The Migraine Brain
Page 9
During postdrome, you may feel withdrawn, exhausted, and fall into a dead sleep for hours. You may not feel like eating, and you may just want to retreat and heal. Some people feel depressed, while others have a surge of energy or sense of euphoria.
What’s the biochemical reason for postdrome? Your body needs to reset itself. All of the chemical changes and hyperactivity that caused the pain and other symptoms need to shut off and reequilibrate so you can get back to normal.
Before they began getting effective treatment that stopped their attacks, many patients tell me that vomiting actually helped them feel better. Some would vomit on and off for hours, then fall into a dead sleep—and when they awakened, they felt cleansed, as if their bodies had been reborn. (I do not recommend that you induce vomiting in yourself, which is not a good idea.) Whether you vomit or not, fall into a deep sleep or not, or otherwise retrench, after the pain stage ends, you may feel strangely renewed and refreshed.
Postdrome symptom
Do I get this?
Fatigue or exhaustion
Depression or sadness
Euphoria or elation
A sense of freshness or renewal
Tender skin or scalp
Excessive urination
Other
Building Your Migraine Profile
Now that we’ve examined the four phases of migraine, it’s time to start building your personal Migraine Profile so you can understand your migraine and conquer it. Your profile won’t be like anyone else’s. Your set of symptoms, the phases you experience, your triggers, and your effective treatments are unique. Using the prompts above about the four stages of migraine and using the My Migraine Profile in the appendix, fill out the form to record the characteristics of your migraine, like the example that follows.
My Migraine Profile
My Prodrome Symptoms
Do I get this during every attack?
How long before the pain phase?
I crave chocolate and junk food like Twizzlers
Yes! I just never realized it was related to my migraine
The day before, usually
I can’t stop yawning
Not sure
3–4 hours before
I’m clumsier when I walk—trip on steps, etc.
Yes
1–2 hours before
My Aura
Visual aura—I see flashing lights and sometimes I get tunnel vision
Almost every time
About 20 minutes before
My Pain Phase
Describe symptom
Headache
Every time
Pain is always on one side of my face or head; it is a throbbing pain; pain is severe to unbearable
Nausea
Every time
Vomiting
Only if I don’t get treatment early enough
Aversion to light
Yes, always
Must cover my eyes
Aversion to sound
Yes, always
Must have silence
Postdrome: My Migraine Hangover
Do I get this during every attack?
Describe Symptom
Exhaustion
Every time
I need to sleep for at least a few hours
I feel strangely cleansed—like I’m getting a new beginning
Sometimes, if I get a really good sleep
With this part of your profile, you now have a clearer picture of how your personal migraine “looks” and “behaves.” Keep in mind that your profile can change over time, acquiring new characteristics and dropping existing ones. It’s important to notice these changes because they may mean that your migraine treatment plan should change, too.
In the next chapter, we’ll examine your migraine triggers and add these to your Migraine Profile.
CHAPTER 4
Your Migraine Triggers
Even if you follow every recommendation in this book, it’s unlikely that you’ll never have another migraine attack because your brain is predisposed to them. But I bet you can cut down significantly on the number of attacks you have. How? There are two parts to reducing your migraines: maintaining a healthy lifestyle and recognizing your own migraine triggers. We’ll talk more about lifestyle issues in Part Three, but for now be aware that as a migraineur, you must do certain things: You need to exercise regularly, eat good foods on a regular schedule, get enough sleep on a regular schedule, and make stress reduction a priority. This is how you’ll stay healthy.
Know Your Migraine Triggers.
The second part of prevention approach is specific to migraines: You’re going to try to reduce your attacks by identifying your triggers and staying away from as many as you can.
What’s Your List of Triggers?
As you now know, the reason you get migraines is because your brain chemistry is abnormal. Your Migraine Brain is hypersensitive to triggers and when it encounters them, it gets agitated and sets off an attack. Triggers do not cause migraine. They ignite it—like putting a match to dry kindling. Triggers only work when a person is already primed and ready to have a migraine.
Common migraine triggers include lack of sleep or poor sleep, not eating on a regular schedule, menstrual period, stress, and weather changes. You may be able to enjoy chocolate with no problem while your roommate gets a violent migraine when she eats a candy bar. She may have no problem with bright lights, loud noises, or cigarette smoke, while for you, going to a wild party is sure to bring on a migraine. Some people get “disco-ball” migraines, triggered by the glittering light patterns of a mirrored disco ball. A blow to the head can trigger a migraine. Even the excitement of a happy event, for some people, results in a migraine.
* * *
Your own triggers are quite different from anyone else’s. The variety is fascinating:
“When I worked in a sunny office, I’d actually have to wear sunglasses indoors because sunlight was a trigger. Dark chocolate—sometimes it bothers me, sometimes it doesn’t. Neck strain, that triggers it, too.”
—Eleanor, 43, nurse
“Female hormones. That’s it. Other than on my period, I don’t get migraines.”
—Flannery, 37, veterinary technician
“The weather—just any kind of dramatic change. The humidity is one big indicator. If it changes a lot, I get a migraine.”
—Brian, 32, computer programmer
“I started having migraines at the age of sixteen. I was in the chemistry lab and we were making oil of banana, and someone burned theirs, and the smell made me sick to my stomach. I was very nauseous, and I ended up having a headache. I was dismissed from school that day and wanted to be in the dark, quiet and motionless. They took me to the hospital but they didn’t know what was wrong with me. They gave me a spinal tap because they thought I had meningitis.”
—Eileen, 44, school aide
“The biggest trigger is stress, and the second biggest is my period, and then blue food coloring. I haven’t discovered any food coloring other than blue that causes it. Secondhand smoke gives me a migraine but only in concentrated doses, like if I stay with somebody who smokes. Fluorescent lights and staring at a computer also contributes.”
—Nonnie, 31, temp worker
“When I’m exercising at the gym, doing the steps, on the bike, and weights, I get a lot of headaches. I think some of my migraines have to do with head movement. Like just now, when I was shampooing my hair in the sink, which I never do: I got so sick I couldn’t get my head out of the sink, I was just so queasy and nauseous. I mean, what the hell happened?”
—Tina, 64, retired kindergarten teacher
* * *
Your list of triggers may be quite long. You may have six, ten, or fifteen things that provoke your Migraine Brain. Certain of them—lack of sleep, let’s say—may always lead to a migraine for you. Others may result in a migraine only sometimes. Or, it may take a combination of several triggers to make you sick.
Creati
ng the list of triggers in your Migraine Profile takes some time, but that profile is a critical weapon in your migraine-fighting arsenal. Once you’ve figured them out, you’re going to try to avoid them whenever possible. And when you encounter triggers that you cannot avoid, you’ll be ready to act to halt an attack that begins. Identify as many of your triggers as you can, and try to determine how likely each one is to lead to a migraine every time. Maybe red wine on its own doesn’t give you a migraine but red wine on an empty stomach does, or red wine on an empty stomach when there are changes in the weather.
One of my patients got serious migraines every time she had even one beer. It made her very, very sick. So, naturally, she avoided alcohol completely. But she got migraines at other times, too, when she had not been drinking alcohol, and didn’t know why. Her reaction to alcohol was a clue. I recommended that she significantly increase her overall water intake. And, anytime she had an alcoholic drink, she was to drink an eight-ounce glass of water along with it. My theory was that she tended to get dehydrated easily—when she drank alcohol and other times, too—and she wasn’t giving her brain the water it needed to stay on an even keel. She became very disciplined about drinking at least eight glasses of water every single day—a total of sixty-four ounces—and even more if she had a beer or alcoholic drink. Within a few weeks, she had reduced her migraine attacks by 50 percent.
She still had other triggers to ferret out, but she’d successfully tackled one of them: dehydration. We then moved on to identifying other triggers and developing a plan for addressing them. Her Migraine Profile triggers also included weather changes, lack of sleep, not eating enough food, and her menstrual period. Yet simply by staying hydrated throughout the day, she avoided half the migraines she used to get. Not everyone will have such fast success in reducing migraines, but any time you can whittle away at your triggers—figure out what they are and come up with a prevention plan for them—you’re making significant progress.
The Most Common Migraine Triggers
In a hypersensitive Migraine Brain, almost anything can trigger an attack: a fight with your sister, the flu, the flickering lights of a computer screen. Something seemingly harmless or even healthy may set off a migraine for some people: I’ve had patients for whom a massage or a pleasant day at the beach triggered a migraine (the muscle manipulation in massage may have been the problem in the first case, the heat and light of the beach the problem in the second).
You probably already know some of your triggers, even if you haven’t thought of them that way. You may have simply known that if you ate certain foods or were around a particular smell, you’d get sick. You may have made the connection between diet cola and getting a migraine, or eating too much sugar on an empty stomach and getting a migraine. Many people have a migraine reaction to strong perfumes such as patchouli oil.
You may have reflexively developed a pretty good migraine-avoidance plan already: staying away from the perfume counter at department stores, say, or avoiding jogging during hot days. Now we’re going to step it up a notch and formalize your trigger-prevention plan.
Here is a list of the most common migraine triggers. It is by no means exhaustive—it’s only a starting point to help you out.
Stress or tension
Sleep issues—lack of sleep, too much sleep, sleep disorders
Certain foods (which vary from person to person)
Hunger and/or low blood sugar
Alcohol, especially red wine
Hormonal changes (women only) related to menstrual cycle or pregnancy
Exercise (yes, that’s complicated—more below)
Strong smells, such as perfume, air fresheners, even flowers
Cleaning fluids, chemicals, formaldehyde, other preservatives
Smoke, especially cigarette smoke
Bright lights, including fluorescent lights
Loud, piercing, or repetitive noises
Caffeine (complicated, since caffeine can treat migraines—more below)
Dehydration
Weather, including changes in humidity
Dust
Sex
A blow to the head
Dental problems including TMJ (malfunction of your jaw joint)
It may take a combination of two or more triggers to launch a migraine for you. An example of a “perfect storm” of triggers: Taking a long trip by airplane. Motion sickness causes some people to get migraines, and flying can lead to dehydration because airplane cabins are dry. Add jet lag or stress, and you have a trifecta of migraine triggers. Airplane travel is difficult for many migraineurs. See Ch. 14.
The Headache Diary
The fastest and best way to identify your triggers is to keep a headache diary, a detailed record of every migraine you get. In it, you mark down the details of each migraine attack: when you first feel it coming on; what the warning signals are; what you ate and drank in the two hours preceding the migraine (to identify any food triggers); other possible triggers such as unusual stress or weather changes; what medicines you took and whether they worked; and how long the migraine lasted.
The diary will help you identify many triggers. Then you can try to avoid them.
Realistically, you cannot avoid all of your triggers. You can stop drinking red wine but you can’t make everyone around you stop wearing perfume. And it’s nearly impossible to eliminate all the stress in your life. But if a particular trigger is unavoidable, you can make extra effort to avoid others. If you have a new baby in the house and you’re up for feedings every two hours, you’ll want to eat well and on time, avoid alcohol, and get more help from family and friends so you can minimize your stress.
Sometimes a migraine needs only one trigger, though. So the other value of identifying all your triggers is this: If you can’t avoid them, you’ll be aware that you’re in a vulnerable position to become sick, and you can be ready to beat back the headache with a treatment plan.
The headache diary is one of the most important tools for getting a full picture of your Migraine Profile and for managing your migraine. You will find a blank headache diary in the appendix. Use it or keep a journal or notebook separate from this book. Be disciplined about recording the information about your migraines. (An example of filled-out diary page will follow in this chapter.)
To identify your triggers, rewind the tape of your life. What happened preceding the attack? Pay careful attention to what you encountered in the hours and days before you got sick.
At first, you may have no idea what set off a particular migraine. So think of it as a detective game. The more in tune with your body you become—the more aware of your environment, the things you eat, your health habits—the more triggers you’ll identify. You may not be able to ferret out some of them easily. Keep the diary for at least three months, and you’ll most likely identify some triggers you never thought of.
Before you begin keeping the diary, read this chapter so that you consider some triggers that might not have occurred to you.
Food and Drink. For potential food triggers, recall all foods you ate or beverages you drank in the two hours prior to the attack. There is a two-hour window in which a food or drink may affect your Migraine Brain; after that time period, the food is no longer affecting your biochemistry. See if you can find any connection between your migraine attacks and foods. If you keep your diary diligently for three months, carefully listing every food you eat and beverage you drink, and still cannot make a connection to your migraine attacks, foods are probably not triggers for you.
Other triggers. For others, the time lag between your exposure to the trigger and the resulting migraine can be longer. For example, a weather change may happen three days before your Migraine Brain reacts. To find these triggers, you may have to be a bit of a sleuth. Look for patterns over a series of migraine attacks.
A Sample Headache Diary (focusing on triggers)
Date/Time of Attack
Severity of Pain (1–10 scale)
Facto
rs Preceding Attack—Possible Triggers
Wed., Jan. 10, noon
8
Don’t know! Not food or drink b/c I didn’t eat any breakfast and haven’t had lunch yet.
Sun., Jan. 14, 3 p.m.
5
Not sure. Had lunch at noon. Was up until 1 a.m. but slept in late, too, so I don’t think it’s lack of sleep.
Sat., Jan. 20, 11 a.m.
5
Had 3 glasses of wine last night. Slept in until 11, woke up with migraine.
Sat., Jan. 27, 11 a.m.
8
Started my period yesterday. Ate wheat toast and eggs for breakfast, which I also ate 2 days ago with no problems. Slept in until 11 a.m.
As the doctor reviewing this headache diary, I see something that jumps right out at me—sleep issues. This patient gets up at 7 a.m. during the week for work, but on weekends she sleeps very late. I ask her about caffeine, and she says she usually has two cups of coffee by 9 a.m. during the work week. So her Migraine Brain may be unhappy about missing its usual dose of caffeine at the usual time and also unhappy about its regular sleep pattern being disrupted. It’s no surprise she got an especially bad migraine on January 27, when she had her period and also provoked her Migraine Brain with caffeine and sleep triggers. Migraines that are linked to women’s periods can be especially painful. See Ch. 5. If this is true for you, take special care to avoid your other triggers at this time.