Navigating the Festive Season with Migraine

Understanding migraine

Migraine is a common neurological disorder characterised by moderate to severe headache and nausea. It is estimated to affect over 4.9 million Australians. Episodic migraine (0-14 migraine days per month) is also more common than chronic migraine (15 or more migraine days per month) (2).

Contrary to popular belief, migraine is much more than ‘just a headache’, and for many people it can be debilitating (3). It is a complex and highly variable disease, with many people having different triggers, symptoms, and attack severity and frequency (2).

Migraine symptoms could include, but are not limited to (4):

• Moderate to severe head pain (usually one-sided and throbbing)
• Nausea / vomiting
• Sensitivity to light, sound or smell
• Aura (including visual disturbances such as bright zigzag lines, flashing lights, difficulty in focusing or blind spots lasting 20-45 minutes)
• Difficulty in concentrating or confusion 
• A feeling of being generally extremely unwell
• Problems with articulation or co-ordination
• Diarrhoea
• Stiffness of the neck and shoulders
• Tingling, pins and needles or numbness or even one-sided limb weakness
• Speech disturbance
• Motor weakness
• Vertigo.

There is no cure for migraine, but there are treatments and lifestyle changes that can help patients manage their migraine (5).

Impact of migraine on women’s wellbeing

While people of any gender can have migraine, women are disproportionately affected. In fact, the prevalence of migraine in women is over two times higher than in men (2).

A survey commissioned by women’s healthcare company, Organon, has investigated the social, economic and physical impacts of episodic migraine on women. The Australian Women and Migraine Survey was conducted in December 2022, and surveyed 1048 women aged 21-50 years.

The survey revealed that (6):

• 80% of women living with migraine feel unsatisfied with how they manage the symptoms.
• Three quarters (70%) of these women say they can’t stop a migraine attack from occurring, and two thirds (68%) can’t reduce their symptoms fast enough.
• Of the 62% of women that experience migraine at work, the lighting in the office (63%) and loud music and conversations (52%) were identified as common triggers.

These results reveal how Australian women are struggling to manage their migraine attacks on a day-to-day basis. Unfortunately, the festive season can further complicate migraine management, with added stress and disruptions to a regular routine. Research has also found that women often do the majority of holiday-related domestic labour, such as cleaning, organising events, cooking, present shopping, and more (7). This can create a ‘perfect storm’ for women living with migraine.

What are migraine triggers?

A migraine trigger is any factor that increases your chance of experiencing a headache or migraine attack (8). Some common triggers are related to your environment, physical or emotional state, or diet (5). A migraine attack could occur anywhere between six hours and two days after you encounter the trigger (8).

Research shows varying results for common migraine triggers. The most common trigger that people experienced regularly include but are not limited to stress (80%), followed by hormones in women (65%) (1). Other major triggers included missed meals (57%), weather (53%), sleep disturbance (50%), odours (44%) and alcohol (38%) (1).

There is a widespread variation in how people experience triggers (1,6). The factor that is most relevant to your friend or family member might not affect you. People also often have a combination of triggers which lead to a headache or migraine attack rather than one isolated cause (1).

Trigger management is not an exact science, but understanding what sets off your migraine attacks can make a big difference in your migraine management. Some factors can be controlled by lifestyle changes to help reduce your likelihood of having a migraine attack. 

Triggers during the festive season

The festive season should be a time for relaxing and celebrating with loved ones, but for people living with migraine it can be more complicated. Many hallmarks of the holiday season can involve migraine triggers, such as:

• Festive lunches or dinners: common foods that are identified as migraine triggers include processed meats, cheese, and chocolate (8). In general people may be sensitive to any changes to their regular diet (8). Alcohol, particularly red wine, is also a common trigger (5).
• Christmas lights: bright or flashing lights can be a migraine trigger (8).
• Travel: holidays can cause a wide range of migraine triggers including stress, sleep disruptions, flying (i.e. plane altitude), changes to schedule or routine (8).
• Candles, scents & perfume: many people are sensitive to strong scents. During the festive season this could include people burning scented candles, being gifted a perfume or cologne (8).
• Music & large social gatherings: loud conversation or music can be a contributing factor for migraine attacks. Social events can also disrupt your sleep schedule, which is another known trigger (8).

In addition to these factors, the festive season in general can be stressful. There’s a lot to plan and prepare for, it’s an expensive time of year, and the back-to-back events and celebrations can be physically and/or emotionally draining. This can be difficult for people living with migraine because stress and anxiety are some of the most commonly reported triggers (1).

Essentially, people are exposed to a higher number of triggers during the festive season, and the cumulative effect can cause migraine attacks. But hopefully, with the right preparation, you can give yourself the best chance of having a migraine-free holiday season.

Preparing for the festive season

Navigating the festive season with migraine might seem daunting, but there are strategies to make it easier. The general approach for trigger management is as follows (4):

1. Identify your migraine triggers. Usually done by tracking possible trigger factors and migraine attacks in a headache diary.
2. Identify behavioural / lifestyle changes. In consultation with your doctor or pharmacist, come up with some possible lifestyle changes to help minimise the impact of these factors.
3. Consider if these are realistic. You won’t always be able to perfectly manage every contributing factor to your migraine. Instead of trying to make lots of changes at once, focus on just one or two changes that will be sustainable in the long term.
4. Evaluate your trigger management strategy regularly. Keep track of how these changes are affecting your migraine attacks and lifestyle and adjust your strategy accordingly.

The same principles still apply during the festive season. It’s important to be kind to yourself and focus on the factors you can control rather than those you can’t. Here are some suggestions for managing specific triggers during the holidays.

Stress

When it comes to managing stress, remember the importance of early planning. This might seem obvious, but try to plan as far in advance as possible. This is particularly important for any big social events or family gatherings. Once these are booked in, think about other factors that might make you busy or cause stress. This could include shopping for Christmas/holiday presents, or looking after your kids once school holidays starts.

When you’re planning your festive season, try to make time for things that you find relaxing. Perhaps you could book a massage in advance if you know it helps with stress or set aside time for an enjoyable hobby. At the very least, try to leave some ‘free space’ in your schedule. This will hopefully make it easier to manage any unexpected events or tasks that come up.

Food & alcohol

Managing dietary triggers during the festive season will be quite different for each person. Your choices will come down to:

• The foods and/or drinks that you are sensitive to;
• The reliability of the trigger (i.e. do you have a migraine attack every time you eat processed meat, or just occasionally? Or is it dependent on how much you eat?); and
• And how strict you want to be about controlling these factors. 

If you want to avoid all dietary triggers this festive season, you could either eat before an event, bring your own food, or ask the host if they can provide a migraine-friendly meal option (depending on your triggers). 

However, some people prefer to take the risk during holiday meals. In these cases, try your best to manage other factors (i.e. sleep, stress, dehydration), and keep some medication with you in case you start to feel a migraine coming on.

Lights, sounds and scents

Decorative lights, loud music, scented candles, and more can all contribute towards a migraine attack. It can be difficult to control these factors in public, but try to create a migraine-friendly space at home. 

If you are going to be at a friend or family member’s house for any events, you could ask them to choose unscented candles or turn off their Christmas lights. Most people won’t mind making these small accommodations for the sake of your health. 

Sleep

Managing sleep during the festive season can be challenging because your general routine is often disrupted. To give yourself the best possible chance of getting enough sleep during this time, try to prioritise sleep hygiene. This could include things like:

• Avoid daytime naps.
• Avoid caffeine after 2pm to ensure does not interfere with sleep that night.
• Avoid alcohol. While you may fall asleep more easily, you will tend to have fragmented, poor quality sleep.
• Consider practising a relaxation technique before bed, to help wind down.
• It can help to have a notepad by the bed to jot down any thoughts overnight. This way, you know you can address them in the morning, rather than staying up thinking about them.
• Avoid using backlit screens (TV, laptops, tablets, mobile phones) for at least one hour before bed.

Throughout the rest of the year, you might be able to get away with a 4pm coffee, or watching television in bed every now and then. But if you’re concerned about your sleep cycle during the festive season, it might be time to re-prioritise these habits.

Coping strategies for migraine symptoms

Unfortunately, even the best trigger management strategies are not a cure for migraine. There is still a chance that you could experience a migraine attack during a social event or while you’re away from home. In these cases, it’s a good idea to have a plan. This could involve:

• Keeping medication with you at all times.
• Seeing your doctor before the festive season to refill any necessary prescriptions.
• If you take triptans, remember to take them as soon as you start to experience head pain (or your most bothersome symptom) (9). Triptans are more likely to work well if you take them earlier, rather than waiting until the attack has progressed (9).
• Ask family members or friends if there’s somewhere quiet and dark that you can go if an attack begins.
• Take a taxi or get someone to drive you to any events, in case you are unable to drive home due to migraine symptoms.

While it’s disappointing and frustrating when a migraine attack disrupts your plans, remember that it’s not your fault. Migraine is a complicated disease, and the best thing you can do is to be as prepared as possible.

Discussing migraine with family and friends

Discussing migraine with family and friends is different for everyone. Some people discuss it regularly, while others may have just received a diagnosis and are talking about it for the first time. Either way, the festive season is a time where it’s especially important to communicate your needs and set boundaries with your loved ones. Some boundaries or requests could include saying no to activities that could trigger a migraine attack, or asking people to not include scented products in gifts. 

These conversations can be difficult, and you might feel anxious about asking people for support or turning down an invitation during the festive season. This is partially because of the stigma that migraine is ‘just a headache’ (3). However, by explaining the realities of a migraine attack to your loved one, you can actually help to combat this stigma. Migraine attacks are often debilitating and it’s important that people in your life understand what you are going through (3).

References:

1. L Kelman, 2007, The Triggers or Precipitants of the Acute Migraine Attack. DOI: 10.1111/j.1468-2982.2007.01303.x
2. Deloitte Access Economics, 2018, Migraine in Australia Whitepaper. Retrieved from: https://www2.deloitte.com/au/en/pages/economics/articles/migraine-australia-whitepaper.html. Accessed December 2023. 
3. SK Parikh, J Kempner & WB Young, 2021, Stigma and Migraine: Developing Effective Interventions. DOI: 10.1007/s11916-021-00982-z
4. Healthdirect Australia, 2023, Migraine. Retrieved from: https://www.healthdirect.gov.au/migraine. Accessed December 2023.
5. Vic.gov.au, 2012, Headache – migraine. Retrieved from: https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/headache-migraine. Accessed December 2023.
6. Organon and Fiftyfive5, 2022, Women & Migraines. Data on File.
7. H Reese, 2019, The Gendering of Holiday Labor. Retrieved from: https://daily.jstor.org/the-gendering-of-holiday-labor/. Accessed December 2023
8. The Migraine Trust, 2021, Migraine attack triggers. Retrieved from: https://migrainetrust.org/live-with-migraine/self-management/common-triggers/. Accessed December 2023.
9. J Pascual, 2002, Clinical benefits of early triptan therapy for migraine. DOI: 10.1046/j.1526-4610.2002.0420s1010.x
10. International Headache Society, 2018, 1. Migraine. Retrieved from: https://ichd-3.org/1-migraine/. Accessed December 2023.