Interviewer: What you eat, what you don’t eat, and other lifestyle factors, they play a role in the severity and frequency of migraine headaches. Dr. Karly Pippitt is a headache expert at University of Utah Health. And let’s just get into how important are lifestyle and nutrition factors when it comes to migraines.
Dr. Pippitt: I’ll often tell patients that medications can only do so much, and so they have to be doing the things that are under their control to help us best control their migraines. And typically, people will have some awareness of some of these because they will have realized these are their triggers.
So sleep is a really big one for people. You want to make sure that you’re consistent in your sleep hours, so trying to go to bed around the same time, getting up around the same time, and just getting good sleep quality, if you have something like sleep apnea or another medical condition, that you’re getting those treated. A lot of people will have already known that if they didn’t sleep very well or if they slept too much, that they happened to get a migraine. So people usually know that that’s a big trigger. Some of us don’t have good control of our sleep because we’re shift workers or something else has happened. And that makes your migraines a little bit worse. So to the best of your ability, if you can control your sleep, that really helps.
Staying hydrated is really huge. We live in a really dry climate, and so making sure that you’re drinking water, drinking things that are going to keep you hydrated throughout the day is really important. Again, sometimes people will be like, “Oh, it was a hot day and I was out hiking and then I came home and I had a bad headache.” There you go. So making sure that you’re staying hydrated.
Being active, right, getting out, doing something. I’m not saying you need to be these crazy Utah individuals who are running ultra marathons and hiking Mount Olympus every weekend. But just go out and walk 20 minutes a couple of times a day, making sure you’re doing that and not just being sort of still and sedentary. That’s a really important thing with your migraines.
And then you brought up nutrition. So not only what you eat, but I would also say how frequently you eat. We’ll typically recommend that patients with migraines or with headaches that you’re eating something probably somewhere between every two to four hours. That’s something to sort of fiddle with, that works with your body best, but not going for long periods of fasting. That tends to be a trigger for a lot of people. And when you do eat a snack, making sure that you’re eating something with a little bit of protein, a little bit of complex carbohydrates, something that’s going to kind of sustain you and keep you going, so peanut butter, nuts, dried fruit, yogurt, cheese, something like that.
And then what you eat, it does matter to a certain extent. A lot of people will say that there are certain foods that are a trigger. And you’ve heard me say that a couple of times now, “What is your trigger for migraines?” It’s helpful to look at what you’re eating and know what some common triggers are, but don’t torture yourself in trying to find what you think is the cause. So some really common triggers, I would say for people, red wines or wines with sulfate. Sometimes alcohol in general, but typically red wines and beer are probably big ones. Chocolate can do it. Processed meat, so things like hot dogs, sausages, that can be a trigger for people. MSG for some people, though I would say the data is a little bit less supportive of that. And then sometimes things like fermented foods can also be a trigger. But everyone is very different. So you may have those and not bother you at all, and other people may be more sensitive.
And also, maybe it’s just you had a night that you didn’t sleep very well, you were really busy at work and maybe you skipped breakfast. And then when you had lunch, you had a hot dog and a Coke and then later you had a headache. Was it the hot dog? Was it the skipped breakfast? Was it the poor sleep? Yes. It was really probably all of those things that did it.
Interviewer: I was waiting for the answer.
Dr. Pippitt: So I think that’s an important thing to think about is that I’ve heard it described at one of our migraine conferences as the inferno of migraine. And so each of those are a little match, right? So a match that you didn’t sleep very well, another little match to some dry kindling that you didn’t eat breakfast, and then whatever you ate for lunch and maybe didn’t stay hydrated. And all of those are really leading to that inferno that then becomes the migraine.
Interviewer: I like to think of things like that in terms of the cup. So you didn’t have your breakfast, you put a little water in that cup, and eventually it just gets so full it runs over. Boom, that’s when you have the migraine headache.
Dr. Pippitt: Absolutely.
Interviewer: That’s kind of my analogy. It worked for me. But I like the inferno. You had fire. I had water. So you went through a lot of kind of lifestyle things that really all of us should be trying to do to the best of our ability anyway — staying active, eating healthy, trying to get enough sleep, controlling our alcohol consumption. When somebody comes in, out of all of those, do you kind of have them start with one above the other? Like what’s the biggest bang for my trigger buck?
Dr. Pippitt: Oh, great question. I would say probably sleep. Sleep is a really big trigger for people. And not just not enough sleep, but too much sleep can also be a trigger for you. Most people, when you come in, we talk about those four. And I’ll tease people that there’s usually one I can pick on them about, right? Like very few of us are like good at all four of those things, so there’s usually one. So if there’s just one, then that’s the one that I’ll typically pick on. But sleep and then a close second would probably be either hydration. I don’t even know that I’d give you a close second, because I feel like all of those are really common, that we get busy, we don’t eat, we get busy, we don’t stay hydrated, and we don’t exercise.
Interviewer: Yeah. We get stressed, we drink alcohol.
Dr. Pippitt: Yeah. So just trying to find time to do the right thing.
Interviewer: I’d like to add in too, for any of those things, it’s really I think important to keep a diary, because before I got my Fitbit a couple of years ago, I thought, “Oh, I get eight hours of sleep. I go to bed at 10:00 and get up at 6:00.” Well, actually, it told a little bit of a different story. I guess I didn’t realize I was going to bed at 10:45 or 11:00. I thought I was going to bed at 10:00. So writing that stuff down and like what you eat is the same thing. So I think really be critical.
Dr. Pippitt: Absolutely. And I love all the activity trackers, because I think a lot of us think that we’re active. I have on my busiest day of clinic, I remember when I first got my Fitbit, I was like, “You got to be kidding me. I’m only doing 3,000 or 4,000 steps. Like I’m exhausted when I come home.” And it’s interesting how different trackers will then talk about how much you stand, how much you moved. Like maybe you didn’t take that many steps, but you were up and moving around. And I was like, “Okay. Either that just made me feel better because I was actually a little more active even if it wasn’t just from like a step standpoint.” But I think that is useful feedback and information for you to act on.
Interviewer: What about posture? Does posture trigger migraines? I know for me, if I sit all day at work, which sometimes, again, I try to get up every 10 minutes every hour. But if I sit all day, I’ll start to notice headaches creeping in around 4:00 or 5:00 in the afternoon.
Dr. Pippitt: Yeah. Posture can definitely lead to more headaches, maybe a little bit more tension headaches and tension headaches can then lead to migraine headaches. So you’re doing the right thing by standing up every 10 minutes or so. Making sure your setup is good so that you’re not hunched over. I definitely have a tendency, even though I have a pretty good setup, to hunch a little bit more, especially as I keep looking into a camera screen, that tends to curl my shoulders a little bit. So standing up, stretching, like bringing your arms above your head, sort of stretching out your pecs is really what you’re looking for. So if you’ve got one of those exercise balls, rolling that onto your shoulders and just letting your arms fall open. We often think about, “Okay. What can I do for my neck?” But we don’t realize that as we’re hunching forward, you’re actually shortening your pec muscles. So opening those up or going to a corner of a room and putting your hand on each of the wall and almost doing a little push-up against the wall to stretch out those areas is huge.
Interviewer: Some great advice to look to try to reduce the severity. Now, do these things reduce both the severity and frequency of headaches, or do they tend to impact one or the other?
Dr. Pippitt: They could do both, to be quite honest. Maybe not as much the like intensity of one that you have, but I suppose if you really filled your cup up and just like kept the hose running, that might actually make a difference with the intensity. The goal is really probably more with frequency, I would say.
Interviewer: All right. And is this an alternative to taking medication, or would you recommend, if somebody has migraines, that this is in addition to?
Dr. Pippitt: I would say definitely in addition to. Like I said, medications can only do so much. So even if we had a perfect medication regimen for you and you weren’t sleeping, weren’t eating, weren’t exercising, and didn’t stay hydrated, I don’t know that those medicines would really do any good for you.