I’m not that kind of doctor! I don’t recommend that anyone does what I’m doing, but I want to put this out there: my lifestyle, geared towards the prevention of migraine attacks.
I have friends who ask me for clues on how to manage their migraine disease and how to best prevent attacks. They know I’ve been at it for a long time. I’ve had migraines for most of my life. The first attack that I remember happened when I was 4. Every summer we went to the seaside. During our stay, invariably, I would get sick: stomach ache, vomiting, dizziness. The “thing” would usually pass if I slept. Having an upset stomach, as a kid, is not unusual. Feeling, in addition, like you’re swept up by a big wave is a good indication of migraine.
I got my official diagnosis in my early 30s. At that time, I would get about 2 episodes each month. Each would last about 3 days. I only realized these are migraines when I got a visual aura that was so bad, I thought I was going blind. It was after a hard run. The dr who diagnosed me gave me a prescription for a triptan (a med that stops an attack in its tracks, if taken early enough) and told me to keep a food diary, to identify any possible triggers. I was puzzled: we were already eating what I thought was a healthy diet! We were vegetarians, and not of the chips, soda, and donuts variety. I tried to keep a food diary, but couldn’t identify any triggers. I’m sure I’m not alone: triggers are rarely as simple as chocolate. Usually, the combination of 2 or 3 triggers, not all of them dietary, is what brings on an attack.
Fast-forward a couple of years. We finished our PhDs and moved to start our jobs. The first two years of my tenure-track job coincided with my migraine disease progressing from episodic to chronic: I would get about 18 attacks each month, which meant that most of my days were spent in a fog of pain, dizziness, irritability, fatigue. Emotionally, I was a wreck: in mourning for my life, anxiously waiting for the next attack to hit.
I tried several preventive meds — the first med developed specifically for the prevention of migraines has just been approved last month; this is from before the era of CGRP inhibitors (said to help some of the migraine sufferers who have 15 or more attacks in a month be in less pain). They made me feel worse. Not only was I in pain; I was also losing hope that things will ever get better. This went on for two years (2014-2016). Nothing helped.
At one point, I asked my neurologist whether going gluten-free would help (I knew it probably wouldn’t, but I was willing to try anything, at that point). He said that unless I have Celiac disease, it won’t. But, he added, some people report that going low-carb helps them. He said nothing more about it. Instead, he started the protocol for Botox injections.
I would like to say that I immediately went home, researched it, and then changed my eating habits. But, of course, that is not true! I did go home and started researching; that much is true. I have access to medical journals and I have a reasonably good understanding of how clinical studies work. So, I started looking for such studies regarding the impact of a low carb diet on the prevention of migraine attacks.
I learned several things: there is almost no research done for migraines. But, there is some research done on the effects of a low-carb diet on the prevention of epileptic seizures. Bingo! Since the current idea is that migraine disease is a close cousin of epilepsy and, since anti-seizure meds are prescribed for the prevention of migraine attacks, maybe changing the way I eat would help.The second thing I learned was that carb restriction is only part of the puzzle. The holy grail of seizure prevention is eating a low carb, high fat diet. The theory is complex, but the short of it is that the excitable brain of someone who suffers from migraine disease or epilepsy can function better if it is fed a constant diet of ketones instead of glucose. The main idea is that by eliminating blood sugar highs and lows, one could ensure that the brain won’t overreact to stimuli by going into any kind of seizure activity.
We may have a better understanding of the science behind this phenomenon, but this is hardly a novel idea. Everyone knows that eating candy on an empty stomach leads to a headache. Because of hyper-excitability, it seems, eating bread on an empty stomach leads to a migraine attack in someone predisposed to getting them.
Things are, as I said, quite complicated. The main idea is to try and keep a level brain. The migraine brain loves routine and abhors change. Knowing what works to keep one’s brain balanced is a life-long process of discovery. I have come to understand that some things are out of my control, e.g. exposure to hot, humid weather reliably triggers an attack for me. We still don’t know what causes migraine attacks. So, despite my efforts, I will probably always get them. It’s not my fault I have migraines: nothing I do causes them. Some of the things I do help keep the triggers at bay; but, this is the best I can do!
So, concretely, what exactly do I do? I follow, more or less, the program laid out by Dr. Josh Turknett, a neurologist, headache specialist, and migraine sufferer himself, in his book The Migraine Miracle Diet. What he describes are common-sense, evidence-based approaches to lowering the threshold of excitability.
- Sleep: one should find the “magic number”. For me, it is 7 h in a 24 h period. Of course, since becoming a mom, sleep is rarely this long. I am sleep deprived, but I still have fewer attacks than I had when I was on preventive meds. I guess sleep is not a major trigger for me.
- Exercise: I used to run. Now, I walk with Luca in my arms. It is a form of cross-fit. Carry a 20 lbs load, while pushing the empty stroller she doesn’t want to use.
- Be mindful. I used to have a practice: I would sit down and contemplate my breath for 20 min per day. Now I don’t do it this way. But, I pay attention to whatever I’m doing when I do it. I really play with Luca; I pay attention to the rhythm of my walking when I walk with Luca, etc.
- Lead a low carb high fat life. This is the piece of the puzzle that really helped me turn my life around.
- Take no meds when an attack comes about. I haven’t taken a triptan in 23 months! I take the occasional Advil (at most once per month). This is important: rebound headache is real! Also, meds like these lower the ability of the body to fight the attack on its own. It’s not addiction, but a phenomenon of vicious dependency: the more meds you throw at it, the less efficient they become. I used to be able to function with Advil alone. When I started taking triptans, they seemed a godsend. Then, I needed to take two to clear up an attack. Then, I had to add Advil, then coffee, then preventive meds! Not good, since, in the end nothing worked any more.
I used to abide by 1-3 above and got 18 attacks per month. I did Botox for about a year, and I was very successful on it: I managed to have only 8 attacks per month. Once I started leading a low low carb, high fat life, I managed to get the number down to 3 attacks per month, on average. This led to more life changes: my partner and I became parents. This is something I was very much against, while in the throes of chronic migraine. I thought it impossible: and I know that to be true, given how difficult it is to take care of someone else when I have a migraine episode. I can do it now, because I know it won’t be there after a while. Otherwise…
So, the biggest beneficial change came about when I switched to living a low carb high fat life. To find out how I use this way of life to manage my migraine disease, read Part II.