The Migraine Brain

by Bernstein, Carolyn; McArdle, Elaine

  There are few situations more fertile for migraine trouble than traveling. Travel’s potential migraine triggers include motion sickness, dry or recirculated air in the plane or other vehicle, lack of sleep or disrupted sleep, jet lag, bad airline or train food, noxious car fumes, and unfamiliar hotel rooms. Even if you aren’t troubled by these, travel by its nature is about change: change in your routine and in your environment. And change is what your Migraine Brain can’t tolerate. Even a day trip with the kids to a nearby beach can set you up for an attack: the chaos of getting everything ready, the motion of the car, the shouting of the excited children, bright sunlight, and the challenge of getting good food and plenty of liquids. Long-distance trips are even more problematic. Instead of enjoying the Uffizi Gallery or successfully networking during a business trip to Chicago, you may find yourself desperate to put your head down on the conference table as a meeting drags on.

  But most of us can’t avoid travel, and often, we don’t want to. It may be required by your job, and can be fun, fulfilling, and educational. You just wish it didn’t take so much out of you.

  You don’t have to avoid traveling in order to avoid getting a migraine. But you do have to plan ahead. Make your Migraine Brain your top priority, ahead of worrying about what clothes to pack or which fabulous tourist sites you hope to visit. It’s the most important part of having a good travel experience. Everything else follows from it.

  I hope that by this point in the book, you feel empowered to put your health first without feeling guilty or embarrassed. Don’t flinch at the fact that you have to pack extra items and take extra precautions to stay healthy while traveling. You certainly wouldn’t hesitate to carry your insulin with you if you were diabetic.

  Healthy traveling is possible, even for many of my patients who are really challenged by long trips. I have a patient who was traveling to London from Boston—a six-or seven-hour flight plus a five-hour time difference. She suffers from severe migraines every time she travels, often having to take to bed for a day or two. She couldn’t see how to avoid it this time, given the substantial triggers involved. She doesn’t sleep well on airplanes and needs a good eight hours a night. The time change puts her entire routine out of whack—when she eats, sleeps, and exercises. Nonetheless, I assured her a migraine isn’t inevitable.

  Here’s what I recommended for a migraine-free trip:

  Eat a healthy, high-protein meal before getting on the flight.

  Drink eight ounces of water every hour, unless you are sleeping.

  When you get to London it will be 9 p.m. London time but 4 p.m. in your internal clock. Have a good meal with some protein, and continue to drink water.

  Then go to your hotel, take a mild sleeping pill, and sleep until the next morning.

  My patient followed these steps and, after a light dinner, went to bed at about 11 p.m. London time, which was 6 p.m. according to her internal clock. Because she’d taken a sleeping pill, she awoke at 9 a.m. London time, which gave her ten hours of good, restorative sleep. She felt refreshed and skipped jet lag entirely. She didn’t get the dreaded migraine and was raring to go for a full day’s activities.

  This may not work for everyone. But by planning ahead, you, too, can avoid or at least minimize migraines while traveling.

  Planning Is Key

  Planning is key to migraine health but even more important when you travel because, typically, you’ll have less control over your situation. You’ll want to anticipate possible problem points and be ready to counteract them.

  Let’s look at three important facets of staying migraine-free during a trip:

  1. Know Your Travel Triggers. Travel is rich with potential migraine triggers, including many you never encounter at home. Identify all the potential triggers of your trip and plan ahead on how you can try to avoid them. But the truth is that you may not be able to. Controlling your environment is much harder when you’re away from home.

  2. Pay Even More Attention to Wellness. Since travel is so difficult for many migraineurs, you have to try to be as healthy as possible before and during a trip. Pay additional attention to your wellness plan and tailor it to travel. For example, figure out ahead of time how you’ll fit exercise into your trip: Find out about nearby gym facilities or running tracks, and bring along your workout gear. Ask about a quiet hotel room. If you’re staying with friends, it’s important to tell them that sleep is essential for you to avoid a migraine. If their home is not quiet enough for you, it may be worthwhile to spend the money for a hotel.

  3. Be Ready to Abort and Rescue. If a migraine does come despite your best efforts, you should have your tools and treatment plan ready and with you. Nothing’s worse than being in a strange city, away from your doctor, and coming down with a whopping migraine only to find that you’ve run out of your medicine.

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  Potential Migraine Triggers

  Motion sickness. Whether in a car, airplane, or boat, many migraineurs are particularly susceptible to motion sickness. Nausea and vomiting from motion sickness can lead to dehydration, which alone or in combination with other factors can lead to a migraine.

  The stresses of travel, including finding your way around a new place or speaking an unfamiliar language.

  Smelly fumes from car or other engines, or other bothersome odors, especially in tight quarters (such as a seatmate doused in strong perfume on an airplane or smoking in restaurants, businesses, or transportation where it’s still permitted).

  Stuffy air in a car, bus, or airplane; air-conditioning you can’t turn off.

  Lack of sleep, a change in sleep routine, sleeping in a new place.

  Different weather or barometric pressure.

  Allergies. Different plants and flowers, for example, or animal hair in the home of a friend you’re visiting.

  Changes in eating routine and difficulty in locating healthy foods.

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  Your Travel Wellness Plan

  No matter where you are going or for how long, the key to staying healthy is to maintain as much of your routine as possible. That means, at a minimum: eating healthy foods on a regular schedule, getting enough good sleep, staying hydrated, exercising regularly, and using relaxation techniques to stave off stress.

  Sleep. You need to take a very aggressive role in trying to ensure good sleep while you travel. Here are some practical tips for maximizing high-quality sleep in a new or strange place:

  Carry your own pillow with you or pack it in your suitcase.

  If you’re staying in a hotel, ask for a quiet room away from elevators and at the end of a hall. Explain that you need a quiet room or you will become ill.

  If you are staying with friends, it may be a little trickier to ensure good sleep. Explain to your friends that you have trouble sleeping, and ask if they can help you by providing you with a dark, quiet room.

  If they don’t have this kind of space, consider taking a mild sleeping pill or over-the-counter sleep aid like Tylenol PM.

  Bring earplugs and an eye cover. (These are in your Migraine Travel Kit, which you should keep ready. See Migraine Brain Travel Kit)

  Make your room as comfortable as possible before you get into bed. Make sure that the room is a temperature you like and you have enough blankets. Get a glass of water for your bedside table. Take a warm bath if this will help you relax. Move ticking clocks out of your room. Unplug nightlights; turn clocks with glowing numbers so they face the wall.

  Healthy Food. Don’t use travel as an excuse to eat bad or nonnutritious foods. You should be as committed to a healthy diet as a diabetic. The world is much more conscious about healthy food than even five years ago, so even airports often have good food choices. You can order a high-protein meal—such as a grilled chicken salad—at many restaurants. And the food in many foreign countries is as nutritious, often more so, as in the United States. Review the nutrition section in Chapter 12. Eat every four to six hours, if even just a healthy snack. Keep nutrition a top prio
rity.

  It isn’t always easy to find healthy foods when you travel. Airplane food is often terrible and can wreak havoc with your blood-sugar levels. You may arrive late in a city after restaurants are closed. That’s why you should always carry nutritious food with you in your purse or carry-on bag: a high-protein sandwich, protein bars, nuts. Don’t eat any unhealthy airline snacks just because they’re there.

  Stay Hydrated. Always carry water with you. At airports you probably won’t be able to carry bottled water through the security checkpoint, so make sure you purchase a water once you are past security.

  Drink water throughout the day during any kind of trip, whether it’s by car, train, boat, or airplane. Dehydration is bad for your Migraine Brain. You need at least eight ounces of water, six to eight times a day, and maintain this goal during travel. It’s inconvenient to have to stop to use the bathroom but it’s a step you must take.

  Exercise. Make exercise an essential part of the daily activities of your trip. Don’t use travel as an excuse to miss your regimen. You need it now more than ever, since travel presents so many other migraine challenges. Exercise will help you stay healthy and provide the endorphin rush that may stave off a migraine.

  Bring your workout clothes with you on any trip, certainly any trip that’s longer than two days. Keep a pair of walking or running shoes in your car for unexpected opportunities to exercise.

  Try to stay at hotels that have gyms or workout facilities. Most hotels these days do, but check ahead of time. If yours does not, ask the concierge to recommend a nearby gym where you can get a temporary membership. Remember, all you need is a half hour each day of moderate exercise to feel much better overall. If this aspect of your regular routine is not disrupted, it will help your Migraine Brain resist getting agitated by change.

  If you have a lengthy layover in an airport, check to see if it has gym facilities. See www.airportgyms.com, which lists fitness facilities at American and Canadian airports and nearby hotels. Carry your gym clothes in your airline carry-on bag. At the very least, have walking shoes in your carry-on bag—or simply wear them on the flight—and take a vigorous half-hour walk in the airport terminal. Everyone around you is rushing anyway. You’ll fit right in, and feel much better.

  Relaxation. Travel can be very stressful, even when your trip is a vacation. So use your relaxation techniques during travel, including:

  Deep breathing—As explained in Chapter 11, deep breathing counters your stress response. Breathe in slowly, to the count of four or six; breathe out slowly, to the count of six or eight. Breathe from your diaphragm and not your upper chest—your belly should be moving more than your chest.

  Yoga—You can do yoga almost anywhere: in a clear space in the airport (say, in the area where you’re waiting for your flight), in your hotel room, or in the guest room if you’re staying with a friend.

  Meditation—You can meditate almost anywhere, including in your airplane seat. If noise around you interrupts your meditation, carry an iPod or Walkman and listen to a relaxation tape or soothing music. Many airports today have meditation rooms. Google the airports you will be traveling through to see if they offer one.

  Car Travel. Many migraineurs have a problem with motion sickness when traveling in a car or bus. Here are some practical steps for avoiding a migraine:

  Keep a Migraine Travel Kit (see Migraine Brain Travel Kit) in your glove compartment or backseat.

  Ask your doctor for a prescription for a motion-sickness medication, if you are susceptible to this problem.

  Or use an over-the-counter motion sickness medication. Ginger-flavored drinks may help, too, as ginger is an old-fashioned antidote for motion sickness and nausea.

  Air Travel. Airplane travel is notorious for triggering migraines. If you are afraid of air travel, anxiety can itself trigger a migraine. Talk to your doctor about taking an antianxiety medication for the flight. Whether you like flying or not, here are steps to a happy, migraine-free flight:

  Wear comfortable clothes. If you are going straight into a business meeting after you arrive, at least bring comfortable slippers to wear on the plane.

  Drink water! Drink so much that you’re going to the bathroom every hour. That’s probably at least eight ounces of water every hour.

  Alcohol doesn’t count. It will dehydrate you. If alcohol is a trigger for you, avoid it since you’re exposed to other triggers on the plane and don’t want to overstress your Migraine Brain. (You may want to limit your alcohol intake even after you’ve landed and throughout your trip to avoid an attack. If you do drink, remember the one-to-one rule: one glass of water for every alcohol drink.)

  Tea and coffee don’t count, either. They contain caffeine, a diuretic that can make you dehydrated. But it’s okay to drink tea and coffee as long as you also drink eight ounces of water every hour.

  Bring good snacks. Stale pretzels served on airplanes are not going to help you keep your blood-sugar levels even. So carry protein snacks, such as protein bars or nuts, or a turkey or peanut butter sandwich. Fruits and vegetables are fine, too, although protein staves off hunger longer.

  Bring a pillow and a sweater or sweatshirt with you in case the cabin is too cold and the seat is uncomfortable.

  Ask for a window seat if you are trying to sleep so you can lean your head against the airplane wall. Or purchase a travel pillow that wraps around your neck and keeps your head in a comfortable position.

  A mild sleeping pill prescribed by your doctor may be good, especially on an overnight flight. If you can fall asleep on the plane, you can get some quality slumber before you arrive at your destination.

  Check into your hotel early. If you’re simply unable to sleep on an airplane, even with the help of a sleeping pill, make arrangements with the hotel in your destination city to have your room available when you arrive. Lie down for three or four hours and then get up and have a healthy meal. Then try to go to bed at a reasonable time that night.

  Fly first or business class if you can afford it, especially for very long flights. If the seat folds down into a bed, which is the case with many overseas carriers, you may be able to sleep a full eight hours and awaken at your destination without any problems.

  During a Layover. As noted above, a long layover is a good opportunity to get an adrenaline burst by exercising. You can use an airport gym or walk vigorously around the airport terminal.

  If you have a long layover in an airport and are exhausted, you may want to spring for a sleeping room that some airports offer or go to a nearby hotel to catch some sleep, if this will stave off a migraine.

  Many airports now also have mini-spas where you can get a massage, a facial, a manicure or pedicure, or other services that can relax you. For a list of airport spas, see www.spaindex.com/Lifestyles/airports.htm. Airports that don’t have spas often have vendors who offer a chair massage. This will at least relax your muscles, including your neck and back muscles, which may help stave off a headache.

  Some Particular Travel Challenges

  Foreign food. Investigate the local cuisine before you arrive to see if it includes your personal food triggers. If onions are a problem for you, for example, you may have a challenge eating in rural areas of Mexico. Plan ahead. You may have to find restaurants that offer continental cuisine.

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  Migraine Brain Travel Kit

  No matter how long your trip, there are some items you should always have on hand:

  2–3 bottles of water

  Ear plugs so you can get some sleep

  An eye cover so you can avoid bright lights and get some sleep

  High-quality sunglasses

  Several high-protein snacks so you’re never without nutritious food. I recommend protein bars, high-protein sandwiches (turkey on whole-wheat, for example), or nuts

  Keep your travel kit in your glove compartment in your car (not the sandwiches, of course). For air travel, keep it in your purse or carry-on bag.

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/>   Sunburn. If you’re going to a sunny locale, don’t get sunburned! Sunburn is not only painful but can dehydrate you, and the combination may trigger a migraine. Wear sunscreen, bring a hat and sunglasses, and drink plenty of water.

  High altitudes. High altitudes may cause the brain to swell, and, as you know, your brain doesn’t like any change. So high altitudes may lead to a migraine. If you are going skiing in Colorado or hiking in Peru, plan ahead for this possibility. Talk to your doctor about whether you are an appropriate candidate for acetazolamide (Diamox), a prescription medicine that acts as a diuretic for your brain, releasing the pressure and thus helping you avoid a migraine.