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9. How can I help myself?

Migraine can leave you feeling as if you are not in control of your life. It may feel as though your migraine decides what you can and cannot do rather than your deciding what you want to do. Being aware of how different aspects of your diet and lifestyle can affect your migraine threshold will help you take back control.

My mum and dad both have migraines. I’ve heard that migraines are hereditary, so just how much can I help myself to have fewer attacks?

Yes, a family history of migraine does mean that you are more likely to develop migraine at some time in your life. There is no guarantee that attacks will develop but an awareness of potential triggers will reduce the chance of attacks developing if these triggers do come together and lower your migraine threshold. This course discusses ways to help you modify your headache threshold and take control of your headache symptoms.

I heard part of a programme discussing migraine and missed the beginning. Can you explain what is meant by the phrase ‘migraine threshold’?

Anyone has the potential to have a migraine. Your ‘migraine threshold’ is the point below which a migraine attack becomes inevitable. The higher your threshold, the less likely you are to have a migraine. Being aware of potential factors or triggers in your life and being in control of them will reduce the chance of your threshold being pushed so low that an attack becomes inevitable. This is different for everyone.

I’d like to try to avoid setting off a migraine if possible. What brings on a migraine?

This is not an easy question to answer, because in reality it is impossible to say. A migraine can happen at any time. All you need is the right mix of triggers together at the right time – the challenge being that the mix will vary every time. The attack happens when all those factors come together and your migraine threshold is finally reached.

I am trying to work out what triggers my migraine but don’t know how to go about it. Please help!

It is not an easy thing to do, as there is unlikely to be a cut-and dried answer. You will have to keep a diary but before doing so you need to decide what factors you want to consider. Do you want to think about meal patterns, fluid intake, your menstrual periods or specific foods? What you have to remember is that triggers tend to work in combination rather than in isolation, and you may find it difficult to find a consistent pattern.

I was listening to something on the radio recently and they kept talking about common triggers but did not really say what they are. Can you tell what they meant by common triggers?

In reality the phrase probably means different things to different people. A trigger is something that increases the chance of a migraine attack happening. ‘Common’ triggers are generally regarded as things such as chocolate, cheese and red wine. Each trigger will potentially have a different impact – until a point is reached when an attack is finally triggered. Migraine attack increasingly unlikely to occur. Trigger points: triggers are specific to you; triggers lower your threshold for a migraine attack to develop, and can do so at any time. Threshold at which a migraine attack will occur.

My experience include things such as irregular eating patterns, irregular or erratic sleep patterns, dehydration, too much caffeine or even caffeine withdrawal; all these can lead to a lowered migraine threshold.

Other factors include stress and sometimes back or neck problems associated with muscle spasm, which can lower your migraine threshold and increase the chance of an attack being triggered.

I keep reading about common triggers. I have tried avoiding them but it doesn’t seem to make any difference. Why is this?

Triggers tend to be very personal and vary from person to person. What seems to trigger an attack in one person may never trigger an attack in someone else. Moreover, the effect or impact of a trigger may vary in the same person from day to day, week to week and attack to attack. The steps you take to reduce the chance of an attack developing may well change the effect that any one trigger has on you at that time.

The other day I was so busy that I couldn’t stop for lunch. Later I got a really persistent migraine. Are the two related?

The simple answer is ‘Yes, possibly’. To understand why this is, we need to think about where your migraine threshold is. If you go without eating for more than 4 hours in the daytime or 12 hours overnight, you could push your migraine threshold so low that an attack is triggered. On this occasion, missing lunch took you from point D to E and an attack was triggered.

I’ve heard that some people with migraine find that certain foods will set off a migraine. What sort of food can trigger migraine?

Any food can potentially trigger migraine in some of the people, some of the time! The difficulty is deciding which food, in whichpeople and when. Some people find that a particular food will always trigger an attack all of the time. In some people a particular food will trigger an attack some of the time. If the food trigger is inconsistent, this usually means that the most relevant factor is where your migraine threshold is, rather than the food itself.

A friend gave me a list of foods I should avoid to prevent my migraine attacks from happening. There are so many things listed I think I’d rather risk the migraine!

In many ways you are probably right to be cautious about avoiding so many different foods. A healthy and varied diet is much more likely to reduce the chance of migraines developing than a restricted and faddy diet. Eating regular meals and having healthy snacks is more likely to raise your migraine threshold. If a specific food triggers your attacks, you will probably have worked this out by now. If you have not identified anything, it is unlikely that one food triggers your attacks all of the time.

I have cut out chocolate, cheese and alcohol but I still get migraines. Why?

Chocolate, cheese and alcohol are rarely true migraine triggers that have a direct cause and effect when it comes to migraine. They may actually represent cravings at the start of the attack, rather than a cause. You may be at point A rather than point D. Triggers are very personal and can vary from attack to attack as well as from person to person and from time to time. The main variable is your migraine threshold at the time that you are exposed to a potential trigger. The other variable is what you do at a point in time or in response to a series of events that may push your migraine threshold down to modify the potential effect of any one trigger.

I’ve read that scientists now say chocolate isn’t a trigger. I can’t believe this, as I get migraine if I eat chocolate when I’m feeling a bit under par but not when I’m feeling fit. Surely they’ve got it wrong?

In some people specific foods may have a direct cause and effect but it is also possible that a craving for a particular food occurs during the premonitory or warning phase of a migraine. There is a perception that the chocolate caused the attack but, in fact, the attack was happening anyway, so the chocolate is not a direct cause. It may be that in your case it has a partial effect and pushes your threshold down so that, if you are feeling under par, your migraine is triggered … or it may be that feeling under par is what really triggered the migraine.

Cheese and oranges don’t seem to affect me but red wine and red meat do. Is there a connection?

Everyone is different and what is important is that you recognize the factors that are relevant to you and take control of those specific triggers as you find them. It may be that you can manage to eat the red meat or drink the red wine separately but not have them together or that you can have them without triggering a migraine when your migraine threshold is high.

Why is it that sometimes I can eat cheese with no problems and other times I have a migraine?

Triggers tend to work in combination rather than in isolation. You could try analyzing what other constants exist when you eat cheese and it seems to trigger a migraine. A little bit of detective work might allow you to find out a few more dos and don’ts and so find a way of keeping your migraine threshold up enough to have cheese. Whenever you have a migraine after eating cheese, try to remember what else preceded the attack: you may find that there is another factor involved.

I understand that everyone is affected differently but how can I decide which triggers are relevant to me?

If we consider different points (A, B, etc.) a particular trigger or food could have an effect on your migraine threshold. If you are at point D or E, it is more likely that a particular food will trigger your attack as it pushes your threshold down to the point at which an attack becomes inevitable.

If you want to see whether a food is going to cause you problems, I suggest you avoid that food – and that food only – for a period of four to six weeks. You should then reintroduce that food and see if your attacks return.

The food may directly trigger the attack or could lead to an increase in frequency of attacks. This avoidance of a food is helpful only if all other triggers stay stable, and that is often impossible to achieve.

Triggers aren’t just about food but are also about things such as irregular meals, too much caffeine, not enough water and changes in sleep patterns. Triggers tend to work in combination rather than in isolation.

A food may be part of a broader, complex mix, making specifics difficult to identify. So look at your life generally to see if you can discover a connection between your migraines and other possible triggers. It might take a bit of time but you’ll be doing something positive to help yourself.

I often have a migraine on the day before a party that I’ve been looking forward to, so I end up not going. How can I stop this from happening?

This is quite a common experience. Getting excited about an event can have the same effect on your migraine threshold as getting anxious and upset about it. Getting and feeling in control can be difficult in this situation. Making a special effort to control all other aspects of your day can keep your threshold a little higher and reduce the chance of an attack developing. It is about pushing your threshold from C or D back to B or A.

I often seem to have a migraine at the weekend. Why is this?

This ‘relaxation’ headache is not unusual for some people. It is often the case if you have a busy and potentially stressful existence. The need to get through the week is such that the migraine attack never develops until it is safe for you to ‘allow’ it to.

Why do I always seem to get a migraine on the first few days of my holiday?

A ‘relaxation’ headache is not uncommon, and the start of a holiday is a period of relaxation. In part it is due to a variety of factors that lead to a change in your migraine threshold. The buildup to a holiday is often a busy and difficult time. Travelling from your home to your holiday destination is also associated with its own hassles and stresses, including missed and skipped meals, loss of sleep and dehydration. Taking all these factors together, it is not surprising that a migraine might happen. Think about the bits you can control, so that the rest will have less of an effect on your migraine threshold.

Why do I always seem to get more migraines when I am working nights rather than a day shift?

Working nights is likely to be associated with a more erratic eating pattern as well as a degree of sleep deprivation and probably an element of dehydration, too. All these elements will tend to push your migraine threshold down and increase the chance of a migraine attack being triggered.

Why is it that I often get a migraine when I am going out to the theatre after work, especially if I don’t get time to eat beforehand?

That is likely to be a mix of the stress associated with getting to the theatre in time, dehydration for a similar reason combined with prolonging the period without food. You could try to reduce some of the pressure by leaving work early so that you are less stressed and have time for a meal before you go out. If you can’t do that, try to have a light snack before you go out. You need to think about what you have to do to nudge your migraine threshold up and reduce the risk of a migraine attack developing at some time in the evening.

Can changes in the weather be a trigger? I seem to get a migraine when a thunderstorm is approaching and sometimes just before it snows.

Changes in barometric pressure associated with changes in the weather have been found to cause an increase in headaches and migraine. Humidity is another factor along with bright, especially flickering, sunlight and cold winds.

My cousin says that she often gets a migraine when she has to work in an office with fluorescent lighting. Is there a connection?

Lighting is always difficult to evaluate but the brightness of fluorescent lighting may cause a degree of glare that could lower her migraine threshold. And the flicker of a fluorescent light can cause migraine in some people.

Sometimes being sick makes me feel better. Does this mean that the migraine was caused by something I ate?

No, it does not. Vomiting is a recognised symptom of the migraine attack, and the onset of vomiting during an attack shows that the attack is progressing. As you have found, having been sick, you often start to get better.

I have four or five triggers but I find it frustrating always making sure that they don’t clash too much. What practical steps can I take?

It may be that you don’t need to avoid all of them at the same time. You may find that one or two of them together are OK. Working out which combination you can cope with is very much trial and error, and may depend on exactly where your threshold is and how sensitive you are to particular triggers. Keeping a diary, perhaps using diary cards, might help you in your detective work.

My main triggers seem to be cheese, chocolate, red wine, oranges and being very tired but sometimes I can eat or drink these items with no ill-effects whereas at other times they’ll trigger a migraine. Is there a ‘threshold’ to these triggers?

There is a ‘threshold’ for your migraine but not specifically a threshold for your triggers. Each trigger has the ability to push your migraine threshold down but the extent to which it does so is variable and unpredictable. Your recognised trigger will have an effect sometimes rather than all the time, because it will take a different mix each time to have the same overall effect on your migraine threshold.

I’ve never had two migraines in the same week that were ‘set off’ by the same trigger. Does this mean that the attack makes me briefly immune to its trigger?

No, not really. Migraine attacks can happen at any time: the lower your threshold, the more likely an attack is to be triggered. Triggers rarely work in isolation, so any trigger can lead to an attack at any time, and are rarely consistent in how long they last. I find that I’m more likely to have a migraine if I’ve been under a lot of pressure at work. Is there a connection?

Stress is a very potent trigger and can often have a significant effect on your migraine threshold, even in isolation. It can magnify the effect of other triggers, so that things that do not usually trigger attacks may become more likely to do so. It’s hard to get rid of all pressure at work but knowing that it can be a factor in triggering a migraine should help you to avoid anything else that might contribute to lowering your migraine threshold. Take control of the things that you can control so that the factors you cannot control are less likely to push your threshold down.

Stress seems to be a common cause of my migraine but part of my problem is worrying when I will get another attack. What can I do?

Stress tends to be a very potent trigger and can readily push your migraine threshold down. If you are going through a phase of frequent attacks, it is not surprising that you become anxious about another attack developing. If you try to take positive steps to raise your migraine threshold, you are less likely to get an attack and will move into a more positive cycle. I tend to offer the following advice:

• Eat regular meals, keep your sugar levels steady

• Avoid known trigger foods and drinks

• Avoid prolonged fasting, avoid hunger

• Ensure adequate fluid intake, avoid thirst

• Be consistent in your sleep habits

• Avoid stress where possible, relieve stress when you can

• Keep your attack threshold high by avoiding multiple triggers

• Don’t be afraid to ask for advice and help

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