Managing Migraine

General Facts

• Migraine is a common condition that causes headache and many other symptoms

• Migraine can occur at any age. Most people find migraine symptoms get better as they get older

• 1 in 7 people have migraine (15% of the population). Three times as many women have migraine as men

• It is a myth that migraine attacks are always severe – migraine attacks may lead to mild, moderate or severe impact

Is it Migraine?

If you have any persistent or frequent headache make sure you consult your NHS GP. Clinical assessment is essential in the diagnosis of migraine, to rule out other causes of headache.

Migraine attacks may include a headache, nausea, vomiting, visual disturbances (aura), word-finding problems, brain fog, dizziness and even muscle weakness.

To find out more about symptoms of migraine visit the NHS migraine website here: Migraine – NHS.

Tension headaches are also common in performers.

If you think you have been affected by migraine in the past, ask yourself the following questions:

• In the past 3 months, has a headache limited me from working, studying or doing my daily activities on any day?

• Do I feel nauseated or sick to my stomach with my headaches?

• Does the light bother me a lot more when I have a headache?

If you answer yes to two or three of these questions, you may have migraine. Arrange an appointment with your NHS GP and see below for more advice about how it can be helped. If you have any persistent or frequent headache, consult your NHS GP.

What Causes Migraine? 

Research into the causes of migraine is ongoing. Environmental factors in and around the body are implicated in the impact of the attacks. Certain neurochemicals in the brain have been identified that are important in triggering attacks and this has led to the development of new, migraine-specific medications.

Sometimes attacks may be triggered by:

• Hormonal changes and hormonal medications such as the contraceptive pill – it is important to contact your GP if you experience migraine while taking medication. Migraine attacks can start at times of physiological change such as Perimenopause and Menopause – they may not be persistent and often settle when the body reaches a new equilibrium

• Fluctuating blood sugar levels

• Dehydration

• Poor sleep

• Computer/TV screens and bright lights

• Stress

• Weather conditions such as thunder, rain, sun and heat

• Change in routine

• Food and drink – Most importantly, make sure you eat regularly and don’t skip meals. See the section below for more dietary advice

What Can Help? 

Everyone’s needs are different and it may take time to find the best management for you. For example, caffeine may relieve symptoms for some people but aggravate them for others. Discuss your symptoms and management options with your GP, specialist or dietitian.

You may find it helpful to explore these options:
 

• Lifestyle and nutrition strategies

• Supplements

• Acute, rescue treatments to quickly abort the migraine attack), on a maximum of 10 days per month (but avoid Codeine and opioids which can worsen migraine rapidly)

• Preventive treatments (medications, injections and neuro-modulation therapies), if you need the rescue treatments for more than 4 attacks per month

• If your current work schedule allows it, sleeping for the same amount of hours each night and having good quality, restorative sleep is likely to help. Fall asleep faster and sleep better – Every Mind Matters – NHS

• Find a way to keep a regular routine. This can be challenging for performing arts professionals, particularly those on tour. BAPAM’s Healthy Practice Diary is designed to help you adopt healthy routines

• Performance spaces and workplaces may be able to help someone experiencing a migraine attack by providing somewhere quiet and dark where they can lie down, giving ibuprofen (or other medication for migraine if appropriate). Noise cancelling headphones and an eye mask may also help, as can staying cool

Dietary Advice

• Ensure the brain has a constant supply of fuel by eating regularly, not skipping meals, eating slow-release energy foods. When on tour, always take supplies to ensure you have food that you can eat if you feel a migraine attack coming on

• There is growing evidence that maintaining a healthy gut microbiome with a plant based diet (5-7 portions of fruit and veg a day), rich in high fibre and polyphenol foods (e.g. colourful fruit and veg, nuts, seeds, extra virgin olive oil) promotes beneficial gut microbes which support the gut barrier, reduce inflammation and support the balance between the gut and brain

• Probiotic, fermented foods may help. You can buy over-the-counter probiotics in tablet form or in a liquid form to be taken first thing in the morning. Too much fermented food can produce gut pain and wind – not great for performance. So start very slowly with e.g. a teaspoon of fermented product with your meal per day and build up to a tablespoon per day for a week until you have reached a sustainable level your gut can manage

• Peppermint oil capsules have been shown to support those who are experiencing gut pain. Peppermint oil relaxes smooth muscle in the gut and has mild anti-inflammatory, antimicrobial, and analgesic properties. Calming the gut may help with migraine attacks. Peppermint tea or camomile tea may also help

• Supplements may be helpful for some people. Vitamin D, Magnesium, Vitamin B2 (Riboflavin) and Co-enzyme Q 10 may help but check with your doctor or specialist if these are right for you and consider changes to your diet first. Supplements may cause stomach problems such as diarrhoea so take them with caution. Further advice from the Migraine Trust can be found here

• Food triggers vary significantly from person to person and may include alcohol, cheese, chocolate, citrus fruits, caffeine, processed and cured meats, monosodium glutamate (MSG), soft drinks, and high amine foods including raisins, figs, dates, pineapple, avocado, plums, bananas and raspberries. You may wish to discuss this with your doctor or dietitian

Reasonable Adjustments at Work 

When attacks are impacting frequently and severely on a person, formally diagnosed migraine can be considered to be a disability under the Equality Act. This puts a duty on employers to make reasonable adjustments (although this is a vague term and subject to variable interpretation).

It can be challenging for freelancers who don’t have direct employers to ask for adjustments. Attitude is Everything’s Just Ask Guide provides advice on how to navigate this. Access Rider templates are available from the Musicians’ Union and Unlimited.

It’s worth discussing how you could be supported with creative collaborators, managers and creative teams.

Adaptations which can be helpful include:

• Being able to reduce light glare by wearing migraine lenses

• Being able to reduce intense noise by using earplugs to dampen external noise

• The ability to take migraine medication swiftly and have access to a quiet, dark place if a migraine attack is starting

• Understanding of the condition by employers, venues and creative team is key to reducing the stress and anticipatory anxiety about getting an attack. Share resources such as Attitude is Everything’s Just Ask Guide and consider using an Access Rider template such as those available from the Musicians’ Union and Unlimited

• Sickness policies may need to be reviewed for those in employment. Short, repeated absences due to migraine attacks may need to be exempted from being counted

Linked Conditions 

Migraine is often linked to other medical conditions. If you have any other conditions and experience migraine symptoms, discuss this with your GP.

Taking control of your condition

Don’t put up with recurring headaches – get a diagnosis, get good information about your options, and you will be empowered to take control of your migraine and get on with building a successful career it the performing arts.

New treatments have been developed over the past few years which are specifically for migraine and can be safe, well-tolerated and effective in many people.

Further Information 

• NHS Migraine advice: https://www.nhs.uk/conditions/migraine

• Patient.info: Migraine: Causes, Symptoms, and Treatment

• The National Migraine Centre is a charity and specialist migraine clinic with UK-wide consultations. Resources include the Heads Up Podcast and Managing your Migraine by Dr Katy Munro (senior GP headache specialist)