as well as treat active migraine attacks, many lifestyle strategies may help reduce migraine frequency and severity.
Here are some lifestyle strategies shown to help, especially when doing several small things consistently, rather than relying on one miracle fix.
The brain is about 80% water, making adequate hydration essential to brain health. Even mild dehydration can have a negative effect, and this is a very avoidable trigger. Try to drink water steadily throughout the day rather than all at once at the end of the day. Many people find that adding electrolytes helps more than just plain water alone, especially when heat and weather are triggers.
You can also boost your hydration through foods with high water content, such as fruits, vegetables, soups, and dairy. While coffee and tea can count towards your daily fluid intake, be mindful of caffeine. Caffeine can sometimes trigger or worsen headaches at high dosages or with sudden withdrawal, but it can also help treat acute migraines in many people. Aim to keep caffeine intake moderate and consistent from day to day.
There is no single prescribed “migraine diet,” but evidence supports a Mediterranean-style, plant-rich diet and avoiding ultra-processed foods. Blood sugar swings seem to be a trigger for many people, so eating regular meals that include protein, healthy fats, and fiber can help keep blood sugar levels stable. Multiple studies also suggest that a low-glycemic diet (lower carb and low added sugars) may be beneficial as well, most likely due to its effect on reducing blood sugar level swings and stabilizing energy supply to the brain.
Common dietary triggers include alcohol (especially red wine), aged cheeses, processed meats, artificial sweeteners, and foods containing MSG. That said, food triggers are highly individual. What triggers one person may have no effect on another. Rather than avoiding large categories of foods based on general lists, keeping a headache diary can help you pinpoint your own triggers with greater accuracy.
Across many studies, as well as anecdotally, supplementation with magnesium (600 mg/day), riboflavin (400 mg/day), and CoQ10 (150 mg/day) shows the most benefit in reducing migraine frequency and severity. These nutrients can also be obtained through food. Magnesium is a mineral found in leafy greens, nuts, and seeds. Riboflavin is a B vitamin found in almonds, eggs, and dairy products. CoQ10 is a vitamin-like antioxidant found in meats, fish, nuts, and vegetable oils. As always, check with your doctor before starting any new supplement regimen.
Many people with migraines are sensitive to bright sunlight, fluorescent lights, and screens. FL-41 glasses are specialized rose-tinted lenses designed to filter out specific blue light wavelengths known to trigger migraines and light sensitivity, as well as eye strain. They can be worn indoors or outdoors and are available in both prescription and non-prescription versions.
While aiming for 7-8 hrs of sleep is a good starting point, research increasingly shows that a consistent sleep-wake schedule is really important, not just getting “more sleep.” Try to go to bed and wake up roughly around the same time every day, within 1/2 hour plus or minus, even on weekends.
Neuromodulation devices use electrical or magnetic stimulation to change nerve activity, and research supports their use to mitigate migraine frequency and severity. They are either worn on the forehead, back of the head, or arm, and are non-invasive. Unfortunately, many times they are not covered by insurance, and costs can be high, but as more people use them, the costs may come down.
Long periods of uninterrupted sitting and screen time can place stress on your eyes, neck, and shoulders, and may contribute to migraines. Make sure you have the correct lighting, good seated posture, computer screen around 20-28 inches in front of your face. Be sure to take movement breaks and spend some time on non-screen activities throughout the day as well.
Keeping a headache diary helps you identify triggers, recognize patterns and assess how well your treatments are working. Note the time of an attack, your sleep the night before, stress levels, and what you ate and drank. Many apps are available to make this easier.
Living with migraines can feel isolating, but you are not alone! Learn as much as you can about your diagnosis and treatment options, and seek out a supportive community.
Resources:
americanmigrainefoundation.org
Apps:
Migraine Buddy
Bearable
Migraine Insight
N1-Headache
What steps will you take to manage migraines?
Heidi Roth RDN, LDN, is a Registered/Licensed Dietitian, Health Coach and nutrition expert with a passion for health and wellness. She graduated from the University of Pittsburgh with a BS in Nutrition and Dietetics.
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