Migraine is often associated with trouble sleeping. This means that a sleep disorder could be making your migraine worse, or your migraine may be contributing to your lack of sleep.
One of the comorbid conditions, a condition that tends to go along with migraine, is restless legs syndrome (RLS) (also called Willis-Ekbom Disease). In RLS, you have trouble sleeping because of sensations in your legs. Your legs feel restless, or throbbing, or aching.
In searching for the latest research for RLS, I was reminded of one that is being used currently that has also been used for a long time for insomnia itself – and that is, progressive muscle relaxation. It was first described in medical literature almost a hundred years ago, but it’s still being studied today.
The beauty of progressive muscle relaxation is that you can learn to do it at home in bed, with no devices or drugs, and no spending of money. 🙂 It’s a technique that has been used with migraine patients, restless legs syndrome patients, and insomnia patients alike. That means that it also may help improve symptoms in a number of related conditions.
Progressive muscle relaxation is a specific way to tense and then relax muscles throughout the body. Detailed descriptions can be found in the linked articles below, but it’s not complicated. And trials have had quite positive results.
If you have trouble sleeping, do yourself a favour and check out an article or two below. This is a simple technique that may make a significant difference.
It’s common to get a headache along with a stroke, or even in the days afterwards. But there is a significant percentage of patients who end up with chronic headache in the months and even years that follow.
It’s very difficult to study post-stroke headache and post-stroke pain in general. For one thing, we don’t understand exactly why it happens (in many cases), which means that we’re not always sure that the chronic headaches are a result of the stroke. Also, the connection between migraine and stroke is well known (see for example Migraine: Doubling the Risk of Stroke?). So it could be that many patients are experiencing a progression in migraine symptoms that may have happened with or without the stroke itself (see the 2019 study Headache after ischemic stroke).
However, typically, chronic headache connected to stroke has a more tension-type headache quality. It can be severe, but it usually lacks some of the tell-tale migraine symptoms such as sensitivity to light and nausea. Usually, but not always. The pain also tends to be more constant, and get worse over time.
There are some common known causes of post-stroke headache. For example, you may be experiencing a side effect from your medication.
But once we get past those common causes, things get a lot more difficult. (Stanford Medicine had the rather discouraging comment regarding post-stroke pain in general – “Medical treatment for post-stroke pain is generally disappointing”!)
At this point, it seems that post-stroke headache, or chronic headache after stroke, is as complex and variable as any kind of headache when it comes to treatment.
If you have experienced chronic headache symptoms after having a stroke, there are some important steps that you need to follow:
Record as much information as you can about your symptoms. When did they start? Have you noticed anything that triggers them? What are your symptoms? Are they constant, intermittent, increasing?
Talk to a doctor or specialist as soon as possible. As mentioned above, there are some common known causes. The solution may be obvious, and you can save yourself a lot of trouble by finding the right treatment early.
Consider talking to a headache specialist, and make sure she or he knows your medical history. You may need to look at current best treatments for this type of headache, but knowing your medical history (including details about your stroke(s)) may help the specialist find better customized treatments for you.
Take care of yourself. Relying only on the next medication can set you up for long term problems. Plus, many of the medications used for chronic post stroke headache have side effects that you’ll need to deal with as well. Eating healthy food, getting proper rest/sleep, engaging in face to face social activities on a regular basis, and slowly and steadily working on an exercise plan under your doctor’s care can make a huge difference. This should go along with medications or treatments that your doctor may recommend.
A study published last month in the journal Nutrients showed some positive results for migraine patients on keto. But it’s not that simple, so let’s take a closer look.
It’s tempting to come up with a headline such as “Keto Diet shown to fight Migraine Symptoms” – but we have to be careful here. It is notoriously difficult to do studies on diet, because diet is so complex. If a patient shows improvements, what part of the diet was really the “cause”? Or was it a combination of things? Or, in some studies, patients who eat a certain way also tend to do other things in life differently.
The other challenge here is that there is no “THE Keto Diet” – in spite of what promotions and labelling may make you think. Yes, “keto” does refer to a specific, measurable thing – it puts your body in a metabolic state called “ketosis”. But of course this can be done using very different diet plans. And the very vague “low-carb diet” may not be keto at all.
The authors of this study are well aware of these and other limitations. They’ve done their best to be very specific about the diets they used. You can read the study yourself using the link below, but let’s look at a quick summary.
The study used three very specific keto diets for at least three months. The specific ratios in the diets (e.g. calories, protein) were adjusted depending on body mass index and general physical activity.
Patients were then monitored for migraine frequency and intensity – but fatigue was also a very important part of the study. All three were measured with recognized metrics.
In the end, there was significant improvement in all three metrics. Migraine attacks were less frequent and less severe, and patients experienced less fatigue.
How all these things were related is difficult to say. Did less intense migraine attacks simply result in more energy in general? What part did weight loss play?
And importantly, what about other diets?
The study authors do look at how this study relates to other studies. This isn’t the first time, by any means, that keto has been indicated as a migraine-fighter, both from anecdotal evidence and scientific studies. So this study does seem to further confirm that keto can be a help. But as the authors note:
Snetselaar et al. conducted a systematic review examining 12 randomized trials evaluating the effectiveness of different types of diets in patients with multiple sclerosis. Eight dietary interventions were compared: low-fat, Mediterranean, ketogenic, anti-inflammatory, paleolithic, fasting, calorie restriction, and control (usual diet). Paleolithic, low-fat, and Mediterranean diets showed greater reductions in fatigue than the control. Considering these results, in the future, we could compare the effectiveness of the KD on curbing fatigue in migraine patients compared with other dietary regimens.
Sometimes “contradictory” diets all help fight migraine – perhaps because most tend to cut down on processed foods and sugar. But that doesn’t mean all diets are equal – we keep researching to find which may be the better migraine-fighter, and perhaps the real question is which is best for you. However, so far, some keto diets do seem to be on the top tier of diets to try.
A useful review was published last year in the medical journal Current Pain and Headache Reports, regarding migraine in patients over the age of 60. It was brought to my attention by an article in Everyday Health last month.
It might be useful to get a quick overview of some of the report’s findings.
Many people with migraine are told that their symptoms will likely diminish or go away as they get older. And that is often the case, especially from a strictly statistical standpoint.
But you are not a statistic, you’re an individual. And the fact is that many people continue to have regular attacks into their 80s, or even start having attacks in their older years. The report found that 10% of older adults had migraine, now spread out more evenly between men and women.
If you started having attacks before the age of 18, you’re more likely to continue having attacks in later years.
How is 60+ Migraine different?
Attacks may not be different, but they can change throughout life. For example, many older adults find that:
Their headache pain is now more often two-sided
They may be less sensitive to light and noise
They may experience fewer “cranial autonomic symptoms”, such as congestion or watery eyes during an attack
Sometimes the attacks are less severe
They may experience “stroke-like” symptoms for the first time, including visual aura, trouble speaking, or difficulty with movement
How is 60+ Migraine diagnosis different?
Your headache specialist will want to make sure that you’re not suffering from other problems that become more serious with age. For example, since migraine attacks can mimic stroke, the most urgent thing with any new symptoms is to quickly rule out stroke.
Cardiovascular issues in general are important to check as well.
The report gives some helpful information about the timing of the headache. For example, if you have headaches that get worse at night, brain imaging might help with diagnosis. Headaches worse in the morning may indicate sleep problems, such as obstructive sleep apnoea.
It’s also all the more important for your doctor to know your medical history, and to watch for any current infections or other problems that may be related. It’s also very important that they pay attention to medications and supplements you may be taking, which could affect or even cause headaches.
How is 60+ Migraine treatment different?
Aside from ruling out other conditions, migraine treatment in older adults can be tricky because of concerns about medication interactions, and other contraindications (e.g. medical reasons why a medication may make another condition or risk factor worse).
CGRP related medications, although they don’t have the long-term history of other medications, are looking like a positive treatment for older adults. The study specifically mentioned lasmiditan, ubrogepant, and rimegepant. Candesartan, also used for high blood pressure, may help.
However, many older medications used for migraine may be used. Some, with newer evidence, are not as much of a concern as they used to be. So there are many other options that your doctor may suggest. The report simply gives the good advice that it’s especially helpful if you’re 60+ to start at a low dose and go up gradually. It requires patients, but it’s worth it.
Although the report briefly talks about lifestyle (diet and exercise), it doesn’t spend time talking about many non-drug treatments. These should be discussed with your doctor, but it widens the options significantly with good evidence-based treatments.
If you or someone you love is 60+ with migraine, it’s worth taking a look at this article, and the report – which is more technical, but has a lot of information.
It’s just in the trial stage. But – what actually is it? Well, it’s the continued evolution of migraine-fighting devices:
The device above is currently called Mi-Helper, and it may not be what you expect. No, it’s not a CPAP, but there are some similarities.
Mi-Helper comes from previous technology known as CoolStat. CoolStat, primarily being developed for hospital use, is a small portable device that provides clean air to a patient at a specific temperature, allowing doctors to keep the body at a specific target temperature without changing the environment of the whole room.
Mi-Helper will also be a drug-free device, and it works similarly to the CoolStat, though it will be developed specifically for migraine patients.
ObvioHealth, the company which will be carrying out the clinical trial, explains Mi-Helper this way:
The small Mi-Helper device* delivers a controlled stream of conditioned air with a nebulized mist to the mucosa membranes in the nose, providing relief from migraine-related pain and associated symptoms such as nausea and photosensitivity. *Mi-Helper is for investigational use only and has not yet obtained FDA clearance
The treatment is estimated to be about 10 minutes, when you feel a migraine attack coming on.
Cooling and oxygen methods for migraine have been around forever, and are very effective. If this device can provide targeted home treatment to the patient, it could be a significant way to fight an attack after it’s started. If this device works well and can be widely distributed, it has great potential.
ObvioHealth hopes to begin recruiting for clinical trials this summer.
For more information, check out the video interview (which actually has some very interesting insights into medical device development) and pictures at Key Tech: CoolTech Medical Mi-Helper