Migraine Management during the Holidays: How to Help Patients Identify, Manage Triggers

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The holiday season brings joy to many. It is a time to take a step back from work and other daily duties, reflect, and be with family and loved ones. However, for persons with migraine, this can be a very challenging time with multiple migraine triggers. Awareness of the most common holiday migraine triggers can be helpful in migraine management, and you may want to share these with your patients.

Some migraine triggers are tangible ones including sugar and alcohol consumed at office and holiday parties. Buffet food may contain additives or preservatives that could trigger a migraine attack. A preventive approach may be to eat a healthy meal or snack prior to a Christmas party and not arrive hungry. Maintaining good hydration and adequate protein intake can help as well. You might suggest that a patient consider bringing to a gathering an appetizer and a beverage that is known not to be a trigger.

Stress is common during the holiday season. It may stem from uncomfortable family interactions, the stress of choosing gifts and wrapping them, and the financial stress of buying gifts while trying to stay on a budget. In addition, a lot of pressure to give to outside organizations comes regularly during this season. Many worthwhile organizations are eager for donations and trying to decide how much and to whom to give can be very stressful. This stress can trigger a migraine attack and negatively impact the person’s overall migraine pattern.

Deciding how much to spend on Christmas gifts and sticking to that budget can help alleviate the stress for a patient who is vulnerable. You might suggest they consider making low-cost homemade gifts to help stay on budget. Also, contributing to only a few organizations in this season can help, followed by discarding all the other requests.

Travel can be a big trigger for migraine. There is stress involved in the travel itself including getting to the airport, the bright lights and noise in the airport, the crowds, flight delays, the uncertainty of weather, and the time changes when travelling to other states or other countries. Also, the changes in barometric pressure when flying can be a migraine trigger. Planning ahead for all these potential triggers is important. For some individuals with migraine, it may be worth recommending that they begin taking a short-term preventive, such as naratriptan or rimegepant.

Sleep deprivation and sleep interruption commonly occur during the holiday season as a result of stress, alcohol, and late-night eating. Remind individuals with migraine that keeping a consistent sleep schedule and not consuming alcohol in the late evening can help minimize this trigger.

It is important to maintain a consistent exercise program during the busy holiday season. Unfortunately, many individuals may not stick to their regular exercise routine as they are busy shopping and going to holiday parties.

Loneliness and depression can trigger migraine during the holiday season. For some it may stem from missing loved ones while others may be divorced or suffering from a recent breakup. Nurturing close friendships can help. Staying in involved in a local church or temple can also be very emotionally rewarding. It may be helpful to remind individuals that reaching out to neighbors and staying connected with community is vital and can help prevent exacerbation of migraine.

Keeping a consistent schedule for sleep, diet, and exercise are critical for individuals with migraine. Unfortunately, the holiday season can wreak havoc on this consistency. Reminding patients of the importance of consistent, healthy routines is critical. Awareness of our patient’s family dynamics is important as we approach the holiday season. Holidays are not happy events for many.

Short-term preventive strategies can help with migraine prevention during the holiday season and may include:

• Naratriptan 2.5 mg once or twice daily during the vulnerable time.
• Frovatriptan 2.5 mg once or twice daily during the vulnerable time.
• Increase in the usual dose of an oral migraine preventive.
• Short course of steroid as a preventive or rescue. For example, dexamethasone 4 mg strength dosed as 3 mg on day 1, 2 mg on day 2, 1 mg on day 3.
• Rimegepant 75 mg every other day during the vulnerable time.

Despite the numerous migraine holiday triggers for our patients with migraine, consistency with good health habits and overall lifestyle can help minimize the expected exacerbation of migraine.