Managing Migraines

A migraine is chronic, complex, and oftentimes debilitating condition that affects 36 million people in the United States. At this time, there is no cure.

Medication is an important treatment option for many patients, especially for chronic migraine sufferers. But a combined approach to treatment that includes certain lifestyle changes, can be even more effective in reducing the intensity and length of chronic and episodic migraines.

Carolyn A. Bernstein, MD, a Mass General Brigham neurologist, explains. “The brain is incredibly regimented. It wants you to go to bed at the same time, and get up at the same time. It wants you to eat regularly, so it has a constant supply of energy. It wants you to stay well-hydrated. It wants you to move your body on a daily basis. It wants things to be the same all the time. Lifestyle changes, such as paying attention to sleep, eating well, exercising and staying hydrated, can have a positive impact on migraines.”

Dr. Bernstein describes common migraine triggers and explores lifestyle changes that may reduce migraine severity.

What causes migraines?

Before she discusses any treatment options, Dr. Bernstein encourages patients to figure out the cause of their migraines by paying attention to what their body is saying.

The following are common migraine triggers:

• Poor sleep
• Certain foods
• Bright lights
• Dehydration
• Stress

“If you can identify your triggers and avoid them, you will feel much better,” says Dr. Bernstein.

What does a migraine feel like?

Most people who suffer from migraines typically say that they sense that “something” is about to happen before they experience one. They may experience:

• Sensitivity to light or sound
• Nausea or confusion
• Tingling or weakness in their arms or legs
• Sparkles or a hole in their vision
• See auras, such as geometric patterns or flashing lights

“Everyone’s subjective experience of a migraine is different, but most are very painful and can last anywhere from 4 to 72 hours. The brain then ‘resets itself’ during a recovery period, where most people feel like they are recovering from a hangover,” says Dr. Bernstein.

Does exercise help migraines?

One of the most potent lifestyle modifications you can make to manage migraines is to incorporate exercise into your life, according to Dr. Bernstein.

“Exercise maintains homeostasis, a state of equilibrium in the body. When the body is in homeostasis it simply functions better overall,” she says.

Exercise helps alleviate migraines symptoms by:

• Improving mood through the release of neurotransmitters called beta-endorphins, which reduce pain
• Improving heart function, allowing it to deliver more blood to the brain and body
• Improving one’s overall sense of wellbeing

When starting an exercise routine for a migraine, start small.

Beginning an exercise routine doesn’t mean you have to run a marathon or do headstands in yoga class. Dr. Bernstein recommends making small additions to your lifestyle, such as walking around the block at lunch, or signing up for a gentle yoga class.

“I recommend a calm form of yoga called restorative yoga. This type of yoga provides blankets and props, and the poses encourage deep relaxation and breathing, so it’s a kind of an active meditation,” says Dr. Bernstein.

Dr. Bernstein also recommends changes that are easy for patients to incorporate into their everyday lives, such as parking their car a quarter of a mile away from the office or fitting in a 30-minute walk during lunch a few times a week.

Other approaches to migraine management

The following alternative therapies may improve symptoms in those suffering from migraines.

• Mindfulness (for pain management)
• Meditation techniques
• Acupuncture
• Tai Chi
• Yoga poses designed for migraine sufferers
• Reflexology
• Chiropractic techniques

“Oftentimes it’s a combination of these therapies that help patients improve,” says Dr. Bernstein.

Another integrative therapy that can provide relief for some migraine sufferers is cranial sacral therapy (CST), a technique that employs gentle movements to release tension in connective tissues, such as the cerebrospinal fluid and bones of the skull and sacrum.

In addition to alleviating symptoms of migraines, CST has been used to address a variety of conditions, including chronic pain, orthopaedic injuries, fibromyalgia, temporomandibular joint (TMJ) syndrome, stress-related disorders, and chronic fatigue.