Migraine sufferers rarely leave home without a stash of medication that they can reach for in the event of a headache. But it’s just as important to recognize what triggers your migraines.
“You always want to make sure you have your migraine medication in hand, so you can take it immediately, should you need it,” says Dr. Paul Cooper, a professor of neurology and endocrinology at Western University. “Timing is very important.”
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Just as important is knowing when a migraine is coming on or what your triggers are, so you can take steps to mitigate the pain or even stop it in its tracks.
The prodrome phase of a migraine can happen anywhere from a few hours to two days before the headache sets in. Approximately 30 per cent of people experience the prodrome phase.
“This can trigger a series of changes in the way you feel. Some people are hyperactive, energized and feel great, while others can feel draggy and flu-like,” Cooper says. “Some people get symptoms of hunger and cravings for certain foods.”
He says that the latter has caused medical researchers to believe that this phase would involve the hypothalamus of the brain — the control centre for the nervous system that affects everything from breathing and heart rate to appetite and thirst. But Cooper says the evidence supporting hypothalamus involvement isn’t strong.
Other symptoms that indicate you could be in a prodrome phase include depression, irritability, sensitivity to light and sound, nausea and difficulty sleeping.
“You want to make sure you’re not sleep deprived when you’re in this phase, or placing yourself under undue pressure or stress — like chasing a deadline. Get some aerobic exercise and avoid things like alcohol that can trigger a hangover headache,” Cooper says.
Auras only occur in roughly 20 per cent of migraine patients and even then they can be unpredictable and tricky to detect.
“The latest thought is that there’s a hyper-excitability that accompanies an aura, where certain neurons in the nervous system in the occipital lobe of the brain are fired, thus giving rise to visual disturbances like sparkly dots, dancing lights, zigzag-like lines and black spots in your vision.”
In extreme cases, auras can cause numbness and tingling and even paralysis. During this phase, certain chemicals are released in the brain causing blood vessels to open and inflammation to set in, which triggers migraine pain.
“An aura can go on [from five minutes to] an hour, so if you take your medication too early, it likely will be ineffective by the time your migraine sets in. If your aura is variable, it’s best to use a non-specific medication like Advil ahead of time to prime things,” he says.
For years, migraine sufferers have been told to avoid triggering foods like aged cheese, chocolate and red wine, but Cooper says this has been disproved.
“In some studies where these foods were [secretly] fed to people who thought they had a sensitivity to it, the people didn’t get a migraine,” he says. “A lot of the triggers we felt were problematic don’t have a lot of evidence to support them.”
He says to definitely try to avoid foods that contain monosodium glutamate (MSG), like canned vegetables, soups and processed meats, and foods with nitrates (predominantly found in processed meats as well as some dairy and vegetables), as these are proven migraine triggers.
“I always tell people that if they think there’s a food that triggers a headache, avoid it. But don’t eliminate all foods from your diet,” Cooper says. “Life is bad enough when you suffer from migraines. Don’t make it worse by going on a diet where you only drink water and eat rice.”
The bottom line, he says, is to try to keep a sense of regularity in your life that includes plenty of sleep and methods to reduce stress.
“I kid my patients and tell them to live in a monastery. The regularity of life is good for patients with migraines because they need to be more rigid about taking care of themselves.”
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