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Lifestyle Changes for Managing Migraine: Q&A With Dr. Starling

Posted on June 30, 2021
Medically reviewed by
Amaal Starling, M.D.
Article written by
Mary Ray

Living with migraine can sometimes mean you have to be a bit of a detective to evaluate what helps reduce your attacks. Members of MyMigraineTeam often discuss the lifestyle changes that have allowed them to experience fewer symptoms. “I've been working on balancing my sleep, stress, eating habits, exercise, and social interaction,” one member wrote. Another said, “Sleep is so important for migraine sufferers. Stress is not a big help either.”

Studies have demonstrated that changing certain lifestyle habits can help reduce migraine attacks, both in severity and frequency. Adopting healthy changes in your life can be an effective complement to your overall treatment plan, in addition to the migraine treatments your health care team recommends.

To gain a better understanding of the lifestyle adjustments that can help you manage your migraine attacks, MyMigraineTeam sat down with Dr. Amaal Starling, a migraine specialist who serves as associate professor of neurology at the Mayo Clinic in Scottsdale, Arizona.

Are there any lifestyle changes that can help reduce migraine attacks?

Yes, and it's all about consistency. I love mnemonics and acronyms, so I always tell my patients about the SEEDS for success in migraine management:

  • S — Sleep hygiene. Going to sleep around the same time, waking up around the same time, avoiding watching TV or being on your phone right before bedtime — all of those can impact your sleep hygiene.
  • E — Eating regular small meals throughout the day, rather than fasting and then eating a large dinner or large lunch and dinner. It allows you to avoid peaks and valleys in blood sugar, which can be triggers for migraine attacks.
  • E — Exercising regularly. The recommendation based on studies is to get at least 20 to 30 minutes of exercise or aerobic activity where you're getting your heart rate up, and to do that at least two or three times per week. In fact, some studies indicate that this is just as effective as some of the medications that we have available.
  • D — This can stand for two things: preventing dehydration, but also keeping a migraine attack diary.
  • S — Stress management. Note that this is not stress reduction. We all have stress, which is just a part of life. Stress management involves learning how to cope with stress.

You mentioned a headache diary. What type of format do you recommend for that?

There are multiple apps that people like to use since they always have their smartphones with them, and that's definitely doable. People sometimes will just do it on their smartphone calendar, but I often recommend keeping an old-school paper calendar and three markers — a green one, a yellow one, and a red one — right next to your toothbrush. That way, when you brush your teeth at night, you’ll make no mark on the calendar if you haven’t had a migraine attack that day. But if you have had symptoms, I recommend you mark the calendar as follows:

  • A green dot — Do this on days when you’ve had a mild attack, but you’re able to function.
  • Yellow dot — Mark this on days when your function is moderately impaired.
  • Red dot — Use this indicator if you have a day when you’re unable to go to work or school, or take care of your day-to-day activities. If you’re having to lie in bed, that's a day you would use a red dot.
  • Star — If you’ve had to use as-needed medications that day, add a star to the calendar next to the appropriate dot color.

I always want that green revolution — getting to those days where people have mild or no impairment of function.

With regard to stress management, are there any treatments or tools that you recommend?

Some great options that have actually undergone studies specifically in people with migraine include biobehavioral options for migraine prevention that work really well in stress management. And that includes biofeedback training, cognitive behavioral therapy, and mindfulness. And there are a lot of great resources online through apps that are very, very helpful and accessible for everyone living with migraine to use.

Can some of these changes reduce the severity of migraine attacks, if they don't actually cut down the number of attacks?

For sure, and that applies with all of the preventive treatment options, including biobehavioral techniques, medications, procedures, or devices. It may not be that they're able to reduce the frequency of the attacks, but they may make them more amenable to the as-needed treatment options. They may increase function because the severity of the attack is reduced. What we're looking for is an improvement in function — that's always the goal.

What are the most common ways you've seen people with migraine deploy lifestyle tools to reduce stress?

One of the things that's really helped my patients manage migraine in a nonmedication way is by working toward shattering the stigma of migraine by participating in migraine advocacy, empowering themselves with knowledge and education and joining a community. It helps them with self-efficacy, and what it also does is turns things around so migraine no longer controls them.

Remember: You are a person who lives with migraine rather than someone who is suffering from a disease. And that is actually a great way to manage the chronic disease of migraine.

Find Your Team

Through MyMigraineTeam, you can join an online social network for those living with migraine. In doing so, you will gain access to a social support group of people who are facing similar challenges and who understand what you are going through.

Have you found lifestyle changes that have helped ease your migraine attacks? How are you managing them? Share your ideas in the comments below, or start a new conversation on MyMigraineTeam.

All updates must be accompanied by text or a picture.
Amaal Starling, M.D. is a migraine specialist who serves as associate professor of neurology at the Mayo Clinic in Scottsdale, Arizona. Learn more about her here.
Mary Ray is the co-founder and COO of MyHealthTeam. Learn more about her here.

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