Nicole Greason says her fiancé can tell when she’s about to get a migraine.
First comes the pinched look on her face. Then her eyes don’t look quite right. That’s when he sends her to lie down, pulls out the ice pack and brings her fluids to drink, says Greason, 46, who works in marketing and public relations at Arizona State University. It’s a lesson learned from past trips to the emergency room when her migraines were especially bad.
“It is the worst pain that you can experience,” Greason says. “It goes beyond broken bones and torn ligaments.” While she’s never been able to pinpoint the exact triggers for her headaches, she does know this: “They feel worse, they are more intense and the duration is longer during the summertime.”
Either directly or indirectly, the main culprit seems to be heat, which can make life difficult considering Greason lives in Chandler, Ariz., where summertime temperatures regularly rise above 100 degrees and the heat can stretch well into October.
For most of the year, her attacks come about two months apart and are often manageable with over-the-counter medications. But come summer, Greason says she expects to have an intense headache episode about every three weeks. She takes special care during hot weather to eat right, get rest and drink plenty of water, often mixing in a quarter-part fruit juice for flavor. On vacations or weekend outings, she diligently checks for access to shade and fluids, and stocks the car with umbrellas and ice packs.
Technically there’s no such diagnosis as “summer headache,” notes Vincent T. Martin, MD, vice president of the National Headache Foundation (NHF) and professor of medicine at the University of Cincinnati College of Medicine in Cincinnati. And though some recent data suggest the summer months are the most common time for headaches, Dr. Martin says “there are lots of potential different reasons for that” and heat may not be the lone cause.
Like any other season, summer brings with it a unique set of triggers: sunlight, dehydration, increased physical activity, allergies and humidity, among others. But smart choices and coping methods can help people with headache stay pain free so they can enjoy the summer months.
1. Shield Yourself
Bright sunlight is a common headache trigger, Dr. Martin says, particularly for migraineurs who experience visual aura. “And it’s not just light, it’s usually glare.” Dr. Martin himself experiences migraine with aura and remembers a time from his childhood when he was riding in a car. The sunshine hit the mirror of the car in front of him and reflected into his eye. “It triggered a migraine instantly,” he recalls. Even the glare produced by sunlight hitting the sand can be problematic. Protect yourself from both bright light and glare with and sunglasses and wide-brimmed hats.
2. Hydrate—Then Hydrate Some More
Dehydration is a very common culprit for headaches no matter the season, says Frederick G. Freitag, DO, a member of the NHF board and medical director for the Comprehensive Headache Center at Baylor Health Care System and director of headache medicine research for Baylor Research Institute in Dallas. In hot weather, our bodies lose fluids at a faster rate. Despite years of public health education and even beauty magazine articles on the topic, many people don’t consume enough clear fluids (see “Hydration Guidelines” below). “Few people even come close,” Dr. Freitag says.
While optimal fluid consumption varies by person, one of the easiest, if slightly unsavory, ways to gauge your hydration is to examine the color of your urine. “It should be nearly colorless,” Dr. Freitag says. “If it isn’t, then there likely is a degree of dehydration occurring.” Constipation can also be an indicator of dehydration, he says. “If you are consuming sufficient fluids, then stools should not resemble pebbles.”
3. Exercise Caution
Making tee time with friends or joining your company’s soccer league? Proceed with caution. Physical activity like jogging could trigger migraines, and strenuous activity like lifting weights could trigger strain-induced exertional headaches.
It is possible to pre-treat exertional headaches with nonsteroidal anti-inflammatory prescriptions (e.g., naproxen) or beta blockers that slow down the heart rate. These are usually taken about 30 minutes before physical activity. See your headache specialist for the proper medication for you, and remember that all-important hydration becomes even more critical when you exercise.
4. Eat Smart, Drink Smart
In addition to keeping a regular meal schedule, remember that some of the classic foods of summer can be part of the problem. If you’re attending barbecues, picnics or outdoor parties, avoid common food triggers such as foods with nitrates (including many hot dogs and prepared meats) and MSG, says Roger Cady, MD, associate executive chairman of the NHF and founder and director of the Headache Care Center, Inc. in Springfield, Mo.
While a cold drink can stave off the summer heat, Dr. Cady advises patients to pay attention to what type of alcohol they’re drinking. White wine or drinks with clear liquors are less likely to trigger headaches than red wine or rum. “And of course, drink in moderation,” Dr. Cady notes.
5. Be Aware of All Your Triggers
In addition to food and drink, dehydration, exercise, bright light and loud noises are significant triggers. But headaches and migraines can also be triggered by wind, extreme temperatures, allergens, humidity, storm fronts and even subtle weather changes. There is no way to truly avoid all migraine triggers, Dr. Cady says. The only way to truly avoid all of these influences is to spend the year’s most pleasant months shut inside a dark room, he says. This is both unpleasant and unrealistic.
Instead, Dr. Cady encourages patients to “think globally” about all the various risk factors for migraine to which their nervous systems are exposed. “Very often it’s a combination of risk factors that are occurring in close proximity that set the nervous system up for an attack of migraine,” Dr. Cady says. “For example, if you aren’t sleeping well or you’ve had a lot of stress at work, it’s probably not a wise idea to go to a wine and cheese party. You have to balance these things out and make yourself a lot less vulnerable.” He notes that risk factors can be avoided in many instances, balanced with protective factors such as regular sleep and meals or modified by using sunglasses. The point is to address the lifestyle factors that can be controlled, to help the body better withstand the external factors that cannot be controlled.
6. Plan Ahead
Warm weather usually means outings and travel plans that can tamper with those critical meal, sleep and medication routines. But before you embark on your day of adventure, plot out your schedule and make sure you have everything you need to make it through the day pain free. “I can’t tell you how many stories I’ve heard that begin with, ‘I went out on the boat and left my meds at home or in the car,’” Dr. Cady says.
7. Relax—It’s Summer
Worrying about headaches can produce anxiety and new headaches. So relax, kick up your feet and enjoy time with loved ones. The summer could also be a great time to try new activities to reduce your headaches, such as biofeedback, yoga or a regular, fun exercise such as tennis or swimming. “I think fun is a good thing for your nervous system,” Dr. Cady says,” and hopefully that’s what we have in the summer.”
In the heat of the summer months, it can be easy to ignore your water intake. But Dr. Cady warns that allowing yourself to become dehydrated “is one of the worst things people with headaches of any sort, particularly migraines, can do.”
To keep your body happy, remember to drink additional fluids before, during and after physical activity. Federal guidelines suggest an extra 8 to 16 ounces before exercise; 4 to 8 ounces every 20 minutes during exercise; and an additional 16 ounces of fluid for each pound lost during the workout. In general, drinking small amounts frequently throughout the day is easier than guzzling giant glasses of liquid in a single sitting.
When it comes to hydration, here’s how some of the most common beverages stack up:
- Water: It is well known that H20 is undoubtedly, absolutely and unequivocally the best way to stay hydrated. It’s free, it’s plentiful, it’s easy to tote around and it will keep your body replenished. Add a little flavor by garnishing with lemon, lime or cucumber slices.
- Sports drinks: Following water, electrolyte-based drinks can be a great option for hydrating, especially for people planning vigorous exercise, Dr. Cady says.
- Caffeine: Though Dr. Cady admits that caffeine withdrawal is the usual cause of caffeine-related headaches, he says his primary objection to coffee and caffeinated sodas is their ability to impair sleep. People who experience headache disorders need a good night’s sleep to help the nervous system recover from the day’s activities.
- Soda: Soft drinks tend to be full of sugar, sweeteners and calories, which makes them a poor choice for hydration.
- Milk: Nonfat milk could have some of the same replenishing properties as a sports drink, according to a study published in the October 2008 issue of the Journal of the International Society of Sports Nutrition. Of course, there’s only so much you want to drink on a hot day.
- Juice: While the sugar and calorie content makes juice a less-than-ideal drink for hydration, juice could be a good choice when adding a small amount to water.