I was first diagnosed with chronic migraine during my two pregnancies. For years I was having daily migraine attacks and the little break from pain I did have I spent in postdrome or prodrome. (Read my full story here.) Despite my supportive family, I felt lonely and truly thought I was the only one struggling with this debilitating illness. Discovering the Migraine Strong community on Facebook opened a whole new world up to me. I learned about the migraine disease and how to take control of it. I met other beautiful and strong people who are going through life dealing with the burdens of migraine. All of a sudden, the world became a little less lonely and living with migraine became a lot more hopeful. I learned how to thrive instead of just surviving. Through Migraine Strong, I also learned about numerous organizations that work tirelessly to raise migraine awareness, raise money for migraine research, and provide migraine education. The top three organizations that Migraine Strong finds the most helpful are: American Migraine Foundation (AMF) – non-profit organization dedicated to the advancement of research and awareness surrounding migraine. Migraine Strong is impressed with their work and honored to be partners with them. You can follow AMF on their Facebook page and Instagram. Migraine World Summit (MWS) – The MWS puts out a free annual virtual event where it interviews migraine experts, doctors and specialists from around the world about migraine. The event is live in March or April each year but you can purchase a pass here to view the Summit at any time. Being that there is less than one certified headache specialist for every 85,000 patients in the U.S., this is a truly a must see event. VEDA – non-profit organization with a mission to support and empower vestibular patients on their journey back to balance. If you have vestibular migraine, you may want to spend some time on this website, as well as on their other social media accounts. Are you new to the migraine world? Here’s a list of resources, our Migraine Strong member, Movement with Migraine recommends, to learn more about migraine. World Federation of Neurology Today I would like to share with you an organization that I recently learned about that deserves some recognition – World Federation of Neurology (WFN). WFN was established on July 22, 1957 and launched the World Brain Day in 2014. The World Brain Day dedicates its focus to a different topic each year. The main objective of this day is to increase public awareness and promote advocacy related to brain health. The first World Brain Day took place in 2014 and the following year it focused on Epilepsy. The third World Brain Day in 2016 had a theme, “Brain Health and the Ageing Population” and focused on diseases such as stroke, dementia, and Parkinson’s disease. In 2017, the World Brain Day’s focus turned to stroke. The topic for the World Brain Day in 2018 was “Clean Air For Brain Health” to raise awareness on the influence of air pollution on neurological diseases. 5th Annual World Brain Day This year, WFN is partnering with the International Headache Society (IHS) to support the 5th Annual World Brain Day. They are dedicating the topic to raising awareness for the most common brain disease in the world – migraine. The key messages being addressed at this year’s World Brain Day are as follows: Migraine is the most common brain disease in the world, affecting 1 in 7 people worldwide. Migraine is a major, disabling disease that can severely impact every aspect of your life. Together, we can ensure those affected by migraine receive the care they need. Migraine is under-recognized, under-diagnosed and under-treated. Migraine receives less research funding than any of the world’s most burdensome diseases. WFN is working really hard to promote the World Brain Day to make sure to reach a wide audience. In June, during the Migraine and Headache Awareness Month, the World Brain Day was promoted alongside the American Migraine Foundation (AMF) in an ad displayed in New York’s Times Square. The Painful Truth The theme of this year’s event is “The Painful Truth About Migraine.” This year, World Brain Day is taking to social media to ask people around the world to share their Painful Truth about migraine using the hashtags #worldbrainday and #thepainfultruth. Migraine Strong asked our members how they would respond to this question and has been sharing their thoughtful quotes on social media. Bringing these quotes into the public eye makes this horrifying neurological disease and its suffering less invisible. We would love to read your painful truth about migraine in the comments below. Webinar We encourage everyone to register and attend the World Brain Day webinar which takes place on July 22, 2019 at 10:00 a.m. EST and join the panelists for a discussion about migraine. The panelists include as follows: Prof. William M Carroll, President, World Federation of Neurology (WFN) Audrey Craven, President, Migraine Association of Ireland (MAI) Prof. David Dodick, Immediate Past-President, International Headache Society (IHS), Chair of IHS-GPAC Prof. Dr. Wolfgang Grisold, WFN Secretary-General Elaine C Jones MD, Director, American Academy of Neurology (AAN) Prof. Tissa Wijeratne, Chair WFN Public Awareness & Advocacy Committee Part of managing our migraine disease is education. We need to educate ourselves about our disease to be able to advocate for ourselves and others in our migraine community. By educating ourselves we can take control of migraine and spread migraine awareness. World Brain Day is the type of the event where we can maximize education. And if education is not incentive enough to register, we will be having a giveaway next week. Keep your eyes open for our announcement!
Fourth of July is always a special holiday for me since it’s the anniversary of being officially diagnosed with vestibular migraine. This was especially bittersweet for me because I had seen so many doctors, went to the ER numerous times, tried vestibular therapy for months, only to still be 24/7 dizzy. Doctors continued to tell me I was just stressed or had anxiety. To have a credible doctor finally validate your illness and understand what you’re going through just feels so good. Still, this time of year can be stressful for many with chronic migraine. Lots of parties, cookouts, and outdoor events can lead to attacks or even just a fear of an attack. Here at Migraine Strong we are all about living your life to the fullest, despite the challenges migraine can bring. So we encourage you to spend time with loved ones, but by still taking care of yourself. Some of our key tips are: Stay well hydrated and cool. Find a shady spot if you need to. A cool cloth can work wonders! Bring ear plugs and migraine glasses if you’re triggered by noise or visual stimulation Take breaks from talking. It’s not rude to simply excuse yourself if you need a small break from chatting. If you just say that your dish needs a little garnish or you need to freshen your drink, it can provide you with a quiet moment to yourself. If you plan to drink, pace yourself or consider using a sulfite and histamine filter like PureWine. Staying on point with your diet can help you keep that trigger bucket from overflowing. Here are some recipes to consider if you’re on Heal Your Headache or Keto. Heal Your Headache/Low Tyramine Diet Mains Simple Grilled Burgers, Steaks, Chicken, or Fish – Marina’s Favorite Grilled Veggie Skewers (vegan, replace onion with shallot) with HYH-Safe Chimichurri Pulled Pork with BBQ Sauce Easy Oven Ribs Sides Simple Potato Salad Cole Slaw (no mayo) Strawberry and Peach Burrata Salad Fourth of July Fruit Salad (vegan/omit coconut for some) – Jennifer’s Favorite Creamy Shallot Dip Desserts Crustless Blueberry Pie (pictured above) Strawberry Cream Cheese Bread (GF) White Chocolate Blondies (Can be GF) Angel Food Cake (DF) Keto Diet Mains Grilled Halloumi Bruschetta (HYH safe) Keto Dry Rub Ribs Chimichurri Steak (HYH safe) – Danielle’s Favorite Steak Fajita Skewers Buffalo Chicken Salad Sides Cauliflower Potato Salad Low Carb Cole Slaw Radish Skewers with Herb Butter Creamed Spinach (Leave out Parmesan for HYH) Desserts Strawberry Cheesecake Popsicles Peanut Butter Ice Cream – Eileen’s Favorite The Migraine Strong team wishes you a happy, safe, and pain-free 4th of July with your friends and family!
The goal of Phase 1 of the ketogenic diet is to get your body into consistent ketosis by limiting your carbohydrate intake to ~25g/day while having adequate protein and getting most of your calories from fat. Read our Starting Keto From Scratch blog to get a jump on this way of eating. This eating pattern allows your body to burn-off a significant portion of your stored glucose (glycogen) and eventually get to the point where it’s using fat for fuel – nutritional ketosis. As promised, this will help explain the goals and tips beyond the first phase. Phase 2- Keto-adaption In this phase, the practical things to focus on are fine-tuning what you buy at the grocery store, prepare at home and order at restaurants. You probably learned a great deal about carbs in Phase 1 so Phase 2 should be a little less time-consuming and easier. In order for the ketogenic diet to be a healthy and sustainable way of eating, it must be well-formulated and varied. Keep the idea of variety and healthier choices in mind but do not put too much pressure on yourself at this point. Your goal for Phase 2 is to continue eating foods that keep you in ketosis while keeping satisfied and not longing for goodies. Establishing the metabolic shift to keto-adaption is the main focus of the second phase of keto for migraine. What is keto-adaption? Keto-adaption refers to the time in which your body has successfully made the switch to becoming an efficient fat-burning machine. It is beyond just being in consistent nutritional ketosis. For decades, most of the living cells in your body have been using carbs for fuel. In the process of the sustained ketogenic diet, they are adapting and making enough enzymes to properly digest and metabolize fat for energy. This means that when there is an increased need for energy, as in physical exertion, your body is able to access and burn fat rather than mobilizing stored carbs. So, improved exercise tolerance during ketosis is a sign of improving keto-adaption. There are other signs, too. Some of them are decreased appetite and cravings for carbs. Many people report an overall sense of improved energy and better sleep. Many also report improved ability to think clearly. For those of us with migraine-associated brain fog, this is BIG. Since the GI tract has been tasked with handling a boost in fat and a decrease in carbohydrate, people often notice significant difference in their stools. Some people may have constipation and some may have diarrhea and some may have a little of both. Usually, people adapt to it over the course of a few weeks. Personally, I didn’t realize how much brain fog I had until it lifted while in ketosis. When does the keto-adaption phase happen? Sorry, but this is another question with the nebulous answer of “it depends, everyone is different.” Most experts think it takes at least a month. This blog written by Dr. Phinney, a pioneer and expert in the ketogenic diet gives more scientific info about markers for this phase and why it is so variable from person to person. In my personal experience, I had been doing keto for about 6 weeks before I felt noticeably better and more energetic than I had in years. After 6 months, I felt like I was hitting my stride and on keto cruise-control. Keto is much more enjoyable in Phase 2! It’s best to keep carbs low but some people can stay in consistent ketosis while eating 50-75 grams of carbs some days. There is a vast difference in food diversity and palatability when you double the upper limit of carbs. At this point, having a blood ketone monitor is very helpful so you can measure your upper limit of carbs. And, since we are all doing this for migraine, this is the phase where the ketones strengthen our virtual force field and allow us to enjoy many foods that were previously triggers. Hello, avocado! Hello gruyere cheese! The metabolic flexibility that develops is what makes this phase so much more enjoyable. I think of this phase as one in which our body seems to favor staying in ketosis and can adjust to slight increases in carbohydrate amounts. This is also the stage where you have learned so much about carb content of foods that you don’t feel the need to diligently track carb amounts. I encourage people to continue to track occasionally to just help them stay in solid ketosis and avoid “carb creep.” This is the time to add some more variety to your diet. Instead of only having green leafies veggies, asparagus and cruciferous veggies, have some onions and peppers. Sprinkle some chopped pecans on your salad. Perhaps you want to try making a cauliflower crust or keto granola. Phase 3 – The well-formulated ketogenic diet for migraine You got things rolling in Phase 1 and keto-adapted in Phase 2. The objective of Phase 3 is to continue to control your symptoms while adding a variety of yummy, wholesome foods to your plate. This way of eating should allow you to maintain your health and ability to participate fully in your community. So, how is a well-formulated ketogenic diet for migraine described? It keeps you in ketosis. You can experiment with your upper-limit of carbs with more certainty if you have a blood ketone monitor. I strongly encourage only increasing carbs with foods considered allowable on the keto diet. Experimenting with grains and sugars of any type is STRONGLY discouraged as cravings will return. I promise! Continue to focus on whole foods with minimal processing. If you have trouble finding or affording fresh foods, try frozen foods without added sugars and sauces. Eat enough food. You may not be hungry but you must eat enough calories and protein to maintain a healthy metabolism and lean body mass. This advice is especially important for people who do not wish to lose weight. Dr. Phinney recommends not going below 1000 calories per day even for those who wish to lose weight. Keep your diet varied so you get different nutrients and you keep things interesting. It can be easy to get stuck in repetitive eating patterns, so challenge yourself with finding new recipes. Try different grocery stores to see what is new. Experiment with different nut oils, infused oils, herbs and spices. Perhaps you can experiment with more recipes. Choose green leafies and veggies that are high fiber. Maybe your family misses your Bolognese sauce. Make pasta Bolognese for them while you have broccoli Bolognese. Time for a check up? If your head is feeling better but you have new symptoms that are not resolving quickly, seek help from a doctor. The information here is not medical advice. A doctor who is keto-friendly would be best, but many in the medical community are not knowledgeable about keto. This list of keto friendly doctors from www.dietdoctor.com can be a starting point for finding a doctor to help you navigate your new way of eating. New or worsening symptoms need professional, in-person attention. Phase 3 is also the time to schedule an appointment with your doctor to get your blood work checked if you haven’t already done so. Experts say that blood lipids can fluctuate quite a bit in the first months of keto and tend to stabilize at the 6-month mark. I am NOT an expert in this is an area. You must do your own research including a consultation with your doctor. What is after Phase 3? Ketosis can and does help many people with migraine who commit to giving it a try. Some do very well with limiting carbs from sugars (including sugary fruits), grains and starchy veggies (i.e. potatoes) without being in nutritional ketosis. You may or may not need to stay in ketosis to get migraine attacks in better control. Personally, I was such a carb addict that I could not have curbed those cravings without the help of ketones. I failed miserably with previous attempts to cut out sugar. The ketones were also helpful in allowing me to eat many foods that were triggers. I liked being in ketosis and enjoyed the reduction in migraine symptoms, especially the reduction in brain fog. You may find that you feel relief with ketosis as well as low-carb/high fat eating without the goal of staying in ketosis. Finding a way of eating that helps you get debilitating migraine under control may take a while and keto may be an excellent tool for you.
The migraine brain is said to be hyper responsive to its surrounding environment. We respond with migraine attacks to things that people without migraine wouldn’t react to at all. The Bucket Theory was developed as a way to explain how difficult to control triggers (like hormones, stress and weather) fill up a portion of our bucket each day. While these triggers are hard to manage, the ones that we have some control over are the ones that we eat and drink each day. What Is An Elimination Diet? An elimination diet is a short term modification of diet that allows us to remove the ‘commonly known’ migraine triggers. These triggers are either high in histamine and tyramine or substances like caffeine and MSG. The purpose of removing these items from the diet is to give the hyper responsive brain a chance to ‘calm down’. To become less responsive and relax. The elimination diet is not meant to be a new way of eating for an indeterminate amount of time. By removing things from the diet that are potentially affecting the brain’s ability to respond appropriately to the environment, we are allowing the potential for other approaches to work. For instance, I was chronic and mostly intractable for 18 years. I had suffered a migrainous stroke prior to starting on the diet and treatment plan. I felt this was my last ditch effort to get control of my migraine disease. While Topamax didn’t work by itself, when I combined it with an elimination diet and the Migraine Strong Treatment Pie, I was finally able to break the chronic cycle I had lived in for so long. I have been able to maintain being episodic since 2015. But (for me) I only followed the elimination diet strictly for four months before I began to reintroduce the foods I had eliminated. Working with the members of our closed Migraine Strong Facebook group, we have found that this time varies from person to person depending on a few factors, including how long it takes to reach baseline. What Is Baseline? Baseline is different for all of us. It is when our migraine attack frequency and severity has decreased significantly from beginning the elimination diet/treatment plan. We can’t really give you numbers here. I can give you my example of baseline and you can extrapolate from there, but we are all different. When I began my elimination diet, I was having daily migraine attacks and it was difficult to determine the ending of one attack and the beginning of the next. My baseline was reached when I was having about 2-4 attacks per month. However, I thought that I could do better, so I held out for going 30 days without an attack. I’m glad I gave up on this unrealistic idea because I didn’t achieve it for more than 3 years! That would have been WAY too long to stay on my elimination diet. Basically, if you are chronic (more than 15 headache days a month) and can get to episodic (less than 15 headache days a month) and the attacks are less severe in intensity, you are on your way to baseline. Survey Says… We did a recent survey in our Migraine Strong Facebook group. This feedback was about elimination diets and if they helped (or not) and how long it took to reach baseline. A whopping 89% said they had a reduction in severity and frequency using an elimination diet and the Migraine Strong Treatment Pie. The majority, 61% used the Heal Your Headache diet, and 47% had reached baseline. Most interesting of all of the polling numbers was the number of people that started this journey with chronic migraine (69%) or intractable migraine (17%) and were helped with the multi modal approach. I was in the same place when I started in 2015. My success was the impetus for starting the Migraine Strong Facebook group in the first place. How Long Do We Tend To Stay On An Elimination Diet? In the Heal Your Headache book, by Dr. David Buchholz he recommends four months for the elimination diet. We have found it’s better to use reaching baseline as your guide, with a few potential adjustments along the way. Some people with episodic migraine may be able to reach baseline within four months. Others with chronic migraine, intractable migraine or 24/7 vestibular migraine may take longer to see their symptoms reduce to baseline. To understand this we look back to the severity of the hyper responsiveness of the brain in these examples. If the migraine symptoms are 24/7, the time it takes for the brain to ‘calm down’ may take longer than another brain that is experiencing less than 15 symptom days a month. In our survey, 43% of our members who reached baseline did so within 5-9 months, 33% within 2-4 months and 23% slightly longer at over 10 months. We think these are realistic numbers based on our members tending to be people with chronic, intractable, vestibular and/or 24/7 migraine. Treating migraine is hard. Finding the right combinations of medication, supplements and other modalities takes time. Some Tweaks To Make Generally speaking, we like to make a few recommendations if you see no improvement within 6-8 weeks after beginning the elimination diet. Take the extra step to eliminate apples and eggs that are served on their own (eggs baked in things are fine). Sometimes eliminating these two extra items will make a significant difference. Though it is not recommended to do that in the beginning. If there is no improvement after that, we always encourage Migraine Strong members to reach out to us. It’s possible a part of the Treatment Pie might be under utilized. While most of our members have improvement in their overall migraine condition and are helped with diet, some are not. As important as the elimination phase of the diet is, reintroduction of eliminated food is perhaps even more important to continue our healthy relationship with food. When Do We Start To Reintroduce Food? Using baseline as a guide, the reintroduction of food will be when your migraine attacks have significantly reduced in frequency and severity. At this point you will have more control over your migraine attacks than you did when you started the diet. The attacks will also be responding to your acute and rescue meds better than when the treatment plan began. Many people feel a normal amount of anxiety when they get to this point and will sometimes delay the reintroduction phase because they are feeling so much better. This is completely normal but we encourage everyone to be brave! Most the of the foods that you have eliminated during the elimination phase will not end up being your personal triggers. The purpose was to allow the brain to have a break from all of the ‘commonly known’ triggers in an effort to calm the hyper responsiveness. Having achieved that, it’s time to add back in the foods that you have truly been missing. We recommend choosing something that you have really missed! Or something that makes meal prep easier. Everything Is a Trigger…Or Is It? This process isn’t as complex as it seems. There are just a few factors that have to be taken into consideration when thinking about outcomes. Many people have anxiety when reintroducing a potential trigger food. This can trigger an attack on its own. It’s important to remember that a majority of these foods will not be your personal triggers. Most of us don’t have a laundry list of food triggers. Many times, food cravings during prodrome seem like triggers when the attack phase happens shortly afterwards. It’s important to set these ideas of past triggers aside (we know how hard this is!!) It’s also important to consider the Bucket Theory and how our bucket can fill up with other things on the days that we are also testing new foods. The Reintroduction Process The reintroduction process is simple. Choose the food you want to reintroduce. Eat it every day for five days and see if you react to your chosen food. It’s super common if you normally have some anxiety to get migraine symptoms on the first day…power through. Make note of how you have been sleeping, and the weather and any additional stress. We can’t control everything and there will never be a perfect time to try a new food. If you have an increase in attacks around your cycle, it’s a good idea to avoid that week for food testing. My Experience With Reintroduction Everyone will have different examples of what they consider a successful reintroduction. For me, I really wanted to be able to have guacamole so avocado was high on my list of foods to reintroduce. I started with half an avocado each day for five days. By day five, I was having some moderate head feistiness. I was able to treat the attack with no problem. My takeaway from the test was that avocado was likely a very low grade trigger. I could likely have it three days in a row, but not five. In my mind, it was a successful reintroduction. I didn’t have avocado or guacamole more than a couple of times a week, so I was in good shape. As the years have passed, I can now eat avocado daily with no repercussions. It’s easy to blame food/drink because it is the one of the only things that we can truly control. I try to look at all of the other things that might have affected me before I blame food. Diet can be a powerful ally in how we treat our disease, but in the end, it’s not the only thing that helps us improve. It is just one slice of the Treatment Pie, one tool in our toolkit. The Treatment Pie – A Multi Modal Approach The success rate in our Facebook group comes from a large percentage (84%) using the Treatment Pie, with just 8% opting for trying the approach initially without prescription medication. This can be most effective for those with episodic migraine. We see most of our members improving more rapidly when they combine prescription medication with the multi modal approach demonstrated in the Treatment Pie (also including supplements, movement, diet, sleep, therapy, meditation, hydration). Take a few minutes to read our blog on the Treatment Pie to understand why throwing everything at migraine can net you the best result. What Do The Experts Say About Diet? It seems every week we see a new headline about which diet is the ‘new healthy’ or the one that will lead us to our demise. The recommendations change monthly, sometimes weekly, about what we should and shouldn’t eat. Is it no wonder that there is little consensus in the migraine community about diet? Our blog about the science behind migraine diets explains the dilemma. Part of the problem is that an elimination diet isn’t super easy. It can be frustrating and annoying to do on your own. I know. I did it. Doctors also loathe adding to our stress by suggesting something that they can’t support in their offices. That’s part of the reason the Migraine Strong Facebook group is around. To offer a community to those that want to give this a try with support from those that are also doing the same thing. Join us on Facebook for a fun, educational and supportive community that talks about a lot more than diet. However, if someone has told you that migraine diets ‘don’t work’, come check out our group to get the scoop on what is happening with us. We think there is a place for diet in the treatment of migraine. It can be a powerful tool that you just won’t know if it works until you give it a try. As always, we’ll be here to help. This blog contains affiliate links
A Vestibular Migraine diagnosis can add challenges to getting quality sleep. As a result, sensitivity to movement, tinnitus and vertigo all hinder quality sleep. Read on to learn some usable tips for dealing with these troublesome symptoms while encouraging your best rest. What to do about Tinnitus Many VMers in our closed Facebook group Migraine Strong reported having difficulty falling asleep due to tinnitus (ear ringing) that is particularly bothersome when it’s quiet. While it goes against other sleep advice, our members with tinnitus feel it’s helpful to mask tinnitus by falling asleep to sound. I agree that falling asleep with a little sound helps me feel more relaxed than I would if I was lying in silence listening to my ears ring. So do what works for you and what makes you feel the most relaxed even if it breaks some of the typical sleep rules. To help ease or mask tinnitus try… Listening to a podcast or a TV that shuts itself off with a timer. Turn on a sound machine with soothing rain or steams. I recommend this one that won’t drive you crazy by looping the same sound over and over. Control the anxiety that likes to tag along with this symptom. Try guided meditations, guided imagery or sleep stories through the Calm App. Try aromatherapy, deep breathing or tense relax exercises as well. Lavender or vanilla scents helps promote sleep. Vinpocetine and Ginko Biloba can help ease tinnitus by pushing blood through small capillaries helping to improve oxygen flow and reducing tinnitus intensity. I like Pure Encapsulations Cognitive Factors because it combines the two. An added bonus is that it also helps relieve brain fog. Some people find lemon bioflavonoids help to ease ear symptoms. It contains a high concentration of eriocitrin which also helps dilate capillaries and small blood vessels increasing oxygen and blood flow. Only authentic lemon bioflavonoid will work. It can’t be citrus bioflavonoid. I like Lindberg brand which I’ve only seen sold here. This Sound Pillow features soft speakers inside to provide you with discreet tinnitus masking without disturbing your partner. Amazon also sells soft speaker mats to place under your favorite pillow. Limit your use of ear plugs particularly while sleeping. Earplugs can reduce your ability to hear external noise making tinnitus more noticeable. Cognitive Behavior Therapy involves working with a therapist to identify and develop strategies to change negative thought patterns that can happen when dealing with this symptom. How to Avoid Sleep Triggered Vertigo It’s important to remember that when most people think of vertigo they think of the spinning sensation that results from “loose crystals” in your inner ear. That type of vertigo is a peripheral vertigo (stemming from your ears) called Benign Paroxysmal Positional Vertigo or BPPV. While those with vestibular migraine can certainly get BPPV and even have a higher prevalence of it, generally vestibular migraine vertigo is different. It’s central vertigo resulting from a disturbance in the brain and not the ears. That means the epley and similar maneuvers are not going to help resolve it. To resolve vestibular migraine vertigo you must get treatment. Please search for an experienced neuro-otologist or neurologist in your area, Even with treatment, for some VMers sensitivity to movement can make it more difficult for us to get a good night’s sleep. Sometimes turning on our side can make us feel an instant spin, but for others only a side position will do. We can have difficulty rolling over and with various head positions that happen while tossing and turning during the night especially if we’re lying flat. As a result, many of us prefer to sleep upright and on our backs. Here are a Few Tips to help Avoid Sleep Triggered Vertigo. Most importantly, get treatment for your vestibular migraine. We recommend a multi modal approach of medication, supplements, diet, exercise etc. under the care of an experienced physician. Try vestibular rehab to train your brain to compensate for sensitivity to movement. Minimize stress. Try deep breathing exercises, meditation, gratitude journaling, forest bathing etc. Whatever helps you feel calm and relaxed…do that! Exercise regularly. Practice good sleep hygiene. Tips can be found in our part one sleep blog here. Train yourself to sleep on your back or the best position that works for you. You can try a wedge pillow, body pillow or adjustable bed to increase success. Elevate your head. This travel pillow can help support your neck while your head is elevated. Wake up slowly. Rising up quickly after lying down for hours can trigger dizzy symptoms as well. Try over the counter meclizine or a very low dose prescription medication like Valium or Ativan before bed. (*Note these should be used short term). Learn more about what Dr. Hain says about benzos and vestibular migraine here. My Personal Sleep Struggle Before vestibular migraine I was a tummy sleeper but since my diagnosis, I’ve needed to sleep upright and on my back. It was no easy task to train myself not to flip over during the night. Early on in my diagnosis I was still trying to sleep in bed. At that time we had, a popular brand mattress with an adjustable base. When I raised the head of the bed up, it forced my guy to have to sleep upright too which definitely wasn’t ideal. On top of that, with the head raised up, I’d end up sliding down sometime during the night & I’d wake up squished at the bottom of the bed or I’d keep turning over in my sleep causing quick vertigo spins. I was so nervous that these quick spins would prevent my brain from calming down so I did my best to avoid them. I tried wedges and body pillows to keep myself propped up but, they just were not enough to keep me where I needed to be and my guy was still forced to sleep higher than he liked. I began to accept that the recliner was the only way I could successfully keep from disturbing my guy and keep myself upright during the night. So I slept in a recliner for nearly two years after diagnosis. A freaking recliner…for TWO YEARS! My Solution My sweet guy kept saying we needed to come up with something to get me back to bed and he was right. Neither of us liked sleeping separately away from one another. While I got used to sleeping in the recliner, I didn’t want my sleeping habits to cause us to drift apart and the separate sleeping arrangement was going on too long (for us). That concern began our search for something that might work for us. After looking at many adjustable bed options we ended up taking a chance and purchasing an inexpensive mattress (we chose two 14 inch twin XLs) and adjustable base from Amazon. This was a bed we didn’t get to lay on before purchasing, we bought it solely based on reviews but, I’m SO happy we did. We chose the split king (two twin XLs) adjustable base so that I can sleep upright at an incline and my guy can lie flat without disturbing each other. We chose a soft cool gel memory foam mattress to go on top of it and it’s totally working! Even though it’s less expensive than the name brand bed we owned before, this mattress is the most comfortable I’ve ever owned. Really, I love it. I don’t know what the difference is in the way this bed tilts but, I have no trouble staying up at the incline that works for me. I adjust my pillows into an upside down U shape to elevate my head and support my arms and I never slide down to the bottom anymore. Happily, I can report that I’m finally back in bed next to my guy where I belong with no spinning! Now if I could just find something on Amazon that keeps my Weimaraners from squeezing into bed with us…winky face. Sweet dreams. This post contains affiliate links.
June is a Migraine and Headache Awareness Month. Every year, in June, migraine advocates, health care providers, and various organizations combine their efforts to raise migraine awareness. Migraine Strong stands with all of them by raising migraine awareness to eliminate the stigma. As you may know, Migraine Strong is led by 5 strong women who also have migraine. Each one of us used our experiences of pain and transformed them into passion to advocate and help people take control of migraine. Migraine is a debilitating neurological disease that affects 39 million men, women and children in the United States and 1 billion worldwide. Migraine is prevalent, destructive, misunderstood, and often dismissed as “just a headache.” After all, it is an invisible illness. The pain, dizziness, brain fog, aura, tinnitus, just some of its symptoms cannot be seen or heard by our friends, co-workers, employers, or strangers. As a result, people with migraine are not always believed or are thought to be exaggerating. This contributes to the stigma surrounding the disease. Stigma The migraine stigma affects research funding, causes mistreatment of employees in the work setting, and increases social isolation for people with migraine. It even contributes to the shortage of medical professionals focused on migraine. In fact, it is because of stigma that people with migraine are less likely to talk about their experiences. And it is that silence that feeds the stigma and it becomes a vicious cycle. How do we break away from this cycle? We need to speak out and raise and awareness. Migraine Awareness Dr. Robert Shapiro, a board-certified neurologist and professor of neurological sciences at the University of Vermont, says that “in order to move beyond the stigma” it is actually “important and necessary” for people with migraine to speak up about their symptoms and the disease. “Advocacy takes many forms,” said American Migraine Foundation Director Nim Lalvani. “It could range from telling a family member that you live with migraine to fighting for migraine-friendly policies in the broader community.” If you are interested in making a difference in migraine community, it is up to you to figure out what makes you the most comfortable and where you can make the most impact. Here are the five ways you can be a migraine advocate: 1. Speak With Your Friends And Family About Migraine By sharing your migraine story with your family, friends, or co-workers, you educate them about this neurological disease. You have an opportunity to teach them that migraine is more than a headache and that it has a devastating impact on people’s lives, including your own. Once you start talking about migraine, you will be surprised how many people you know also have been affected by this disease. Yes, at first, sharing our story can be scary and intimidating for fear of being judged or shamed. But there are so many positives to sharing your story as well. Sharing our story can help others realize that they are not alone and offer hope that they desperately need. Sharing our story can also be empowering and help ourselves during the healing process. Finally, sharing our story raises awareness by teaching others to appreciate the impact migraine has on our lives. Your voice and story is unique and powerful. It can make an absolute difference and so can you. Use it to join other voices to make a change. Inspire others with your story of strength and hope. Are you ready to share your story beyond your family and friends? You can submit it to our partner, American Migraine Foundation to be published on their website. 2. Share Information About Migraine On Social Media To Spread Awareness Social media can be a valuable tool in raising migraine awareness. In addition to the Migraine Strong Facebook group, Migraine Strong has a strong presence on social media with an Instagram account, a public Facebook page, and a Twitter account. These accounts are public and that is where we post blogs, graphics, and articles about migraine. When you see an article, blog post, or other helpful information about migraine disease, share the link to your Facebook page, Instagram account/stories or re-tweet on Twitter. By doing so, you are spreading awareness. 3. Change Your Language It is time that we collectively started being intentional about our language when it comes to migraine. Migraine is not a headache and we need to stop referring to it as such. One of our Migraine Strong FB Group administrators, Jennifer Bragdon, has been vocal about this topic in the group for the past year. So we were excited to hear at the 2019 Migraine World Summit that most experts do not use the word “migraines.” The “s” in the word “migraine” needs to be eliminated because migraine is a disease, not a symptom. It is a neurological disease which doesn’t just exist while we are in the middle of an attack. We don’t get “A migraine” or “migraineS.” We HAVE migraine. Even when we are not experiencing symptoms, Jennifer goes on to say, “we have to work on suppressing an attack through trigger avoidance, lifestyle changes and for some of us, daily preventive medication(s).” While talking about specific symptoms (head pain, dizziness, nausea, paralysis, fatigue, blurry vision, etc), refer to them as “migraine attacks”, or “migraine pain.” Why does changing the language even matter? Referring to migraine disease as “migraines” sounds to much like “headaches” and further perpetuates the stigma that migraine is just like a headache when it is so much more disabling than that. This small change in our vocabulary can make a huge impact in reducing stigma and raising migraine awareness. 4. Be Your Own Advocate One of the ways to become an advocate is to become your own! It is also absolutely necessary to be your own advocate before advocating for anyone else. Educating yourself about migraine, possible diagnoses, symptoms, and treatment options is one of the best things you can do for your health. Showing up for an appointment with your neurologist or a headache specialist and passively listening to what they have to say may not be enough to set you on the path for improvement. You need to come as an informed and educated patient who is prepared for the appointment and ready to be involved in the conversation about your care. Becoming your own advocate is your best chance at improving your health. If you have an appointment coming up, this blog is a great start – 20 Questions to Ask Your Specialist. 5. Join A Migraine FB Group And Support Others While Being Kind Those of you who are members of the Migraine Strong Facebook Group already know that we are a different kind of group. Our members and administrators speak to each other with utmost kindness and respect. Migraine Strong is our safe space and we guard it fiercely. Our members are advocates on a daily basis. They push each other to advocate for themselves in their daily lives and they do so with compassion. Whether its giving advice on how ask doctors about trying out new medications, how to speak to family members about migraine, or how to stand up for themselves in the workforce. Our migraine family is raising our own advocates. There are many migraine groups on Facebook. No matter which group you join, you can become a migraine advocate as well. You can share your experiences in the group, help other members with questions, and support them on their individual healing journeys. Along the way, be gentle and kind. Furthermore, ask the administrators of the group if you can assist them in raising migraine awareness, by sharing blogs, graphics, facts and quotes. Other Ways To Get Involved In addition to the 5 ways discussed above, there are more opportunities to get involved: Headache On The Hill – the goal of Headache on the Hill is to unite healthcare professionals, migraine and cluster headache advocates and patients to speak to members of Congress about the experience of living with migraine. If you do not wish to speak in front of Congress, head on to the “Take Action” tab on their website for tasks you can do at home. Miles For Migraine – Miles for Migraine produces fun walk/run events, typically a 2-mile walk and 5K and 10K races to raise money for migraine research. Aso hosts adult education days, and a youth program for kids and teens impacted by migraine and other headache disorders. What a fun way to raise awareness and stay active. Check out their calendar for the races near you. Runnin’ For Research – organizes and implements 5K runs and walks throughout the United States. Their mission is to improve the quality of life of those who suffer with headache and migraine disorders through fundraising for quality research and the promotion of patient empowerment, community awareness, and local and national advocacy. Check out their calendar for the races near you. Migraine Solidarity Day, June 21, wear a pair of sunglasses to support the 1 billion people worldwide who live with migraine disease. Post your photos to social media with the hashtags #ShadesForMigraine and #MHAM. RetreatMigraine – this is a conference led by and focused on people living with migraine disease. The retreat provides support, community, disease and treatment education, advocacy training, and complementary therapy experiences. RetreatMigraine has concluded for 2019. You can check back here for announcements about future events. The Mighty – become a contributor for The Mighty, a digital health community created to empower and connect people facing health challenges and disabilities. Write your story or an article about migraine or another chronic illness you have and submit it to them for approval. If they like it, they will publish it! We often feel that our own voice or actions do not matter. We tend to see ourselves as not significant enough to make a change. Often we think that someone else will make a difference. But it is that kind of thinking that stalls our progress. We can all make a difference together by taking those actions that best fit our personalities and that we are physically capable of doing. I will leave you with inspiring words from Amaal Starling, M.D., a top headache specialist, and an amazing advocate in the migraine community, who said “There’s no room for stigma, shame and blame in the genetic neurologist disease of migraine. Reframe migraine one conversation at a time until we shatter the stigma. If we can eliminate stigma, there will be increased funding, more specialists, and better treatments.” You can follow Dr. Starling on Twitter where she writes her own tweets. How would you like to contribute to the migraine community? Feel free to reach out to us and we will try to help you make it happen!
Alicia’s Indoor Lenses Review When I first experienced the horrible symptoms of chronic vestibular migraine I worked at a giant corporate office with an open floor plan – my worst nightmare. As my light sensitivity and ataxia got worse, I was grasping at any treatment I could to still be able to function at work. It’s a terrifying thing to be faced with expiring FMLA and still have ongoing symptoms. I found myself wearing sunglasses almost everywhere, just to get some relief. That’s when my neurologist recommended I try FL-41 lenses. Lenses for Traveling TheraSpecs was kind enough to offer me and Jennifer a free trial of lenses in exchange for an honest review. I selected a pair of the Audrey lenses, which are one of their most popular frames. In fact, I saw a lot of this style at this years Migraine World Summit live event. I was anticipating them being a little heavier on my face than they actually were. It was a nice surprise for thicker frames. My face tends to be very sensitive with certain pressure points, so this was a big plus. Since I received these right before several trips to California and Kauai, it gave me lots of time to test it in airports, which are always a little difficult for me. Since we fly out of DFW, I feel like it’s just constant chaos from tons of people, loud noises, and lots of bright lights and open windows. In fact, a lady was getting tackled to the ground by police while screaming her head off as we exited security. While TheraSpecs can’t exactly take away crazy, it can help with keeping you (and your brain) calm! Anytime I feel my eyes are strained a bit or start to notice that build up of pressure in my head, I would slide them on. It really helped take that edge off. Big Box Stores Obviously I spend a lot of my time at the grocery store and lately with the cookbook, I’m there sometimes 2-3x a day. This used to be one of my worst triggers. I remember first starting the Heal Your Headache diet and feeling incredibly overwhelmed by trying to dodge carts and small children. All while reading tiny little labels when my eyes felt like they were jumping around. When you have a vestibular disorder like vestibular migraine, these types of big box stores can be incredibly disorientating. At the time I really didn’t think of using my FL-41 lenses and now I wish I would have. Most days I can handle shopping without them, but whenever I feel overly stressed or it’s a crazy day there with lots of people, I like to slid these on as a preventative measure. You know when you’re a kid and you pretend certain glasses give you X-ray vision or make you invisible? It’s sorta like that. I kinda like that it feels like I’m in my own little rose colored world. Final Thoughts The only downside I really noticed when trying these was that the rose colored tint is kind of dark and very pink. Now that I work from home, most of the lights in my house are off or dimly lit. I also keep the brightness on my computer screen turned down really low. This made it difficult for to me to use these inside my house when working on my computer. I find they’re better suited for extra bright and busy places like the airport or grocery stores. Perhaps if you’re in an office with a ton of florescent lights that you can’t control, it would be a good fit. Audrey Indoor Glasses Jennifer’s Outdoor Lenses Review I work full time as an Early Intervention Developmental Specialist. This requires me to travel to various local preschools daily to observe children so needless to say, I spend a lot of time driving. On top of that, I live in Florida where the sun shines for at least a portion of nearly every day. After my VM diagnosis, I began to have a lot of trouble with very bright sunlight as well as dappled light. That light that comes in through the trees creating speckled areas of sun and shade that flicker as you drive through them…you know that light I’m talking about right? It’s pretty much torture for someone with vestibular migraine. It’s painful and sometimes even disorienting. So, I knew I needed to do something about it. When I saw an opportunity to try TheraSpecs I knew I had to try their outdoor lenses. The 3 Perks of Outdoor Lenses I have to say I was impressed from the moment I opened the box. I received the TheraSpecs style called The Haven in tortoise. They feature dark, polarized, outdoor lenses that provide better protection against bright sunlight than regular sunglasses with 100% UVA/UVB protection. They were delightfully presented in a well cushioned box, protective bag and even included a lollipop. A LOLLIPOP! If you know me, you know sugar is not a trigger for me and it definitely brings me to my happy place. Score one. Once I put them on I was pleasantly surprised. My head is on the smallish size so I always worry that sunglasses will look too big or fall off my face when I bend down. That didn’t happen with these, they fit perfectly! Score two! The next thing I noticed is how little they weigh. This was unexpected and not something I even considered before trying them on. They are very lightweight, so they won’t cause trouble for those that are sensitive to the pressure some glasses place on your nose. Another great aspect of their fit is that they aren’t tight but are also not so loose they are in danger of falling off. I’m not sure how they accomplished the perfect balance of holding onto your head without squeezing it but they did – score three! Next I stepped outside to get a good look at the tint. I can’t believe how much crisper they make the world look, but still tone down the bright light. It’s like some kind of magic trick. I’m not very tall and often have to look up at people I’m chatting with. Gazing upward toward the bright Florida sun can be problematic. These really do help to turn down the brightness helping to relieve migraine associated photophobia. It’s Really it’s kind of amazing. Score four. The Driving Test Lastly, I put them to the test and wore them while traveling to a school visit. I drove through my first patch of dappled light and honestly, for the first time I didn’t flinch. Before long I was focused on the traffic & songs on the radio. The next thing I knew I arrived at the school. I realized that I wasn’t bothered by the light for the entire drive. I was a little disappointed in myself that I didn’t pay closer attention and focus on my response to the light for the entire drive, then quickly realized it was actually the best possible response. To go on with my day and NOT realize I had vestibular migraine for a few minutes. What an amazing gift. Score five. If I had to have one criticism, the only thing I would say is that I wish the tortoise shell design on the arms of the glasses was a bit lighter in color. It’s so dark you can hardly notice it while I’m wearing them. I think the goal was to match them to the dark lenses. Honestly though, I’ll take the dark arms over not having to cringe each time I drive through dappled or bright sunlight. I love these glasses! If you have trouble with bright, outdoor or dappled, flickering light I would definitely suggest giving them a try. Haven Outdoor Glasses Both lenses were provided to us for free by TheraSpecs in exchange for a review. All opinions are our own.
We’ve joined the American Migraine Foundation to fight migraine, a debilitating neurological disease, together. As part of our ongoing commitment to providing meaningful information, resources and support for those living with migraine, Migraine Strong, is thrilled to announce our new partnership with the American Migraine Foundation. The American Migraine Foundation is the official resource for millions of Americans living with migraine seeking reliable information about diagnosis, treatment and advancements in research. Launched in 2010 as a patient support and advocacy effort of the American Headache Society, AMF’s mission is to mobilize a community for people living with migraine and their support networks, and to drive impactful research into the third most common and sixth most disabling disease around the globe. “Migraine Strong is a cornerstone organization in the migraine world. It is truly an honor to work alongside them as we #MoveAgainstMigraine,” says American Migraine Foundation Executive Director Nim Lalvani. “We look forward to continuing to make an impact together.” Like Migraine Strong, American Migraine Foundation is dedicated to helping people with migraine live meaningful and pain-free lives. We’re so excited to join forces with AMF to provide support, advocacy and treatment innovations to people living with this disabling disease. The American Migraine Foundation supports people living with migraine by providing free, comprehensive information sourced directly from headache specialists, by maintaining a searchable database and map to improve access to headache specialists, by investing in research efforts towards new, innovative treatments, and by creating support networks and communities where people with migraine can support and learn from each other. We couldn’t be more excited about this collaboration. Be on the lookout for additional resources and enhanced communication from our team in the very near future. Together, we are as relentless as migraine.
The Migraine Strong team developed the treatment pie as a way to illustrate the need to attack migraine using a multimodal approach. These nine slices represent the medical interventions and lifestyle changes that are known to best affect migraine outcomes. When applied together, they have a greater chance of reducing the frequency and severity of migraine attacks than any one slice alone. The slices are described below. The Treatment Pie: Medications – Refers to Acute medications (taken at the onset of an attack) and Preventive medications (taken daily to reduce the number of attacks). Rescue medications can also be prescribed to treat migraine symptoms even if they don’t abort an attack. This also refers to neuromodulation devices. Miscellaneous – Many therapies can find their way into this category including chiropractic, massage, cranial sacral, acupuncture. Hydration – The Institute of Medicine (IOM) recommends 74 ounces per day for women and 101 ounces per day for men. Meditation – This is an intentional practice, focusing inward to increase calmness, concentration, and emotional balance. Therapy – Encompasses many different forms of therapy including Cognitive Behavioral Therapy (CBT), Talk Therapy, Biofeedback Therapy etc. Sleep – Waking and sleeping at the same time each day and avoiding naps is part of having a well ordered sleep schedule. The migraine brain likes routine and having too much or too little sleep can disrupt its happy balance. Our sleep blog explains it in depth. Diet – A migraine oriented elimination diet, like Heal Your Headache, (limited in scope and time) can be helpful in allowing the brain to calm from its hyper-responsive state. A Ketogenic diet can also be helpful and this blog explains how to get started from the beginning. Movement – Daily movement is helpful. This doesn’t have to be training for a 5K. It can initially be walking around the living room. Supplements – Several supplements have been shown to be beneficial to migraine including ginger, magnesium, Riboflavin (B2) and Feverfew. Our blog here explains how. Which Combination Of Slices Will Be Most Effective It’s doubtful a day goes by in our closed Facebook group without some reference being made to the treatment pie. It has become one of our favorite resources over the years and with good reason. In this one graphic we can reference every effective piece of treatment we can think of to fight migraine. While each of these slices will have a different percentage of effectiveness for every individual, we have found that combining them makes the greatest impact in our battle to gain control over migraine. The Theory In Practice When I first started working on this theory, I had been chronic and mostly intractable for 18 years. I had tried many medications to reduce and treat my migraine attacks to no avail and had recently been diagnosed with a migrainous infarction (stroke). At the end of my rope as far as treatments went, my headache specialist and I combed back through everything. We determined that I hadn’t really tried an elimination diet, but had previously done an avoidance diet. So I reread the Heal Your Headache book by Dr. David Buchholz and put that into action. I committed to the four months of his plan and looked at what else I could do to make this time most effective. Daily exercise is well known to help with migraine management, so that was added to my list. Several supplements have broad scientific support in their ability to reduce migraine symptoms and attacks so they were added to the mix along with cleaning up my sleep cycle. I kept track of my daily water intake to ensure I was well hydrated. The Calm app was a great way to bring in daily mindfulness and meditation. We also kept my preventive medication the same, but changed my acute/rescue medications. The Result I wouldn’t say that making all of these changes at one time was easy. It wasn’t. I threw more than one adult tantrum in the grocery store looking for foods that were diet compliant. Pausing the treadmill to deal with bouts of nausea was an exercise in sheer stubborn will. And the brain fog I was dealing with, along with copious amounts of pain made everything seem insurmountable. But I had made a commitment to my family to stick with it for four months. After about six weeks I had an amazing break of 22 days with no head pain! Of course, I thought I was cured. Spoiler alert! I wasn’t. I had made great strides in figuring out some things that made migraine shrink away from the light…and I wasn’t going to give up. The treatment pie was in its infancy and would eventually be pulled together with the help of the wonderful Migraine Strong admin team. Deciding What To Try First These questions come up quite often. Should I trial one medication or supplement at a time so I know what is working? Should I start diet first to see if that works by itself? What is reasonable in regards to change when it comes to attacking migraine? These are all good questions and the answer is…it depends. As migraine falls on a spectrum, the mild end and the more severe end, how we attack it will vary. If you have episodic migraine, trialing things within some slices one at a time may work well for you. We would still recommend that you jump on a diet, hydrate, get your sleep cycle organized etc. But when it comes to supplements and medication, we might tell you that trialing one at a time is the right approach to see how things pan out. This way, you would be able to keep a good record of things to see how each addition affected your migraine attacks. When Migraine Is More Complicated However, with chronic, severe or complex migraine it becomes more complicated. Then we would recommend that you throw the entire treatment pie at migraine. And instead of trialing one supplement at a time, hit migraine with ALL of the scientifically recommended supplements as well. If you are trying a preventive with only limited success, we would recommend discussing with your doctor the option of adding another preventive to the mix to boost the one that you’re currently taking. Dosages for both medications and supplements seem best tolerated when started low and increased slowly, allowing for adjustments to any side effects. The majority of our group has sensitivities to medications and seems to do better with a ‘start low and go slow’ approach. We think this approach would help with adjustment to the side effects that so many of us find intolerable. This is important for people with migraine and may be even more important for Vestibular Migraine. While it used to be the conventional wisdom to try one thing at a time, throwing everything at migraine (especially when you are chronic) has a greater chance of having a more satisfactory result. At the 2019 Migraine World Summit, Dr. David Dodick agreed that ‘throwing the kitchen sink’ at chronic migraine is how to get the best results. Once you feel better, you can peel back the layers and see what is working best for you, then eliminate the extraneous therapies. The most important goal is to make a significant impact on your migraine disease and be able to enjoy your life again. Avoiding Analysis Paralysis We want to hit migraine with everything we have to see what sticks. If we can make a dent in the frequency and severity of our migraine attacks, then we can figure out what is helping us the most. Trialing things one at a time could take months or years to figure out what is (or could be) helping us, when it could actually end up being a combination of treatments. By taking this multimodal approach, it also removes the dreaded ‘analysis paralysis’ we can all fall into. When we research every single option without being able to make a decision and analyze everything until we are paralyzed with indecision. Throwing all our options at migraine allows us to figure out what is helping the most! And as always, we will be here to help. This post contains affiliate links.
If you are reading this, then you have heard that the ketogenic diet can be an excellent way to help manage migraine. As a registered dietitian schooled in the low-fat era, I thought “Eww, gross!” about low-carb and keto. I wish I had been more open-minded sooner as keto is not at all what I thought it would be like. It helped my head and my overall wellness and was delicious. You may be considering this significant change in the way you eat to help you find a new level of relief from migraine attacks. I will focus this piece on some basics and not on a history of keto nor if it’s right for you. This is written with the assumption that you have done your own homework and have asked your doctor for input. This also assumes you have decided to learn more and perhaps dive in and commit to keto for a few months to see if it can help reduce attack frequency or lessen some symptoms like brain fog. The focus will be on the general ketogenic diet. Toward the end there will be a link to a video interview where I was interviewed by Ashley Koff, RD, an internationally-renowned registered dietitian, about the ketogenic diet for migraine that you may find helpful. Phase 1 of the ketogenic diet can include some migraine-specific tweaks and I mention those modifications at the end of this piece. What is the Ketogenic Diet? The ketogenic diet is a low carbohydrate diet that is high in fat and moderate in protein. The purpose of this way of eating is to generate nutritional ketosis. If you aren’t currently on a ketogenic diet, your metabolism is using glucose (blood sugar) as its primary fuel source. Your body gets the glucose it needs from digesting the foods you eat as well as using stored glycogen from your liver and muscles when you haven’t eaten in a while. After prolonged periods without adequate food and/or extreme exercise, you may start using your body’s fat storage. When your body uses its fat, the fuel source is from ketones. Fat does not breakdown to blood sugar so your body switches fuel sources from blood sugar to ketones. The keto diet excludes all added sugars, grains and starchy vegetables. Because of the natural sugars in fruit, small amounts of berries are the only suggested fruits. Although technically, avocado is a fruit and is allowed. Keto includes lots of fat and fatty foods. All meats, poultry and seafood are allowed as well as full-fat cheeses and cream. Low-carb veggies and leafie greens are allowed. Getting into consistent, sustained ketosis is what I consider as Phase 1 of keto. For most people this will take at least a few days and will depend on your own metabolism as well as how low your carbohydrate level has been. The goal of maintaining the diet is to switch your metabolism so that you become a fat-burning machine instead of a carb-burning machine. Phase 2 of the ketogenic diet happens when your personal “hybrid engine” goes through a process referred to as “keto-adaption.” Based on the research and observation of Dr. Stephen Phinney, one of the most prominent doctor in the field of low-carb and therapeutic ketosis, this process can take several weeks but is usually complete by 8 weeks. During this phase of the ketogenic diet, your brain, other organs and your biochemistry must adapt to have the appropriate amounts of enzymes for the different types of chemical interactions that keep us healthy and feeling good. For most people, this Phase 1 transition period is not notable but others may have some symptoms like lethargy and headaches. Getting Started – Phase 1 This is the nitty gritty of what you need to know to get you through the earliest and trickiest phase of the ketogenic diet. There are three steps to phase one which I outline for you below. #1- Commit to keto for at least 3 months and print a list of allowed foods. Pay special attention to having enough quick, convenient foods that are portable if you know you will be eating away from your home. Keep things simple. In this early phase, keep daily carbohydrate intake to 20-30 grams. I suggest keeping it simple and not trying to make some favorite carby foods into acceptable keto foods. Save cauliflower crust pizza and keto desserts for another time. My favorite resource for practical information is DietDoctor.com. This beginner’s section is excellent and the visual guides are beautiful as well as helpful in understanding carb sources and making the best choices. This snack list will help you plan foods to always have at the ready. Planning and setting up your environment is critically important in the beginning but will become second nature as you get into ketosis and think less and less about your next meal. Buy and prepare lots of simple favorites from the lists. Plan on luxuriating in decadent, fatty foods. This will keep you from obsessing about the carby foods that will not be on your plate. If you have a sweet tooth, you may want to make some simple “fat bombs” to keep on hand to help with cravings. Your current diet may be quite high in carbohydrate. Jumping into keto was surprisingly easy for me. I was addicted to sugar and carbs and I’m still shocked that I not only survived, but thrived. Anticipating being without carbs was worse than the reality of what the diet was like. The yummy, satisfying fat suppressed my appetite and surprisingly took most of my cravings away. Embrace this change and know that the way you will be eating will change quite a bit. DO NOT TRY TO HAVE A PERFECT, WELL-FORMULATED KETO DIET DURING PHASE 1. You will not be eating like this for long. Your goal is setting up your first week or two to be as easy as possible and that might mean being repetitious and decadent. I ate an embarrassing amount of cream cheese but it was delicious! Planning is key. #2- Get a bunch of cheap Ketostix from the diabetes section of a pharmacy or order these on Amazon. These are urine dipsticks that will help you determine if your body is making ketones. It is not a great way of measuring your degree of ketosis but will help you know when your body is shifting into ketosis and can be quite motivating when you see your first positive signs of ketones. Blood monitors are much better but that is added expense and probably not necessary. The results from Ketostix merely provide some info that is likely helpful in the early stages of the diet. I admit to being obsessed with the ketostix and using them a few times a day. I was very excited to see my efforts paying off and couldn’t wait to see my results. #3 Keep hydrated and focus on your electrolytes. When starting the ketogenic diet, your body goes through many changes as it becomes a fat-burning machine. For many people, the keto foods they choose to eat are whole foods and much less processed than foods they used to eat. This often means that their sodium intake is lowered without them realizing it. At the same time, the lowered carb intake and burning-off of the body’s stored carbs signals the kidneys to make more urine. So, many people notice that they are needing to pee more as well as needing to drink more. For overall health, as well as to avoid some of the common side effects of keto, it’s important to boost your fluid intake as well as your electrolytes (sodium, potassium and magnesium) intake. DietDoctor.com recommends drinking 3 liters per day (~101 ounces) for the first week of keto. As someone who struggles with drinking enough, that amount seems daunting but it’s just during the first week of keto. Paying attention to electrolytes is also very important for overall health and easy transition to ketosis. This link discusses amounts and sources of key electrolytes to make sure you are aware. Personally, I do best when I drink homemade, salty broth along with salting my food well and taking my usual magnesium supplements. Keto for Migraine Many of you have already noticed that quite a few keto mainstay foods like avocado, aged cheeses, nuts and bacon are considered common migraine triggers. I typically recommend going through a migraine-oriented elimination diet prior to trying keto to figure out your potential food triggers. If you have figured out your triggers, you should avoid them in Phase 1 of keto. Once you are in ketosis, the ketones seem to work their magic and provide a virtual force field and allow trigger foods to be safely eaten. Weird, right? I had a LOT of food triggers but was able to eat nearly all of them while in ketosis. It was fantastic and I felt more freedom at restaurants. My experience with this force field phenomenon is not unique, fortunately. I hope keto allows you to find relief as well as enjoy foods you have been avoiding. Combining Phase 1 of keto while eliminating common migraine triggers can be rather repetitive, but is certainly doable as it typically lasts for just a few days to a week. You can find a pattern that will work for you. However, you certainly do not have to do these tweaks especially if you are not convinced that the common triggers that I mentioned are YOUR triggers. You can simply jump into the unrestricted keto food list. There is a lot more to the ketogenic diet than the above 3 steps, but the steps and the resources from DietDoctor.com will help you get on your way. Look for more information on the ketogenic diet as when I write my next blog on Phase 2 in a few weeks. Video Interview Of Danielle Aberman By Ashley Koff