Positive Health Online

Just why are more Brits in pain and how can we manage migraine attacks more effectively? Suzie Sawyer, Clinical Nutritionist, provides her Top Tips.

Migraines are severe, throbbing headaches that may or may not be accompanied by nausea, visual disturbances, and other symptoms. And make no mistake, they cause immense pain, disrupt lives and are debilitating.  Migraines can occur anywhere from once a week to once or twice a year, are often caused by a familial pre-disposition and tend to be more common in women. This is partly due to their hormonal fluctuations, especially when oestrogen levels are low pre-menstrually and post menopause.  Latest research[1] has found that COVID-19 has caused a surge in migraine attacks for sufferers so these stats are only going the wrong way.

https://simple.wikipedia.org/wiki/File:Migraine_comorbidities_2.PNG

Photo Credit: Wikipedia

The brain of a person with migraine is always sensitive to change because of the genetic link with this condition. The changes may be in our internal or our external environments; even changes in barometric pressure can be a trigger. It is true to say that the lockdowns have caused many changes in our daily lives due to a number of factors.

• Around 10 million people aged 15-69 in the UK suffer from migraines, which are classified as a disabling illness, while headaches are amongst the most common neurological reasons for attending A&E;
• The number of admissions to hospitals in England for headaches and migraines has increased by 14% over the last five years;
• Around 2.5 million GP appointments are linked to headaches and migraines, around 100,000 of which are referred to hospital for further assessment;
• It is estimated that the NHS spends around £150 million per year on treating migraines and £250 million on care for headache sufferers;

The cost to the Wider economy is even higher, with around £4.4 billion a year lost to three million migraine-related sick days.

Broken Sleep

Sleep is vital and when it comes to migraines; a lack of sleep can trigger an attack. Anxiety, stress, and low mood are key contributors to restless sleep, which have all been factors during the pandemic and continue to be problematic.  Effectively we have another major health issue, now referred to as “coronasomnia”. Sleep is vital for our overall health but is especially important for migraine sufferers.  Research is still evolving as to why poor sleep affects migraine sufferers so acutely but it may be down to changes in the central nervous system and to brain neurotransmitter regulation.[2]

Snack Attack

Mealtimes may also have altered with the temptation to snack, cravings for comfort food and the simplicity of takeaways leading to a change in the balance of carbohydrates, fats, and proteins.  This may lead to blood sugar imbalances alongside alcohol and caffeine intake possibly increasing, further exacerbating the issues. Dips in blood sugar levels, often caused by erratic eating patterns, can trigger attacks, therefore, it’s important to eat every three to four hours.

One of the keys to balancing blood sugar levels is to eat protein with every meal and snack.  Great suggestions for snacks are some chopped apple with a few nuts and seeds, sliced chicken pieces with oatcakes, or rice cakes with humus and chopped carrots and cucumber. If you’re on the run frequently or away from healthy food, then try to plan ahead and pack what you need to avoid blood sugar dips.

Fitness Fluctuations

Clinical Nutritionist, Suzie Sawyer from feelaliveuk.com adds: “All these changes to internal and external environmental factors from sleep to fitness fluctuations can impact and irritate the brain of a migraine sufferer.  Trying to control them as much as you can is key – it’s all about keeping to a routine and staying on top of your nutritional intake. 

Keeping fit and active is especially important for migraine sufferers as it can help to reduce stress and anxiety, and maintains good circulation. We know that high levels of the stress hormone, cortisol, can be a major migraine trigger, partly down to how it affects other hormones, especially oestrogen levels. High cortisol reduces oestrogen; hence this can be a major issue for women. When the going gets tough, how much better do we feel just from taking some time out and walking around the block in the fresh air?”

Suzie’s quick fixes help to control the frequency and severity of migraine attacks post-lockdown and beyond:

1. Stick to a routine sleep pattern by wherever possible going to sleep and waking up at the same time each day – even at weekends. Once awake in the morning, try to get outside into the daylight and fresh air for your exercise even if this is just a simple walk round the block.
2. Exercise little and often, which is often better than an occasional full-on 2-hour workout. Go gently at the start, eat and drink to maintain blood glucose levels and hydration and stretch out gently afterwards. But do remember, that just because you’ve done a half-hour walk, you don’t need to take on board lots of additional food;
3. Eat regularly every 3-4 hours and introduce a bedtime snack, especially if you eat your main meal in the early evening. It’s important not to miss meals either. Think about the balance between the food groups and try and reduce refined carbohydrates like sugar, cakes, biscuits, and fizzy drinks. Focus on low glycaemic carbs such as whole grains, beans, lentils, and starchy vegetables. You can never eat too many vegetables, whatever the variety!  Snacks of nuts, seeds, cherries, olives, chopped veggies and hummus are great choices;
4. Practise Mindfulness, relaxation breathing exercises (both slow inhalations and exhalations), yoga stretches and other techniques like meditation can all help reduce anxiety and improve restorative sleep quality;
5. Beware of caffeine and alcohol. It is tempting to have these to relieve our stress or perk us up, but both are not helpful for sleep quality and may result in triggering a migraine attack. This is especially important for women struggling with hormonal fluctuations (around menopause, for example);
6. Supplement your diet with Vitamin D. There’s been so much research and information around the unequivocal need for vitamin D supplements to protect the immune system, especially against Covid-19.  However, research has also found serum vitamin D levels (25(OH)D), to be low in migraine sufferers.  It’s a no brainer for supplementation! Choose a high potency complete multivitamin and mineral, with good levels of vitamin D for your daily supplementation such as Alive! Ultra Wholefood Plus or Alive! Vitamin D3 Gummies with added Calcium and phosphorus – www.feelaliveuk.com .   Alternatively try sugar-free Nature’s Way Vitamin D3 High Strength 50µg Chocolate Chewable Tablets.  All suitable for vegetarians;
7. Understand your food triggers. Certain foods are known to be problematic for many migraine sufferers, with yeast and wheat being frequent offenders. Food high in histamine including shellfish, dried fruits, fermented foods including yoghurt, unripe bananas, avocados, and aubergines are also to be watched. Elimination diets are often helpful and it may be that you need to consult a nutritionist for further guidance;
8. Don’t upset yourself. Avoid reading, watching, or listening to depressing or anxiety-provoking news stories which can often circulate widely on social media too. Find a trusted news source and only update yourself once a day – preferably not just before going to bed. It is very easy to get overly upset and that will raise stress hormone levels which in turn can make migraine attacks more likely;
9. Stay hydrated. Dehydration is often a migraine trigger, and replenishing fluids can restore your body’s balance of water and electrolytes If you find it a struggle to drink enough water, try adding a slice of lemon or lime to make your water taste better. Also, watch your caffeine intake, which can be dehydrating in large amounts;
10. Consider Feverfew. The herb Feverfew (Tanacetum parthenium) contains a wealth of plant compounds with anti-inflammatory and other properties, including the ability to reduce production of histamine.  Research suggests that the parthenolide compounds may also help reduce blood vessel constriction as well as acting on the brain’s serotonin system in a similar way to medications used to treat migraine[3].  By inhibiting the production of inflammatory prostaglandins severity of attacks are reduced.  MigraHerb® Feverfew Migraine Relief capsules is a traditional herbal medicine used for the prevention of migraine headaches.  www.migraherb.co.uk.  Suitable for vegans.

Foods and Drinks that HELP

• Pineapple – Fresh pineapple contains the enzyme bromelain which is has often been cited as natural pain relief. Bromelain has anti-inflammatory properties and has long been used to calm the pain of migraine and headaches;
• Watermelon – Watermelon is actually 92 percent water. Getting plenty of water — both by drinking it and by consuming foods that contain lots of water — will help you stay hydrated.  Getting enough fluids is important for all aspects of health, including migraine;
• Herbal teas – Tea can help with overall hydration, which can prevent or relieve a headache, and depending on the type of tea, there are other benefits as well. Peppermint oil is used as an essential oil for headache or migraine. You could put peppermint oil or fresh peppermint in a cup of hot water and inhale the steam and also drink the liquid. A study published in 2019[4] in the International Journal of Preventive Medicine found that a drop of diluted peppermint oil dripped into the nose was effective in decreasing the intensity of headaches caused by migraine in about 42 percent of participants who tried it. There is some evidence that ginger tea can help with a tension headache.  Also, a study published in Phytotherapy Research[5] found that drinking a half teaspoon of powdered ginger in warm water helped reduce migraine severity;
• Mushrooms – Adding foods that are high in riboflavin (vitamin B2) such as mushrooms, quinoa, nuts, and eggs help with that. There is research[6] to suggest that riboflavin may help in preventing migraines.  Try this Mushroom brunch recipe – it's comforting yet healthy, low-calorie, and gluten-free too!   
• Broccoli – Changes in hormone levels can lead to headaches, especially for women with menstrual migraine or headaches. Falling levels of oestrogen, which occur just before menstruation begins, can trigger an attack.  Women who have this type of migraine would benefit from increasing their intake of cruciferous vegetables, because of their effects on oestrogen.  Cruciferous vegetables contain hormonally active compounds called phytoestrogens, which have a balancing effect on oestrogen, naturally filling up oestrogen-receptor sites around the body and hopefully preventing migraine attacks.

The foods that trigger migraines will vary from person to person, and some individuals may not have any food-related migraine triggers.

However, common foods to AVOID, especially during a migraine attack, including foods that contain the amino acid tyramine are:

• Aged cheeses
• Alcohol, particularly beer and red wine
• Chocolate
• Cured meats
• Food preservatives, such as nitrates, nitrites, MSG, and artificial sweeteners
• Smoked fish
• Yeast extract

Not eating anything at all can also lead to an increased incidence of migraines. For some people, prolonged hunger and not eating enough are known headache triggers. This may be due to a link between low blood sugar levels and worsening migraine headaches.

References

1. https://www.nationalmigrainecentre.org.uk/migraine-and-headaches/migraine-and-headache-factsheets/migraine-in-a-time-of-covid-19/
2. Cindy Tiseo et al. Migraine and sleep disorders: a systematic review. J Headache Pain.  ;21(1):126. Oct 27 2020.
3. Anil Pareek et al. Feverfew (Tanacetum parthenium L): A systematic review. Pharmacogn Rev;5(9):103-10. Jan 2011.
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647908/
5. https://pubmed.ncbi.nlm.nih.gov/23657930/
6. https://pubmed.ncbi.nlm.nih.gov/22529203/

Product Recommendations

• Alive Ultra Wholefood Plus Tablets range 60s £20 – Holland & Barrett and feelaliveuk.com
• Alive! Vitamin D3 Gummies 60s – from £12.99 - Holland & Barrett and feelaliveuk.com
• Nature’s Way Vitamin D3 High Strength 50µg Chocolate Chewable Tablets 90s – from £9.99 natures-way.com
• MigraHerb Feverfew Migraine Relief Capsules 30s – from £6.90 – Holland & Barrett and migraherb.co.uk