S3:Ep5 – 5 Lifestyle Changes for Managing Migraine

TRANSCRIPT

Voice-over: Welcome to Spotlight on Migraine, hosted by the Association of Migraine Disorders. Join us for fresh perspectives by medical experts and advocates as we explore the spectrum of migraine and dig deeper into this complex disease.

Neuro-ophthalmologist Dr. Rani Banik joins us to explain her five pillars of health for managing migraine, which include easy-to-implement lifestyle changes in nutrition, hydration, caffeine, sleep, and stress management.

This episode is brought to you in part by our generous sponsors Amgen and Novartis.

Molly O’Brien: Hello and welcome to Spotlight on Migraine. I’m your host, Molly O’Brien. Today we’re talking all about natural therapies and stress management for migraine. There are lots of option out there, but how do we decide what could be best for us if we’re not looking for pharmaceuticals to take right away.

So to help us dive into this topic, I’d like to introduce neuro-ophthalmologist Dr. Rani Banik. Dr. Banik, thanks for joining us.

Dr. Rani Banik: Thanks so much for having me again on your show, Molly. I really appreciate the invitation.

Molly: Yeah, it’s great to see you, as always. Treating patients with migraine is part of your profession, but treating migraine is also very personal to you, and you’ve kind of developed some natural remedies, some natural therapies [and ideas?] focusing around five pillars of health. And that’s really helped you and in turn helped your clients. Can you talk to us a little bit about that?

Dr. Banik: Yeah, absolutely. So, as you mentioned, I’m a migraine sufferer, and I was getting chronic headaches almost every day for years. And I tried medications. I tried a whole range of them. They weren’t working. And then finally, when I started to kind of look at my own lifestyle and my choices, and I realized, well, maybe some of these things that I’m doing aren’t so healthy for me, and maybe that’s what’s triggering my migraine. And when I finally started to address those, I started to get better. So it really kind of tuned me in into the effectiveness of some of these simple lifestyle strategies and natural therapies to help improve symptoms.

So in terms of the five pillars that you mentioned, it may seem like a lot, but you kind of do a little bit to try to address a little bit, not everything all at once. But the five pillars are nutrition, hydration, caffeine, sleep hygiene, and stress management. So those are really the five main areas that I try to teach my patients in terms of — especially, people who have chronic migraine like I did. What are the things that you have in your control that you can do to help you improve your symptoms?

And I’ve found really amazing success when people integrate these natural lifestyle changes with, sometimes, medications. And for many people, they’re even able to get off of their medications because they’ve implemented some of these changes.

Molly: Well, we like the sound of that because not everybody wants to be taking medications all the time, so. And I also liked what you said; it helped you tune in. And I really do think it’s important for us as migraine patients to be able to tune in to our body and know what’s going on.

So let’s dive into those five pillars of health, like you mentioned: nutrition, hydration, sleep, caffeine, and stress. So we’ll go one by one, give us some information. How important is nutrition and nutrition management for migraine?

Dr. Banik: Yeah, I would say it’s probably the cornerstone of natural migraine therapy. What we eat really reflects on the status of our health. And so as part of that, first of all, many people with migraine have triggers, foods that trigger their migraine. So it’s really important to be a detective, to figure out what your specific foods are that may be triggering your symptoms.

So what may affect you may not affect your family member or your friend who has migraine. So everyone is very unique in this respect, and really it does require some detective work. So for some people, if their trigger happens to be fermented products like cheese or perhaps wine or beer, you have to cut that out. If it happens to be big swings in blood sugar — for example, if you have something really high carb — simple carbohydrates, your sugar goes up suddenly, and then all of a sudden it crashes down. That can be a trigger for them.

So, really, you kind of have to look at what you’re eating and also how it coincides with your symptom timing. And I typically ask patients, “Really think back to what you had, not just the day of, but the day before and maybe even two days before, because something you had may have triggered your symptoms.” And even foods that are rich in certain things like nitrates or nitrites or histamine, these are oftentimes triggers for many people.

And then the other side to this is that many people who have migraine have some micronutrient deficiencies, so whether it’s magnesium or certain B vitamins, or perhaps their bodies aren’t able to process folate properly and they need a specific type of folate. So you want to really promote foods that promote energy metabolism and brain health, and so that’s also important. So you may be cutting out some foods that you’re sensitive to that you get may be triggering your symptoms, but then on the other hand, you want to include a whole range of foods that are nutrient dense.

And that’s kind of like a nutshell. We could talk about this for hours, actually.

Molly: I know. We really could. And we have talked about using food as fuel and to manage migraine on the show before. And with you, we talked a little bit about what you can do for better eye health and eating, that kind of thing.

So just to kind of keep it simple, do you have any idea on one or two maybe “superfoods” on what can help with migraine that we can add into our diet?

Dr. Banik: Yeah, absolutely. So if you’re thinking about a superfood, I’d probably think of something that is a plant, a plant product. And one thing that comes to mind is spinach, because it has just so many amazing nutrients, some of the ones that I had mentioned.

But basically any colorful fruit or vegetable will provide you with a lot of the nutrients you need, and it’s also important to rotate through them. And I think we talked about this before, maybe, also, is you don’t want to just eat the same thing every meal. Then you may become deficient in other things.

So I always tell my patients, “Try to eat the rainbow of colors during the week.” So if you’re eating, let’s say, 3 meals a day, 7 meals a week, that’s 21 meals out of the week. Try to have a different color with each meal, and that will give you that variety of all the nutrients that you need, all the vitamins and minerals and antioxidants that your brain needs to stay healthy.

Molly: It sort of sounds like a challenging task, but when you break it down like that, it seems simple. Just add a different color on your plate for each meal. So I think that’s an easy way that you can add in good nutrients to help you with migraine.

Dr. Banik: Yeah, just plan out your week, and it’ll be simple. You don’t even have to think, “Oh, did I have my kale this week, or did I have my berries this week?” You just rotate through, and it’ll naturally happen.

Molly: I love that. So let’s move on to the next pillar, which is hydration. Now, I have to tell you, as someone living with migraine, it gets real frustrating when people say, “Oh, just drink more water.” It’s kind of a backhanded thing. But, in reality, hydration can impact migraine in our body. So let’s talk a little bit about that and how being hydrated can help.

Dr. Banik: Yeah, so if we think back to the pathophysiology of migraine, what we think is going on in migraine, usually it’s triggered by changes in blood flow and blood vessel diameter. So when we’re dehydrated, our blood vessels tend to constrict, and we think that one of the very first things that happens in migraine — maybe there’s a whole cascade of events that happens, but we think that initially there’s some form of blood vessel constriction, and then there’s a dilation of blood vessels. So you want to prevent that constriction, and one of the best ways you can do that is to stay hydrated and, plain and simple, keep your blood volume up and drink plenty of fluids.

And hydration doesn’t just mean having water. A lot of people think, “Oh, I should be having eight glasses of water a day.” There are other ways you can hydrate also. There are various other beverages other than water. Just try to avoid caffeine. We’ll talk a little bit more about caffeine too.

But there are plenty of, again, plants, like fruits and vegetables, that are very high in water content. So, for example, if you have watermelon, I think it’s over 95 percent water, or other great hydrating fruits and vegetables like cucumbers and other melons. So there are other ways to get your hydration needs for the day, so — especially if someone knows what their triggers are and they think, “Oh, I may be predisposed to migraine today or maybe tomorrow,” really boost up your hydration, and hopefully you can ward off that attack.

Molly: And I like those suggestions too of implementing certain foods that are primarily water, and that helps get different colors into your diet too.

Dr. Banik: Exactly. You kill two birds with one stone there, so, yeah.

Molly: It all links together. Let’s move on to sleep, and sleep can be a really tricky topic for a lot of people but also people living with migraine. We know that good-quality sleep is important, staying on a good sleep schedule, having good sleep hygiene. But it can be really difficult to do all that and be stressful in itself to make sure you’re getting enough sleep. So let’s talk about how sleep can impact migraine.

Dr. Banik: Sure. So people with migraine, their brains and their whole bodies crave regularity. We need habit. We need to have a routine. And sleep is just so important because it’s restorative. Our brain basically recharges and refreshes when we’re sleeping, so we need to have that rest for our brain.

And you had mentioned a couple of important things, but I would say the most important thing in terms of sleep hygiene is going to bed at the same time every day and waking up at the same time every morning, because, again, that will give you that regularity. And sometimes it’s challenging. Especially if you’re traveling or you’re crossing time zones, it may be very hard to do that. But just try to stay on some type of schedule, and even on the weekends. I mean, I find this challenging myself too because on the weekends, I want to sleep in. But I really do try to maintain a sleep schedule because my brain just functions better like that. I know that when I’m keeping that schedule, it helps.

And in terms of how much sleep, everyone is different, but I think the general recommendation for most adults is anywhere between seven to eight hours a night. Now, some people can get by on a little bit less, six and a half or six hours. Other people need more, maybe nine or ten hours. And you just have to feel — kind of experiment to see what your body responds best to.

You should wake up feeling refreshed. I mean, that is the most important thing. If you wake up and you feel like, “I just want to go back, crawl under the covers, and take another five or ten minutes,” that means your body’s not refreshed yet. So figure out how much sleep you need, and try to maintain that regular sleep schedule.

Now, another part of this is your sleep environment, and this is really, really important. You really do need to have as close to complete darkness as possible when you’re sleeping. So that means perhaps getting blackout shades, perhaps wearing a sleep mask, definitely trying to eliminate any sources of blue light in your bedroom environment, whether it’s from your phone or a clock on the bedstand or something else that’s blinking in the distance. Just try to get rid of that blue light, because we know that blue light interferes with sleep and it makes it harder to fall asleep. So just a couple of simple tips there.

Molly: All good suggestions and strategies. Let’s head over to caffeine. You touched on this just briefly when we were talking about hydration. Caffeine can also be sort of tricky, right, because some people, it can be a trigger, and then for some people, they actually use caffeine to treat their migraine. So how do we break down caffeine and the relationship with migraine?

Dr. Banik: Yeah, great question, and this is another topic we could talk about for hours. But caffeine is really — it’s a double-edge sword. So, on one hand, as you mentioned, some people can benefit from caffeine. Having a caffeinated beverage can actually break the cycle. For other people, they may need more and more and more caffeine to ward off their headaches.

So what is this link between caffeine and migraine? So caffeine works on receptors called adenosine receptors, and these are receptors found throughout the body, but particularly on blood vessels in our brains. And so adenosine receptors affect the size of the blood vessels. So caffeine will constrict the blood vessel.

And what happens is if you don’t have that much caffeine in your diet and you have caffeine, it will help to constrict a dilated blood vessel and kind of ward off an attack. But if you have a lot of caffeine, what happens is your body doesn’t respond as well. Those adenosine receptors just don’t respond as well to caffeine, and you end up needing more and more and more of the — it’s really a drug; caffeine is a drug — to keep them constricted and to prevent the headache.

So my typical recommendation is if you have really very little to no caffeine in your diet, it’s fine to use caffeine as needed to break an attack. And, actually, many of the over-the-counter migraine medications have caffeine as a main ingredient, and that’s why they work so well, like Excedrin Migraine, for example.

But if in your diet, in your lifestyle — if you need a couple of cups of coffee or tea or soda or whatever it is every day, that means your body’s probably dependent on that caffeine. And if you do suffer from chronic headaches, you want to tone it down. And it doesn’t mean that you have to cut it out. This is really, really important. A lot of patients tell me, “Dr. Banik, I can’t. I just can’t give up my morning coffee.” And I say, “It’s OK. You don’t have to give it up, but slowly reduce it.”

You don’t also want to just go cold turkey, because your brain is not going to like that. But try to reduce it, I would say, by half a cup every week. So, for example, if you drink four cups a day total of some kind of caffeinated beverage, go down to three and a half cups for a week, and then three cups, and two and a half, and so forth until you get down to one cup or less a day. And try to just maintain that.

And you’ll see. I think your headaches will definitely improve in terms of frequency. I’ve seen that for myself. At one point, I was drinking — this is crazy; I’ll admit this — I was drinking eight to twelve caffeinated beverages a day to keep my migraines under control. I mean, it was bad. I was in bad shape. So once I realized what I was doing to myself, I started to make changes, and now things are definitely better.

Molly: I do have to say, that sounds like a lot of caffeine. But also you noted there too that it’s important to taper down slowly, because sometimes when people quit cold turkey, whether they give up coffee or whatever they’re drinking or eating that might have caffeine, because foods do too — some foods do too —

Dr. Banik: Chocolate. Yeah, chocolate has caffeine as well, yeah, so.

Molly: So I think it’s important to note kind of that taper-down system because some people, if they do take it out cold turkey, it can trigger a headache or it can trigger migraine, which defeats the whole purpose of doing it anyway, right?

Dr. Banik: Yeah, it can definitely cause rebound headaches, and you don’t want to go through that, so yeah.

Molly: No, we don’t want that. OK, let’s talk a little bit about stress and stress management for migraine. And you and I were going back and forth on emails, saying we could talk about this for hours. So stress is beneficial in our life. It’s an important thing that we have in our life to keep us going and to avoid certain situations, all that jazz. But stress can also be really bad for migraine. So let’s talk. If you can, explain a little bit about the relationship between stress and migraine, and then hopefully we can go over some stress-management strategies.

Dr. Banik: Yes. I love how you put it, that there’s good stress and not-so-good stress, because we do need some degree of stress just to keep us going, just to give a sense of purpose, to kind of have goals and try to get there. So that’s a good type of stress.

But the other type of stress, that negative type of a stress, can come from so many different sources. And we all have stress in our lives, whether it’s from our work or our family or school or just the home situation or health issues. We all have various levels of stress. And it’s really a matter of how you manage that stress or how do you respond to that stress, and what is your body’s reaction to that stress. And that’s really what we want to try to modulate when it comes to migraine.

So there are many different ways to relieve stress, but you have to find out what works for you or what combination of things work best for you. And there are certain things that some of my patients, they don’t even realize that they could be using as stress-management tools. So, yes, we all think about doing yoga or meditating or going for a walk. I mean, these are the most common ways that people love to destress.

But other things like, for example, just simply listening to music, I mean, that can be a big stress reliever for lots of people. I know it definitely is for me. Whenever I feel like my mind is just racing, I just turn on my favorite music, and it just puts me in a different state. It’s almost like it resets that button.

Or finding a hobby — this is one that I really, really love. It could be something as simple as gardening, and it just kind of gets your mind off of the stressors. I mean, they’re still there, but it gets your mind off of them. Or for some people, it could be artwork, doing some kind of painting or sketching or maybe even just doing a puzzle. That actually is a great way, a simple way to relieve stress.

And, actually, if you do it with others, that’s even better because spending time with others is an amazing way to relieve stress. I mean, just enjoying the company of someone else, having a cup of tea with someone or going for a walk or just sitting and chatting with your family — that is also. It can be a major way to relieve stress for many people.

So find what works for you, but try to incorporate some form of stress reduction into your life every day or maybe, again, multiple different forms. Like you mentioned that this morning you did your yoga, so that’s a wonderful way to start out the day, just to kind of — puts you in a certain state of mind and really decreases the frequency of headaches, I think. And it’s been clinically proven as well.

And I can tell you that many of my patients, when they do get flares of migraine, where they have escalating episodes, more frequent episodes, I’ll ask them, “What’s going on? What’s going on in your life?” And the most common response I get is that it’s been a really stressful period. And if they can find ways to modulate that, they’ll just be in a better state, so.

Molly: I do think it is so important to be able to manage our stress for so many reasons, especially when it comes to migraine and how important that link is.

Dr. Banik: Yeah, absolutely. So sometimes stress can be very overwhelming, and we feel like it’s all up to us, and it’s internal. Nobody else knows what we’re going through. But it’s completely OK to seek help, to seek outside help. And if that means talking to a therapist or perhaps even being put on medications, that’s perfectly fine. Because if that helps you function better, you will just be the more better off for it.

So there should not be any stigma attached to seeking outside help. You shouldn’t feel like, “Oh, I’m weak because I can’t deal with this on my own,” or “I should be able to deal with it, and I can’t,” or “I used to be able to deal with it, and I no longer can.” It’s hard to get out of that mindset, but you should not feel guilty about seeking outside help if you’re very, very stressed.

Molly: I think that’s a great point that you make, that you don’t have to go at it alone. Especially if it’s going to help you overall in your physical health and your mental health, then go ahead and get help, if you choose to do so, if you need it.

Dr. Rani, is there anything else that you want to share with us before we wrap things up here?

Dr. Banik: Well, I’ll just tell you from my personal story, again, that these lifestyle changes that I implemented really made a tremendous difference. And it’s not also something that you start changing these things and you’re going to see results like that. It’s not going to happen overnight, so you really have to be consistent with it.

So whatever changes you choose to implement, whether it’s nutritional or lifestyle, then give it some time. Give it at least three months to see if it’s working for you or not. And after that three months, if it’s not working for you, then change it up. Try something different and explore other things. But just keep at it because eventually you will turn the corner too.

Especially, like me, if you have chronic migraine, if you had chronic migraine, it’s not an overnight miracle cure. That’s really important just to keep in mind and have realistic expectations. But keep trying because eventually something will work.

Molly: That’s such a positive note to kind of wrap up with, that make sure you give it time and keep going. Keep trying.

What an excellent discussion that we had today. I’d like to say a big thank you to our guest, Dr. Rani Banik. Dr. Rani, thank you so much for joining us today and giving us all your insight.

Dr. Banik: Thank you so much, Molly, for having me on. I really enjoyed our conversation.

Molly: I did as well. And if you want more information or suggestions on natural therapies for migraine, you can follow Dr. Rani on social media. She has a lot of info out there. Check out her web page.

And, always, for more information on migraine and potential treatments, you can visit MigraineDisorders.org for the latest. Until next time, I’m Molly O’Brien. Thanks for watching Spotlight on Migraine.

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This podcast is sponsored in part by Amgen/Novartis.

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