By Dr Nazeli Manukyan
We are all facing challenging times with uncertainty and disruption in our daily routine and work pattern. We are confronted with an overflow of information, financial pressures, health anxieties and increasing stress.
Our recent poll on the effect of the lockdown on migraines showed that 25% of participants found it helped their migraine. About 50% reported a worsening. For the other 25% there were no changes.
Surely as migraineurs, we are experienced in dealing with lots of challenges in our lives, rescheduling our plans, managing and shifting expectations, weathering the storm of migraine attacks and adapting to pain. So how can we use our self-discipline and resilience to get through this together?
1. Access to treatment and uncertainty
Those migraine sufferers who were having Botox, nerve block injections or were on a waiting list to consider those treatment options find themselves in limbo, as face-to-face appointments are cancelled in the NHS and private sector. Though essential to some, these procedures are postponed until it is safe for both patients and clinicians, in accordance with the pandemic guidelines. Meanwhile, you have the options of remote consultations with specialists (book a consultation today) and discussing other treatment options, such as use of neuromagnetic devices, increasing or switching prophylactic drugs, re-trialling a few previous options and optimising your medications for pain and nausea. So, take control of your treatment plan and make enquires about alternatives.
We entered the exciting era of new CGRP injectable treatments, such as Aimovig and Ajovy, which are monthly self-injections and safer options instead of Botox or nerve block. Ajovy (Fremanezumab) has been approved by NICE for chronic migraine in England and Wales and whilst there is a delay in the uptake of the patients in the NHS, it is available on a private basis from our clinic.
2. Self-discipline and control
We’ve all heard about the importance of maintaining our routine as much as possible during the lockdown in terms of exercise, sleep, meal and work patterns. This advice is very similar to what we recommend for managing migraine triggers and minimising disruptions.
Look after your personal, physical and emotional health. Be realistic, plan ahead for your day, pace your activities and resist the urge to over-schedule yourself, even when working from home. There is a temptation for migraineurs to do too much, to push too hard and overcompensate on good days. Everyone’s abilities to cope and adapt to changes vary, so don’t be judgemental to yourself and don’t compete with others.
Maintain a routine in sleep, exercise and meals to bring a sense of normality and be in control. Be aware of your caffeine and alcohol intake, as they are important culprits in migraine. Caffeine is also implicated in poor sleep quality. One or two cups of coffee in the morning are acceptable. Be aware of high caffeine content in combination painkillers. About half of the caffeine continues to circulate in our body 6 hours later and about a quarter of it 12 hours later. Consider drinking alcohol moderately, if at all. Alcohol before bedtime leads to frequent awakening and loss of restorative sleep time.
We know that migraineurs are sensitive to changes in the brain’s biological clock which controls the sleep and wakefulness cycle, hence the importance of sleep routine.
As headache specialists, we aim to focus on the concept of regularising the sleep pattern and synchronising our biological clock in order to control migraine frequency. This is more important than trying to increase the overall duration of sleep or catching up on sleep over weekends.
So the usual advice applies, such as: keeping lights dimmed an hour before sleep, restricting social media activities in the evenings, avoiding falling asleep in front of the TV, going to bed when feeling sleepy and tired, keeping body temperature down and choosing activities to slow the heart rate such as yoga or meditative breathing. There is an ancient yoga breathing technique where you close the right nostril and inhale only through the left nostril, or using alternate nostril breathing. This helps to calm the sympathetic nervous system, quieten the mind and promote sleep.
I find the most useful advice is to tune in to your inner rhythm and set your alarm to wake up at a consistent time every morning, preferably rising in sync with sunlight and nature.
Vigorous exercise can be a trigger if you are not used to it, so gentle, low-impact exercise is better for migraine. Regular exercise is helpful in combating stress and promoting release of neuromediators such as dopamine, noradrenaline and serotonin, as well as endorphins which are well known as pain relievers and mood boosters.
Since the lockdown, many of us have enjoyed a slower pace of life and having more time for exercising, whether jogging in the park or doing online classes. Personally, I have been re-discovering the beauty of my local park with its amazing greenery and spring blooming which have an immediate calming effect.
5. Focus on positives
Migraine attacks begin deep in the brain and the severity and frequency of the symptoms can be influenced by your mental wellbeing and emotional balance. Mind-body techniques, such as deep breathing, guided visualisation exercises and mindfulness meditation, have physiological effects on the body and the parasympathetic nervous system. They help to counterbalance the damaging effects of stress. We should feel less lonely and isolated, keeping connected with family and friends via phone calls, video calls and other means of online access.
Shift your focus onto positive changes that came with the lockdown and remove yourself as much as you can from the daily negative headlines all around us. Have you returned to your forgotten hobbies or embarked on something new, such as learning a new language, honing your baking skills or polishing your musical skills? My daughter has been focusing on her crocheting projects between her hospital shifts.
The positive within our team has been the readiness for radical changes. Within days we shifted to running virtual consultations, so we can continue looking after headache patients and survive as a charity.
Enduring migraine pain can be made easier when you shift your focus onto waking up migraine-free and feeling reborn. Similarly, we all should focus on better times after the crisis and feeling proud of ourselves overcoming another challenge.