The Impact of Stress on Migraines

I did an Instagram poll on migraines a few weeks ago, and just followed up with the results a few days ago and I thought it would be really useful for folk to be able to access a bit more info than my 60 second reel.

It's thought that migraine affects around 10% of the population in the UK (1) and it is so much more than a headache. Migraine symptoms are wide and varied and include, but are not limited to: pain, nausea, vomitting, aura (visual disturbances, I'll talk more about these below), tinnitus - or ringing in the ears, light sensitivity and intolerance to smell and movement. Migraines can last from a few hours to several days for some people.

Aura is a really unique one in migraine and it can differ from person to person. It can include seeing light, flashing light, blind spots, general vision changes, tunnel vision - or for myself, I get what feels like a blind spot in one small area, it feels like a little pixelated block, which gets bigger and bigger. Aura usually starts before the pain begins and sometimes folk can have an aura migraine which comes without any pain. It's still pretty debilitating, and quite odd if it's the first one you've had as you sort of 'wait' for the pain to start.

It is thought that migraines are caused by abnormal brain activity which temporarily affects the nerve signals, chemicals and blood vessels in the brain (2). It is thought that there is a genetic component to this, and that if a family member suffers, then you may do too (3). Some people find that they are more inclined to get their migraines at around the time of their period, and for some of those people, often pregnancy and breastfeeding can halt their attacks - unfortunately it didn't make a difference for me, which was a bit disappointing to be honest!

As I discussed in the reel, the straw poll I did threw up a lot of common triggers: stress, hormones, changes to light/brightness and citrus fruit. The NHS website has a really comprehensive list - I'm going to include it here because I thought it was really interesting, and I figure that if you're reading this then you might, too (4).

'Emotional triggers:

stress
anxiety
tension
shock
depression
excitement

Physical triggers:

tiredness
poor-quality sleep
shift work
poor posture
neck or shoulder tension
jet lag
low blood sugar (hypoglycaemia)
strenuous exercise, if you're not used to it

Dietary triggers:

missed, delayed or irregular meals
dehydration
alcohol
caffeine products, such as tea and coffee
specific foods, such as chocolate and citrus fruit
foods containing the substance tyramine, which include cured meats, yeast extracts, pickled herrings, smoked fish (like smoked salmon), and certain cheeses (such as cheddar, stilton and camembert)

Also, foods that have been stored at room temperature, rather than being refrigerated or frozen, can have rising levels of tyramine.

Environmental triggers:

bright lights
flickering screens, such as a television or computer screen
smoking (or smoky rooms)
loud noises
changes in climate, such as changes in humidity or very cold temperatures
strong smells
a stuffy atmosphere

Medicines:

some types of sleeping tablets
the combined contraceptive pill
hormone replacement therapy (HRT), which is sometimes used to relieve symptoms associated with the menopause.'

This seemed like a really comprehensive list, and is really broad. And I wonder just how much each one comes up. I know from my work, that stress and hormones is one which comes up frequently as big triggers.

The Migraine Trust reckon that we lose 43,000,000 days per year in the UK from illness with migraines (5). That seems like a staggering number, but one that I can believe, knowing how long migraines can persist, and just how helpful rest is.

Pain medication and specifically migraine medication, can be really helpful when you've got an episode - but what can we do to help reduce them in the first place?

For many of the patients who I work with, helping to balance hormones and reduce stress can have a really positive impact on their migraine frequency and severity. So what can we do with herbs, diet and lifestyle to help? It's a mammoth question and one that I'm sure spans beyond a lowly blog post, but I'll kick off regardless.

Adaptogens: adaptogenic herbs are usually one of my go-to for anything stress related. They help the body to adapt and respond to the environment, nourishing and helping to provide balance, often in times of stress and pressure (6). They can be incredibly helpful when stress is a trigger, and that doesn't need to be big deadline/gas bill stress: it can be the grind of daily life stress. And it's important that we don't undermine that as a real cause. I've included one of my favourite adaptogenic tonics, Ashwagandha, in my Nourish cacao blend. It also has Oat which is a nerve tonic (see below) and is a blend which is perfect for a daily drink, to help give us a bit of a boost, whilst nourishing our nervous system, without the wiriness of another cup of coffee!

Probiotics: I bang on about these for pretty much everything, but there is research to suggest that specific strains of bacteria are helpful for those who suffer with migraines (7) and for the most part, they are well tolerated and have minimal side effects. So this is something that I definitely discuss with patients.

Magnesium: This is something that seems to be well recognised. A deficiency in magnesium in the diet, can be a factor in increased incidence of migraine, and supplementation can reduce the frequency of migraine (8). Supplementing can be a useful way to go about increasing magnesium levels, as can increasing magnesium containing foods, which includes greens, nuts, seeds, chocolate (dark and good cocoa content) and avocados. Epsom salts are also a wonderful source of Magnesium, and some of the respondents to the survey said that a bath can help when they're actually suffering with a migraine - so perhaps whack some Epsom salts in your bath, too, as a preventative as well as when you're having an episode?

Nerve tonic herbs: This is one which is really useful for when stress is a big ole' factor. Those lovely nerving herbs which help to reduce stress and anxiety, without leaving you drowsy, can be super helpful in supporting your nervous system through more challenging times. My faves include passionflower, lavender and lemon balm (part of the reason I included them in my Chillout tea).

B Vitamins: With particular attention to Riboflavin B6 and B12, it is thought that B vitamins can be useful in helping to prevent migraine attacks and reducing severity (9). This, like the magnesium, can be taken as a supplement, or can be added to the diet. Some people start off with supplements when they're right in the thick of it - and as they start to feel better, find that they are more able to make dietary changes. I always feel like that is a good option. B vits in general are thought to help the body in times of stress (10), so not only helping with the migraine situation, but helping with energy levels and your ability to cope both physically and mentally with the demands of stress.

Diet and Lifestyle: This is a huge topic. When people join me on my 14 week programme, we spend a lot of time going over this and it's because it's important. Suffice to say that it's an individual and bespoke approach, and the aim of the game is to dial down stress: we acknowledge we can't always switch it off, but dialling it back can be a tremendous help. Whether that be doing a bit of mindful breathing, listening to a podcast on a stressful commute, going for a ten minute walk on your lunch break, drinking a bit more water, or eating a bit more veg - we discuss things that are doable for YOU at helping to manage those stress levels a bit better, and getting the most from your food without further adding to the mental load.

Identifying dietary triggers is a big one too: in the poll, citrus fruit came up quite a lot as a trigger, more than chocolate or dairy (which to be honest I thought would come up more!) and so keeping symptom diaries can be super helpful to do this. If you've got a calendar or note app on your phone, or a paper notebook - then recording dates and recalling what you've been doing or eating the days prior to a migraine can be useful. You can review this when you're feeling recovered and see if you can make any links. This is something I will often ask in our appointments - if you don't immediately know, then we work together to figure them out. And then we work together to find out how best to avoid those foods, or to at least minimise them.

Environment: I have tried really hard to remove some of the environmental triggers that affect me, from my life. This is something that I think we learn over time, and of course, like lifestyle, some things are unavoidable. But again it's about how we limit or manage exposure to those things, too. So for me, I always wear sunglasses when I'm outside, as bright light is a huge trigger. Moving my clinic room around has helped in so far as I don't need to use a ring light all the time - but now I am facing a big window and so my shutters really help as I can selectively close them, to limit the light coming in - whilst you're still able to see me on screen :) I have also tried to remove as many articifically smelly chemicals (usually cleaning products) from the home. I do find that the overwhelming stench of products which has become popular in recent years, is a real trigger for me. I tend towards essential oils as room fragrance, either blends from Holistic Kitchen, or my fave candle from Neal's Yard: they don't seem to impact negatively, perhaps because they are more natural - but also because the products contain essential oils geared towards managing stress.

I'm also a big fan of my essential oil rolls ons - particularly Sleep and Calm, which can be really helpful in curating a peaceful environment with minimal disruption or difficulty: you can pop them in your bag, or a coat pocket, and roll on when you need to. When I'm really struggling I will dab a little of the oil under my nose, so that I'm immediately taking deeper breaths to help smell the oils, which definitely helps dial down those stress levels for a moment!

The way that migraine affects individuals is so unique: but for those of you who have stress as a trigger, then I invite you to see if there is something from this list that you're not already doing, that would be within your capabilities right now: perhaps the food diary is the way forwards for you? Perhaps a few minutes of calm per day is doable. Perhaps a bit less coffee and a bit more herbal tea might push your buttons? See if you can keep at it for a few weeks, and then layer in something else: add some probiotics to your shopping list (and remember to take them), ditch the smelly disinfectant (or open a window when you're using them) and so on. Layer in those extra things which help you to reduce your stress levels on a day to day basis and see if that has any impact on your migraines. And perhaps even your day to day stress levels, too.

If you'd like to chat further about how I may be able to support you on a 1:1 basis, be it with migraines, stress, hormones, or anything else: then please do get in touch with me.

If you feel you are in more urgent need of medical attention, as always my suggestion would be to contact your GP/NHS Direct/A&E in increasing order of urgency.