Tis the Season for Holiday Headaches

Thank you to Lawrence Newman, MD and Michelle Pipia-Stiles for their contributions to this spotlight!

From dealing with “the in-laws,” to waiting on endless lines while doing holiday shopping, let’s face it—the holiday season can sometimes be anything but jolly! What’s worse is that for millions of migraine sufferers, the holidays can be even painful…literally.

If you think of every potential trigger for migraine, this is the time of year we expose our migraine sufferers to all of them. We tend not to eat right, exercise enough, sleep well, and stress levels definitely tend to escalate. The good news for migraine sufferers is that there are things they can do to prevent severe episodes of migraine.

  • Plan in advance: Make lists of everything you need to do, buy, pack or cook. If traveling, allow extra time to navigate airports and crowded highways. If possible, don’t shop during peak hours when stores are mobbed.
  • Don’t skip meals: Empty stomachs can spur headaches. If unable to follow your normal eating schedule, pack snacks. Avoid foods such as ripe cheeses, processed meats, and chocolate, which can cause headaches in susceptible people.
  • Avoid last-minute shopping: Winter coats, hot stores, long checkout lines, and looming Christmas deadlines can give even the most ardent shopaholic a tension headache. Don’t try to pack too much shopping into one day. Shop early, or consider online or catalog shopping.
  • Limit exposure to smoke or perfume-filled rooms: Both can trigger headaches. Find some fresh air.
  • If you drink, do so in moderation: Alternate alcoholic drinks with glasses of water. Avoid red wine, which contains an amino acid known to trigger headaches. Limit your alcohol intake in the hour or two before bedtime.
  • Schedule personal time: Many people try to pack too much holiday socializing into too little time. Don’t feel you must attend every holiday event to which you are invited. Give yourself a break and plan some down time. A few hours alone each week can reduce stress.
  • Maintain a regular sleep and eating schedule: Changes in either of these areas can bring on migraines.

1Lawrence Newman, MD, is President of the American Headache Society and Director of The Headache Institute at Mount Sinai St. Luke’s Roosevelt, Mount Sinai Beth Israel.

Michelle Pipia-Stiles was Associate Director, Public Affairs, Continuum Health Partners, New York, NY.

Migraine and Sleep During the Holidays

iStock_000053162730XXXLargeHave you ever noticed that people often get sick around the holidays? That’s not just because they are under lots of stress, but because their sleep habits are also disrupted. Stress and sleep not only hurt our immune system, but they interact with each other. Studies show that periods of high stress and poor sleep increase one’s risk of having a migraine more than either one of these alone.

Here are suggestions to follow:

  • Keep a consistent bedtime and wake time every day, even on the weekends.
  • If you have trouble sleeping at night, avoid daytime naps as much as possible. If you must nap, try not to nap for more than an hour or any time later than early afternoon. If you nap to find relief from a migraine, try to keep your normal sleep schedule otherwise.
  • Use the bed only for sleeping and sex. Doing anything else in the bed (eating, studying, reading, watching TV, talking on the phone) will actually make it harder for you to fall asleep when you need to.
  • Don’t stay in bed if you can’t fall asleep. Few things are more frustrating than not being able to fall asleep, but tossing and turning in bed will only make your sleep problems worse. If you can’t fall asleep within 20-30 minutes, get out of bed, go into another room, and do something relaxing until you feel tired. Repeat until you are able to fall asleep within 20-30 minutes of getting in bed. (Most people change positions a couple times within 20-30 minutes, so if you’ve changed positions several times or start to feel frustrated that you can’t sleep, it’s time to get out of bed).
  • Don’t watch the clock—it will only make you anxious and more frustrated if you can’t sleep.

Following these tips to establish and maintain good sleep habits can help you feel better rested, have better energy levels, and possibly avoid some migraines for good measure. If you find that you tend to wake with a migraine, discuss both your sleep habits and sleep quality with your doctor.

An additional tip regarding stress: there’s still some disagreement regarding whether stress itself is a migraine trigger, or if there are other triggers that occur more frequently during times of stress and may go unnoticed. These triggers may include less sleep, an irregular sleep schedule, poor quality sleep, skipping meals, consuming too much caffeine, and not taking in enough fluids to remain hydrated. Keeping a detailed journal during stressful periods can help identify the potentially avoidable triggers.

Migraine, Diet, and Food Triggers

Certain foods and liquids can trigger migraine for many people, and these foods are often plentiful during the holidays. Commonly reported food triggers of migraine include red wine, processed meats, chocolate, nuts, and aged cheeses. Think through your food and beverage choices and you can help reduce your risk of having a migraine.

  • Skipping or missing meals is a much more common trigger of holiday_partymigraine than any particular food, so make sure to eat regularly during the day. That’s three meals…don’t skip breakfast!
  • Avoid eating within a couple hours of bedtime or drinking caffeinated beverages after early afternoon.
  • Identify potential dietary triggers. Start keeping a migraine diary now, and see if you can identify particular foods that are followed by a migraine headache at least half of the time you eat them. Avoid those foods during the holidays.
  • Red wine is a common migraine trigger, so opt for white wine or another beverage instead, unless you discover that these are migraine triggers for you. And because alcohol and dehydration can trigger migraines, be sure to drink in moderation. Alternating a glass of water with an alcoholic beverage will help.
  • Practice healthy eating habits: In addition to not skipping meals, limit your intake of processed foods, sodium, sugar, and carbonated drinks.

Seasonal Triggers of Migraine
Holidays can be fun but challenging times of year for migraine sufferers. From the stress of last-minute shopping to traveling all over to visit loved ones, the holidays can be outright stressful!

Common sources of stress during the holidays include:

  • Visiting Loved Ones: long distance travel, seeing in-laws, remembering deceased loved ones, tensions between family members
  • Shopping: battling crowds, standing in long overheated lines, last-minute shopping, searching for parking spots, bright and blinking lights
  • Partying: eating or drinking too much, parties with “aroma overload” from perfume, scented candles, flowers, decorations, staying up too late, inconsistent sleep patterns
  • Foods: eating unhealthy foods or those that may contain triggers, eating too much, excessive caffeine intake, staying hydrated.
  • Personal: different work schedules, irregular sleep habits, neglecting exercise, trying to do too much, neglecting personal time.

Do you notice what all these sources of stress have in common? They prevent you from taking personal time to manage your stress and migraine. Migraine results from a brain that is very sensitive to even minor deviations in routine, so make managing migraine a priority.

This season, make a deliberate effort to manage stress and take personal time for yourself. Don’t wait until stress reaches a point where it triggers a migraine…use some of these tips to get a handle on holiday stress!

Tips for Managing Stress During the Holidays

Set aside some personal time for yourself12-28-09 ornaments118.jpg

  • Ensure you set aside some time for rest, relaxation, and stress relief, even if it’s just for a few minutes each day. Keep up with any exercise: yoga, meditation, or other positive health habits you normally maintain. Don’t feel obligated to attend every event you’re invited to—you’re not a bad person because you say “no.”

Plan ahead

  • Avoid last-minute shopping when lines are longest and stores are most crowded. Discuss plans with relatives and friends well in advance, but try to remain flexible if the plans change.

Be consistent in your sleep and eating habits. 

  • In the midst of the holidays, good sleep and eating habits often take a back seat to other demands. Not getting enough sleep and missing meals are two of the most common triggers of migraine, so ensure that you are keeping a consistent sleep and eating three meals every day. Try to go to bed and get up around the same time every day, and don’t skip any meals. If you don’t have time to prepare a full meal, grab a healthy and protein-rich snack.

Be smart about traveling. 

  • Avoid last-minute travel or traveling during rush hour. If you’re crossing several time zones, anticipate jet lag. Start adjusting your sleep schedule several days before departing.
  • While traveling, behave as if you were already at your destination (if you’d be asleep at your final destination, sleep—if you’d be awake, stay awake). If you’re traveling west, once you’re at your destination expose yourself to sunlight or other bright light later in the day to help you stay alert. If you’re traveling east, exposure yourself to sunlight early in the morning to help your body adjust.

Realize you can’t control everything

  • Unexpected sources of stress will undoubtedly come up, but accept that you can’t control every possible trigger of migraine. Ensuring that you are taking some personal time for yourself and keeping regular sleep and eating habits will help you cope with unexpected stressors.

Take care of yourself even after the holidays end

  • Recent research shows that some people experience migraine after coming down from a period of high stress (experiencing low stress after a period of high stress), the so-called “let-down headache.” Once the chaos of the holidays start to wane, be sure to keep practicing good stress management.

Winter Blues and Migraine

iStock_000052885846SmallMany people notice that their mood drops a little when winter rolls around. This occurs because our bodies receive less sunlight during the winter months, and sunlight is a strong regulator of our sleep and our moods. A small decrease in your mood during the holiday season is normal, but these mood changes may put you at risk for a migraine attack. Some people experience symptoms of major depression during the winter months, and individuals with migraine have higher rates of depression than those without.

Tips for Coping with Winter Blues:

  • Stay active! Stay involved in activities, exercise, and get out of the house more.
  • Seek out others. Spending time with friends, family, or social groups can reduce feelings of isolation and provide social support. Volunteer for a meaningful cause, be active in community or religious groups, and participate in social events—even if you don’t feel that motivated to do it!
  • Use sunlight to your advantage. So long as bright light isn’t a trigger for your migraine attacks, expose yourself to sunlight or other bright light (but don’t look directly at it, of course) for 20 minutes each morning. Try sitting down to eat breakfast by a large window that receives morning sunlight from the east.
  • Remember that your drop in mood is temporary and will improve when spring comes.
  • If the holidays cause you to remember something that has been lost (a loved one, a relationship), accept your feelings of sadness. Value the fond memories but don’t let them detract you from the present and the future.
  • Talk to your doctor if you experience more serious mood changes such as very sad mood most days, loss of interest in normal activities, or thoughts of suicide. For more information on seasonal depression, check out http://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/basics/definition/con-20021047 or http://www.cnn.com/2011/HEALTH/01/03/sad.seasonal.affective.disorder/

News, Links, and Additional Information

Mayo Clinic: Stress, Depression, and the Holidays

Cleveland Clinic: Managing Holiday Stress

AHS President Larry Newman, MD, director of The Headache Institute at Mount Sinai St. Luke’s Roosevelt, Mount Sinai Beth Israel, gives tips on managing migraine during the holidays.

Reduction in perceived stress as a migraine trigger: testing the “let-down headache” hypothesis.
Lipton RB, Buse DC, Hall CB, Tennen H, Defreitas TA, Borkowski TM, Grosberg BM, Haut SR.

Study: Migraines triggered by stress relief?

Association between Stress and Headache Frequency (S41.007) Sara Schramm et al.

Trigger Factors and Premonitory Features of Migraine Attacks: Summary of Studies
Jelena M. Pavlovic MD, PhD, Dawn C. Buse PhD, et al

Headaches & Holidays
Dr. Joel R. Saper

This study supports the stress/sleep interaction effect on headache