It happens every year like clockwork.
By April 1, Jessica Kubasak has run out of sick days at work. By New Year’s Eve, she has 20 illness-related absences on the books.
Kubasak, a 30-year-old health care provider from California’s San Fernando Valley, has been a migraine sufferer for more than 15 years. She says her migraines occur eight or nine times a month and last two or three days at a time—that’s at least 384 hours worth of nausea, headaches and light sensitivity every month.
“It tortures every part of your body,” says Kubasak, who relies on provisions in the Family and Medical Leave Act to acquire the unpaid sick days necessary to treat her condition.
Unlike most migraineurs, Kubasak isn’t affected by common triggers, such as chocolate, citrus-packed foods or even hormonal shifts brought on by her menstrual cycle. Unfortunately, her migraine’s accelerant—like a match to dry brush—is stress.
“Migraines look for change and tend to get people when the boat is rocked,” says Jason Rosenberg, MD, a neurologist and director of the Johns Hopkins Headache Center at Bayview in Baltimore. “On average, people who have very frequent headaches are suffering disproportionately from mental health issues, ranging from anxiety and PTSD to major life stressors and counterproductive coping skills.”
In several medical studies, migraine patients have reported stress as a serious trigger, often edging out missed meals, bright sunlight and weather changes as the most common precipitant. Chronic stressors, such as economic uncertainty, career difficulties and family issues, can wreak havoc on anybody, but they’re especially tough on migraineurs, who already walk an emotional tightrope.
“The body was not created to handle that kind of stress on a regular basis,” says Kathleen Hall, PhD, noted stress expert and founder of the Stress Institute in Atlanta.
The body’s response to stress is to reduce body temperature and dilate blood vessels, which makes patients more susceptible to other migraine triggers, according to Hall. However, by embracing a stress reduction and relaxation plan, she says migraine sufferers can impact brain function and spur the release of pain-blocking chemicals, such as serotonin, dopamine and endorphins.
Relief is possible, but it requires a coordinated plan of attack. Here are seven essential moves every migraine sufferer should master.
1. Know your enemy
Before declaring war on stress, migraineurs should channel their inner Sherlock Holmes and uncover the sources of their triggers.
“I always ask my patients, ‘What’s your number one stressor?’” says psychologist Kathleen Farmer, PsyD, co-founder of the Headache Care Center in Springfield, Mo. “And they look at me as if they have no clue.”
Some migraineurs find it helpful to keep a headache journal or just a simple list detailing the actions, events and emotions that precede a migraine, says Farmer, who has worked with headache sufferers since 1996.
“You need to recognize your behavior and see how you can prevent that stressor from affecting it,” she says.
After a relatively calm period, Kubasak noticed an uptick in her migraines about two years ago, coinciding with a period of increased anxiety at her job. As a child life specialist at a comprehensive cancer center, Kubasak is tasked with helping kids—many of them terminal—cope with their diagnosis.
“That’s when I started listening to my body and finding out what causes it stress,” Kubasak says. “I knew immediately what was behind the change.”
2. Get serious about sleep
Most overextended adults treat a good night’s sleep like a luxury instead of a necessity. But even something as seemingly minor as missing a bedtime or logging fewer than seven hours of rest each night can disrupt a migraineur’s hyper-excitable nervous system and produce stress, Farmer says.
Good sleep habits elevate your mood and equip you to better handle the day’s stresses. They also aid in the production of migraine-alleviating brain chemicals, such as dopamine and serotonin.
To achieve better rest, Farmer recommends going to bed and waking up at the same times each day—even on weekends. Sheep-counting migraineurs also should follow the National Sleep Foundation’s tips for ensuring optimal sleep. These include maintaining a quiet, cool and dark place to sleep; engaging in a relaxing activity, such as reading a book or chilling out to music, before bedtime; and upgrading those flat pillows and lumpy mattresses, which can cause overnight discomfort.
3. Vote your stressors off the island
It may be impossible to rid your life of everything that stresses you out—unfortunately killer bees and the Internal Revenue Service aren’t going anywhere—but you can adapt to your stressors and modify your reactions.
“Migraineurs are known to put themselves last and put other people and their deadlines first,” Farmer says.
She suggests inoculating yourself from people and situations that are certain to push your emotional buttons, whether that means avoiding a confrontation with a toxic co-worker or letting voicemail pick up that call from your in-laws after a trying day at work.
“You have to ask yourself, ‘What can I do to protect my migraine threshold?’” Farmer says.
4. Eat smart, drink like a genius
Think of your body as a brand new, gleaming CL-class Mercedes Benz. You wouldn’t fill its tank with low-grade gasoline, so why are you fueling your body with sub-optimal foods?
“People think of stress as a mental state, but there are physical stresses, as well,” Dr. Rosenberg says. “Skipping a few meals and pigging out at a fast food restaurant does things to the body that can be considered stressors.”
That’s why migraineurs need to monitor their diet, make sure they’re staying hydrated and avoid skipping meals—especially breakfast, which gives the body the resources it needs to tackle internal and external stressors.
Java junkies and Diet Coke fiends who suffer from migraines should definitely limit themselves to two caffeinated drinks per day, according to Farmer.
“On one hand, caffeine is good for headaches because it constricts blood vessels,” she says. “But too much of it actually can produce headaches.”
Over the last year, Kubasak has found stress relief by eliminating foods that rely on non-essential fats and sugars, as well as embracing a daily meal plan heavy on vitamin-packed fruits and vegetables, lean animal proteins and water.
5. Get fit
If you were to stack all of the unused gym IDs hiding in wallets and purses around the world, you could probably construct the world’s tallest gym—and still few people would find time to visit it. But exercise is a proven stress reliever, and a regular fitness regimen will better equip you to handle life’s mental and physical rigors.
“Exercise takes your mind off things,” Dr. Rosenberg says. “It makes you more physically healthful, relieves muscle tension, gets the blood moving, reduces inflammation and provides an overall sense of well-being.”
Dr. Rosenberg recommends breaking a sweat for at least 20 minutes three times a week to pre-emptively reduce stress levels and improve overall health. If you’re concerned exercise might exacerbate your condition, he suggests low-impact activities, such as yoga and tai chi.
The greatest challenge for most migraineurs is getting up and active, which is why Hall urges people to start small. Simply learning meditation, relaxation techniques, controlled breathing or visualization can be useful, especially for people who are unable to fall asleep at night.
“You don’t have to do aerobics to reduce stress,” she says. “You can walk up and down the stairs, or place five-pound weights by your chair and lift them while watching TV. You’re still building muscle and reducing stress.”
6. Reprogram your mind, rehabilitate your body
“Retraining your nervous system to relax is a process. Migraineurs need to relax every single day for at least 10 minutes, which is sometimes hard to do,” Farmer says. “A behavioral response to pain and stress has to be unlearned.”
Biofeedback is one way to change your physiological response to stressful events. Attaching a biofeedback system, which monitors the body’s heart rate and tension levels, will let you know when it’s time to relax—either through measured breathing or quiet meditation. The at-home systems are small, roughly the size of an iPod, and can be purchased for as little as $100 at amazon.com.
When Kubasak feels a migraine coming on, she enters lockdown mode.
“I immediately go to a quiet place and practice deep-breathing exercises and guided imagery, where I picture myself in happy surroundings to get away from that sensation for a minute,” she says.
7. Be patient with yourself
Gaining control over your stress triggers doesn’t happen overnight. Stress is an evolving, shape-shifting organism that affects each host differently. Often the biggest impediment to successfully taming stress is the fear of change.
“There are all sorts of barriers to doing the right thing, even if the patient knows what the right thing is,” Dr. Rosenberg says.
That’s why he prefers to start by focusing on the lowest-hanging fruit. Then he gradually nudges migraine and headache sufferers onto a positive path.
“For most people, it’s more realistic to take small steps in the right direction with positive reinforcement rather than trying an immediate whole-life makeover,” he says.
When headache patients know which medications to take, develop an action plan for life’s twists and turns, and adopt coping strategies, they can begin to let go of the anxiety and chronic components of pain, Dr. Rosenberg says.
It’s not easy, but that doesn’t mean the struggle isn’t worthwhile. Just ask Kubasak, who recently experimented with acupuncture as an alternative migraine treatment.
“My acupuncturist creates a stress-less environment during my appointments that helps me get centered and become a little more understanding and patient,” Kubasak says. “I don’t expect to ever completely rid myself of migraines, but I hope I can control my stress and make them less frequent and less debilitating in the long run.”
Many people are extremely susceptible to their stress triggers during the perilous hours between 9 a.m. and 5 p.m., Monday through Friday. Migraine sufferer Jessica Kubasak offers her go-to stress reliever when work anxieties pile up and she feels the onset of a migraine headache.
- Find a quiet, dark place.
- Lie on your back or, if the office floor is too heinous, cross your arms on your desk and rest your head on them.
- Focus on the location of the pain.
- Take long, deep breaths and hold them to the count of 10 before exhaling to the count of 10.
- Imagine a blue light that cools your entire body. Picture a beam of that light starting at your toes and working its way up your body to your head, relieving the pain and tension as it moves.
- Do this three to five times until you feel your heart rate return to normal and your body loosen up.
- Drink a cool glass of water.