Understanding your migraines, and how nutrition can help

A head-thudding migraine can bring your day to a standstill. You may need to cancel all your plans, step away from your work or lie down in a dark, quiet room while everyday sounds and smells feel totally overwhelming. And when someone describes a migraine attack as “just a headache”, it can feel as though they haven’t fathomed what you’re going through at all, especially if you can get them several times a month.

Migraine is a complex neurological condition, and the symptoms can affect you before, during and after the headache itself. One in seven people live with migraines, with women being much more likely to get them than men.

Understanding your own migraine pattern, then recognising your early warning signs and having a plan for an attack can help you feel more prepared and supported. It is important to remember that if your migraine attacks are new, or worsening, you must speak to your GP so they can assess your symptoms and discuss suitable treatment.

In this blog, I’ll help you understand what happens during a migraine attack and to recognise your warning signs. I also share some simple evidence-based nutritional tips that we incorporate into our NatureDoc clinical work, which may help you manage things better.

What does a migraine look like?

You can have a one-off migraine or the occasional migraine. Migraine attacks can also be described as ‘episodic’ or ‘chronic’, depending on how often you experience headaches. Episodic migraine means you get fewer than 15 headache days a month. Chronic migraine means you are having headaches on 15 or more days per month for more than 3 months, with at least 8 of those days having migraine features.

Some people who suffer from migraine attacks also experience aura, which is usually visual, such as seeing zigzags, light spots, blind spots or fuzziness.

Other symptoms of a migraine include:

• Throbbing, pulsing or pounding headache
• Nausea or vomiting
• Sensitivity to light, sound or smell
• Neck and shoulder pain
• Dizziness
• Brain fog
• Visual disturbances
• Mood changes
• Fatigue
• Numbness or tingling
• Speech difficulties

You may experience some of these symptoms rather than all of them, and your attacks may not feel exactly the same each time.
Migraine attacks can occur throughout both childhood and adulthood and are around three times more common in women than men after puberty. Whilst there is no scan or blood test that can diagnose a migraine, tests may be used to rule out other causes, and patterns in symptoms can help a doctor to make a diagnosis. Keeping a simple diary of dates, symptoms and severity can be helpful to bring to an appointment, to help understand your triggers and create an action plan. It is also useful to record how long attacks last and any medicines you take.

The four phases of an attack

A migraine attack can usually involve four phases: a premonitory phase, an aura phase, the headache phase and the postdrome phase. You might not experience all four, and the phases can overlap. Knowing what to look out for may help you recognise when an attack is starting.

Premonitory phase: This phase can start up to 48 hours before the headache begins, with various symptoms such as neck stiffness, dizziness, difficulty concentrating or thinking clearly. You might experience light or sound sensitivity, stomach ache, mood changes or loss of appetite or simply feel really tired and irritable.

Aura phase: Aura symptoms such as flashing lights, zigzags or blind spots usually fade within an hour. Why some people experience aura and others don’t is not fully understood, but it is linked to a wave of altered electrical activity spreading across the brain.

Symptoms of aura are not limited to changes in vision; they can also include tingling, numbness or difficulty speaking. Aura usually happens before the headache but can occur during it or without a headache.

The headache phase: This phase can last between 4 and 72 hours and is associated with pain, nausea and sensitivity to light or sound. This can make everyday tasks feel impossible to do, and you may need to stop what you are doing and rest in a dark, quiet room.

The postdrome phase: This is often referred to as the migraine hangover phase. It can leave you feeling foggy and drained, and it may take a few days to feel like yourself again. About 80% of migraine sufferers experience this phase and often proper rest is key to recovery.

When to get urgent help

Most migraine attacks do not need emergency medical care, but it is important to know when to seek help. Also call 999 if you have a sudden, extremely painful headache, sometimes called a “thunderclap headache”. You should also seek medical help if you also have sudden speech difficulties, loss of vision, confusion, a seizure or any weakness on one side of your body or face. A headache following a recent head injury, such as concussion or one that comes with a very high temperature or symptoms of meningitis, also needs emergency help. Another reason to seek immediate help is if an aura symptom lasts longer than an hour, or you have an attack while pregnant or soon after giving birth.

Common triggers

Usually there isn’t just one single trigger that causes a migraine attack to start, but rather a group of triggers that tend to build up and push you over the threshold. Often what people think are triggers, are actually early signs that the attack has already started. You won’t always be able to identify a trigger, and an attack doesn’t mean you’ve done anything wrong, but a diary can help you notice patterns without feeling you need to monitor every little thing you do.

Here are some commonly reported triggers:

• Stress or the release of stress (which may explain why you have an attack the minute you try to relax after a period of stress)
• Too much or too little sleep
• Hormone changes
• Alcohol
• High caffeine intake or changes in your usual caffeine intake
• Missing meals
• Strong smells
• Bright or flickering lights
• Falling barometric pressure (weather changes)

One specific cause is worth noting and that is the relationship between migraines and our jaw. Temporomandibular disorder (TMD) is a group of conditions affecting the movement of the jaw, causing pain and dysfunction. It can be associated with teeth grinding, stress, jaw injury or arthritis, and it often improves on its own. Migraines and TMD often occur together, and studies suggest an association in both directions; people with TMD are more likely to get migraines and people with migraines are more likely to have TMD. If you suffer with both, mention it to your GP or dentist, who can explore this further with you and help you to find TMD relief.

What can you do to help yourself

A few manageable habits can help you manage things better. Start with one or two of these changes that fit around your life, rather than trying to change everything at once.

• Try to keep your meals and sleep schedule at a similar time each day. Having regular meals, around every 4 to 5 hours, can help to avoid big dips in your blood sugar.
• Avoid fasting, as this has been recognised as a trigger for migraines in certain people.
• Keep hydrated, especially when you are busy and might forget to drink.
• Plan ahead when you have a busy week or change to your schedule. Make time for meals and breaks and keep any prescribed attack treatment accessible.
• Keep a diary recording symptoms and severity of attacks. Include their duration and any medicines you take.
• Reduce sensory load if you feel it makes your symptoms worse, for example turn your screen brightness down and avoid strong perfumes.
• Learn your own warning signs so you can take action sooner. If possible, pause what you are doing and find somewhere quiet to rest.

If a migraine attack starts, resting in a dark and quiet room may help, alongside any treatment recommended by your GP. And let those around you know what can help you, whether that’s a little quiet or a hand with the children so you can fully recover.

Nutrition and eating patterns

Here are some of the foods and eating patterns which you can explore to see if they help mitigate the frequency of your episodes:

Oily fish: Eating oily fish such as salmon, mackerel, anchovies or sardines may reduce the incidence of migraines due to its anti-inflammatory effects and pain-relieving compounds.

Low GI foods: Glycaemic index (GI) is a measure to determine the effects that certain foods have on blood sugar levels. Some research suggests that a diet rich in low-GI foods such as beans, lentils, wholegrains, vegetables, nuts and berries, combined with protein from meat, eggs or fish to steady blood sugar may help reduce the number of migraine attacks.

Foods low in histamine: Studies have found that migraines are more common in people with allergic conditions, such as asthma, however the researchers do not know why this connection occurs yet. Histamine is a natural chemical which acts as a messenger in our brains and is involved in allergic reactions.

For some people, foods and drinks that are high in histamine may be a trigger for migraines. High histamine drinks and foods include wine, fermented products like kefir or sauerkraut, dark chocolate, tomatoes, avocados, cured meats and seafood, so elimination of these foods with professional support, may help to manage your attacks.

Mediterranean style diet: Eating a dietary pattern that follows a Mediterranean style of eating has been linked to lower frequency of migraines, as well as shorter attacks. This includes eating foods such as fish, wholegrains, legumes, fruit, vegetables and olive oil, and limiting refined carbohydrates as well as reducing intake of alcohol and added sugars.

Gluten and coeliac disease: People with coeliac disease have a higher risk of getting migraines than those without coeliac disease. If you are getting migraines and feel you react to gluten, ask your GP for a simple blood test and keep on eating gluten until that test is done. It is important to note that there is no evidence that following a gluten-free diet in the non-coeliac general population will help to decrease migraine occurrence.

Supplements: What the evidence says

When trying new supplements to help with migraines, it is important to try them one at a time, so you can monitor how you feel and react to them. Also commit to taking them daily for at least 3 months, to gain the full benefits. Here are some of the most researched supplements to help with how often you get a migraine, how long it lasts and how severe it is:

Riboflavin (B2): Vitamin B2 has been shown in studies to help reduce migraine frequency and support mitochondrial health which is vital for cellular energy.

The dose used in research for adults is 400 mg a day. For children and teenagers, the right dose depends on age and weight, so please work with a practitioner. Take in the morning with breakfast, or split into two doses, morning and evening. Don’t be alarmed if your wee is bright yellow when taking this. It’s a common and harmless side effect!

Magnesium: Magnesium can help reduce the frequency of migraines. It may calming nerve cells, blocking pain-signalling chemicals and help control how the blood vessels in the brain widen.

Studies in adults have used 360-600mg a day, ideally split into two doses. For children again work with a practitioner as the dose will need to be adjusted to age and size. There are several types of magnesium and research has used several forms including citrate and oxide. Whereas the bisglycinate is a gentler option on the tummy if they upset the tummy. Magnesium may be particularly helpful for menstrual-related migraines.

Coenzyme Q10: Coenzyme Q10 is a natural antioxidant that can support energy production in your brain cells and high doses can help to prevent migraine attacks.

The research dose for adults is 300 mg a day, usually taken as 100 mg three times daily. Again seek professional advice for children. It is best absorbed when taken with a meal that contains healthy fats, like olive oil, nuts, avocado or oily fish.

Round up

Many people get migraine attacks, yet they are still widely misunderstood. Living with migraine can be exhausting, particularly when its symptoms are more than a headache. Understanding your warning signs, making room for you to recover and having the right nutritional tools can help you feel better supported.

You do not need to work all of this out alone and if you would like help putting these steps into practice or want to explore the root causes of your migraines our NatureDoc clinical team offers personalised nutrition and lifestyle support alongside your medical care. Get in touch to find out how we can help.

Ask me what supplements can help… make a booking, or anything else!