A thread: What people with #Migraine can do to help.
I’ve practiced headache medicine for 16 years. Trained @UNCneurology & started career @UPMC. Now @WVUMedSchool for 12 & the @WVURNI.
Rule#1: nothing is universal - people are unique and how they respond is unique
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Rule#2: none of this is “blame the patient” - you are not the cause of your migraine disease. You may be able to participate in the reduction of the frequency and severity of attacks.
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People who are active participants in their health and work on headache hygiene often do better with less need for medication.

Rule#3: for those who don’t have migraine. Migraine is not “just a headache”. & any annoying situation you find yourself in is not “such a migraine”
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Ok - rules done
If you have migraine, here is my non-comprehensive list of things to consider working on.
-sleep: getting enough is paramount. It’s restorative and allows recovery. Pick a bedtime and stick to it. No TVs, phones, or other screens in bed. No work in bed.
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-sleep continued: no pets in bed. Lights out. No caffeine after lunch. Don’t eat right before bedtime. If you wake up in the night, don’t turn on a screen. If you can’t sleep at night, don’t take naps during the day. If you need a nap, go outside and take a walk
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-exercise: this one is tough. During #migraine attacks exercise can be an aggravator. At least in between attacks. 30 minutes, 4 days per week or more. It has to include getting your heart rate up and sweating. Walk, run, bike, swim, row - something.
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-exercise continued: here’s a crazy idea - try exercise during an attack. Start slow and work up to it. Sometimes the first couple minutes are hard, but then relief. I don’t know why. Endorphins? Vascular relaxation? Sweating it out? Distraction? Not sure. But give it a try
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-food: you need it. Regularly. Eat meals at regular times. Don’t skip. In general, the less processed it is, the better it is for migraine. Read labels for msg (flavored potato chips, ramen noodle seasoning packs, etc) and nitrates (deli meat, bacon, hot dogs).
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-food continued: look up migraine diets online. But you don’t have to adopt them all at once. Look for things listed as common food triggers and get rid of a few. See what happens. Keep experimenting until you figure out what food triggers you have.
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-water: drink it. Not something with water in it. Just water. As long as you have access to clean water, make this your primary source of fluid intake. Avoid caffeinated drinks like coffee and energy drinks.
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-community: there are many, many people with migraine. Like 40 million in the US. You aren’t alone. And many of them are willing to help. Follow some of the #migraine #advocates and #educators online. I invite them to tag themselves here (I don’t want to miss anyone!)
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-community cont: find someone local you can share your story with. Family, pastor, counselor. Someone who will listen without judgement.
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-stress reduction: I always struggle with this one. How can we reduce stress. Maybe we can’t. But we can improve how it affects us. Check out @DawnBuse and her work. Learn how to say the word “no” and mean it.
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-No: too often people feel obligated to give 100% of themselves to serve others. But if you aren’t taking care of yourself first, your 100% becomes less. A healthy you is better for those you love than an unhealthy you. But that means you need to say “no” sometimes.
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Lastly, just a short list of things:
Stop smoking
Stop blaming yourself
Find a doctor who listens

There are 100s of things that could be added to this thread. Go for it #migrainetwitter.
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@TRobert @amfmigraine @miles4migraine