S1 E6: Migraine Prevention – Lifestyle and Supplements

A National Migraine Centre Heads Up Podcast transcript

Migraine Prevention – Lifestyle and Supplements

Series 1, episode 6

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[00:00:00] Did you know there’s no such thing as a normal headache, headaches need a diagnosis, our doctors can help. Welcome to the Heads Up podcast brought to you by the National Migraine Centre, the only UK charity treating migraine and headache.


Dr Jessica Briscoe [00:00:22] Today, it’s me, Dr. Jessica Briscoe, and I’m joined by Dr. Katy Munro.


Dr Katy Munro [00:00:27] Hello there.


Dr Jessica Briscoe [00:00:27] And welcome to the Heads Up podcast. So today we’re going to be talking about prevention, the prevention of migraine attacks. Really, we want to know about why people would want to use a preventer. Well, I mean, obviously, they want to stop an attack, but when do you decide that you’re going to use it? So ideally, it’s to try and reduce the number of acute attacks you’re having and reduce the amount of medication you’re using to manage those attacks. It also can help to reduce the impact of migraine on your day to day life so the disability, which we talk about quite a lot, actually, and essentially quieten the brain down so stop that overactivity from the nervous system. So when would you start to preventer?


Dr Katy Munro [00:01:10] I tend to talk to people about the basics of prevention right at the very start in terms of non tablet ones, because I think a lot of people don’t really want to take medication. So I’ll come back to that question, if I can.


Dr Jessica Briscoe [00:01:27] A bit previous with my question?


Dr Katy Munro [00:01:28] Yes, you have sped ahead of me there. So I would normally just start banging on relentlessly about lifestyle changes that people can make. So we say to people, do you eat regularly? And almost invariably they would say yes. So I tend to say to them, exactly when do you eat? And just make sure they realise that having something every three to four hours and maybe a bedtime snack is very important. And we know that the brain likes routine, so routine in sleep times and then I think on a previous episode we’ve talked about exercise and how helpful that can be.


Dr Jessica Briscoe [00:02:03] Yeah, I mean, I think you’re actually particularly good at asking about specific timings and actually with the sleep, it’s the sleep time and the eating times are quite linked, don’t you think? I mean, if you’re actually someone who has a very early dinner, so say about six o’clock and you won’t necessarily have anything before you go to bed and then you wake up at six a.m., that’s 12 hours of not doing it. So it is actually quite important to think about that sort of thing.


Dr Katy Munro [00:02:28] Yes, definitely. So routine, trying to keep in to regular eating, sleeping times, doing exercise regularly. And then a lot of people have tried supplements for things or heard that there might be. So there are various supplements that we know have had some study evidence. The one I really like and again, we’ve talked a little bit about this already is magnesium. So they studied the citrate form of magnesium, but there are loads of different ones. It’s a bit confusing, actually.


Dr Jessica Briscoe [00:02:57] Yeah, and they’re not all particularly- they’re not all equal. So magnesium citrate is fairly well absorbed. We actually often advise malate because that’s quite well tolerated and it is used for other related conditions so fibromyalgia, we use magnesium malate a lot for. That one and there is another form called glycinate.


Dr Katy Munro [00:03:23] So it doesn’t really matter, what the whole key to it is that it’s one that is bioavailable and also needs to be a pretty high dose and that is where we run into problems sometimes. When you’re taking a high dose of magnesium by mouth, some people get quite an upset tummy and I do like to warn them about that.


Dr Jessica Briscoe [00:03:42] Yes, so stomach pains and the laxative effect.


Dr Katy Munro [00:03:45] Yes, so start low and creep it up gently. But then you do need to take it for at least three months if you’re going to see if it’s working.


Dr Jessica Briscoe [00:03:52] Yeah. And the next thing I actually think works quite well with magnesium and there’s very good evidence for is riboflavin, vitamin B2, as someone once said to me, the thing that’s in Rice Krispies. So it’s a B vitamin, a lot of people say to me, I already take a multi vitamin, a multi B vitamin. It’s not a high enough dose in vitamin B complex. So you want to be taking 400 milligrams daily. And the main side effect with that one seems to be that it turns people’s urine more yellow and also some people have actually a bit of gastritis stomach, a little stomach upset as well with that one. So just a few things to look out for.


Dr Katy Munro [00:04:27] And again, the mantra you need to keep trying it for at least three months at high dose. All of these things are pretty safe. But if you have any problems with your kidneys or if you have other medications or medical conditions, you’re not sure whether these are safe for you obviously, just check it out with your doctor or with us. Coenzyme Q10 is the other one that has some study evidence and that I think the studies were 100 milligrams, three times a day, which most people find three times a day is quite hard to remember to do and it is quite expensive too.


Dr Jessica Briscoe [00:04:58] It is the one that is more expensive, I have to say. It can be effective.


Dr Katy Munro [00:05:02] It can be helpful and you can take one or two or three of these all together and I don’t think there’s any real studies to show whether that’s more helpful to do one or two of them or all three in one great gulp in the morning.


Dr Jessica Briscoe [00:05:16] There are other supplements that are available and I know a lot of people talk about feverfew and butterbur. We actually don’t advise to take those ones because they don’t have evidence to back them up and actually, feverfew can, I think particularly feverfew, can cause some liver problems.


Dr Katy Munro [00:05:34] And butterbur i think. Feverfew, I think can cause mouth ulcers, too. But the problem with any herbal products is the variability of the strength. So we tend to steer people away from those. But I know that some people have tried them but we probably would say be cautious.


Dr Jessica Briscoe [00:05:49] And then there’s acupuncture as well. Now, there is actually evidence for acupuncture being helpful to prevent migraine. In the studies people had to have it quite frequently, which can get quite expensive. And I also think it’s important to point out that acupuncture is very practitioner dependent so it really varies according to so who’s giving it.


Dr Katy Munro [00:06:11] That’s a really good phrase. I completely agree. You need to find somebody who is experienced at doing acupuncture and who’s probably recommended or the British Association of Acupuncture is a good source of information about acupuncturists. But, as you said, Jess, there is some evidence that it helps some people but I think, like everything we talk about in migraine prevention, we can’t look at you and know that that’s going to suit you and nothing works for everybody.


Dr Jessica Briscoe [00:06:40] Absolutely. It’s not a one size fits all.


Dr Katy Munro [00:06:42] Definitely not.


Dr Jessica Briscoe [00:06:43] So there are some other things, though. We talk about this a lot, stress reduction techniques. So practising mindfulness, exercising, so particularly with yoga, can be very helpful. Having massage can really help. Actually often some people when they’re having shoulder pain during an attack, other sorts of relaxing exercises like Tai Chi can be helpful.


Dr Katy Munro [00:07:04] And just physical things like ice packs or heat packs that can help. You know, sometimes people like to prevent an attack coming on by using those physical things. Stretching maybe some posture exercises like Pilates, lots of other things out there. So I think it’s a really good idea to look at what you’re doing in general to try and reduce the irritability of the brain so that your migraine attacks are not coming quite so frequently. It changes the threshold for attack. It makes it a little bit farther away. What about diets? I know you’re keen on talking about nutrition.


Dr Jessica Briscoe [00:07:42] Yes, I am quite keen, actually. So there has been a lot of people coming to ask about keto diets or low carb diets. Actually, fairly recently there has been some good evidence. I heard about it in a conference not that long ago about very low carb diets and keto diets and the fact that they have been shown to be beneficial in migraine. And I was actually quite sceptical before that. I’ve always advised on a low carb diet, as I know you have too, because actually if you think about the way- maintaining a steady state blood sugar level, stopping too much of that variation, carbohydrates are a sugar. They naturally cause more variability.


Dr Katy Munro [00:08:21] More peaks and troughs of your blood sugar.


Dr Jessica Briscoe [00:08:23] So actually, it’s actually nice to see that there is some evidence that we were right.


Dr Katy Munro [00:08:28] Yes. Are there any diets you warn people away from?


Dr Jessica Briscoe [00:08:32] I do warn people away from- actually the thing I warn people about with keto diets is the side effects, I have to say. So some people don’t get on that well, especially women I find don’t get on well with it. And it’s very difficult if you are vegan. I think diets that I tend to warn people away from anything that’s too restrictive. So things where they say to cut out huge food groups,  so saying go completely gluten free or dairy free without having any evidence of being intolerant to these things, if they’ve always tolerated them quite well. There isn’t particularly evidence that those specific food types will cause migraines.


Dr Katy Munro [00:09:07] Yeah, I think that’s right. We do see quite a lot of patients who’ve cut out this and cut out that and cut the other and end up with really quite restrictive diets. So just to be careful about that, I think. The other type of diet that seems to be really quite trendy at the moment is the intermittent fasting, or the 5:2 diet. So some people are doing this intermittent fasting where I think they have to not eat anything for 16 hours. I would put a big red warning flag above those diets for migraine patients, wouldn’t you?


Dr Jessica Briscoe [00:09:37] Specifically for migraine patients because as I said, you need a more steady state blood sugar level. If you’re having huge gaps of time between eating that is likely to trigger migraines.


Dr Katy Munro [00:09:47] Yeah, and the 5:2 is a similar sort principle where you have very low calorie intake. I think it’s about 600 calories on two days a week.


Dr Jessica Briscoe [00:09:57] Yeah, very low.


Dr Katy Munro [00:09:58] And then five days a week you, kind of, eat whatever you fancy that’s general principle, i think.


Dr Jessica Briscoe [00:10:05] Pretty much.


Dr Katy Munro [00:10:05] But I just feel that’s a little bit tricky for people who are having a lot of migraine, that they may well irritate the brain a bit too much with those kind of diets.


Dr Jessica Briscoe [00:10:14] What about things like- there was a lot about a few years ago about daith piercings?


Dr Katy Munro [00:10:20] If you look on social media, there’s loads of people who have tried these. So this is a piercing that you have in your ear. It’s a specific place in your ear. And we have a lot of people who have tried it or ask us about it and we do have to be a bit cautious because nobody’s actually done any studies to see if it’s a true thing. And a lot of things work because people believe that it will do them good and this is an effect called placebo effect. So does it matter if it is a placebo effect?


Dr Jessica Briscoe [00:10:52] I don’t think it necessarily matters. I’d be very wary about spending a lot of money on a daith piercing.


Dr Katy Munro [00:11:00] Yeah!


Dr Jessica Briscoe [00:11:00] Because I think that that can be a risk. I think there’s absolutely no problem with people trying it, because especially if you want a nice piercing and it might work.


Dr Katy Munro [00:11:09] Well yeah, if you want a piercing well why not? But there are certainly lots of anecdotes. But as somebody once said, and I can’t remember who it was, ‘the plural of anecdote is not evidence’. So just because it worked for one or two people doesn’t necessarily mean that it’s an evidence based treatment. And there are people out there very happy to take your money.


Dr Jessica Briscoe [00:11:31] So there are a few other things that have been out there recently.


Dr Katy Munro [00:11:33] Yes there are some wacky things we came across the other day. Burning buffalo hair. Do not try this at home. I have no idea why anybody would think that would stop a migraine.


Dr Jessica Briscoe [00:11:45] So what do they do with the buffalo hair?


Dr Katy Munro [00:11:46] I have no idea. Do you have a handy buffalo, we could try it?


Dr Jessica Briscoe [00:11:50] Absolutely not.


Dr Katy Munro [00:11:52] No nor me. Also somebody commented that the cause of somebody’s migraine might be all the men that were surrounding them but I really don’t think we can blame all men for causing migraines. So let’s just ignore those wacky ones. I think the message really is if it sounds a bit wacky, it probably is a bit wacky. So maybe check it out on some sites like our website or the migraine trust website where there’s a lot of actual proper information.


Dr Jessica Briscoe [00:12:19] So next time we’ll be talking a bit more about medical interventions for the prevention of migraine as I tried to jump forward a bit too early at the beginning, didn’t I, Katy?


Dr Katy Munro [00:12:28] Yes, I’m going to save all that information for next time.


Dr Katy Munro [00:12:31] So just to make sure that we do have a next episode. We just wanted to remind you that we are a charity and we do rely on your donations to keep us open, able to see patients and to do this podcast. We’ve also got some exciting guests coming in the next series and we really need some good equipment. So if you could just donate a pound or two via our virgin giving link that can be found on the blurb or just go to Virgin Giving and type in Heads Up podcast. Show us some love, but brilliant, if you could do that. Thank you. Charlotte and Swati spoke to a couple of our patients about the kind of lifestyle changes they’d made and what difference this made to the frequency and the impact of their migraines.


Charlotte [00:13:19] Thank you so much for joining us on our podcast. I know migraines have impacted your life a lot. So I first wanted to just ask you a bit about how migraines have affected you.


Patient [00:13:30] Yeah, so I’ve had migraines since I was about four and a half. They used to affect me every Monday afternoon, mainly, when I was at school. So I never spent Monday afternoons at school. It was like to the point where I’d go completely white, I’d be violently ill and I’d end up getting sent home and going and lying in a dark room with an ice pack on my head, taking kind of like ibruprofen and Calpol, when I was that young, to try and get the pain to go away. And then as I’ve got older, they kind of switched days to like midweek so Wednesday. And I thought, oh, maybe it’s because I’m doing too much exercise during the start of week and not kind of fueling my body in the right way. But as I’ve grown up, I’ve realised no matter what I do, kind of, I will end up with migraine in some form, whether it be just like a mild one where I can still carry on with my day but be in quite a bit of pain or be so severe that I’m stuck in bed for like five days. And I’ve realised that I can’t kind of go on technology as much as I used to. So I can’t spend like eight hours a day sat at a desk on a screen because it hurts my eyes and glasses aren’t strong enough to kind of help eradicate my migraines.


Charlotte [00:14:41] I understand that you sort of made some changes to your lifestyle, which is actually had sort of an impact on your migraines? Improved them a bit?


Patient [00:14:50] So instead of like working in an office and stuff, I’ve realised that that’s not OK for my body and that I need to be around people more and outside more to make sure that I don’t get them.


Charlotte [00:15:01] And when it comes to sort of diet, have you made any changes with your diet and has that helped at all?


Patient [00:15:06] Yeah, so I kind of cut out carbs as much as I can. I still have some because almost everything in the supermarket nowadays contains some form of carbohydrate. So I’ve kind of cut down as much as I can. Like I don’t eat bread, I don’t really eat kind of like snacky carbs, like crisps or anything like that as it’s just too much and my body becomes very kind of bloated. And I notice afterwards I start to feel very groggy and therefore a migraine shortly after kind of starts. I’ve tried to introduce more kind of low carb things like alternatives to bread. So I’m still getting the satisfaction of eating something that I like, like pizza, but in a low carb form by eating like cauliflower crusts or like low carb mini cheese based crust. So it’s higher in your fat and your protein than it is in your carb.


Charlotte [00:15:58] And has that kind of thing helped?


Patient [00:16:00] So it has helped a lot. In the last three months I’ve only had five major migraines, where they have lasted more than two days and I only have maybe one or two a week now, kind of, migraines in general, which for me is amazing. Because it got to a point where I was having them like every day. So yeah, it has helped a lot. It was surprising to begin with, like, I really didn’t want to kind of cut out the foods that I liked because I kind of used food as a comfort blanket so cutting it out was very difficult. But once you do cut it out and like, notice the benefits of cutting it out, you’re like, OK, this is actually doing something good for my body.


Charlotte [00:16:41] Worth it in the end. And what about things like exercise? Have you found- I know you mentioned sort of exercise almost was triggering them, but have you found it’s been helpful or not?


Patient [00:16:51] Yeah. So I don’t do as much exercise as I used to when I was at school. I played netball and hockey and rounders and stuff almost every day and I think it was getting to the point where I didn’t have enough time to actually rest my body as well as fuel it before I started another exercise. Whereas nowadays I don’t tend to do that kind of exercise anymore. I do more walks with my dogs. At work I’m on my feet for seven to eight hours a day as I work in retail. On my days off, I try to do at least three mile walk just so that I’m outside. I’m getting the fresh air. My body’s still active and I’m not just kind of sat not doing anything and not fueling my body.


Charlotte [00:17:30] Yes, it’s kind of like keeping active, but without being too intense that it’s actually making it worse. Getting that balance.


Patient [00:17:36] It’s knowing your body’s limit of what it can take within a certain period of time. Like I would still play hockey, but for many reasons I don’t, one of them being that I know the next morning I will wake up with a migraine because my body just can’t handle that much physical exertion at one point.


Charlotte [00:17:56] And what about sort of other things like sleep? Have you found like regulating sleep patterns and your sleep routine? Has that helped at all with your migraines?


Patient [00:18:06] Yeah, I’ve always struggled sleeping like since I was a kid. I’ve never been able to sleep very well. I always end up falling asleep around two or three o’clock in the morning. And when I was at school, I was waking up at seven a.m. to go catch a school bus. My body just wasn’t rested well enough. Whereas now I’m older and I’m not in school and I have kind of more time to prioritise my sleep, I guess. Whether that be sometimes I do still fall asleep at two o’clock in the morning, but I’m able to sleep through till about 10 a.m.


Charlotte [00:18:36] So it’s like getting the amount of sleep, right?


Patient [00:18:38] Yeah, for me, I’m quite lucky with my lifestyle and my job that I am able to kind of fall asleep later and wake up later in the day. So I’m still making sure I get at least six to eight hours of sleep a night. I also try to, before I go to bed, to kind of like turn on my electronics off, stay away from them, like read a book or play white noise helps soothe me to sleep because I find that my mind kind of keeps going some nights and I just need something to distract my mind from going.


Charlotte [00:19:09] So sort of everyone talks about, you know, taking medication for migraine. But do you find like for people listening to this podcast, that actually looking at your lifestyle and making little changes within your lifestyles would be something that they should do and have a look at and it could really improve their migraines?


Patient [00:19:25] I think so, yes. Because to me, I’ve tried every kind of prescription medication that the NHS can give me, and none of them have really worked. They’ve either caused other issues like anxiety or panic attacks, or they made me just not feel right within myself. And so kind of my last resort, well not last resort, it shouldn’t have been the last resort, but it was for me, was changing the way I lived my life and having to sacrifice things like working in an office to kind of make it work. But if you find what works for you, just do it, whether that seems right or wrong. If changing your lifestyle works for you, do it because in the long run, it will make you happier.


Charlotte [00:20:06] It’s better than living with the pain of migraine, isn’t it?


Patient [00:20:09] Yeah, exactly. It’s not always nice changing your lifestyle because everyone gets stuck in their routine but when everything else is kind of failing you and you don’t really know what else to do, you kind of have to look at the overview of your whole life and think, OK, what is there that I could maybe not eat or not do as much anymore, like going out and drinking and staying late out? Like with those kind of things you’ve got to think is the three hours of fun you’re having worth the five days of pain you’re going to have.


Charlotte [00:20:44] I know it’s not really fair is it?


Patient [00:20:47] No it’s not. I mean, I’m twenty two. So you would have thought I’d be kind of going out partying, drinking with my friends. But I’ve noticed that the money I’m spending and the pain I endure is just not worth it. I can have fun without drinking and staying out late.


Charlotte [00:21:03] Yeah. And so much better for it at the end of the day.


Patient [00:21:05] So much better.


Charlotte [00:21:07] So is there anything else you sort of changed in your lifestyle or do you think those are the three main things that you’ve looked at?


Patient [00:21:13] I think they’re the three main things I’ve looked at. I think it’s just a matter of finding what’s right for you and kind of sticking with it. Kind of doing it over a couple months before you give up on it because that was one thing I always found was that I would take a medication for maybe two or three weeks and it just not work. Whereas when you change your lifestyle, you’ve got to persevere for a month, two months, three months.


Charlotte [00:21:34] Well, that’s been really great. I think everyone out there is going to really enjoy hearing your experiences and maybe try it themselves and see what works for them. So thank you so much for joining us.


Patient [00:21:43] You’re welcome. Thank you so much.


Swati [00:21:45] Thank you, Charlotte. We recently did a poll on our social media platforms, Facebook, Twitter and Instagram, and we asked migraineurs to tell us if they’ve tried any diet changes or have made any dietary modifications that have helped with their migraines. We had an incredible response. Nearly 700 people voted in that poll and 80 percent of them said, yes, they have made changes to their diet. We had some incredible comments, some of them finding it very useful, some of them finding it not so useful. Our next patient on this podcast is Daisy. She was part of this poll and I’m just going to call her now and speak to her about what modifications that she tried and how it’s helped her. Thank you for joining us today, Daisy. I’m just going to start off with asking you, can you tell us a bit about your migraines?


Daisy [00:22:39]  I had chronic migraine since I was about seven or eight. And then when I was 17, I started having hemiplegic migraines and then a couple of years later, I got diagnosed with cluster headaches as well. So the clusters, I have episodic but my migraines are chronic still, I think.


Swati [00:22:56] So currently in terms of your headaches, is it cluster headaches you get or you still get hemiplegic migraines?


Daisy [00:23:01] Yeah, no, I still get hemiplegic migraines a lot more so.


Swati [00:23:03] So you get both cluster and hemiplegic?


Daisy [00:23:05] Yeah. I have the hemiplegic migraines a lot of the time and then I just have episodic cluster headaches once a year or so.


Swati [00:23:13] Oh wow. So I know that you said yes to changing diet and modifications. Has that helped and what modifications did you do? What dietary changes did you do?


Daisy [00:23:24] Well, when I first went to the migraine centre, it was a few years back now and just actually learning more about it from Dr. Munro, I started eating more protein and like eating little and often, I try not to skip a meal and just being a lot more aware of what I eat and how it’ll affect my brain and it definitely helped with the hemiplegic migraines, especially. Even just the day to day attack, it sort of helps keep my energy up, I think.


Swati [00:23:51] Perfect.


Daisy [00:23:52] Yeah and it wasn’t even like a massive change it was just being a lot more aware of what I actually eat. And I know, like, if I’ve gone a certain amount of time without eating I can feel like an attack starting to come and I’ll make sure to get some energy from somewhere and rather like just processed foods and everything. It doesn’t stop it, but it does help to keep it under control, I think if I really watch what I eat.


Swati [00:24:13] Thank you so much for joining us today, Daisy.


Daisy [00:24:15] Thank you.


Dr Katy Munro [00:24:18] So our next episode is going to take this subject a bit further. We’re going to be talking about medical interventions for the prevention of migraine. Join us next time.


[00:24:33] You’ve been listening to the Heads Up podcast, if you want more information or have any comments, e-mail us on info@NationalMigraineCentre.org.uk. Till next time.


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