Living with Migraine
Clinical Nutrition • • 1 minute to read • By Dr Poonam Vichare, INFS Faculty
Author- Dr Poonam Vichare
It is a common, chronic, incapacitating neurovascular disorder, characterized by attacks of severe headache, autonomic nervous system dysfunction, and in some patients, an aura involving neurologic symptoms. It affects more than 10% of the general population. Despite recent progress, drug therapy for preventing and treating migraine remains unsatisfactory for most patients. Migraine is highly prevalent, affecting 12% of the population, attacking up to 17% of women and 6% of men each year
Not every headache is a migraine. It is characterized by typical features as below
- At least five attacks fulfilling criteria B-D
- Headache attacks lasting 4-72 hr (untreated or unsuccessfully treated)
- Headache has at least two of the following four characteristics:
- unilateral location
- pulsating quality
- moderate or severe pain intensity
- aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs)
- During headache at least one of the following:
- nausea and/or vomiting
- photophobia and phonophobia
- Not better accounted for by another ICHD-3 diagnosis.
Migraine probably results from a dysfunction of a part of the brain-stem that is involved in the sensory modulation of the signals from the blood vessels of the brain. There is a short phase of hyperemia (increased blood flow) which is then followed by oligemia (reduced blood flow). This is responsible for the blurring of vision, dizziness, flashes of lights in front of eyes. These events are due to the activation of the trigeminovascular system – TVS which is responsible for the transmission and perception of pain, and release of inflammatory mediators.
There are several types of migraine which includes:
- migraine with aura –associated with specific warning signs just before the migraine begins, such as seeing flashing lights
- migraine without aura – the most common type, where the migraine is not associated with specific warning signs
- migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but no headache develops.
I ndividuals living with migraine are more susceptible to the influence of transient factors, termed “triggers,” that raise the risk for having a migraine attack. These include:
- Irregular meals and fasting triggers migraine headaches.
- Common food triggers include Caffeine, chocolate, milk and products, alcohol, Nuts, citrus fruits, processed meat, MSG (monosodium glutamate), aspartame, fatty foods.
- Alcohol – depletion of magnesium could lead to migraine headaches. *
- MSG – induces vasodilation by activating the neurotransmission pathway which releases nitric oxide. *
- Foods rich in nitrites/nitrates – sausages, processed meat, fish.
Few other trigger factors that can precipitate an episode of migraine include-
Emotional triggers like stress, anxiety, tension, shock, depression, excitement
Physical triggers like tiredness, poor quality sleep, shift work, poor posture, neck or shoulder tension, jet lag, low blood sugar (hypoglycemia), strenuous exercise
Dietary triggers like missed, delayed or irregular meals, dehydration,alcohol, caffeine products, such as tea and coffee, specific foods such as chocolate, citrus fruit and cheese
Environmental triggers like bright lights, flickering screens, such as a television or computer screen, smoking (or smoky rooms), loud noises, changes in climate, such as changes in humidity or very cold temperatures, strong smells, a stuffy atmosphere.
One can keep a log of their migraine severity with the help of the “Migraine Disability Assessment Scale (MIDAS)”
Living with migraine
A migraine diary with the details on various aspects of the episodes like the date, time, what triggering factor, duration of the attack, symptoms experienced & medication taken (if any) can help in tracking the progression of the disease.
Nonpharmacologic intervention includes educating the patient about the disorder, its mechanisms, approaches to treatment, and changes in lifestyle involved in the avoidance of triggers of migraine.
In patients with migraine, the brain does not seem to tolerate the extremes of any situation well. Thus, regular sleep, regular meals, exercise, avoidance of peaks of stress and troughs of relaxation, and avoidance of dietary triggers can be helpful.
The crucial message is that the patient should aim for a certain habit formation, rather than restricting a long list of foods and activities.
Individuals with migraines should ensure that they do not skip any meal. Dehydration is also a common trigger factor, so drinking plenty of water prevents the attack. Certain foods that have long been identified as common migraine triggers like aged cheese, chocola te, caffeine, nuts, citrus fruits, aspartame, fatty foods, and food containing nitrates, the chemicals found in hot dogs and other processed meats should be avoided.
Magnesium and vitamin B2, or riboflavin, help reduce migraine frequency, according to the American Migraine Foundation , so one can incorporate magnesium-rich foods like dark leafy greens and legumes, and foods rich in B2, such as fish, almonds , and eggs, into the diet.
Regular exercise can reduce both the frequency and intensity of migraine, so it’s beneficial to get some exercise.
- Goadsby, P. J., Lipton, R. B. and Ferrari, M. D. (2009) ‘Migraine — Current Understanding and Treatment’, http://dx.doi.org/10.1056/NEJMra010917, 346(4), pp. 257–270. doi: 10.1056/NEJMRA010917.
- Migraine - Illnesses & conditions | NHS inform (no date). Available at: https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/migraine#causes-of-a-migraine (Accessed: 13 March 2022).
- Migraine - Oliver Sacks, Oliver W. Sacks - Google Books (no date). Available at: https://books.google.co.in/books?hl=en&lr=&id=X4luPiGW140C&oi=fnd&pg=PR2&dq=migraine&ots=BzqUjD8Syd&sig=zM0OxzSZz8b9kSF6bCks-G2Psf0&redir_esc=y#v=onepage&q=migraine&f=false (Accessed: 13 March 2022).
- Migraine without aura - ICHD-3 (no date). Available at: https://ichd-3.org/1-migraine/1-1-migraine-without-aura/ (Accessed: 13 March 2022).
- Pietrobon, D. and Moskowitz, M. A. (2013) ‘Pathophysiology of Migraine’, http://dx.doi.org/10.1146/annurev-physiol-030212-183717, 75, pp. 365–391. doi: 10.1146/ANNUREV-PHYSIOL-030212-183717.
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