HEADACHES and wellness

Healthy lifestyle habits have been shown empirically to matter in migraine management. Here is a handy pneumonic to establish healthy habits: SEEDS.

Sleep

Eating

Exercise

Drinking

Stress Management

Why will improving these habits matter in headache and TBI patients? The appreciation of central nervous system hyperactivity is something that is becoming more commonplace. Best-selling author Dr. Norman Doidge refers to it as a “noisy brain” it in his book “The brain that heals itself” where he shares the stories of neurological patients and their quest for taking back their lives.

Neurofeedback practitioners measure this noise with quantitative EEG (qEEG). It may be reflected in higher amplitudes of electrical impulses in certain parts of the brain, more areas of uncommon activity, higher coherence between parts of the brain (less flexibility), disadvantageous frequencies of electrical impulses, etc. (Soutar & Longo, 2011). Furthermore, functional MRI (fMRI) has shown that patients who sustain concussions have significantly more neural activity than their non-concussed counterparts (Barkhoudarian et al., 2011). Central Sensitivity Syndrome has recently received more attention. Many of the conditions that are commonly part of this syndrome are also commonplace among headache, chronic pain and TBI patients.

It has been empirically accepted that the SEEDS habits balance a hypersensitive nervous system and may raise the threshold for migraines; that is, so it becomes harder to trigger a migraine. (Image above created by Migraine Association of Ireland, 2016)

Here are a few tips that can prove helpful to improve one’s sleep:

• Patients receiving Cognitive Behavioural Therapy for Insomnia (CBT-i) have a 60% reduction in their headaches 2 months out. (Smitherman et al., 2018)
• Sleep Hygiene and relaxation strategies are helpful techniques to foster sleepiness.
• A YouTube video called “Weightless” by Marconi Union has been shown to help people fall asleep faster although it may not work for everyone.
• Many of our patients find bedtime story apps helpful.

There are many potential triggers that have been identified for migraines. Lately, the idea of “triggers” triggering the migraine has come into question. The actual migraine process (pathophysiology) usually kicks before a patient feels the pain, sometimes several hours before. Some experts now feel that cravings (“triggers”) may go hand-in-hand with an active migraine that has not caused any pain yet. So maybe, these “triggers” are things that are just correlated with migraines and are actually just symptoms of the migraine rather than triggers for it. So the line between cravings and triggers becomes a bit less clear. However, caffeine is still accepted as a trigger and there may be merit to eliminating suspected triggers and seeing how it pans out.

Generally, nutritious, regular meals are helpful. Some diets that are spoken of are:

• Diets that eliminate “triggers”, especially caffeine. Just say no to caffeine is the best policy for migraine patients.
• Other elimination diets show promise but require further research. One study found that in migraine sufferers who also have IBS, eliminating foods based on IgG results (Antibodies to 270 food allergens) showed improvement in IBS and migraine symptoms (Aydinlar et al., 2012). In a sense, this would be identifying an anti-inflammatory diet.
• Anti-inflammatory diets are becoming more spoken of. Research in this area is ongoing. Dr. Heather Tick’s website is a good resource for more information on this sort of diet.
• Diets containing increased omega-3 (Ramsden et al., 2013)

There are some challenges to implementing dietary changes, some of which we reviewed in our podcast Concussion 101 (Episode 4 – “To rest or not to rest”). But for those determined individuals, it may carry other health benefits above and beyond helping with headaches. It is always best to consult a registered dietitian before making any changes to your diet to ensure you are getting a balanced diet.

Dr. Leddy’s research, that brought us the Buffalo Treadmill Protocol, found that submaximal threshold cardiovascular exercise helps restore balance to a dysfunctional autonomic nervous system. Several articles have also shown that walking decreases headache frequency and quality of life (Cephalalgia 2011;31(14):1428–1438. Headache 2014;54(1):40–53. Headache 2008;48(6):890–899. Int J Sports Med 2011; 32(6):455–460. Headache 2009; 49(4):563–570. Headache 2016;56(2):357–369.). From bestselling author Dr. Ratey, “Spark: The Revolutionary New Science of Exercise and the Brain” goes into the transformative effects of exercise on the brain and is an informative read.

What about for those patients who find it hard to get motivated? There are many strategies but some patients have really enjoyed:

• Miles for Migraine virtual walk/run or getting an activity tracker so they can gauge their progress.
• Exercise and diet also help maintain a healthy weight. Improvements in migraines severity, frequency and duration have been noticed after improvement in weight. (Bond et al., 2014)
• Healthier weight is also associated with better sleep.

Most of us are aware that headaches are more frequent when one gets dehydrated. Hydration for performance (i.e., reducing headaches) and hydration in the context of cardiovascular collapse are on different levels but are of the same nature. You don’t have to be dehydrated to the point where you will benefit from iv fluids to have your performance affected.

It is important to space your fluid intake out throughout the day as most of the fluid one drinks will go out of the vascular system into the surrounding tissues. If you drink all your water in one fell swoop, lots of it won’t have the time to diffuse to muscles and other tissues where it will be useful before it is excreted by your kidneys.

It is often heard that one should aim for about 2 liters of fluid per day. Fluids that are diuretics (alcohol, tea, coffee, etc.) will detract from this quota. However, the actual quantity of fluid is not a set value and will vary between individuals and activity levels. What constitutes adequate hydration is something learned more through awareness and experience. Aim to keep your urine light in colour (it should have the colour of lemonade but not apple juice). Keep in mind to drink more to account for losses with exercise.

Stress is a big topic and it’s far-reaching: unwelcoming hands can fiddle with many aspects of our lives. There are many strategies available to check this.

We have dealt with this topic extensively on our website in our introduction to concussion articles “Concussions 101” and in our Library (CBT, mindfulness, relaxation training, therapeutic activities, biofeedback, etc.). We have touched on it in many of our episodes (Episode 4: To rest or not to rest [Rest]; Episode 5: The glass is half full [Positivity]; Episode 6: Down but not out [Mood]) in our podcast Concussion 101.

Educating patients about headache demystifies what is happening to them. It has been shown to also improve headaches in and of itself (Bond et al., 2014). There are many good resources for educating yourself about your condition.

Do get a good understanding of your headaches, it’s useful to use a headache journal. Journaling (for all sorts of things like thoughts, fears, stresses, medical conditions, etc.) in general is a good stress management technique, to get things out of your mind but storing them somewhere in case you ever want to have access to them. This frees up your mind and allows you to be more mindful. Headache journals will also help your treating team with management.

Meditation is a hot topic right now. The number of articles published on meditation have swelled near 100-fold from 2000 to present which goes to show the public interest in this area (Lauricella, 2016). A study out of Massachusetts General Hospital in 2011 that received a lot of attention was the first study to report that meditation leads to increased gray matter in the brain. The study looked at mindfulness meditation training for 8 weeks and showed with neuroimaging positive measurable changes in brain regions associated with memory, sense of self, empathy and stress.

Breathing is another hot topic now. A study out of Northwestern University in 2016 showed that the rhythm of breathing creates electrical activity in the human brain that enhances emotional judgments and memory recall (Zelano et al., 2016). We have written on heart rate variability (HRV) elsewhere and the benefit of training at the resonance frequency.

Aydinlar, Elif & YALINAY DIKMEN, PINAR & Tiftikci, Arzu & Saruc, Murat & Aksu, Muge & G Gunsoy, Hulya & Tozun, Nurdan. (2012). IgG-Based Elimination Diet in Migraine Plus Irritable Bowel Syndrome. Headache. 53. 10.1111/j.1526-4610.2012.02296.x.

Baillie LE, Gabriele JM, Penzien DB. A systematic review of behavioral headache interventions with an aerobic exercise component. Headache. 2014 Jan;54(1):40-53. doi: 10.1111/head.12204. Epub 2013 Aug 28. PMID: 23992549.

Barkhoudarian G, Hovda DA, Giza CC. The Molecular Pathophysiology of Concussive Brain Injury. Clin Sports Med. 2011. 30:33-48.

Bond DS, Leary KCO, Thomas JG, et al. Can weight loss improve migraine headaches in obese women? Rationale and design of the WHAM randomized controlled trial. Contemp Clin Trials 2014; 35: 133–144.

Britta K. Hölzel, James Carmody, Mark Vangel, Christina Congleton, Sita M. Yerramsetti, Tim Gard, Sara W. Lazar. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 2011; 191 (1): 36 DOI: 10.1016/j.pscychresns.2010.08.006

Busch V, Gaul C. Exercise in migraine therapy–is there any evidence for efficacy? A critical review. Headache. 2008;48(6):890-899. doi:10.1111/j.1526-4610.2007.01045.x

Darabaneanu S, Overath CH, Rubin D, et al. Aerobic exercise as a therapy option for migraine: a pilot study. Int J Sports Med. 2011;32(6):455-460. doi:10.1055/s-0030-1269928

Irby MB, Bond DS, Lipton RB, Nicklas B, Houle TT, Penzien DB. Aerobic Exercise for Reducing Migraine Burden: Mechanisms, Markers, and Models of Change Processes. Headache. 2016;56(2):357-369. doi:10.1111/head.12738

Lauricella, Sharon. (2016). 2016 Lauricella JRH Spiritual Hygiene Meditation Media Coverage Lauricella 2016.

E Ramsden, Christopher & Faurot, Keturah & Zamora, Daisy & M Suchindran, Chirayath & Macintosh, Beth & Gaylord, Susan & Ringel, Amit & Hibbeln, Joseph & Feldstein, Ariel & Mori, T.A. & Barden, Anne & Lynch, Chanee & Coble, Rebecca & Mas, Emilie & Palsson, Olafur & Barrow, David & Douglas Mann, J. (2013). Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: A randomized trial. Pain. 154. 10.1016/j.pain.2013.07.028.

Smitherman, Todd & Kuka, Alexander & H. Calhoun, Anne & Brooke Pellegrino Walters, A & E. Davis‐Martin, Rachel & E. Ambrose, Carrie & Rains, Jeanetta & Houle, Timothy. (2018). Cognitive‐Behavioral Therapy for Insomnia to Reduce Chronic Migraine: A Sequential Bayesian Analysis. Headache: The Journal of Head and Face Pain. 58. 10.1111/head.13313.

Soutar, Richard. Longo, Robert. Doing Neurofeedback. ISNR Research Foundation, 2011. Print.

Varkey E, Cider A, Carlsson J, Linde M. Exercise as migraine prophylaxis: a randomized study using relaxation and topiramate as controls. Cephalalgia. 2011;31(14):1428-1438. doi:10.1177/0333102411419681

Varkey E, Cider A, Carlsson J, Linde M. A study to evaluate the feasibility of an aerobic exercise program in patients with migraine. Headache. 2009;49(4):563-570. doi:10.1111/j.1526-4610.2008.01231.x

Zelano, Christina & Jiang, Heidi & Zhou, Guangyu & Arora, Nikita & Schuele, Stephan & Rosenow, Joshua & A Gottfried, Jay. (2016). Nasal Respiration Entrains Human Limbic Oscillations and Modulates Cognitive Function. Journal of Neuroscience. 36. 12448-12467. 10.1523/JNEUROSCI.2586-16.2016.