Migraine headaches can be debilitating, and undue stress can exacerbate the condition, creating new problems. Lauren R. Natbony, MD, a Headache Specialist at the Mount Sinai Center for Headache and Facial Pain and an Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai, provides some suggestions for how to manage your headaches when life gets stressful.
What’s the difference between a migraine and a regular headache?
Headache is a catchall term for any type of pain in the head. Almost everyone has experienced a headache in his or her life. Migraine, however, is more than just a headache. It is a chronic and disabling neurologic disease that affects the way the brain processes pain. Headache is only one symptom of migraine and typically presents with moderate to severe pain on one side of the head. The pain tends to have a pounding or throbbing quality and it often gets worse with movement. Other symptoms include sensitivity to light, sound or smells, nausea and vomiting. Some people may also see spots or flashing lights in their vision. We think that migraine is likely genetic, meaning that it runs in families and is inherited.
How does stress affect migraine sufferers?
Stress can cause migraine and migraine can cause stress. Since they both feed each other, it can turn into an endless cycle. Stress causes various chemical and hormonal changes in the body. In some people, these changes can trigger a migraine. And, if your body is accustomed to daily stress, a day without stress—like a weekend or special event—can result in a letdown migraine. This can be a real bummer and can ruin any attempt to unwind.
How should migraine patients cope with unexpected stressors?
The COVID-19 pandemic is a great example of an abrupt, unexpected stressor and a change from normalcy. First, it is important to recognize that the migraine brain is very sensitive to change. Thus, keeping a consistent schedule every day (to minimize change) is crucial for migraineurs. Multiple lifestyle modifications can also help the brain cope better with stress.
What can patients do to help manage their migraines?
First, establish a sleep routine, as sleep is essential for brain health. Try to go to bed at the same time every night and wake up at the same time every morning. While it can be difficult to get good quality sleep during stressful times, it’s something that should be prioritized for everyone—especially migraine sufferers. It is also important to have a morning routine, whether it’s going outside for some fresh air after waking, talking on the phone to a loved one, or drinking a hot beverage while reading the newspaper.
You should also eat something rich in protein within 30 to 60 minutes of waking up. Throughout the day, eat healthy, nutritious meals with plenty of fruits, vegetables, and protein. Try to eat something with protein every 3-4 hours. Protein helps to stabilize blood sugar levels, and abrupt changes in these levels can trigger migraine. Also, be sure to stay hydrated by drinking at least 64 ounces of water a day.
Another thing that can be helpful is exercise, which is a great stress reliever. Engaging in regular physical activity—ideally at least 30 minutes 5 days a week—will help reduce stress not only in the moment but also over time. Relaxation techniques like yoga and meditation are also helpful and have evidence for benefit in migraine
Do I need to schedule an office visit with a headache specialist or are video visits just as worthwhile?
Video visits are a great option for those with migraine and headaches. The fact is, patients with migraine do not love coming into the office. Travel to the office itself can be a stressor. Likewise, the office can seem bright and noisy and trigger a migraine for some.
Seeing patients in their own space is extremely helpful. For example, I have patients who do not know all the medications they are taking. During video visits, I have them walk over to their medicine cabinets and show me the bottles. We review the medications—and their doses—and I can give them much better advice. I also have patients who will tell me they do not have space to exercise. During video visits, I can see their home and together we can carve out a space for exercise. I can also suggest different lifestyle techniques based on their living environment to improve headaches.
Why see a specialist?
It’s important that migraine sufferers work with doctors who understand the condition. There are many treatments available, but treatments should be tailored to each patient’s lifestyle and health concerns. I aim to help my patients control their headaches, especially during stressful life events.
At the Mount Sinai Center for Headache and Facial Pain, we understand what you are going through and are committed to working with you to get you the relief you need.