Lifestyle modification remains foundational in the prevention and management of migraine. Sleep optimization and sleep apnea screening, regular exercise, diet optimization, and individualized trigger assessment, along with behavioral therapies, are essential components of wholistic care.

To me, the most impactful lifestyle modification in migraine care is optimizing sleep. Not getting a good night’s sleep can aggravate a person’s migraine and make attacks worse. One issue that people often do not consider is the potential presence of sleep apnea in patients with migraine. So, if the patient snores at night, I will recommend a sleep study early on in treatment. If you treat the sleep apnea and the patient can sleep well, this may help reduce or eliminate morning headaches.

Another factor to consider about sleep is to make sure that when patients are getting ready to sleep, they have no distractions. I tell patients not to put the television on or listen to the radio when they are trying to fall asleep. Patients should have consistent times for when they go to bed and when they get up. How much sleep a person needs is individual. Some patients only need 6 hours of sleep each night and some need 10, but patients generally know when they feel refreshed. If something interferes with that, it could be that they are not giving themselves a chance to sleep or that something is keeping them awake.

There are also a number of other behavioral strategies to optimize migraine management. One is relaxation therapy. There are online programs that teach people to sit down and do the exercises when they are getting tense and nervous. Another strategy that we encourage is biofeedback, where patients with migraine look at a device and learn how to recognize and control certain physiologic responses to pain or stress that can contribute to their migraine. Yoga can also be helpful. Anything that helps a person manage their feelings can help with migraine.

Discussions about exercise should be individualized because patient experiences can differ. There are some people who will exercise when they get headaches, and they experience some relief. However, if someone is a sprinter and they start running for a mile, for example, and get a bad headache, that is a problem. In general, if a patient has a reasonable exercise program and does it regularly, it will typically help with migraine prevention.

Optimizing diet matters too when discussing migraine treatment. It used to be believed that eating chocolate could initiate a migraine, but studies have not shown chocolate to be a migraine trigger. However, one of the premonitory symptoms of migraine can be the desire to eat chocolate. So, it may not be the chocolate that gives a person the migraine; it may be the migraine that makes them crave chocolate. Additionally, drinking alcohol can induce headache, and a person can also get a migraine headache if they do not eat and their blood sugar goes down. There can be other specific food triggers for an individual patient, but the most important practical thing is eating on a regular basis. Fasting can induce migraine, so it is important to try not to skip meals.

When discussing lifestyle modifications with patients with migraine, I do not tell them what to do. Instead, I ask them what they currently do and whether those things make their headache better or worse. What helps the patient is finding out what bothers them, what triggers their headache, and what they are currently doing to relieve it. Then we can try to identify and fix what is broken. I think that this is the point: to fix what is broken. Do not look to break things.