Holiday Hidden Dangers for Migraineurs

As joyful and wonderful as the holidays are, they can be a dangerous time for migraine sufferers.   Almost all of the positive aspects of the holidays have hidden dangers, that if avoided, may help reduce the chances of getting a migraine.  When so many potential triggers are present, it’s even more important to know how to limit your exposure to them.  So, what are the dangers?

DANGER:  Vacation – It’s great to finally get time off from work, but may aspects of vacations can trigger migraines… sleeping in (too much sleep can trigger a migraine, as can skipping that morning cup ‘o’ joe), changing sleep habits, travel through time zones, sharing a hotel room with your screaming kids

SOLUTIONS:  Try to keep the same sleep schedule, and don’t skip that morning coffee.  If you want to cut down on your caffeine intake, this is probably not the time to experiment, and it needs to be done gradually.  Also, bring ear plugs and a sleep mask, consider trying melatonin which may help regulate sleep.

DANGER:  Stress – From planning the holiday meal, to preparing for guests and shopping there are many stressors during the holidays.  Some people may have a migraine triggered by stress, and some will get ‘stress let-down’ migraines.  This occurs when after a stressful event, you’re finally feeling relieved that it’s all over and you can relax, and BANG!  There it is.

SOLUTIONS:  Plan ahead over a period of time.  Write things down, shop in advance and slowly prepare for the holidays.  Trying to get it all done in one week for some people can be a recipe for disaster.  If you need to, consider letting another friend or relative host the party or guests.  Be extra careful about exposing yourself to triggers during this period, as they are more likely to trigger a migraine attack during this time.  Lastly, if you are prone to ‘stress let-down’ migraines, you may want to talk to your doctor about how to take medication to prevent the headache from coming.

DANGER:  Parties and Holiday Meals – The food and drink is in abundance, and you look forward to it every year.  Different foods and drinks may trigger headaches in different people, and it may take time for you to figure out if you have food and drink triggers, and what they are.  The amount of food you eat may also play a role.  And what about those smells?  People coming to the party dressed to impress, but too often scented to the max.  Scented candles and other holiday decorations and smoke may also be present, lingering in the air, awaiting your arrival.

SOLUTIONS:  Firstly, don’t skip meals earlier in the day in anticipation of a large holiday meal.  Skipping meals may in and of itself trigger a migraine.  Avoid your food and drink triggers entirely, if possible.  If you don’t know what they are, try to stay away from cured meats and aged cheeses (skip the pepperoni and cheese plate), hot dogs (pigs in blankets), pizza, highly spiced foods, deli meats, MSG.  Opt for white wine or light colored liquor over red wine and darker liquors.  Or no liquor at all.  Try to stick to the most natural and unprepared foods, veggies, fruit, simple grilled meats breads.  Eat chocolate and other sugary things in moderation.  As for the smells, if you’re close enough to the hostess, you can contact her ahead and talk with her about your problem, maybe she can limit the scented candles.  Let your friends know ahead of time that perfumes and colognes may set off your migraines, and ask if they can refrain for this event.

Stick to your normal routines as much as you can.  It is the fluctuations and changes in the environment and lifestyle, that tend to trigger migraines.

The NFL’s New Rules

It was a notable weekend where numerous severe neurological injuries were incurred during football games.  Representatives from the NFL have stated that there will be new penalties enforced for devastating and illegal hits, to help protect players from concussion and other injuries.  

Protecting athletes from concussion is a good thing.  The most important issue here in my mind, is the NFL making a statement and setting a standard for younger players and their leagues.  When the NFL comes out with a strong statement like this, people listen.   How this will affect the game and the way players play is entirely another thing, and not something that I can truly comment on.

Concussion is under recognized, and under reported, and can have devastating neurological consequences, including even death.  Of course, most concussions are mild, and people recover from them.  It is more likely, though, that permanent brain damage will result if a first concussion is not fully healed before a second concussion happens.  You must allow the brain to heal FULLY before engaging in risky activity.  You should see a doctor to help determine when that healing is complete.

There is also an increased risk of sustaining permanent brain damage after recurrent concussions, and the more concussions you have, the more you’re likely to get. 

Knowledge and awareness helps to guide us through making important decisions.  The decision on whether to play should only be made with full awareness of the potential risks.  But in the end, it is the choice of the individual and/or parent, so providing the appropriate information on which to base decisions is an important step.

Botox for Migraines!!!!

The FDA recently approved onabotulinum toxin A (more commonly known as “Botox”) for the treatment of chronic migraines.  Chronic migraines are defined as occurring on 15 days or more per month.  Headache specialists have been injecting onabotulinum toxin A for migraine prevention for many years.  It is a generally safe treatment, although safety and effectiveness should be discussed with your doctor.  One of the nice things about Botox injections for migraine prevention is that if it works, it usually has none of the potential side effects that some of the prescription medications have.  For people who have tried other medications and modalities, it is a great option to discuss with your doctor.

Injections are done in the office, and take the same time as a regular office visit.  No special preparation is needed, and afterwards you can go about your day as your normally would with little restrictions.

Botox can be used for several other neurological conditions as well, in addition to cosmetic uses.


Vertigo and dizziness are common problems in migraine sufferers.  In general, as a neurologist, I see a lot of patients with dizziness.  The problem tends to be more prominent in migraineurs.  There are several different potential causes of vertigo, and even more in migraineurs.

Vertigo can be present as a part of migraine, is very common after concussion, and can be caused by a host of middle and inner ear disorders, as well as brain disorders.  In some cases, dizziness can be related to dehydration, blood pressure drops, or heart problems.
Vertigo can be an associated symptom of migraine (like nausea and sensitivity to light), it can be an aura-type symptom (preceding the migraine in a very distinct episode), it can be the only manifestation of migraine (migrainous vertigo, a variant of migraine) or it can be a symptom in the general life, intermittently and not associated with actual migraine attacks, of a migraineur, but related to the migraine by the genetic underlying sensitivities.
Of course, migraineurs can also get vertigo from the more typical and non-migraine related causes, such as inner ear infections, labyrinthitis, benign positional vertigo, menierie’s disease, other ear problems, and even strokes.
It is an interesting and common problem.  It, unfortunately, is very difficult to treat.  Keep yourself well hydrated and ask your doctor if any of your medications can be adding to the problem.  Often times it will go away on it’s own, if it is from a benign cause.  In severe chronic cases of vertigo, a special type of rehabilitation can be useful.

Summer is Time for Concussions????

With kids, young and old, all out of school there is plenty of time and good weather for sports, recreation, and travel.  We need to be cautious with our fun, just a little, to avoid potentially long term problems.  That is truly the issue, who wants to think about head injuries as your heading to the pool or out for a game of softball?  Since the 1970’s when I grew up, though, times have changed.  Kids now wear helmets when they ride bikes, and sit in carseats til they’re 10 or so?  I remember, but won’t go in to detail, riding on what was essentially the hood of my dad’s car while he drove 30 mph down our street.  Boy, it was fun.  We blasted Fleetwood Mac, the wind racing through our hair… those times are over, though.  Car seats, seat belts, all this safety.  But we, as a society, decided to make these changes because we knew the tragedy of losing a young healthy vital person for no reason.  Now, all kids wear helmets when riding bikes, and they are getting more and more common on the ski slopes too.  Why?  Because even though we all want to feel the wind in our hair, we know better.  We don’t want the tragedy to be our own loved ones, or our own selves.  When this all started, everyone was upset.  But we got used to it as a society, and now we all do it.  I, for one, rebelled against seatbelts for a few years.  Now, I feel naked without one.

So, back to summertime fun and concussions.  We need to think about it, talk about it, know about it.  Fatal brain injuries are tragic, and thankfully uncommon.  Concussions are surprisingly common, and surprisingly dismissed.  Yet, concussion can be downright dangerous, and can lead to long term consequences for our brains.  We neurologists have some idea about the consequences in adults, and still don’t understand many of the consequences in children.  In adults, concussions can lead to headaches, memory loss, mood changes, depression, dizziness, balance problems, impaired concentration, and more.

Think about safety and your brain.  Protect it.  You might need it one day.  (or tomorrow.)  If you get a concussion, stop doing what you’re doing, rest, and contact your doctor.

Memorial Day Weekend’s Coming – Tip #4

  If you’re heading out to a barbecue this Memorial Day Weekend, skip the hot dogs if your migraines are sensitive to nitrates.  Other cured meats and sausages, hard cheeses, heavily spiced foods, avocados and alcohol may all trigger migraines too. 

Instead, opt for burgers or chicken on the grill not too heavily spiced and without seasoning salt.  Grilled veggies are always a good choice too.  Drink plenty of water, and if you want to have a drink, opt for a vodka or gin drink that’s not too sugary.   And please, have a designated driver.

Do Children Cause Headaches?

Children can cause headaches in so many ways, that so many parents can attest to.  The good news is, they grow up.  The bad news is, the bigger they get, the bigger the headaches.  That’s what my mom would say, anyway.  Headaches can be aggravated by pregnancy and childbirth, as well as changes throughout parenthood.

Lots of changes in headaches can occur during pregnancy.  Hormonal fluctuations during the pregnancy can tend to worsen headaches in the earlier stages of pregnancy, and tend to protect against headaches during mid and later stages of pregnancy.  Childbirth itself is a whirlwind of hormones, stress, sleep disruption and metabolic changes in the body that certainly can bring on a migraine, but often the migraine will wait a few weeks to rear it’s very ugly head.  Watch out, though, it could be a bad one!

 Newborns and infants disrupt sleep patterns, and if it’s a first, the stress of being a new parent doubles the danger.  During this time, many women breastfeed their babies and can’t take medications for headaches to worsen the problem.  There are methods that can help, though.  You will have to put yourself first, occasionally, taking time to meditate or relax, do some exercises to help ward off those headaches.

As kids grow up, the headaches they induce mostly stem from stress, but there can be some other situations that are less obvious.  Having a sick child not only stresses a parent, but often disrupts sleep, and can change many lifestyle habits that contribute to headaches such as dietary changes or changes in exercise habits.  Holidays  may bring lots of obvious stressors, but the family vacation?  To some, a smooth sail.  To many, not so much.  Take a vacation on your own, or with your adult partner, for a couple of days when you get back! 

How ’bout those college applications?  Exciting?  Yup.  Watching your child’s hopes and dreams expand and materialize?  Yup.  Pressure?  Yup.  You may think the pressure is all on the kid, but in my experience, the parent is feeling it, sometimes even more.  Does your child’s success reflect on you as a parent?  Well, if you’re feelin’ that a little too much, the headaches are likely to be a sign to back off and take time to reflect on the stuff that really matters. 

So, kids can cause headaches, for sure.  But always remember the joy and hope they bring to our lives.  There has to be some sacrifice, doesn’t there?