This is my final post in a series about migraines. You can start with the first post about hormones, the second about leaky gut and brain, the third about sensitivities, or the fourth about mitochondrial dysfunction. This post covers factors related to your lifestyle – things that you do, subconsciously or consciously, that can trigger migraines. These are things that you can change.
Muscles and joint tension
I often see migraine patients who also have muscle tension in their jaw, neck, shoulders, and back. Some women report their headache comes from a certain spot, a common one is underneath or near their right shoulder blade.
Many women report widespread pain throughout their shoulders, back, and even chest. Some have been diagnosed with fibromyalgia. Others identify occipital pain, which is the area where the back of your neck meets the back of your skull.
Frequently women with migraines have a habit of jaw clenching, which can be either while asleep or awake. Your jaw can be tight, sore, and also asymmetrical.
What to do?
These migraine triggers are often fairly straightforward to reduce. There are many modalities, depending on the type of muscle tension. My top suggestions include:
→ Acupuncture is effective for most types of muscle tension. Sometimes the addition of micro-current, electrical stimulation on the needles, gua-sha (scraping), or cupping works well.
→ Feldenkrais lessons, either private bodywork or at-home lessons, are my #1 modality for neurologically changing your habits of tension, including in your jaw. A good at home jaw set is Sensory Motor Education for the Mouth and Jaw.
→ Cranial osteopathy is an excellent physical modality to release tension and restrictions in your head, neck and jaw, as well as other areas. This work is done by osteopathic physicians who have trained in cranial work.
→ Craniomandibular therapy performed by a well-trained dentist can help with jaw issues. For those who have studied the work of Weston Price, author of Nutrition and Physical Degeneration, you know that traditional cultures had wider teeth and more forward-positioned jaws, before degeneration occurred with the introduction of modern processed food. This branch of dentistry works with TMJ dysfunction, and uses devices that move your recessed lower jaw forward.
→ If your muscular tension or pain is metabolic, and not due to habits of tightening, then a Functional Medicine approach is ideal. Many cases of fibromyalgia are not true fibromyalgia, but rather a metabolic issue that can be solved. Often it is caused by lipopolysaccharide (LPS) toxins from gut infections, thyroid problems, and mitochondrial dysfunction.
Overuse of pain medications with rebound headaches
Most pain, headache, and migraine medications cause rebound headaches, especially if used two – three times per week, or more. This is known as Medication Overuse Headache (MOH). These medications include:
- NSAIDs Non-steroidal anti-inflammatory medications, such as Advil, Motrin and Aleve.
- Sinus relief medications
- Codeine and other prescription narcotics
- Ergotamine medications
- Pain meds that contain butalbital such as Fioricet/Fiornal
- Pain meds that contain caffeine
- Simple analgesic pain relievers such as acetaminophen or aspirin
Some of these medications are mixed together. For example, Fioricet is butalbital, acetaminophen and caffeine. Excedrin Migraine is aspirin, acetaminophen and caffeine.
What to do?
→ Get off these medications completely, or limit their use to no more than once per week. It takes time to withdraw, so plan a time when you can get through migraines without these medications. I recommend addressing the other triggers and causes described throughout this series while or before doing this. Most people get through the worst of the withdrawal from these meds within one week.
This one may seem like a no-brainer, but it’s a real thing. Observational studies indicate that water deprivation, in addition to impairing concentration and increasing irritability, can trigger migraine and also prolong migraine duration. In those with water deprivation-induced headache, ingestion of water provides relief from headache in most individuals within 30 minutes to 3 hours. It is proposed that water deprivation-induced headache is the result of intracranial dehydration and total plasma volume.
What to do?
→ Easy peasy fix. Make sure to get enough fluids from non-caffeinated beverages AND foods throughout the day, preferably not right before bed. Get a stainless steel water bottle. If it’s 17 oz, a common size, most women should drink about three – four bottles. Divide your body weight by two, and that’s the number of ounces to aim for. However, the fluid in food counts too!
Sleep deprivation and circadian disruption
Sleep deprivation in general is known to be a migraine trigger. However, oversleeping is also a migraine trigger. In fact, some data indicate that it is sleep continuity disturbance that impairs your pain inhibition, and increases spontaneous pain. So, a change in your sleep routine can be a major trigger.
What to do?
→ Apply the rules of Sleep Hygiene. Keep a regular sleep routine. It’s natural to have a different schedule over the weekend, but if you vary it widely, it may be a headache trigger. You might feel better keeping the same routine as weekdays. If you work nights, it is best to keep your sleep schedule the same as on your days off. Night shift work may not agree with you if you suffer from migraines.
There’s a common phenomenon which people get migraines on the weekend, or when they go on vacation. This is often because of change in sleep routine, but there may be more triggers such as foods, beverages, and barometric pressure changes while traveling.
Please contribute any comments or questions below!