Migraines Triggers Effects and Tips to Live with Them

Hey there, everybody, and welcome to this video on migraine triggers, effects and tips to live with them. I'm your host, Dr. Donnellice Snipes. In this video, we're going to discuss the prevalence of migraines. We'll talk about different things that might be the underlying cause of them. We'll also explore triggers for migraines and tools to help you cope if you struggle with migraines or chronic migraines. About 15% of the population in the United States suffer from migraine, which accounts for about 35 million people. 15% is 1.5 out of every 10 people, or 3 out of every 20 people struggle with migraine. Next time you're in a meeting at work that has 20 people in it, look around. Three of those people probably struggle with migraine. Migraine is defined as a recurrent headache disorder manifesting in attacks that last four to 72 hours and may or may not have aura. It's also important to remember with migraines, they're not just headaches. When people have migraines, they also have nausea, dizziness, sound sensitivity, noise sensitivity, smell sensitivity. Their entire system often becomes very hyper vigilant and hypersensitive to everything that's going on around them. What causes them? Well, they don't know, unfortunately, but they have some indications. And as science improves, we're getting some more knowledge about what may cause migraines and chronic migraines. In many people with chronic migraine, there are changes of the pain modulation and sensitization of the trigeminal nerves. So the way the body processes pain changes. And then the trigeminal nerves, which are the nerves that are associated with your face, basically they become more sensitive, so the person experiences enhanced pain compared to what they would be experiencing outside of a migraine episode. Tumor necrosis factor alpha levels in the cerebrospinal fluid of chronic migraine patients also indicates that chronic inflammation, systemic inflammation, is a factor in the progression of migraine. Now, tumor necrosis is a really skin scary word, and it's just one of your inflammatory cytokines, basically. So don't get all freaked out about the word tumor. What we're looking at is a marker that indicates in many, if not most people with chronic migraine there is systemic inflammation. What other things are associated with systemic inflammation that we know of? Depression, fibromyalgia, a lot of different chronic pain conditions, autoimmune issues. So we're starting to see some overlap here. Many people with chronic migraine also have deficient levels of endocannabinoids in their cerebrospinal fluid. And that is a really interesting point. Endocannabinoids are your natural or the cannabinoids that your body makes. It's not cannabis that you would ingest, but it's something your body already makes. And they've determined that in people with chronic migraine, many times the levels of their natural endocannabinoids are too low. They've also found that serotonin and dopamine levels are implicated in migraine. Now, we don't have a way of specifically measuring serotonin and dopamine levels in the brain, but they have found that systemic levels of serotonin and dopamine may be different in people with chronic migraine. Not every person with migraine or chronic migraine has every one of these issues, which is why we can't say this is what causes it, this is how to fix it. But it is interesting to note that there are multiple avenues. So if one avenue doesn't work for you, there are other avenues to explore. Unfortunately, migraine, whether it's chronic migraine or episodic migraine, impacts every aspect of a person's life. Some people with especially with chronic migraine may develop addictive behaviors in order to try to numb that pain, in order to try to make the pain go away. Some people with addictions may develop migraine. But because guess what, we know that addiction alters the dopamine, the serotonin and the endocannabinoid system. So if someone's dependent on substances, they've altered those systems. Therefore, part of withdrawal for those people may end up being migraine. Irritable bowel syndrome and celiac disease are also frequently seen in people with migraine, as well as an alteration in the gut microbiome when we're stressed, Whether it's pain or cognitive stress or emotional stress, when we are stressed, our vagus nerve picks that up, relays it to the brain, and as a result, the gut microbiome changes. The bacteria in our gut is altered to produce fight or flight chemicals and help us gear up for fight or flee instead of producing the other chemicals that we would use during relaxation. We also see a concurrence of obesity in people with migraine. We know that people who have high levels of fat tissue, adipose tissue, tend to have higher levels of systemic inflammation. But we also have seen that people with migraine, because of their impaired ability to do the things that they like to do and maybe self soothing through eating. There are a lot of ways that people who experience Migraine may inadvertently gain more weight, but there is a strong connection. When we see migraine, we often see weight gain, not always. Some people with chronic migraine have a lot of nausea and so they just don't want to eat. Sleep is another thing that is fascinatingly correlated with migraine. They find that a lot of our sleep functioning and sleep regulation takes place in our brainstem. They've also found that what they're starting to learn about the causes of migraine may also in part take place in that brainstem. They found a strong correlation between people who have migraine also having insomnia, restless leg syndrome or bruxism, grinding their teeth at night, or tmj, which is kind of interesting. Bruxism and TMJ is often associated with stress. And we'll get down there in a minute. Restless leg syndrome, we know, is associated with an alteration in dopamine levels. So. And insomnia can be caused by a lot of things, but the underlying pathology that they see in people with insomnia and migraine is a stress response system, an HPA axis that is hyperactive. So people that have a lot of anxiety also may also have insomnia and have difficulty getting to sleep. Sleep is regulated in part by drum roll, please. Serotonin. Therefore, seeing this correlation between sleep disorders and migraine, between serotonin and dopamine related disorders and migraine gives scientists and physicians new avenues to pursue to explore what might be the underlying cause of an individual's migraine. As I said, we can't say that this causes it for every person. We need to treat the person as an individual, affect or emotional or psychiatric effects and triggers. And I don't like the term psychiatric because it sounds like there's a problem that is like an illness. And in reality, most people with migraines are struggling to cope with life on life's terms. They are reacting with a expected reaction to a unexpected situation. People with migraine may struggle with depression, including suicidality. The the interesting thing here again, depression is associated with altered levels of serotonin, norepinephrine, dopamine, as well as a bunch of other things. Therefore, people with depression may be at higher risk of developing migraine. And they find that in psychiatric facilities, people who are hospitalized with major depressive disorder often also have migraine, but is often not even assessed for. So if somebody has major depressive disorder, it is important to also ask about pain. Chronic pain migraine depression is also associated with inflammation. So depression and the underlying causes of depression may also contribute to the development of migraine. Likewise migraine, which for many people feels out of their control. It feels like it comes from out of the blue. It inhibits them from engaging in a lot of things that they want to do in their rich and meaningful life. So they start to feel hopeless and helpless and unmotivated and apathetic. And because of the migraine, they're not sleeping well. So because of the migraine they also may be fatigued, which compounds their feelings of hopelessness, helplessness, guilt, all that stuff. So it totally makes sense. It sucks. But this can be a treatment target to help people identify strategies that they can use in order to feel more empowered. Anxiety and chronic stress Chronic stress contributes to muscle tension, contributes to chronic activation of that HPA axis, contributes to poor sleep, and can contribute to things like bruxism that may trigger a migraine attack. Anxiety is the same way. So why do I have both of them? Because a lot of times people think of anxiety as generalized anxiety disorder. I don't like the term disorder, but they think of it as something different than stress and they minimize the impact of chronic stress in their life. But it's important to recognize that activation of the HPA axis or your stress response system activation is activation is activation, whatever name you want to put on it, it is triggering that fight or flight response which is going to impair sleep, ultimately impair long term energy, and may contribute to the development or an episode of migraine. PTSD is also associated with migraine. For people who've had traumatic brain injury, there is something called post traumatic headache syndrome, but that is specific to people who've experienced mild or moderate traumatic brain injury. For people who've experienced PTSD in a more emotional or cognitive aspect, you don't quite see that as much. But if they do have hyper vigilance, if they do have high levels of anxiety, they often are at greater risk for also developing migraine. The take home there is to if the PTSD is addressed, if the hyper vigilance is addressed, if the person is able to actually relax and not have negative cognitions and perceptions, it may help mitigate the frequency and intensity of the migraine. Guilt is another common feeling that people experience when they have migraines. They feel guilty that they got one. They feel guilty that they have to call in sick to work or they have to go home. They feel guilty that they can't do what they are expected to do around the house or go to their kid's soccer game or whatever they're expected to do. They feel guilt. Guilt is self Anger. Guilt is being angry at yourself for not being able to do something that you think you, quote, should be doing. Guilt gets tied up with anger, which gets tied up with anxiety. Fear of rejection, fear of abandonment, fear of getting fired, which gets tied up with depression, that sense of hopelessness and helplessness. So, as Hayes calls it an acceptance and commitment therapy, we start having dirty discomfort. We start having this onion, if you will, of emotions, and they're all distress emotions. And it's important to start peeling back those layers because the more you struggle with it, the more difficult it becomes to cope with. And in one of my other videos, when we talk about dirty discomfort, I make the analogy. If you watch some of the old Chuck Norris or martial arts movies, sometimes you'll have the lead character, and this one lead character has to battle off four or five different bad guys at the same time. That's dirty discomfort. That's way freaking harder to do and than battling one at a time. So feeling guilty, dealing with guilt by itself is a whole lot easier. But if you start feeling anxious that you're going to be rejected and angry that you can't control it, and hopeless and helpless that things will get better, then all of a sudden you've got multiple bad guys coming at you, so to speak. So it is important for us to help people identify. And cognitive behavioral strategies can be very helpful. Distress tolerance, journaling, and cognitive processing. Cognitive processing can also be useful for helping people peel back the layers of that onion. And anger and frustration are very common. Being angry at your body for not doing what it's supposed to do. Being angry that you are hurting again, being angry that others may not understand. Being angry that others don't feel this, and life is unfair. There are a lot of things that can trigger anger. Anger triggers that fight or flight response, triggers that tension and can trigger migraine. So the migraine can trigger anger, and then anger can trigger or worsen the migraine, which is why we need to break the cycle. Cognitive dysfunction is also common in migraines. And even if you haven't ever had a migraine, if you've had an intense pain or a really bad headache, and I'm not saying that there is a correlation, a really bad headache is not the same as a migraine. But I'm just trying to help everybody kind of conceptualize what this might be feel like. Think about a time that you felt awful, you know, your head hurt, you were nauseous, it was just a bad time, maybe you had the flu. How fast did you process information? Were You Johnny on the spot like you usually are, or did it take you more time to process stuff and think through stuff? Kind of like you were thinking in a fog. Your basic attention, your ability to focus on what you were doing. How good was that? A lot of times when people are in pain, especially if they have a headache and head related pain, but sometimes it's just any kind of pain. It makes it more difficult to focus on things other than the pain because your brain's saying, hey, something's wrong. You need to pay attention to what's going wrong and not pay attention to working on the spreadsheet or whatever you're working on. It makes sense why it's hard to pay attention, but it's also frustrating because sometimes your logical mind is saying, paying attention to it doesn't do any good because I can't fix it right now. Guided imagery, meditation, grounding exercises can all be helpful for people who are having difficulty with basic attention during their migraine episodes. But it can also just be helpful to be self compassionate and recognize that, you know what, Today is not going to be an A day. Today I'm going to do what I can to the best of my ability and that's all I can do. Executive functioning like organizing and planning and even impulse control can also decline when somebody's having a migraine. When people are in pain, they tend to be more impulsive. When you're in pain, it's harder to sit down and think about, okay, what are the six steps we need to take in order to accomplish this goal? You, your brain is saying, fight or flee. Fight or flee. Stress, pain, something's wrong. And not wanting you to focus on something completely unrelated, your brain and your body are trying to help you stay safe and help you have the energy to address what you need to address. Verbal and nonverbal memory and even verbal skills can also take a hit. When somebody is experiencing a migraine episode, it may be hard to come up with words. It actually hurts to think environmentally people when they are experiencing a migraine episode or even between migraine episodes. Environmental sensitivities can trigger migraine. That people may be sensitive to light, noise and smell. Blue light is the worst. Bright lights can be really painful. And fluorescent lights, now fluorescent lights typically have a lot of blue in them, but fluorescent lights in and of themselves have been shown to be bad light flickering. In people with epilepsy, flickering lights can actually trigger a seizure. But in people with migraines, being around a flickering light can trigger a migraine episode. And that can even mean if you're driving down the road and you're driving through a tree lined street and the sun is coming through the trees and it's kind of flickering or strobing, that can also trigger a migraine. Obviously you can't make the sun go away. It can be helpful, for example, to wear sunglasses, maybe to travel when it's not light out, travel when it's dark outside so you don't have that same problem. Sometimes you got to get creative to do some of those workarounds and smells and we're going to talk about some of these, how to address some of these things when we get down into reasonable accommodations in a minute. People who have migraine or chronic migraine often have difficulty working and may even have activities with difficulty with activities of daily living like cooking. Lots of smells in cooking, lots of sounds with pots banging, even with the microwave going off and the beeping can be ear piercing. For somebody who has a migraine, they may have difficulty having the energy to get up, they may feel nauseous, they may have dizziness and have difficulty standing in the shower. All of those things need to be accounted for and recognize. Being compassionate, recognizing instead of being angry that this is happening and trying to push through it. What can you do to address it and mitigate the problems? Can you get a shower seat so when you are having migraines you can use the shower seat? Can you turn off the beeping on the microwave so when you have a migraine it doesn't feel like somebody is pounding on your head at work? There are a lot of reasonable accommodations. You can go to askjan.org but a lot of those accommodations are also helpful in the home environment, especially if you live with other people or animals. Migraines can also take a toll on financial stability. If people, especially people with chronic migraine who have difficulty working outside of the home, it can be difficult for them to maintain the financial status that they had before the migraines onset. Looking at ways to modify that, talking with a financial planner can be helpful. Financial stress is stress. Stress is going to trigger that HPA axis. That HPA axis may trigger migraines. So we need to consider all the possible triggers and minimize as many as we can interpersonally or relationally. Migraines can lead to conflict in relationships with when someone has a migraine, they may become very impatient with others because they're in so much pain. And I think most of us who have experienced pain before can sympathize or empathize with a person who may be irritable when they're in pain. So we do want to recognize that because it can be overwhelming for people who don't really understand what's going on, or for children who, who don't really understand what's going on. And especially children may internalize it and think, oh, daddy's mad at me or mommy's mad at me, instead of understanding that mom or dad is really, really sick and they're not angry with you, they're just angry and they're in pain and they hurt. Children understand hurt. Sometimes there's conflict in relationships because of what we'll just shortly call ignorance. Other people don't understand the magnitude of the pain or all of the associated symptoms of migraine. It can be very helpful for a person with migraine to educate those in their life about what it feels like when the migraine is starting to come on, what it feels like if they have an aura, what it feels like in the migraine phase of the, of the episode, and what they can do to be helpful. Many times people are ignorant and, and they lack empathy because they think, oh, just take a, you know, Excedrin migraine pill and you'll be fine. That's not it. That doesn't work for a lot of people. Assuming that there is such a simple solution minimizes somebody's frustrations and their struggles with chronic migraine. People with chronic migraine may also experience isolation or reduction in social activities due to their pain. Or they may start feeling left out because they frequently cancel on people. So people stop inviting them. They're like, well, John will call when he wants to go out, and John is just sitting around waiting for other people to call. So sometimes the person with migraine may need to reach out to others and invite them to do things. Sometimes the person with migraine may need to reach out to others and say, okay, I can't do this, but how about one of these things? Sometimes the person with migraine needs to explore ways they can engage in those things that make their life rich and meaningful to the greatest extent possible. And while they are living with migraine, and because of all these things, because of the conflict, because the fears of rejection, because of the changes in activities that they can and cannot do, sometimes a lot of people with chronic migraine experience lowered self esteem. They feel defeated sometimes. And that is an important target, one of many important targets for helping somebody develop strategies to live with migraine as behavioral health providers. Can we make migraine go away? No. Are we going to treat their migraine? No. What we are doing is helping them figure out how to cope with and live with the symptoms of migraine. And we're treating the associated issues like the guilt and the anger and the depression and the fatigue and the self esteem. Treatment strategies that are evidence based include acupuncture and nutritional therapies. Caffeine and alcohol seem to be triggers for migraines for a majority of people. But other people with chronic migraine and with frequent migraines also may have food sensitivities that include nitrates, nitrites, msg, dairy products, gluten. Many times the treating physician and or nutritionist will work with the person on an elimination diet where they eliminate certain foods and see if that helps with their migraine frequency and intensity. A variety of drugs from beta blockers to SSRIs have been shown to be effective with migraine. Which one's going to be effective depends on what is triggering that particular person's migraine. I've seen commercials on the use of Botox as well for chronic migraine. So that's out there. That's obviously something that a person would need to explore with their treating physician. In terms of cognitive behavioral therapies, Mindful awareness is so important. Being aware of how you feel in the moment, being aware of the situation. So you're more cognizant of potential triggers. That way you can address them before they become a problem. You can. If there's something that is too scented, you can either remove it from the room before it triggers a migraine or you can go to another room. You can be more aware of your personal emotional and cognitive stress and use distress tolerance skills or other skills in order to mitigate that before it triggers an episode. Mindful awareness is wonderful for prevention and mitigation. Stress reduction is kind of comes from mindful awareness. Once you're aware of what may be causing the stress, then you can work towards stress reduction. You can work toward using cognitive behavioral tools such as living in the and and unhooking and a lot of the other tools that I've talked about in order to prevent your stress level, your stress meter from going off the scale. You can actively work to reduce stress in your life and reduce the unnecessary stress that a lot of us subject ourselves to with taking on too many demands and shoulding ourselves and feeling guilty and those sorts of things. Pain tolerance is another thing that we can work on in cognitive behavioral therapy. Guided imagery can be really helpful in helping people develop their ability to tolerate the pain. And these are very similar to distress tolerance Skills, which is what we use to help people tolerate emotional distress. Pain tolerance skill specifically focuses on the physiological pain the person is feeling and strategies they can use in order to cope with it. When people start feeling more able to manage their triggers and vulnerabilities and more able to cope with the pain when it does happen, it increases their sense of self efficacy. And there's something called headache management self efficacy, which has been shown to greatly improve the reported quality of life of people with frequent or chronic migraines. As they feel less controlled by the migraines, as they feel more able to deal with that when it happens, they tend to feel more empowered, less hopeless, less helpless, more motivated to capitalize on the times that they're feeling good. Biofeedback is another strategy that has been shown to be helpful for migraine treatment. Remember, when the stress response kicks off, it often triggers migraines for people. Biofeedback helps people focus on their heart rate and or their breathing. By noticing that and by watching that, people can reduce their stress response. If you slow your breathing and you slow your heart rate, that triggers the relaxation response. You can do it with a fitness tracker and slow your breathing so you can watch your heart rate go down. You can do it with a chest strap. Those are inexpensive methods for biofeedback that a lot of people can use. And finally, transcutaneous vagus nerve stimulation has been shown to be effective with some devices actually being FDA cleared for use in treating migraines. Transcutaneous vagus nerve stimulation is something that we've talked about for a variety of things, where people will often use a clip on the tragus of their ear. But there are also devices that are contact transcutaneous nerve stimulation, so somebody can put it directly on a pain area. And working with their doctor, they can figure out where it's best, where they're best suited to place it in order to help with their particular migraine. In terms of reasonable accommodations, there are a lot of strategies and steps people can use in order to prevent triggering a migraine and or to cope with it when it happens. As I mentioned earlier, Askjan.org is the place that a lot of human resources professionals go to figure out what are some reasonable accommodations for our employees. But it's also a great place to go if you have a loved one who has a particular issue and you want to find out how can I help them live a higher quality of life, what can I do? So flexibility, flexible, regular scheduling can be very helpful. Keeping somebody's circadian rhythms steady. Is helpful. If they're day shift, keep them on day shift, don't suddenly switch them to night shift. Job restructuring can be really helpful and it doesn't have to be all the time. Maybe when a person's having a flare up or they feel like they're starting to have a migraine come on, maybe at that point they can't do certain duties. If they work in a retail store, they may have to move off of the floor floor so they're not at the cash register and they're not doing stock. They do something in the back room when they are starting to have a migraine so they can get away from some of the bright fluorescent lights. And interacting with people that add stress. It depends on the person what they can and cannot do and what triggers their migraine more. The same thing is true at home. If somebody feels a migraine coming on, doing dishes is probably not in their best interest. Or vacuuming something that's going to be loud and clangy or, you know, annoying, like the vacuum cleaner or, you know, washing dishes and the clanking sounds. So on those days the person can do something else around the house instead of those particular chores. Light is a huge trigger for a lot of people and you can now get glasses that are not prescription, but they are blue blocking glasses and those can help people with migraines. Filters that go on mobile devices, computers, television screens that filter out harsh, especially blue light can also be really helpful at preventing migraine and switching to softer bulbs. Getting rid of the fluorescent lights and switching to something that's like an LED light can be helpful, especially if it's warm and it's not really harsh, not really strong in the daylight or blue tones. Making sure you have an ergonomic workstation is also important. It doesn't matter if you sit at a desk or you stand at a kitchen counter all day and you're a chef. It needs to be an ergonomic situation. When you have muscle tension, you often guard especially around your neck. And the more upper body tension and stress you have, the more likely you are to trigger a migraine attack. Escape options can be really helpful. It makes the person feel like they have plan B, they have somewhere they can go in an emergency at work. And I use the term safe room. What I mean is a room that's dark, that's quiet, that's not super smelly and that doesn't have a bunch of allergens and in it, where can they go where they can be not bombarded by migraine triggers? The same Thing at home, where can they go? In our house we have dogs, we have cats, we have teenagers, we have lots of people cooking, there's lots of smells. So a person in our household, you know, where could they go where they wouldn't be subjected to breath, bright lights, allergens and huge amounts of Axe body spray. And that can be a room. We have a finished basement and there's a room down there that might be useful for that particular situation. But having a person know that they have a safe place they can go so they're not always stressed that, well, if this comes on, there's nothing I can do, and if they're not at home, how can they get home? Driving with a migraine is not. Some people can't do it at all. But it's certainly not advised because of the impaired cognitive functioning. Smells and scents. There are personal air cleaners that evidently you can wear around your neck that can use a HEPA filter to keep a lot of the allergens away from you. The downside to that, wearing it around your neck. Some people find that pressure on the back of their neck can contribute to a headache. So that may or may not work for some people. Whole house or whole office air purification systems. Or if somebody has an office where they can shut their door, having a good standalone air purification system with a HEPA filter can be really helpful. And having a fragrance free policy, you don't know when a migraine is going to strike a particular individual. You don't know when they're going to be sensitive to it. So. And once you have a fragrance on, it's really hard to get it off. So having a fragrance free policy in the workplace can be very helpful. And at home, potentially having a fragrance free room is an option and maybe even a fragrance free policy with cleaners and detergents and soaps. And if somebody needs to put on perfume or cologne, they do it after they leave the house. And finally, noise reduction earplugs, those are the go to in order to reduce noise. A white noise machine can be helpful. I tend to find those more annoying than the noise itself. Sound absorption panels and I have some that are behind my computer right now so my voice doesn't echo quite as much. You can get them really cheaply. You can get old cardboard egg crates, they're not really aesthetically pleasing, but hey, if you are artistic, you can spray paint each one of them, let them dry outside so you don't bring the smell of the paint inside. But then you can have a collage of sound absorption panels on your wall and that stops the echo, the echo from the floor, the echo from the walls that you hear when you're in an environment that doesn't have a lot of soft surfaces. Noise canceling headphones are an option for some people, and again, it has a good and a bad side. If you can get noise canceling headphones that are earbuds, that's really helpful. If they are actual headphones, people with TMJ may find that they are uncomfortable because it presses on that joint. So finding a strategy that works for that individual and making sure that there is an option for the person at work or at home to either type or write their responses in order to communicate versus talking and listening if they're having a migraine episode or if they're in that pre migraine phase so the sound of people's voices doesn't continue to trigger their migraine episode. Migraines are extremely painful and extremely stressful. Migraine treatment involves not only addressing the underlying migraine causes, but also reducing the physical, emotional, cognitive, environmental, and interpersonal triggers that are caused by the migraines themselves.