HEALTH

One of the first things you learn when you start managing your migraines is to identify and avoid triggers. I learned this some years back, shortly after a murderous 5 day migraine I had in Arizona - I was at higher altitudes than I was used to, and there were forest fires all week, exposing me to lots of smoke. I was drinking way more coffee than usual to keep up with a busy vacation schedule with lots of driving. I was on an erratic sleep schedule. Voila: smoke + altitude + excess caffeine + sleep schedule changes = nasty head-banging five day migraine. This experience started me on an important inquiry - what are my triggers, and how can I avoid them?

There are common migraine triggers and then the ones that seem relatively unique to each of us. If your brain is a loaded gun, ready to fire off with a migraine, and you know what pulls the trigger, that helps, right? You can avoid the triggering event or substance and reduce the likelihood that you'll get a migraine. Those who have developed chronic migraine can be described as having a hair trigger - their nervous systems are being tripped off constantly.

Thinking terms of triggers, I find myself wondering what loaded my migraine gun, and how I can I keep it unloaded. I don't know that much about guns, but I know that with an old-fashioned revolver, you need to first load it, then cock the trigger, then fire. This gives us a useful analogy - we want to stay unloaded, and if perchance we get loaded, we want to avoid cocking that trigger.

It takes more attention, more thought, more observation and introspection to stay unloaded than to determine your triggers. Practices that calm our nervous systems can help keep the gun unloaded. When I took on a daily relaxation practice, doing deep breathing and meditation to calm my system down every day, I reduced my migraines. When I got out of practice, the migraines started increasing again.

In an oversimplified description: in a migraine attack certain stimuli trigger neurons in the brain to fire off (there goes that gun analogy again) in a rapid sequence, increasing vascular pressure. This leads to head pain, nausea, dizziness, visual disturbances (aura) and in rare cases, temporary paralysis. Common triggers include:

- Bright or flashing lights

- Smoke

- Dehydration

- Chemical fumes, scents

- Alcohol (particularly red wine)

- Hormonal fluctuations (including menstruation)

- Insufficient sleep, too much sleep, or changes in sleeping patterns

- Changes in the weather (usually large changes in barometric pressure as when a frontal system moves through)

- Motion travel

- Loud noises

- Certain foods

- Changes in altitude, or being at a high altitude when unaccustomed to it

- Sudden or drastic changes in eating habits (such as missed meals or dieting)

- Changes in caffeine consumption

Think again about your triggers. Are there times when you just don't know what hit you? Or times when you get Migraines but can't identify a trigger? You may get lots of Migraines on the weekends. If you look more closely, you may realize that you sleep later on weekends, or eat differently. Dig deeper. Think about the hidden triggers that may be affecting you. Think about things that may have happened up to 2 days before the Migraine hit. Expand your list.

In addition to whatever triggers you have identified, you need to take stress into account. Stress itself is not considered to be a migraine trigger, but it lowers your resistance to other triggers. Stress also makes you tense up, especially in the head, neck and shoulders, which can bring on a tension-type headache. For migraineurs, a tension-type headache can trigger or morph into a migraine. Some of us seem to be able to resist all our triggers until excess stress hits.

What do you have to give up to avoid triggering Migraines? It's easy to say "I need to give up chocolate - I need to get to bed by 10:30 every night - I need to stay out of smoky bars - stop going to concerts." Easy to say, hard to do. It's hard to give up things we enjoy. It's important to allow ourselves to feel grief for what we must give up. It may or may not be forever. But if we ignore our sadness, that sadness is underneath, adding to our stress and pain. List what you are giving up. Let yourself mourn the changes you must make to be healthy. What are you giving up, that you will miss or mourn for? What would it look like if you let yourself mourn?

We are given the term trigger to describe what happens to our nervous system in a Migraine attack. I took that term to the logical conclusion and brought you the picture of a cocked gun. What more positive image could we use for our sensitive nervous systems? Prayer plant leaves curl up if they are touched. Flowers bruise and wilt. A butterfly's wings lose precious little feathers if brushed. A bubbling pot of delicious soup will boil over if too many ingredients are added. Puppies are bouncy and resilient, but also need to be treated gently. What is a beautiful, positive, fun, endearing thing that your nervous system could be, that you could want to care for? Think of a better image for your nervous system. Think of 5 better images of your nervous system. Write them down.

"Avoid your migraine triggers, " is a piece of advice we've all heard. It's good as far as it goes. What if we took on not avoiding something but creating something? What if each of us took on creating a life that nurtures our unique and sensitive nervous system?