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New Year’s is my favorite holiday. I love the hope it brings. It is a time to assess what we want out of life and take ownership of what we can control or change on our route to accomplishing our best life. Then we write it all down. The Merriam-Webster Dictionary defines a New Year’s resolution as, “a promise to do something different in the New Year”. For most of us, our biggest goal is fewer migraines or more up-time and less downtime due to our illness. If you gave up on this notion long ago, I know how you feel. I’ve been there.
The first time I remember having a migraine I was four years old. After that, I have no memory of a pain-free day until age thirty. I spent most of my adult life chronically underweight from nausea and vomiting caused by this disease. Since my headaches were misdiagnosed as sinus headaches until I was 17, I gave up seeking help for years. The good news is that by the time I finished high school I had already perfected some strategies that got me through. During college and grad school, I kept Imitrex injections stowed away and used them when I had a big test. I had to do a certain amount of very specific types of exercise every morning in order to keep the pain in the “survivable zone”. Of course, I never went anywhere without my sunglasses and I never studied near a sunny window. Back then, I stayed as far away from doctors as I could because they mostly made me feel worse, physically and emotionally.
For years, I assumed daily migraine was just the cross I had to bear. I didn’t talk about it and I didn’t have much hope that I could ever fix it. It was not until I experienced some limited success with rhizotomies (nerve ablations), that I really turned the corner and realized I could have some control over my health and my future. Years ago, there were only a few medications and strategies available to try and combine to see if they would lead me to a better outcome. Now, there are more resources available to fight migraine than ever in history.
Decreasing frequency and severity of migraine disease is almost never an overnight process accomplished by changing or trying one single thing. It is more like building a wall brick-by-brick until the enemy finally cannot break through. Each strategy or medication added to your anti-migraine “wall” is a brick that will lead to a healthier you, and ultimately, the life you envision for yourself.
Here are some strategies you can adopt to make 2019 the year you overcome your migraine disease:
1. Try a new healthcare provider, specialist, migraine strategist, or possibly a counselor or physical therapist who focuses on migraine or chronic pain.
I did not see a healthcare provider for many years because I could no longer handle the disappointment I felt when they could not help me. This is the space many people are in when I meet them, often despondent and hiding at home. If this is where you are, make this the year you find someone new. It is a whole new world now for those of us suffering from migraine. There are more medicines being developed and more treatments being studied than ever before. Also, healthcare providers are becoming more and more educated on the subject of migraine. If your provider does not understand you or your disease, find someone who does.
2. Try a new medication. Perhaps one of the new anti-CGRP therapies or botox.
Are you someone who has been afraid to try Botox or a new preventive therapy? Perhaps 2019 is your time. Take a chance for your health. A recent study showed Botox for migraine to be safe and effective over a three-year follow-up period1. We now have three options available to us to try anti-CGRP therapy: erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality) are all delivered via subcutaneous injection. If you’ve tried one without overwhelming results, it does not mean another won’t help you. Eptinezumab should also be available soon and will be delivered quarterly via IV infusion. It took thirty years for me to find a medicine that made a difference for me. I am so glad I did not give up. If a medication gives you some relief but not a lot, it could change your whole world when it is combined with a second of another type. Again, these are bricks in the wall we are building to defend ourselves against migraine.
3. Alter your exercise habits and keep them steady
At this time, the definition of migraine indicates that it is exacerbated by exercise. However, I have found that the right type, amount, and timing of consistent exercise can be an important component of decreasing pain levels and migraine frequency. This notion is backed up by recent data. Data published in the Journal of Headache and Pain recently showed that although exercise may trigger a migraine, regular exercise may have a prophylactic effect on the frequency of migraine2.
Please do not think I am discounting your experience if you are one of those people who is triggered by exercise. I know it happens. A recent study found that individuals with migraine are likely to experience kinesiophobia (defined as a debilitating fear of movement and physical activity resulting from a feeling of being vulnerable to injury or a repeat injury)3. Unfortunately, kinesiophobia can lead to more pain and disability.
If exercise causes you problems, try changing the type of exercise you are doing. The biggest exercise-related migraine trigger I see is upper body and strengthening exercises. Even yoga can cause problems for some people if it focuses on the upper body or does too many inversions. Try walking, jogging, or an easy swim at the same time each morning and see if you can reduce your pain levels.
If you are triggered by increases in heart rate, start very slow. If you need help, find someone who understands migraine and can work with you. I have met people who were once competitive college athletes, yet they needed someone to walk on a treadmill next to them due to the negative effects of their migraine experiences.
4. Make a vision board
You do not have to believe in the law of attraction or that there is magic in visualization in order to benefit from a vision board. When we have a chronic illness we fall into survival mode or autopilot even more readily than the average person. Pull yourself out of this mode and imagine your ideal life without migraine. What do your relationships with your partner, family, and friends look like when you imagine yourself healthy? What does your career look like? How do you spend your time?
If you make a visual representation of these things (a vision board), then at the very least, it serves as a daily reminder of what you are working toward. It will help you keep your focus on your ideal life and health. It will also remind you of the daily ACTIONS you need to take to get there.
5. Mindfulness meditation
More research needs to be carried out in the area of mindfulness and migraine. However, clinical evidence exists to show that mindfulness can dampen many variables related to migraine progression4. Not to mention, it may help prevent the overwhelm caused by living a life with migraine. Mindfulness is described as a focused awareness of the present moment and non-judgemental acceptance of stimuli. If you’ve lived a significant amount of time with migraine, you most likely have learned to practice some mindfulness on your own. But I would not advise trying to incorporate mindfulness or any meditation regimen when you’re feeling your worst. It is best to start when you’re at your best and make a regular practice out of it.
6. Biofeedback or acupuncture
Is there an alternative approach to migraine management that you have yet to test out? Everyone is different in their response to alternative treatments, just as everyone is different in their response to migraine medications. Again, very little research has been carried out in this area. However, there is some evidence that biofeedback can lower headache frequency and acupuncture can improve quality of life in certain people who suffer from migraine5,6.
Remember, a single strategy for overcoming migraine is almost never enough. Keep testing new strategies until you find your magic combination. It is scary to try new providers and new treatments because the failures we experience are so disheartening. This is where the vision board comes in. Go back to your goals, dust yourself off and try again. I had a migraine essentially every day for 26 years. While I will never be entirely free of migraine, I have felt like a nearly healthy person for over ten years. Never, never, never give up. Do at least one thing each day that will put you in a better place tomorrow. Sending everyone the best wishes for a beautiful 2019!
(1) Vikelis M, Argyriou AA, Dermitzakis EV et. al. Sustained botulinumtoxinA therapeutic benefits in patients with chronic migraine over 3 years of treatment. J Headache Pain. 2018 Sep 17;19(1):87.
(2) Amin FM, Aristeidou S, Baraldi C et. al. The association between migraine and physical exercise. J Headache Pain 2018 Sep 10; 19(1):83.
(3) Benatto MT, Bevilaqua-Grossi D, Carvalho GF et al. Kinesiophobia is associated with migraine. Pain Med. 2018 Nov 20 [Epub ahead of print]
(4) Komandur B, Martin PR, Bandarian-Balooch S. Mindfulness and chronic headache/migraine: mechanisms explored through the fear-avoidance model of chronic pain. Clin J Pain. 20187 Jul;34(7):638-649.
(5) Cho SJ, Song TJ, Chu MK. Treatment update of chronic migraine. Curr Pain Headache Rep. 2017 Jun;21(6):26.
(6) Jiang Y, Bai P, Chen H et. al. The effect of acupuncture on the quality of life in patients with migraine: A systematic review and meta-analysis. Front Pharmacol. 2018 Oct 26;9:1190.