The Migraine Brain

by Bernstein, Carolyn; McArdle, Elaine

  Eat dinner at least four hours before going to bed. A full stomach can inhibit sleep.

  Don’t drink much liquid within two hours of going to bed. Getting up to go to the bathroom is the number one reason for interrupted sleep in women.

  Don’t drink caffeine close to your bedtime. I recommend that most people stop drinking caffeine by 6 p.m. each night. But you may need to stop earlier. As people get older, they become more susceptible to the stimulating effects of caffeine. If you’re having trouble sleeping, cut back on caffeine at a point earlier in the day, but don’t change your caffeine routine too quickly or you can end up with a caffeine-withdrawal headache, which in turn can lead to a migraine.

  Be careful about alcohol. Alcohol disrupts sleep patterns. Don’t drink it if you are having trouble sleeping, or keep it to a minimum.

  Practice relaxation techniques. Visualization of relaxing scenes was a key sleep aid in the UNC study where women decreased the number of their migraine attacks. Keep your mind on visual scenes—the beach, a forest stream, a sunset. If you find yourself thinking in words, bring your focus back to comforting visual images.

  When traveling, plan ahead to minimize interruptions to your sleep. See Ch. 14.

  If you still have problems, talk to your doctor. If you have consistent, continuing problems with sleep, you should be evaluated for a sleep disorder. If you have sleep apnea, for example, the treatment may be as simple as using a CPAP, a device you wear over your face that gives you a regular stream of oxygen, or another, similar device. Your doctor may prescribe a mild sleeping pill such as eszopiclone or zolpidem or suggest you try an over-the-counter sleep aid. These OTC sleep aids often contain antihistamines, which is why they make you fall asleep, and generally are safe and nonaddictive. However, you don’t want to take sleep aids every night for long stretches of time because you may become psychologically dependent, afraid that you won’t be able to sleep without one, which in itself will keep you awake.

  How to Sleep During a Migraine Attack

  For many migraineurs, sleep is the cure-all. Once they fall asleep, their sleep can be deep and heavy, and they may awaken completely restored, feeling refreshed or even euphoric. We’re not sure why this is. Sleep probably lets the brain reequilibrate and restore itself to a baseline of health.

  But how do you sleep if you’re in the middle of a migraine attack? If your abortive medicine or treatment didn’t work, you’re in for a challenge. It’s really hard to zonk out when your head is pounding.

  The best choice may be to take your rescue medication, a painkiller that often will act as a sedative.

  If you’re not nauseated, try eating a banana or drinking a glass of milk. Both contain L-tryptophan, an amino acid that helps you sleep.

  You may want to take an over-the-counter antihistamine or sleep aid, which makes you sleepy and is safe for most people.

  If You Really Can’t Get the Sleep You Need…

  What if you simply can’t get eight hours of sleep a night? What if you have a new baby at home, or you work as a firefighter? Are you doomed to getting sick?

  Yes and no. It will be very hard to reduce the number of migraines you get until you can keep a regular sleep schedule. But don’t despair. There are ways to make the best of the situation.

  Catch up on sleep. Be creative in finding ways to sneak in some sleep. Take naps whenever you can. Hire a “night nanny,” if you can afford it, to get up with your baby at night or early in the morning. Find a migraine buddy who also has small kids and take turns watching each other’s children while you nap. This isn’t ideal for keeping migraines at bay but it’s the best you can do until your life changes.

  A preventive medication may help you. And keep your abortive medications with you at all times.

  Take extra good care of other aspects of your health. Eat healthfully, exercise, practice relaxation techniques, and avoid as many other triggers as you can.

  * * *

  Trying to Lose Weight? Sleep!

  Sleep deprivation can make you fat by reducing chemicals that suppress your appetite. And people who are exhausted tend to eat more in an attempt to gain energy. Some scientists believe the obesity epidemic among children is at least partly related to sleep deprivation among today’s kids, few of whom get as much sleep as they need. Obesity, in turn, leads to other health problems.

  So if you’re trying to lose weight—and have fewer migraines, too—commit to getting more sleep.

  * * *

  If this period of sleep deprivation is temporary, you can wait it out. But keep in mind that you are depriving your body of something it needs, and that will catch up with you.

  Monitor yourself carefully to see if your migraines are increasing in frequency. If you are chronically sleep deprived, there’s a strong likelihood you’ll move from episodic migraines to transformed migraines that come nearly every day.

  Your Sleep Journal

  Is sleep a problem for your migraines? Record how much sleep you get each night and how you feel when you wake up (do you feel refreshed? Or tired?). Monitoring yourself for a couple of weeks may give you some insights on the sleep-migraine connection. See the sleep journal in the appendix.

  Healthy Eating

  “My biggest trigger is hunger. Even before I started getting migraines, I was a grumpy person if I was hungry. But now, if I’m hungry, I’m going to get a migraine. I absolutely have to carry a Power Bar with me.”

  —Felicity, 29, college professor

  “I plan my day around eating. I will almost always get a migraine if I don’t eat enough or miss meals. It’s so obvious that my husband and my friends will remind me, ‘Have you eaten yet? Can I make you a sandwich?’ And if I’m on my period, when I tend to be ravenously hungry anyway, I have to be even more careful to eat enough, since my period is a trigger, too.”

  —Fiona, 49, writer

  Eating healthfully minimizes migraines and dramatically reduces the number you get.

  But forget so-called “migraine diets.” There is no food plan that prevents migraines for all of us. While certain foods can trigger migraines in one person, they often have no effect on someone else. What’s most important is to keep your blood-sugar levels even by eating regularly and eating healthy foods. If you skip meals, go too long between meals, or eat high-sugar and low-fiber foods, your blood-sugar levels jump all over the place and your Migraine Brain may react.

  You’ve probably heard of the glycemic index, a measure of your blood-sugar levels. When you eat foods high in fiber and protein, the sugar you need for energy is released more slowly through your body, like a time-release drug. But when you eat highly processed and sugary foods, you get energy too fast—and then suddenly crash when the sugar runs out. Your pancreas releases insulin to digest the sugar and carbohydrates in the foods you eat. If you eat very sugary or processed foods, your body digests the sugar very quickly and you have a surplus of insulin. This surplus causes your blood sugar to plummet. You become tired and hungry, and you may respond by eating more sugar. That’s why you may feel like you need a nap after eating. And your blood-sugar levels are fluctuating throughout, seriously provoking your Migraine Brain.

  You can check the glycemic index of foods at www.glycemicindex.com for information about the value of keeping your glycemic intake on an even keel, including what foods to eat and which to avoid.

  Good nutrition has numerous other benefits besides helping with migraines, of course. It keeps your body strong and healthy. It’s critical for avoiding diabetes, obesity, heart disease, and emotional and mental problems. Eating healthfully is simple, but it’s not always easy. It requires effort to avoid the poor food choices that are all around us all the time—at fast-food restaurants, in convenience stores, heavily marketed on TV. Good food choices require a bit more planning, discipline, and time—but it’s worth it if you want fewer migraines.

  Fortunately, the steps for healthy eating to avoid migraines are simple:

  Eat
breakfast. You need a protein and good nutrition when your day begins. This simple step alone may go a long way in cutting down on your migraines.

  Eat every four to six hours. You want to maintain consistent blood-sugar levels. Instead of eating three large meals a day, try eating five or six smaller meals. This doesn’t mean you can’t go to lunch or dinner with your friends. Just order smaller portions, since you’ll be eating again later.

  Eat protein at every meal. Protein takes longer to digest than carbohydrates and is absorbed more slowly into your system, keeping your blood-sugar level even. You won’t be hungry again as quickly as when you eat simple carbohydrates. You don’t have to eat animal protein. Tofu is a complete protein that includes all the nutrients of animal proteins. If you eat animal protein, stick with lean meats to avoid heart disease and for better overall health.

  Eat complex carbohydrates instead of processed foods. Complex carbohydrates—brown rice, whole wheat bread, and whole-grain products—take longer for your body to digest and keep your blood-sugar levels on a more even keel. Oatmeal is excellent for breakfast, especially hand-cut oats, which take longer for your body to digest.

  Eat healthy snacks. When you get hungry between meals, eat something that will give you protein: a protein bar, nuts, peanut butter on whole wheat crackers or toast, yogurt.

  If you find yourself waking up with a migraine and you also are hungry, make sure you are eating enough in a healthy dinner each night. If you eat dinner early, eat a high-protein snack an hour or so before bed. Don’t eat a heavy meal more than four hours before bedtime, however, as this can interfere with sleep.

  Keep your kitchen stocked with healthy foods and snacks that keep your migraines at bay. Healthy foods are better for your family’s health, too. Peanut butter, whole-grain breads, yogurt, and nuts are all excellent choices.

  Stay hydrated. Drink six to eight eight-ounce glasses of water throughout the day.

  A good guide to nutrition is Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating, by Walter C. Willett, M.D., Dr. P.H. (Free Press, 2001).

  There are a couple of other steps for using nutrition to minimize migraine:

  Figure out if you have any specific food triggers. See Ch. 4. If so, avoid them.

  Maintain a healthy weight. Obese people may get migraines that are more frequent and painful, studies show.

  Adding a magnesium supplement, riboflavin, and/or coenzyme Q10 to your diet may help prevent a significant number of migraines. See Ch. 11.

  Obesity and Migraine

  “With my migraines I get total carb cravings, so of course most of my life I’ve been overweight. Because I get migraines all the time.”

  —Lindy, 39, lawyer

  Morbidly obese people may get six times as many migraines as people of normal weight, some studies show. Children with migraines are 36 percent more likely to be overweight, one study found. The more overweight the child, the worse their headaches—more frequent and more severe. And the migraines of obese people appear to come more often and are much more painful. Obesity is connected to numerous other serious health problems including heart disease, stroke, and diabetes.

  It’s not that obesity causes migraines, but obese people ususlly don’t exercise and often are poor sleepers, two factors that scientists theorize are key in migraines.

  If you want fewer migraines that hurt less, you have to maintain a healthy weight. But if migraineurs need to eat every four to six hours to maintain even blood-sugar levels, how can you lose weight?

  The best option is to consult with a nutritionist to develop an eating plan that will keep your blood-sugar levels consistent while helping you lose weight. Some insurance plans cover the cost of a consultation with a nutritionist. If you can’t see a nutritionist, I often recommend the South Beach Diet. It is healthy, emphasizing low-fat protein, vegetables, and fruits, and can help you lose weight without restricting the calories you consume. Weight Watchers also has a healthy eating plan that won’t jeopardize your migraine health. Weight Watchers Online is an excellent choice if you don’t want to attend group meetings or your schedule makes it hard to do so.

  You simply can’t lose weight and stay healthy unless you exercise. Diet alone will not sustain weight loss. On a very restrictive diet, your body goes into starvation mode, learning to survive on fewer and fewer calories, which makes it even harder for you to lose weight—and you feel terrible. So add in your half hour of exercise, five days a week. You’ll find it easier to lose weight—and you’ll feel better.

  Make sure you get seven to eight hours of sleep a night. Sleep deprivation is a major factor in obesity. Lack of sleep causes you to crave junk food and depletes your body of appetite-suppressing chemicals. It also interferes with how your body metabolizes insulin, which can lead to diabetes and cause you to gain weight. For good sleep hygiene, review the Sleep section in this chapter.

  Eating Disorders

  Many women have issues with food, weight, and body image. It’s a pervasive problem in Western society that unfortunately has spread to other parts of the world.

  We all feel pressure to be slender. Worried about weight and deluged with unhealthy eating choices, it’s no wonder so many women end up with distorted attitudes about food.

  At least 5 percent of college-age women suffer from anorexia or bulimia. Eating disorders are dangerous to your self-image and health—and can be fatal. Anorexia is the leading killer of young women ages fifteen to twenty-four; in fact, it kills twelve times more women than all other causes in this age group combined. But young women aren’t the only ones at risk. Eating disorders are on the rise among women over age thirty, too.

  * * *

  Migraine Brain Snack Attack

  Keep your blood-sugar levels even throughout the day. Every four to six hours, have a healthy snack, such as chunks of cheese in a baggie, little cartons of yogurt, a protein bar, or unsalted nuts. These protein-rich snacks are ideal for your Migraine Brain, and they’re small and can fit in your purse.

  * * *

  Extreme diets—such as those that severely restrict the number of calories you eat—can also trigger migraines. If you avoid eating, are on a strange diet, or are binge-eating, you are interfering with healthy body chemistry and provoking your Migraine Brain. While I sympathize with your desire to be slender, don’t make yourself sick. There are better ways to lose weight.

  If you haven’t reached the point that you have an eating disorder but you have an unhappy feeling about food or your body, professional help can benefit. There are effective programs that can turn your life around, including Overeaters Anonymous, a free, twelve-step program available in many communities. You can find a local group by Googling or asking your doctor for help. You can also find therapists who specialize in treating eating disorders and body-image issues.

  WATER—Drink Up!

  Perhaps the simplest step in cutting back on migraines is this: stay hydrated. Dehydration is a powerful trigger for many people, although they often have no idea it’s a problem. For most migraineurs, that means drinking at least six to eight eight-ounce glasses of water during each day. The amount needed to keep your brain hydrated varies from person to person, but don’t go below six glasses of water a day. When your brain is dehydrated, it may react with a headache that feels the same as a hangover headache. Your whole head will throb, but you won’t have nausea and other common migraine symptoms. However, this headache—like any other—can morph into a migraine. So be doubly careful about dehydration.

  Drinking plenty of water is good for everyone, not just migraineurs. Among other things, it prevents fatigue, so if you feel an energy lag, try drinking two glasses of water.

  It’s important to stay hydrated throughout the day. Going without water and then drinking six glasses at night will not give your Migraine Brain the consistent hydration it needs, and getting up during the night to go to the bathroom will interrupt your sleep.

  A Word about Alco
hol

  Many migraineurs find alcohol a particular problem. According to one study, almost a third find that alcohol triggers a migraine attack, and some get really sick with even minor amounts of alcohol. Migraineurs’ brains appear to be extremely sensitive to alcohol. If you aren’t drinking heavily yet have a severe reaction to alcohol, it may be a migraine, not a bad hangover.

  Alcohol dehydrates your brain, which can trigger a migraine, and many kinds of alcoholic beverages contain chemicals that can trigger migraines. See Ch. 4.

  If you’re going to drink alcohol, remember the one-to-one rule: Drink at least one eight-ounce glass of water for every glass of beer or wine or cocktail you have, more water if you’re particularly susceptible to dehydration.

  There’s nothing wrong with avoiding alcohol altogether, of course. If you think you may have an alcohol problem, see Chapter 13.

  Relaxation and Stress Reduction

  Life is challenging, and to stay healthy you need techniques for reducing stress. It can make you sick—very sick—and, of course, trigger migraines.