MIGRAINE

To be diagnosed with migraine, the International Headache Society specifies that patients must have had at least 5 headache attacks that lasted 4–72 hours (untreated or unsuccessfully treated) and that the headache must have had at least 2 of the following characteristics:

• On one side of the head
• Pulsating
• Moderate or severe pain
• Aggravated by or causing avoidance of routine physical activity (such as walking or climbing stairs)

In addition, during the headache you must have had at least 1 of the following:

• Nausea and/or vomiting
• Sensitivity to light and sound

The signs and symptoms of migraine will vary between patients, between migraine episodes and between phases of an episode in a patient.

Commonly reported symptoms that occur in 4 phases of a migraine headache

Adapted from Cleveland Clinic, Mayo Clinic and Andreou et al.

When you’re living with migraine, it’s invaluable to keep the lines of communication open with your family, friends and coworkers: they can’t understand what it’s like to live with migraine if you don’t talk openly about it.

Here are some tips and helpful insights we’ve learned from migraine patients:

• Ask those closest to you to learn about your condition. This way they’ll understand your symptoms, or even go with you to your appointments. They can read this or other web sites, or consult reliable sources like libraries, or refer to our resources section. Migraine CanadaThis link opens the page in another browser window., the Headache Canada Network (ESC)This link opens the page in another browser window., the Canadian Migraine SocietyThis link opens the page in another browser window. and, in Quebec, Migraine QuebecThis link opens the page in another browser window. are good sources of information.
• Let them know you need their support. This could be just a sympathetic ear when you need to talk. Be sure to tell them that having migraines means you will have good and bad days.
• Always be open and honest about your migraines. It’s the only way people can help you. Remember, if you’ve ever said to a friend or family member, “You don’t know what it’s like”, that’s maybe because you haven’t told them. It’s best to give others a very clear idea of how they can help you. Here are some examples of what you may ask of your friends and family:
  • Bring you the notes from a missed class
  • Do a few of your chores when you cannot do due to a migraine
  • Take a walk together
  • Do a hobby with you
  • Try migraine-friendly recipes (nutritious according to Canada’s Food Guide and avoid your triggers)

Migraine is different for every patient. Don't hesitate to ask questions and get involved in decision-making regarding your health. And keep in mind there are many options available to you, so if one approach isn’t working, another one might.

Here are some tips on how to get the most out of your appointment with people on your healthcare team:

• Before the appointment:
  • Write down your goals (e.g., establish a treatment plan or simply better understand migraine)
  • Keep a Headache Diary that includes:
    • Your triggers
    • All symptoms you experience even if they are not related to headache (such as digestive problems)
    • Change in your headaches or other symptoms over time
    • Updated complete list of the medications and supplements (and their doses) that you are currently taking
    • Effect of any medications you take
  • List any questions you have
• During the appointment:
  • Be open and honest about how you’re feeling and how the different symptoms of the disease affect your quality of life
  • Take notes
  • Ask who you should call if something happens between scheduled appointments

Poor sleep can be a migraine trigger.

Here is some general guidance to improve your sleep:

• Use your bedroom to represent sleep:
  • If you can’t fall asleep in 20-30 minutes, you should leave the bedroom, so you don’t associate it with frustration and anxiety.
• Keep your bedroom quiet, dark, and cool (consider a white noise machine)
• No screens (TV, phone, laptops, tablets) in the bedroom
• Try to go to bed at the same time each night
• Do not take naps during the day
• Try bedtime relaxation techniques such as progressive muscle relaxation
• Look into sleep restriction therapy (the goal of this therapy is to be asleep 90% of the time in bed)

If you have been diagnosed with a disorder called “sleep apnea” (breathing stops and starts repeatedly while sleeping), your doctor will have specific advice for you. People with chronic migraine are more likely to suffer from sleep apnea.

Exercise may be helpful in managing migraine by decreasing the number of migraine days and reducing the intensity and duration of migraine headaches.

Exercise advice:

• Aim at 30 to 60 minutes of exercise 3 to 5 times a week
• You can start small with as little as 5 minutes per week
• Gradually increase the amount of time and frequency of exercise
• Try to choose a type of exercise you enjoy
• If you find your migraine headaches are stopping you from exercising, talk to your doctor about preventive treatment

People with migraine should eat regular healthy meals, drink enough water, and limit caffeine consumption.

In the prodrome of a migraine episode, you may experience several symptoms including food cravings. The prodrome can occur up to 72 hours before a headache, so it can be difficult telling the difference between a craving and a trigger. Make sure to keep a careful record of cravings in your migraine diary.

General diet and hydration tips:

• Keep in mind that there is no specific “migraine diet”
• Eat healthy meals at least 3 times a day; 5 to 6 meals per day when hunger is a trigger
• Avoid skipping any meals
• Stop consuming caffeine or consistently limit yourself to 1–2 cups of brewed coffee (200 mg of caffeine per day)
• Achieve and maintain your optimal weight
• Stay hydrated, aiming for 7–8 glasses (8-oz) of water per day

When planning meals, consider the above advice and consult Canada’s Food guide for help making healthy food choices.

Eating regular meals is particularly important for people who suffer from migraine headaches – migraine tends to be more common when meals are skipped, especially breakfast. Eating breakfast within 30 min to an hour of rising in the morning is considered to be optimal. Long periods of time between meals can trigger migraine attacks, or lead to more severe headaches because of low blood sugar levels.

In people with migraine, caffeine can act in a range of ways:

• Caffeine may be a migraine trigger.
• Stopping caffeine may be a migraine trigger. People with migraine who consume caffeine regularly can become prone to attacks if they decrease or stop their intake.
• Caffeine affects sleep: It can take up to a full day to completely eliminate caffeine from your body so the effects of caffeine can affect your sleep even if you only have a cup of coffee in the morning. Poor sleep is a trigger for migraine.
• Caffeine can help to treat a migraine headache. Caffeine can boost the effect of other pain killers.

Caffeine can be in coffee, black, white, and green tea, energy drinks, soft drinks, chocolate as well as over the counter supplements and medications. According to Migraine Canada, the jury is out on whether its best to reduce caffeine intake (to 200 mg per day or lower) or to stop altogether. If you choose to reduce your caffeine intake, here are some tips:

• Do not stop caffeine suddenly! This may result in a withdrawal headache.
• Reduce caffeine slowly by week (at each week cut out the equivalent of ½ to 1 cup of coffee tea, or soft drink).
• If you get a withdrawal headache, you can treat it with caffeine or with your usual treatment for acute headaches.

Maintaining a migraine diary will help you and your doctor understand your current headache pattern, assess how you are responding to treatment, and monitor how much treatment you are using.

Diary tips:

• Track your headaches, any medications you use and their effects in a migraine diary (see below)
• Bring the diary to appointments with your doctor

What you can include in your diary:

• Headache frequency, duration, and intensity
• Medication use and effect, including:
  • Effect or lack of effect
  • Side effects such as medication overuse headaches
• Headache effect on daily activities including work
• Potential triggers
• Lifestyle habits

Migraine Canada offers a mobile diary app as well as access to various printed versions.

People with migraines tend to experience stress. Stress can trigger migraine and the pain of migraine creates more stress. Also, your body can get accustomed to stress so a weekend off (of work for example) can be a trigger leading to a “let down” migraine.

One of the most effective things you can do to control migraine is to reduce your stress.

Here are a few tips to reduce stress:

• Prioritize: when making your to do lists, assess each item by how much stress it will cause and eliminate or minimize stress-causing items whenever possible
• Schedule in time for you (a half hour “breathing” period can make all the difference)
• Make time for relationships and personal growth (do something fun!)
• Be assertive and be clear with other people on what you want and don’t want

In addition to the above, there are specific techniques that can help you manage stress:

• Behavioral management (can be individual or group sessions; teaches you how behaviors and thoughts affect your perception of pain)
• Mindfulness (this is awareness of thoughts, feelings, and sensations in the present moment without judgment)
• Biofeedback (a relaxation technique that uses special equipment to teach you how to monitor and control certain physical responses to stress, e.g., muscle tension)
• Relaxation techniques like visualization or progressive muscle relaxation

Neuromodulation devices use electrical currents or magnets to adjust or change activity that occurs in the brain. This technique may be used to help stop attacks that are already underway and it can also be used preventatively.

Side effects of neuromodulation may include light-headedness, dizziness , tingling, ringing in the ears, or the occasional headache.

Depending on the severity of your migraines, you may have one or more of the following people on your healthcare team:

• Family physician
• Physical therapists
• Occupational therapists
• Neurologist
• Walk-in clinic physician
• Pediatrician
• Nurse practitioner
• Pharmacist
• Psychologist
• Nutritionist/dietician
• Chiropractors

Other healthcare professionals may also be involved, such as nurses and social workers.