The Migraine Brain

by Bernstein, Carolyn; McArdle, Elaine

  Gyms often offer reciprocal memberships at other gyms around the country for times you are traveling on business or for vacation.

  Most hotels today have gyms on site or have an arrangement with a nearby gym for guests.

  Here are some fun kinds of exercise you may not have considered trying:

  Nordic-walking—uses ski poles to exercise your arms as you walk. It’s an excellent way to get added aerobic benefit—and burn 40 percent more calories—without additional stress on your body.

  Rollerblading

  Rock-wall climbing

  Hiking—all you need is a pair of hiking boots (buy them at any sporting goods store) and an appreciation of the outdoors. You can solo or join a group.

  Kayaking

  Cross-country skiing

  Pilates

  Tai chi

  Try something new and challenge yourself in a new direction. You may find an activity that you really enjoy, and find that it becomes an important part of your life.

  A Few More Tips

  Don’t give up after only a few tries because you don’t feel any difference in your health. Do it half an hour a day, five days a week. Keep a record in your headache diary of how often you are exercising. Give it six weeks to kick in, to see whether there is any effect on your migraine frequency.

  Plan for your exercise. The night before, or first thing in the morning, figure out when you’ll be fitting in exercise that day. Some people do it first thing in the day to get it out of the way and get their blood rushing for a good day. Try it at lunchtime. (Don’t worry about showering, unless you sweat heavily.) But don’t put off thinking about it until your day is almost over and you’ve run out of options.

  Mix it up so you don’t get bored. Do one activity one day, another the next day. If you get sick of running, switch to cycling. On vacation, try rollerblading or skiing. Just get your half hour in no matter what it takes.

  Whatever your preferred exercise is, you can always revert to the best standby: walking. If you can’t get to gym class or your bike has a flat, put on comfortable shoes and get in a half-hour walk.

  Once your Migraine Brain is used to exercise, be careful of stopping suddenly. Your brain is used to the benefits of exercise. If you’re injured or ill, you have to be creative. Try other exercises that your body can tolerate. Swimming is a great sport if you’re injured since it’s low impact. You can lift weights with your arms if your legs are injured. Yoga is excellent in these cases, but let your instructor know what your injury is. If you’re ill, you probably don’t feel like exercising. But unless you’re really sick, a walk is almost always good for you. It gets your blood pumping, you breathe deeply, it gets you out of the house, and it lifts your mood. Here’s our mantra: Moving is always better than not moving.

  Do not try to exercise vigorously during a migraine. For most people, the physical exertion makes the migraine much worse, since it causes blood to rush to your head. But mild exercise at the start of a migraine may help stave it off because you increase endorphins, your body’s natural painkillers. Take it easy, though, and don’t make yourself worse.

  What If Exercise Triggers Your Migraines?

  Some people get migraines when they exercise and may be prone to orgasm-related migraines, too, because the physical reaction is the same: your blood pressure goes up. See Ch. 13.

  Don’t use this as a reason to avoid exercise or avoid sex, either, which is also good for your health. Instead, you need a plan for preventing migraines while you exercise and for treating those that arise.

  Water. Stay hydrated before, during, and after exercising. That means drinking water throughout your exercise session, especially if you are in hot weather or a hot room. How much water you need varies from person to person, but make sure your mouth isn’t dry and make sure that you sweat. If you’re exercising hard and not sweating, that’s a sign of dehydration. And don’t get thirsty. By the time you feel thirsty, you already have a substantial fluid deficit and a migraine may be brewing.

  Nutrition. Eat sufficient food about an hour and a half before you exercise. Exercise causes your blood-sugar level to decrease, so make sure you have plenty of fuel in your system. A protein bar or nuts, for example, are good snacks prior to exercise. If you get cramps when you’ve eaten too soon before exercising, you’ll need to schedule your meals and your exercise more carefully—and a regular schedule is always good for migraineurs.

  Warm up. Don’t launch into sudden, vigorous exercise if that triggers migraines, which can happen for some people. You can prevent this and avoid muscle sprains, too, by warming up. This can be as simple as walking for five minutes before you begin a run, stretching, or gently lifting light weights.

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  Red Flag!

  In very rare instances, a headache during exercise can be a sign of a more serious health problem. Call 911 and go to the Emergency Room if you get a headache during exercise, and:

  You’ve never had an exercise headache before.

  You’ve had an exercise headache before but this one is different—in the way the pain feels or where it is or there are other new or changed symptoms.

  You injure your head during exercise and get a headache as a result.

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  Take aspirin or ibuprofen. Some people find that taking an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) such as aspirin or ibuprofen before exercise reduces the chance of a migraine arising. Take two ibuprofen or two aspirin and see if this helps. Ask your doctor first if this is safe for you.

  Preventive meds. If you get migraines every time you exercise, talk to your doctor about taking a daily preventive medication. Not convinced that you need one? As part of migraine wellness, you’re exercising five days a week, which means you’re triggering a migraine five days a week. If migraine is preventing you from daily activities such as exercise, then on the MIDAS scale you’re probably in a category of disability that merits a daily preventive med. If you don’t want to use medication, review Ch. 11 to learn more about using magnesium or other dietary supplements as a preventive.

  Your Migraine Exercise Plan

  Your goal is half an hour of exercise every day, at least five days a week, rain or shine. It can be really helpful to keep a calendar, both to remind yourself to exercise and to congratulate yourself at the end of each week and month with concrete evidence of your effort. Just mark on your day minder or kitchen calendar—no need to keep a separate record unless you want to.

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  How to Squeeze in a Half Hour of Exercise When You Can’t Do Your Regular Routine:

  Vacuum your house vigorously while you listen to salsa!

  Chase your kids around the park. Keep moving!

  Put on your stereo and dance by yourself.

  In an airport, walk vigorously around the terminal.

  In a mall, walk vigorously around the shops. It’s fine to window-shop but don’t stop to buy anything until your half hour is up.

  Pump weights to music. Pick up some arm weights and pump for half an hour.

  Turn to an exercise channel on TV and work out with the show (this is great if you’re in a hotel without a gym).

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  Keep Moving All Day Long:

  Pace back and forth in the office or at home when you’re on the phone. This burns calories.

  Climb the stairs instead of taking the elevator every chance you get.

  Walk on the golf course instead of taking a cart.

  In a parking lot, park far from the entrance of the mall or grocery store. By itself, this won’t keep you fit, of course, but combined with other exercise, every bit helps.

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  Sleep

  “Lack of sleep always gives me a migraine.”

  —Emily, 43, tutor

  “Sleep deprivation makes migraines worse every time.”

  —Flannery, 37, veterinary assistant

  “When my schedule is changing a lot in my
eating or sleeping, I end up invariably with more migraines.”

  —Brian, 32, computer programmer

  “I have to have sleep. I get really, really sick whenever I don’t.”

  —Marie, 41, writer

  Sleep. Sleep. Sleep.

  Ask migraineurs to list their top triggers, and almost every one will say sleep. Lack of sleep, interrupted sleep, poor-quality sleep, too much sleep—it makes us sick.

  You almost certainly won’t be able to cut back on migraines unless you get seven to eight hours of good sleep each night. In fact, if you don’t sleep like this, your migraines may well get worse and come more often. They may even transmute into daily migraines. That’s why good sleep has to be a top priority for you, perhaps your number one priority.

  Sleep is essential for your brain to restore and refresh itself, and if you don’t sleep well, there are adverse health effects: You won’t have the energy to exercise, your body may prompt you to overeat, and you’ll have more stress—all of which are more triggers for your Migraine Brain.

  A fascinating new study at the University of North Carolina at Chapel Hill shows that good sleep habits can significantly decrease the number of migraines you get and how much they hurt. The study followed a group of women with “transformed migraines,” which used to come sporadically but had transformed into daily or near-daily headaches. In the study, the women were instructed to follow certain steps for good sleep hygiene, including getting eight hours of sleep each night, avoiding watching TV or listening to music in bed, eating dinner at least four hours before bedtime, and limiting how many liquids they drank in the two hours before bed. The results were striking. The frequency of their migraines decreased by 29 percent, and the intensity of the pain decreased by an astonishing 40 percent. By the end of the study, the majority of women practicing these steps had actually reversed their migraine pattern—their headaches no longer came daily but were sporadic once again.

  For us migraineurs, this study and similar research on sleep is very good news as we explore ways to feel better. Here’s something over which we have some control—sleep—that can make an enormous difference in our migraine health.

  Lack of sleep switches on your sympathetic nervous system, which floods your body with cortisol and adrenaline, triggering the “fight-or-flight” response so that your stress level, heart rate, and blood pressure increase. Stress, of course, is a significant migraine trigger. Sleep also helps keep your brain on an even keel chemically, scientists believe, something our Migraine Brains crave. No doubt there are other physiological connections between poor sleep and migraines.

  Seven to eight hours of good sleep and a regular sleep routine are hugely beneficial to your Migraine Brain. Of course, for many of us this is easier said than done. Sleep deprivation is at epidemic levels in the United States. More than 70 million Americans may have trouble sleeping, according to the National Institutes for Health. As many as a third of Americans show symptoms of insomnia, though most have not been diagnosed or treated for it. Americans get an average of 6.8 hours of sleep a night during the week, a full hour less than they need, according to a 2005 poll by the National Sleep Foundation. Many doctors believe that sleep is the next big frontier in understanding health, and that new research will confirm how critically important it is for all of us.

  Sleep Disorders

  If you aren’t waking up refreshed even after sleeping eight hours, you may have a sleep disorder. If you can’t fall asleep or stay asleep, you may have a sleep disorder. Do you snore? You may have a sleep disorder. You need to address this because your health is at stake.

  If you get chronic headaches, you’re twice as likely to snore. And chronic snoring can lead to heart and brain problems. Chronic snoring is very common, involving about 45 percent of Americans, and is often a sign of a sleep disorder such as sleep apnea, in which you stop breathing for periods of time while sleeping. At least 20 million Americans suffer from sleep apnea but most have never been diagnosed even though it can be fatal. There are excellent treatment options for sleep apnea, including using a CPAP unit. See Ch. 4.

  If you suspect you have a sleep disorder, talk to your doctor as soon as possible. Discuss the problems with your primary care physician as well as your headache specialist. They can make recommendations for treatment, including seeing a sleep specialist or going to a sleep clinic. This may be one of the most important steps in your migraine health. Improving your sleep may very well reduce the number of migraines you get—and help you avoid a host of other health problems, too.

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  Want to Stay Alive? Sleep!

  People who sleep seven to eight hours a night have the lowest incidence of death from all causes.

  Sleep disorders are related to life-threatening illnesses including heart attack, high blood pressure, and stroke, as well as depression and attention deficit disorder. More than 100,000 automobile crashes each year and at least 1,500 auto fatalities are caused by drivers who are sleepy, according to the National Highway Traffic Safety Administration.

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  Headaches and Snoring

  If you get chronic headaches, you’re more than twice as likely to snore, and snoring can interrupt healthy sleep. Talk to your doctor. Losing weight and cutting out alcohol may reduce your snoring, which may help you sleep better and, in turn, reduce the number of headaches you get. You may also want to have a sleep evaluation to determine whether there are other physical disorders causing snoring, such as sleep apnea, a very common and serious—a potentially fatal—condition.

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  Sleep Hygiene for Fewer Migraines

  How do you fit seven to eight hours of sleep a night into your crowded life? Keep to a regular sleep routine, whenever possible. At a recent medical conference where I was speaking about migraines, a husband and wife—both physicians—waited to speak with me. They both got migraines, and their primary trigger was poor-quality sleep. Any change at all in their sleep cycle could make them sick, they’d discovered. If they slept in late for just an hour on a Saturday, they’d each get a migraine. So they’d learned to maintain a rigid sleep schedule whenever possible, going to bed at the same time and getting up the same time, even when traveling. This way, they managed to dodge most of their migraines.

  Another doctor I know often got migraines on Saturday morning. She said that an eminent neurologist told her it was because, “You have time to have a migraine on the weekend.” I tried not to look appalled, and told her the more likely explanation was physiological. When she slept in late on Saturdays, she interrupted her normal sleep cycle and also delayed her first cup of morning coffee—both changes in her routine that could be powerful migraine triggers. There is a physiological reason for migraines that we can often identify. The best way to find a trigger is to look for any changes in your normal life pattern—including changes to your sleep pattern that preceded a migraine attack.

  Of course, in the modern world, sleep has taken a back seat to other demands on us. Work, family, housework, social obligations, and other issues tug at our time, and it’s easy to cut back on sleep. But our bodies are not set up for less than seven to eight hours of sleep a night and we are paying the price with health problems such as obesity, accidents, and the inability to function well.

  So, how can you get plenty of good-quality sleep?

  Keep a regular sleep routine. Go to sleep around the same time each night and wake up around the same time each morning. Your Migraine Brain likes consistency.

  Try to get eight hours of sleep, or at least seven. You need this much, experts insist. If you miss getting enough sleep one night it is possible to catch up the next night. But miss an entire night of sleep, and it takes your body two to three weeks of extra sleep each night before you’re functioning normally. A chronic sleep deficit can’t be cured by catching up later, and the negative effects on your body are serious.

  Don’t take naps during the day. This disrupts your sl
eep at night. (However, in acute situations such as travel or a new baby in the house, naps may be necessary.)

  Keep your bedroom dark. A darkened room is essential for good sleep for everyone, and migraineurs are particularly light-sensitive. Even a brief exposure to a bright light during sleep can significantly interrupt your sleep cycle, researchers have found. Don’t use a night light. If you have to get up in the night to go to the bathroom, keep light levels very low and get back into bed with the lights out as soon as possible.

  Have a quiet, comfortable bedroom. Arrange your bedroom so that it optimizes sleep for you, including keeping the room quiet and dark. Invest in a good mattress.

  Have a bedtime ritual. This may sound goofy or childish, but a bedtime ritual can cue your body and mind for sleep. It may include a warm bath before you turn off the lights. You may also want to use relaxation techniques such as deep breathing, which will help you sleep by calming your nervous system.

  Don’t work or watch TV in bed. They keep your brain waves active when they should be slowing down for sleep.