This is a sponsored post. I decided to work with Med-IQ to help generate awareness around migraine symptoms and treatment. Med-IQ is an accredited medical education company that provides an exceptional educational experience for physicians, nurses, pharmacists, and other healthcare professionals.
With the holiday season upon us and the pandemic in full swing, the stress levels are at an all-time high. Relying on stress management strategies is now more important than ever. It is also equally important to discuss with your doctor the new migraine medications to treat acute attacks.
Migraine And Stress = Vicious Cycle
Migraine causes significant stress to our lives. It is extremely stressful to keep up with doctor appointments, multiple medications, deal with frequent symptoms, including pain, and not know whether we would make it to the important scheduled events. Those of us who are parents must also juggle raising children while managing the burden of a needy disease that requires a strict routine.
People with migraine must also manage external factors that cause stress, especially over this past year. Anything from changes in jobs, family matters to dealing with the pandemic’s effects can cause stress and worsen migraine attacks.
Living with migraine causes stress, while stress causes worsening in migraine attacks, so we become trapped in a vicious cycle.
Stress Is A Migraine Trigger
According to the American Migraine Foundation, stress is a migraine trigger for nearly 70% of people living with migraine.  The relaxation following a period of high stress has also been associated as a migraine trigger and is often referred to as a “let down migraine. Therefore, stress management must be an important part of our natural migraine prevention plan.
It is important to remember the distinction that stress does not cause migraine. Migraine is a genetic neurologic disease that has many triggers. Stress is a common migraine trigger. Although stress does not cause migraine, it can make it worse.
Manage Migraine And Stress With Natural Treatments
We live with migraine disease every day, even when we do not experience migraine attacks. Therefore, we must still manage migraine daily with lifestyle changes and/or daily preventive medications. If stress is one of your migraine triggers, finding ways to manage stress levels can help prevent future migraine attacks.
Here are some stress management strategies to incorporate into your migraine prevention plan:
1. Cognitive Behavioral Therapy (CBT)
Cognitive behavior therapy is a psychological approach to managing migraine. CBT facilitates the development of skills that increase a person’s ability to cope with pain and reduce migraine-related distress.  CBT shows strong evidence to help patients reduce the frequency of attacks with no side effects. CBT is short-term, usually requiring 10-12 individual 1:1 sessions of 50 minutes each. Patients are required to do homework in between, recording thoughts, responses, and incidents. Insurance plans often cover CBT. 
Ask your neurologist or headaches specialist if you are a candidate for CBT. You can ask your doctor or insurance company for a referral.
Mindfulness is a psychological process where we focus our awareness on the present moment.  For people with migraine, mindfulness can lower stress, improve pain tolerance, reduce the frequency of attacks, reduce the intensity of symptoms, reduce medication use, and improve quality of life. 
Meditation is one of the mindfulness practices which has been shown to help migraine and reduce stress. I highly recommend doing this simple eight-week program of mindfulness-based practices through a book, You Are Not Your Pain by Vidyamala Burch. Although she does not have migraine, she lives with chronic pain and spoke at the Migraine World Summit. Another way you can practice meditation is through guided meditation apps such as Calm or Headspace. The apps guide you through the process with a soothing voice which reminds your mind to come back from wandering and focus on breathing instead.
Biofeedback uses an instrument that monitors a bodily response, such as muscle tension or skin temperature, as the person tries to modify that response.  The monitor provides the patient with constant information on whether they are successful in relaxing their body based on their muscle tension and body temperature.
Biofeedback is generally done under a guidance of a trained psychologist or psychiatrist. There is a new biofeedback therapy app, JUVA, which will be launching soon.
4. Planning Ahead
Whether it’s planning your day, a strategy for an acute migraine attack, or a celebratory event, more planning means less stress. Wherever in your life, you anticipate the most stress, attempt to plan ahead as much as possible. This will help you feel more prepared, reduce stress, and possibly avoid migraine let-down episodes.
Here are some ideas how you can make plans which will minimize stress:
– Use a planning calendar on the desk with a daily and monthly view;
– Create a migraine toolkit for when you have an attack;
– Create a plan for the kids for when you have an attack;
– If you have young kids, have a list of quiet games and activities they can play during your migraine attack;
– Schedule rest time and self-care;
– If you are traveling, start packing one week before;
– Make a to-do list;
Self-care is any activity we do intentionally to take care of our physical and mental health. For those of us with migraine disease, self-care is crucial. According to Elizabeth Seng, Ph.D., assistant professor in the Albert Einstein College of Medicine at Yeshiva University, incorporating self-care practice into your regular schedule can reduce the frequency of migraine attacks.
Here are some ways to incorporate self-care into your daily routine:
-Read a book
– Listen to an audiobook;
– Go on a walk while listening to music;
– Sit on a bench at a park
– Go for a walk on a nature trail;
– Spend time by yourself while everyone is asleep;
– Take a hot shower while someone watches your kids;
– Do yoga;
– Write in a gratitude journal;
– Listen to guided meditation;
– Listen to music;
– Cook your favorite nutritious meal;
– Take a bath;
– Watch Netflix;
– Get a massage;
6. Focus On Supportive Relationships
Research shows that supportive relationships are good for our mental and physical health.  So it is no surprise that surrounding ourselves with people who support, motivate, and believe in us is so important to our mental well being. Instead, focus on the people in your life who are there to support you and find ways to do the same in return. Foster the relationships that bring positivity into your life because they are the ones that will reduce your stress. Although it may be hard to distance or remove yourself from situations or people who cause you stress, your mental and physical health needs to be your top priority. Migraine disease already tries to destroy us. Do not surround yourself with people who are trying to do the same.
Manage Migraine And Stress With New Medications
If stress is one of your migraine triggers, the strategies above can help to reduce your stress. However, there is no cure for migraine, and even if we avoid our individual triggers, we are still susceptible to migraine attacks. That is the nature of this disease. Therefore, make sure to speak to your doctor about the new migraine medications to treat acute attacks so that you are better prepared when a migraine attack strikes.
New Migraine Medications For Acute Attacks
It is exciting that for the first time since the triptans, we finally have new migraine medications to abort migraine attacks. These are acute medications, meaning they must be taken at the start of an attack.
Ubrelvy – Dose: 50-100mg
Nurtec – Dose: 75mg
Reyvow – Dose: 50,100, 200mg
Ubrelvy and Nurtec are both CGRP blockers, and Reyvow works similarly to a Triptan without affecting as many serotonin receptors or causing vasoconstriction. Many headache specialists, like Dr. Amaal Starling, Associate Professor of Neurology and Consultant in the Department of Neurology at Mayo Clinic College of Medicine and Science in Phoenix, AZ, in this FB Live, recommend taking these early on in an attack in an effort to increase their efficacy.
Although many doctors hope that Ubrelvy and Nurtec work similarly to CGRP preventive medications and do not lead to rebound headaches, at this time, there are no studies to confirm that. To that end, we must not medicate more than 2-3 times per week in order to avoid rebound headaches.
These new migraine medications are excellent news for people who do not respond to triptans or cannot use them due to the risk of stroke. If you cannot take triptans, make sure to speak to your doctor to determine if these medications may be an option for you.
Help Is There For You
Migraine and stress can often feel overwhelming. Especially during a pandemic, migraine attacks and stress have significantly increased and interfered with the quality of life for many people. If you feel that the strategies and medications above are not enough for you, speak to your primary care physician about what you are feeling and/or request a referral to a therapist or psychiatrist. Additionally, there are online apps for talk therapy, such as Talk Space and Better Help, where you can speak with a trained professional from the comfort of your own home. Talk Space now partners with many health insurance companies, so make sure to check if your sessions would be covered by your health insurance. Please know that you are not alone and that it is okay to work on your mental health.
Disclaimer: I was compensated by Med-IQ through an educational grant from Allergan to write about the realities of migraine as a neurologic disease. All opinions are my own.
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