Blog #5: How’s your pie?
How many treatment options does it take to become a real migraineur? Answer? Too many to count.
Okay so I made that up and it’s super lame. Sorry. But it does sum up life trying to tame the migraine beast.
We know there’s no one magical migraine treatment; it takes a whole army of treatments to help win, or at least not lose, the migraine war.
The Treatment Pie by the Migraine Strong team recognises this multimodal approach to treating migraine. I also think it’s a great explanation for people who don’t have migraine disease to help understand the massive effort it sometimes takes to just “show up” in life.
There are 9 pieces of pie: medications, hydration, meditation, therapy, sleep, diet, movement, supplements and miscellaneous.
These are my current treatment pie pieces (I’ve tried other things but we can explore those later). We of sensitive migraine brain are all unique, so what works for me may not work for you. But I hope my pie provides a bit of food for thought about your own pie.
Medications
I take candesartan 32mg every evening as a preventative. I take sumatriptan 100mg as an abortive, followed by another 100mg an hour or so later if the first dose has provided some relief.
I saw my neurologist in March, and she recommended I try sumatriptan injection (Clustran) 12mg for a severe migraine. I’ve used the injections twice – wow does it work fast!
If you use Clustran, PHARMAC funding for it stops on 1 September 2020. They began funding Imigram prefilled syringes on 1 April, so I assume if you use Clustran you’ll be encouraged to swap if you don’t want to be out of pocket.
There’s brief information on PHARMAC’s website if you want to know more.
Hydration
I never leave home without my drink bottle and it keeps me, and my migraine beast, company wherever we go. I don’t religiously calculate how much I drink but dehydration is one of my triggers so I’m in a reasonably good habit of staying hydrated.
Meditation
If you’ve read this blog you’ll know I’m a bit of a latecomer to meditation and to be honest, I’m struggling to make it a habit.
I recommend the book Full Catastrophe Living: Using the wisdom of your body and mind to face stress, pain, and illness, by Jon Kabat Zinn as a good place to start if you’re new to meditation and mindfulness.
I’d love to hear if you benefit from regular meditation – inspire me to work harder please!
Sleep
I love sleep.
I was never a morning person; goodness knows how I managed to be at work at 7am for the 14 years I worked as a nurse. I’m also not a night owl so I make sure I’m tucked up in bed, sometimes with a book, by about 9.30pm most weeknights. Yup, this is how this 40-year-old rolls now.
I also don’t oversleep because too much sleep can tip me into the migraine zone. Which isn’t really a problem now as since having kids I can rarely sleep past 7am. Even if I wanted to, my body clock has reset to early mood, or there’s the million things mums need to do every morning anyway which gets me out of bed.
Diet
Is there a word limit for this blog? I could write a thesis on everything I’ve read about the best and worst foods for migraine disease.
My focus at the moment is on good gut health. In February I began working with a woman who uses functional foods based on traditional Chinese medicine to help rebalance my gut. Over the past few months I’ve included lots of functional foods she’s recommended – some as simple as green tea, eggplant, kelp and grapes – into my daily diet.
From researching and writing articles about gut health for my day job, and also a personal interest in the microbiome, I appreciate the impact a good gut has on brain health.
If you’re not familiar with the connection between your gut and brain, here’s a very simplistic, 112-word summary:
Your brain and gut are connected by the vagus nerve, which runs from the bottom of your brain to your gut. Through this nerve the brain and gut send messages to each other.
The brain and gut also communicate with each other via neurotransmitters (chemical messengers). This communication system is known as the gut-brain axis.
Your gut is teeming with microscopic life – mostly bacteria but also other microbes like viruses and fungus – who call your gut their forever home. This collection of microbes is called your microbiome. Too many ‘bad’ microbes living in your gut isn’t good and it sends ‘bad’ messages to your brain and makes your brain feel pretty blah.
You may feel completely overwhelmed with the number of search results if you Google gut-brain axis. I recommend 2 books to help understand the basics:
10% Human: How Your Body's Microbes Hold the Key to Health and Happiness, by Alanna Collen
Gut: The Inside Story of Our Body's Most Under-Rated Organ, by Giulia Enders
I’ve read about people who’ve had great success with elimination diets and following recommendations from Heal Your Headache, by David Buchholz. It can feel overwhelming knowing where to start, but the first step is always the hardest, so I encourage you to become familiar with the impact of your diet on your migraines.
I have future posts planned which will dig much further into the research around the impact of diet and gut health on migraine disease.
Movement
Exercise helps keep my migraines slightly in check. My motivation varies, but after a more sedentary (lazy) 2019 I got off my ass and joined the gym before Christmas. My husband, boys and I had just spent six weeks in New York and South America travelling, eating and Lime scootering so I needed to get back into exercise.
I also walk and hike regularly and having a young family also keeps me active. I used to run but not so much anymore.
I recommend this podcast by Dr Rangan Chatterjee if you’re struggling with motivation to get moving. He talks with behavioural scientist Professor BJ Fogg about making new habits stick and he has a pragmatic approach to how to start exercising regularly.
Supplements
Most mornings I drink a ginger tea, either tea leaves or a ginger decoction. I’ve taken magnesium in the past and I’m open to trying other supplements but I’m focusing on my functional foods at the moment. Only so many toppings you can put on each piece of pie at one time.
Butterbur, magnesium, Coenzyme Q10 (CoQ10), riboflavin (vitamin B2) and feverfew seem to be the most highly recommended supplements.
Miscellaneous
I bet our collective migraine tribe minds can fill a book about what else we’ve tried. This year my miscellaneous pie is acupuncture with a fantastic Chinese medicine doctor and a few deep tissue neck and back massages (bliss).
But wait!
You may have noticed a piece of my pie missing – therapy. This covers treatments such as cognitive behaviour therapy and biofeedback. I haven’t explored this area but I’ll put it on my (ever growing) research list. I wonder if this blog counts as therapy?
If you’ve read this far, I’m sure you want to know if all my pieces work.
Yes they do.
While I still battle my migraine beast on a daily basis I know without enough sleep, rubbish food, no exercise, little to drink and no medication, my migraines would be a lot worse.
Which piece is the best? I don’t know. They collectively form my treatment pie and although it seems like a lot of faff, it’s totally worth it. Apologies if you were hoping for a definitive answer. That would make this whole migraine business far too easy!
So, when was the last time you looked at your treatment pie? Are there pieces you can tweak that might make a difference?
I’d love to hear what works for you, so please comment below, join the conversation on Facebook or send me an email: sarah@sayline.co.nz