Aggie E.

Krl

Cure Your Migraines the Natural Way

Journey to Wellness: A Step-by-Step Guide to a Headache-Free Life
wholly design

Aggie weaves together the science and art of healing ones body in a holistic way in Cure Your Migraines The Natural Way
John Gray, Ph.D. author of Men Are from Mars, Women Are from Venus

Aggie E. Krl

Cure Your Migraines the Natural Way

Journey to Wellness A Step-by-Step Guide to a Headache-Free Life

 2011 Aggie E. Krol wholly design

www.whollydesign.com www.curechronicmigraines.com

All rights reserved. No part of this publication may be copied and redistibuted apart from original distribution by any electronic or mechanical means without permission in writing from the publisher.

Cover illustration: Matt Krol www.freehandillustration.com Design and typesetting: Piotr Bujas www.fourthsecession.org

Note 8, Acknowledgments 10, Foreword 12, Introduction 14, Begining the Journey 16 Part 1 - The Science 21
1. The Brain in Migraine 2. What causes Migraine 3. Is It All in the Genes 22 32 43 6. Why Eat Raw 7. The Truth About Fats 8. Hydration Is Not Just For Plants! 9. Chees and Whine? (Alcohol) 147 155 162 170

Part 2 The Therapies 50

Part 4 Mind And Body 175

51 62 73 88 92 101 1. Migraine and the Psyche 2. The Answer to Stress: Psychological Resilence 3. Emergency Measures 4. Prevention: Developind Treatment Plan 184 207 210 176

Contents

1. Landing on the Chiropractors Table 2. In Morpheus Arms (sleep) 3. The Punk at the Gym 4. Body Posture Vademecum 5. Allow Your Neck to be Free: Alexander Technique 6. Happy Points Therapy Massage

Part 3 Nutrition 106

1. Cravings 2. Chamomile Tea at Starbucks?? (Caffeine) 3. Sugar Junkie 4. Going Raw: The Giant Leap 107 115 121 132

Epilogue (Thank Your Body For Your Migraine) Bibliography

220 223

When you exercise with incorrect posture, you reinforce poor posture. When you lift weights or work out on a treadmill with hunched neck and shoulders - youve just created a bad posture thats harder to correct.
Joe Gutierrez, Personal Trainer

There is too much of a tendency to substitute drugs for people

Joan Levin

Note To Readers

to remain migraine-free. It is my belief that most of the strategies youll find in these pages will work for most migraineurs, but some may not work for all migraineurs. No single therapeutic approach is guaranteed to work for all of us. We are all different. This book is not meant to be a complete academic treatise, nor is it meant to be used as a diagnostic tool or substitute for any treatment that you find works for you. Rather, its meant to be used as a guide to increase your awareness and understanding of all the possible causes and triggers of your migraines and help you develop proactive strategies for preventing them. Ive made every effort to ensure that the information and research provided in this book is accurate and current; however, I cannot warranty its reliability, completeness, or timeliness. Research is a moving target. Science makes new discoveries every day. I encourage you to consult with a competent physician before you make any significant changes to your lifestyle, such as to diet or exercise. Ask questions. Expect answers. If you dont receive thorough and convincing answers, dont be afraid to seek a second opinion, or even a third, if necessary. First and foremost, I encourage to take responsibility for your own health and well-being. Once you find the path to true Wellness, there is no turning back.

y goal in writing this book is to share with all migraine sufferers the therapies and strategies that have allowed me

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foreword

Foreword
I have never had a migraine headache. I have never experienced an aura. As a matter of fact, I would be hardpressed to tell you the last time I had any type of head pain. Although I have no personal experience with the physiological effects of migraine, I have been treating this condition indirectly and directly for a good part of my life. You see, my mother had migraines. I was a young boy, not currently in school. I was the one who walked into that cold, dark, silent room with a cup of tea and a dry piece of toast. There was very little conversation with my mother during her episodes; if any. Most interesting were the trips to the hospital and visiting the doctors. I spent a lot of time in waiting rooms, looking at magazines, and watching the doctor and his patients. Migraine headache is a process. There are many types of headaches of which migraine is one. Migraine headache is clinically represented in a class of other benign headache types. The brain, in and of itself, is pain insensitive. It is the pain sensitive structures such as the meninges, skull, sinuses, neck muscles, ligaments, blood vessels, temporomandibular joint, and dental constructs that are responsible for delivering their unique neurological information to the brain. There are good and bad stories in life. The same can be said for headaches. Although the vast majority of headaches are benign, there are other presentations of head pain that are not. It is axiomatic that diagnosis steers treatment. Getting the right diagnosis is fundamental. Treatment, depending on diagnosis, may involve other specialty physicians and providers. This integrative approach must

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foreword

again follow guidelines for responsible clinical decision making; investigate your team, do your homework, and have your team communicate effectively with you and each other. A great many people suffer from migraine headaches. The disease-centric conventional medical approach may work for some; but not for others. If you are reading this book, chances are that you are in the latter category; you are not alone. Quite often in clinical practice, for a patient to attain adequate improvement with their primary complaint, they must look beyond the primary problem to the diet, lifestyle, attitudes, beliefs, habits, emotions and environment that form the foundation for the individual patients overall health and well being. Our current healthcare system is primarily focused on acute care followed by chronic disease management with little to no attention paid to preventive care. This book provides a shift in consciousness toward prevention and promotion of health and fitness and not on the disease specific condition; migraine headaches. Our conscious and unconscious influences, feelings, and inclinations support and perpetuate our health behavior. Motivation for upgrading your health promoting aspects of living and willingness to overcome disease promoting behaviors are the key tenants for re-establishing your foundations for health. However, change involves commitment to self-autonomy and being responsible for your personal ownership of health. This book has the necessary ingredients to get you started on the right path. If you are ready for your transformation, buckle up and read on.
Robert Zoboski, DC, FACO

14

introduction

What have you been told about your migraines?

The clinical world is full of treatments for migraine. Chances are, for every treatment you discover, your research will reveal hundreds of different opinions. With so much misinformation out there, choosing the right path out of the wilderness can be daunting. Its no wonder that so many people linger, untreated, for years in pain and misery. And choosing the wrong treatment can have negative consequences, such as exacerbating your migraines, or creating a new illness altogether. You can waste thousands of dollars and years of your life on failed treatments, never getting better, never living a fulfilled life. I remember researching migraine treatments online one night, while battling yet another headache with medication. I believed that cure was hopeless; after all, the consensus in the medical community was: There is no cure for migraines. Still, I wasnt ready to give up. That evening, I read a website post from a man sharing the pain and suffering wrought by his migraines. He described lying in bed with a gun in his hand, thinking of simply pulling the trigger and irrevocably, once and for all, ending the pain. This is what a true migraine can do to you. And only a fellow migraine sufferer understands. Thats why I wrote this book. Ive become passionate about helping migraine sufferers understand what migraines really are, what triggers them, and how to prevent them. My goal is to help you avoid the pitfalls and landmines, and take charge of your health today. If you, or someone close to you is a migraineur, Cure Your Migraines the Natural Way will be both a journey of selfdiscovery and a roadmap to a healthier, happier future.

15

introduction

I encourage you to begin this journey with an open mind. For the few hours it will take to read this book, forget what youve read, forget what others have told you. Try to set aside your preconceived notions about what works and what doesnt. What you are about to read may change the way you view migraines forever. This book will give you the strength and confidence to trust your own inner wisdom, and empower you to make healthy choices that have a lasting impact on your health. Within these pages, Ill reveal the step-by-step healing process that freed me from the shackles of migraine attacks, and the strategies I employ every day to prevent migraines return. And youll learn how to develop a migraine-vanquishing system that works for you. Also, while lifting weights, every muscle of your core should be contracted this allows you to practice overall good posture, as well as train individual muscles. Core muscles include not only abdominal muscles, but all other muscles except limb muscles, as well. Strong core muscles help you maintain proper spinal alignment.

16

begenning the journey

Beginning the Journey

Someone or something is piercing the side of your head with a little nail you cross your fingers, hope it will stop But it doesnt. Youre filled with dreadyou know its going to get worse. It doesthe nail plunges deeper into your brain, the pain grows sharper, more intense. Soon, the pain spreads you can feel it creeping across your entire head, behind your eyes, across your face. The nail has become a railroad spike, and someone is hammering it down through your skull, drilling into your brain, splitting your head wide open you have a splitting headache

A migraine attack
Sound familiar? If so, youre not alone. Around 18 percent of women and 6 percent of men have suffered migraine attacks. I was one of them. The book youre about to read is the book I wish someone else had written first, so that all I had to do was read a book, follow instructions, and banish my migraines forever. I wasted seventeen years of my life living like a lab rat, experimenting with different cures. I took nutritional supplements. I cut back on chocolate. I eliminated certain foods. I took painkillers. I tried anything and everything just to get by. Nothing worked. At some point, those excruciating headaches just became part of my reality. They were simply always there, whether I was at school, at work or at home, no matter what country I lived in or what treatments I used to stop them. I was a migraine sufferer. I was stuck with migraine, and migraine stuck to me. Usually, my migraines were accompanied by nausea, and often at the most inopportune times. I would be hungry but afraid to eat because I knew I couldnt hold the food down.

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begenning the journey

When migraine attacked me at work, I couldnt get anything done, but I usually had to tough it out. I couldnt endanger my job by going home sick. My self-esteem plunged. I felt inferior to my coworkers who were healthy and energetic and could sometimes work circles around me when I was in the throes of a migraine attack. It seemed that I was forever making pacts with myself to catch up the next day. Sometimes the pain would grow so intense and the nausea so strong that I was forced to leave work, no matter what the consequences. I had to get home and just get to bed. Sleep seemed to be the only thing that helped ease the pain if I could fall asleep. Fighting the throbbing pain, praying that the headache wouldnt keep waking me up during the night. Hoping that when I awakened in the morning, that terrible headache would be gone. In my early twenties, I didnt understand the mechanisms underpinning migraine. I would vomit if I ate, but I thought perhaps I just had stomach problems that happened to coincide with a headache. So many times, I abused my body, and allowed my body to continue abusing itself. Regular painkillers, like the over-the-counter naproxen and ibuprofen classes, never worked for me. Then I discovered triptans, a class of medication unknown to me growing up in Eastern Europe. Once I began living in the United States, I graduated to selective serotonin receptor agonists. I didnt even knowwhat serotonin was. I didnt really care. I just wanted the pain to go away. I believed that a miracle would happen if I took this magic pill at the onset of a migraine. It not only took away the headache completely, but made me want to dance and sing with joy that the headache had vanished so quickly. The doctor had warned me that these magic pills were not be taken too often, only for a migraine attack. What he didnt tell

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begenning the journey

me, however, was that this medication could cause rebound. I started noticing that I needed triptans more frequently, and that the short, initial miracle reaction didnt happen so quickly anymore. It took longer for the drug to work. Sometimes, the headache would come back, and in less than twenty-four hours, Id need another pill. That was it. I knew I couldnt keep relying on this medication to heal me. I started rebounding my usual average of 3 to 4 migraines per month became 7 to 8 migraines per month. Plus, Id get several regular (non-migraine) headaches each week. On rare occasions, I had a workweek free of headaches, but that only ensured that I would get a severe headache during the weekend. Something was always out of balance its so clear to me now. Sometimes I prayed for healing, but those prayers were never answered. I resigned myself to the notion that this was just how it was going to be for the rest of my life. Deep down, I knew that something was very wrong. I wasnt supposed to feel like this. Life was not supposed to be like this, and this was no way to live. I wasted so many days of my life simply trying to escape the throbbing pain. Well, I knew this definitely wasnt good health. But what was good health anyway? I never knew, had never experienced true wellness before. I was often sick throughout childhood. I never really took proper care of my body, never had a healthy exercise routine, never paid much attention to my diet, aside from dieting occasionally, which never really worked for me, anyway. Why me? I didnt understand. Other people could party all night, get no sleep, drink as much alcohol as they wanted, and pop out of bed the next morning feeling fine. Not me. I could never do that. Normal for me was already a life of headaches and pain. We humans are highly adaptive; evolutionarily, weve

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begenning the journey

had to adapt to survive. We tend to adapt to our symptoms and come to believe that this is simply how life must be, or at least, this is how our lives will be. We forget what it felt like to feel good. My breakthrough would come at the age of 30. It was a very difficult time in my personal life that happened to coincide with the announcement that I was going to be laid off from my job within a few months. Desperation set in. I finally surrendered and agreed to go back on an antidepressant. I was back at my doctors office for more triptan refills, and the doctor is asking me if I wouldnt prefer to take preventative medication on a daily basis. Id always refused the maintenance regimen before because I believed it would be a prison sentence. I convinced myself that I wasnt that bad. I was determined not to become dependent on medication to survive. But I simply made sure that this medication was not habit-forming and surrendered to the prescription. It was a low dose, after all. A couple of months went by I didnt feel any better. The migraines didnt go away, the depression didnt budge. At times, thoughts of suicide even accompanied my bouts of depression. Most of us have considered ending it all at one time or another, even if only briefly, even if only during periods of severe psychological or physical pain. But the depression conspired with the migraines, hovering overhead ominously, a big gray cloud following me everywhere I went, always threatening another storm. Did I simply needed a stronger dose? Or a different drug? I wanted to stop the medication altogether. But I was even more fearful of what might happen if I stopped taking it. Would life be even more unbearable? Living in fear was so unlike me, yet fear began to consume my life. I kept praying for a solution to my problems emotional and physical.

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begenning the journey

Five months on the antidepressant, stressed to the limit, waiting to be laid off from my job of six years, I got out of bed one night to go to the bathroom and felt a piercing pain in my back. My spine going out was an additional measure of pain that I was totally unprepared for. The simplest daily task suddenly became a major undertaking taking a shower, sitting still at a desk for longer than 30 minutes holding myself upright required all the willpower I could muster. But, as is often said, it is darkest before the dawn. Today, I am so grateful for that night of torturous pain. It was a warning sign. It was a clue. And, as youll learn in Chapter 5, it was the turning point that put me on the path to health and happiness.

PART

The Science

1.1
The Brain Migraine

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the science

Migraineurs are complicated creatures. We are all alike. And we are all different. We come from different gene pools and different environments. We have different physiologies and chemistries. Weve each experienced different stressors throughout our lives, and weve developed varying levels of emotional resilience to cope with those stressors. So, its no surprise that treatment for migraine doesnt come in one-size-fits all. There is no single cure for migraine thats guaranteed to work for everyone. Finding the right treatment means finding the treatment thats right for you. Migraine is a neurological disorder that has always been shrouded in mystique. Its causes, as well as effective treatment approaches, have historically been confusing, complicated and controversial. But there are some certainties. Youll learn about a handful of deadly culprits that are all but guaranteed to trigger migraine attacks. Some may be familiar, some may surprise you. The good news is, most of those culprits are easy to remove from your life. Migraine may happen inside your head, but the ripple effect is tremendous. Migraine spills over into our personal lives, insinuating itself into our relationships, depriving us of energy and joy. And migraine trails its victims to the workplace, negatively impacting performance, career satisfaction, job security, and, ultimately, self-esteem. Ultimately, there is no such thing as a mind-body split. Our mental and physical states are inextricably bound. Psychological symptoms what we think about have just as much impact on our health as physical symptoms, and any treatment plan must consider both. An integrated mind-body view of migraine as a complex of symptoms that are activated by abnormalities in the whole person mind-brain, body, and spirit will empower you, and help you develop your own personalized approach to

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the science

complete wellness. This book will show you how migraine is linked to psychological disorders, as well as other medical conditions, and why this matters. Well explore a balanced holistic (whole-body) approach to preventing migraines that will not only dramatically improve your long-term migraine prognosis but your overall mental and physical health, as well. The techniques youll learn in this book will help you lessen the severity of a migraine attack, or head it off altogether. Conquering migraine it not a strategy. Its a lifestyle. In order to develop a treatment plan that works for you, you must first understand what migraine is and what causes it.

What Is Migraine?
Migraine is no respecter of age, ethnicity or socioeconomic class. It infiltrates every population across the globe. Nearly one in five women (18 percent) and one in 15 men (6 percent) suffer migraine attacks. And roughly 50 percent of migraine sufferers experience severe functional impairment and often require complete bed rest to recover from an attack. Migraine is more common than diabetes or asthma, and is most common during our peak productive years of ages 25 to 55. Whats going on in a brain under attack by migraine? Migraine is a neurological disorder, and while the exact mechanism behind migraine is not known, most researchers believe that migraine is caused by a genetic abnormality that makes the neurovascular system hyperexcitable. Once prodromal activation occurs (e.g., symptoms might include sugar cravings, neck and back pain, insomnia, depression, anxiety), the trigeminal nerves in the brain release certain brain chemicals neurotransmitter substances P and KA that initiate a cascade of events. These chemicals bind to receptors on

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the science

intercranial blood vessels, which causes vessel dilation or enlargement, plasma protein extravasation (blood plasma flowing into surrounding tissue), and ultimately inflammation. Activation of the trigeminal nerve cluster relays a signal to the trigeminal nucleus caudalis, a brain stem structure at the top of the spine whose job it is to forward pain impulses to the thalamus and ultimately to the sensory cortex. Once these first order trigeminal neurons become oversensitized, even a benign stimulus (such as a pulsating artery) results in throbbing pain that is, as youre no doubt aware, made worse by physical activity. This phenomenon, known as peripheral sensitization, triggers a domino effect if the pain is not quickly and effectively treated. Second and third order neurons extending through the midbrain to the thalamus and cortex become (and remain) continuously activated, which leads to central sensitization. The skin becomes so hypersensitive that youll experience pain from cutaneous (skin) stimuli that are normally not painful, such as brushing your hair or wearing eyeglasses. Johns Hopkins University researchers have another theory about migraines that shifts traditional explanations of dilating or constricting blood vessels at the back of the head to changes within the meninges, the protective tissue layers covering the brain. SPECT studies have revealed inflammation at areas in the meninges that precisely matched places where patients reported feeling their headaches, thus linking abnormalities in the meninges with the pain. Electrical overstimulation of the trigeminal nerve inflames the meninges and causes migraine symptoms that are similar to bacterial or viral meningitis symptoms throbbing headache, nausea, and sensitivity to light and sound. (Centofanti, Marjorie, 1999) A migraine attack may include cortical spreading depression (CSD), an electrical phenomenon that may start in the occipital lobe of the brain and slowly progress forward across the

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the science

cerebral cortex. CSD is a wave of strong neuronal depolarization that disturbs the delicate balance between neuronal (nerve cell) states of excitation and inhibition. CSD generates a hyperactive flurry of electrical signals, followed by long-lasting neural suppression. Most researchers believe that CSD triggers migraine aura and makes the brain more vulnerable to migraine attacks. Some research suggests that CSD may even trigger the mechanisms that initiate the headache.

Do You Have Migraine?

If you have any doubts about whether you have migraine, ID Migraine, a quick three-question test developed by migraine researchers at the Albert Einstein College of Medicine in 2003 may provide confirmation: Has a headache limited your activities for a day or more in the last three months? Are you nauseated or sick to your stomach when you have a headache? Does light bother you when you have a headache? If you answered Yes to at least two of these questions, odds are good that youre a migraine sufferer. Migraine is mysterious, in part, because its a moving target the symptoms can sometimes be hard to evaluate and can change from one attack to the next. Although symptoms are not perfect clues to the underlying biological abnormalities from which they arise, theyre often our best guides to the intricate workings of brain-mind and body. Think of migraine as a syndrome, a collection of debilitating neurological symptoms that arise from a common cause. This syndrome often manifests in an increasingly worsening series of symptoms or phases. (They dont call em attacks for nothin!)

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the science

Migraine phases include:

Prodrome, which occurs hours or days before the headache Aura, which immediately precedes the headache Pain phase, or headache phase Postdrome Attacks are often preceded by prodromal symptoms (often called premonitions) several hours or even a day or so before the headache sets in. Premonitions may include feelings of elation or intense energy, food cravings (e.g., sugar), thirst, increased frequency of urination, neck and back pain, drowsiness, irritability, sleep problems, anxiety or depression. In fact, depression, anxiety, and sleep disturbances are common for chronic migraine suffers. (Youll soon learn why.) The prodrome is a warning of oncoming migraine, and an opportunity to thwart a full-blown migraine attack. For some migraineurs (15 to 20 percent), the prodrome may be followed by an aura phase, symptoms that typically last for twenty minutes to an hour just prior to the headache stage of an attack. Aura symptoms include visual disturbances; hypersensitivity to light sound, odors, touch and feel; vertigo; and speech disruptions. The headache or pain phase typically includes intense, throbbing pain on one side of the head (both sides are affected in about one-third of attacks). Attacks last between 4 to 72 hours and are often accompanied by one or more of the following symptoms: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound (phonophobia) and light (photophobia), touch and smell, and tingling or numbness in the extremities or face. Why do these secondary symptoms occur? The headache pain causes the sympathetic nervous system to kick into gear, responding with nausea, diarrhea and vomiting. This sympathetic response also delays the emptying of the

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the science

stomach into the small intestine (affecting food absorption), decreases blood circulation (causes cold hands and feet), and increases sensitivity to light and sound. The postdromal period following the headache phase can last up to 24 hours after the headache ends. Symptoms that persist through the postdrome include, moodiness, lack of concentration, fatigue and weakness. How do physicians diagnose migraine? In diagnosing migraine without aura, physicians typically use whats known as the 5, 4, 3, 2, 1 criteria 5 or more attacks 4 hours to 3 days in duration At least 2 of the following: unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity At least 1 additional symptom, such as nausea, vomiting, sensitivity to light, sensitivity to sound Only two attacks are required to warrant a diagnosis of migraine with aura. Your physician may also rely on neuroimaging and lab tests to confirm a diagnosis, including electroencephalography (EEG), computed tomography (CT), magnetic resonance imaging (MRI), and spinal tap. Theyre looking for such symptoms as: Bleeding within the skull Blood clot within the membrane that covers the brain Stroke Dilated blood vessel in the brain Too much or too little cerebrospinal fluid Inflammation of the membranes of the brain or spinal cord Nasal sinus blockage Postictal headache (after stroke or seizure) Tumors

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the science

Pulling the Trigger

One of the most important aspects of designing your personal wellness system is identifying your personal migraine triggers so that you can develop the right treatment approach. (For example, if your primary trigger is stress, stress relievers like chiropractic, yoga, meditation, massage and aerobic exercise may help.) The more triggers you can identify, the more likely you are to prevent the onset of migraine. I cant overemphasize the importance of becoming a high self-monitor! Different migraineurs have different triggers. Your triggers may change over time, and your response to triggers may even vary from migraine to migraine. For most migraineurs, migraines are set off by a combination of triggers (e.g., dietary, hormonal and environmental), as opposed to a single thing or event. To illustrate, in one large study of migraineurs, most people had at least one dietary trigger fasting was the most common, followed by alcohol and chocolate. Hormonal factors appeared in 53 percent of migraines, the pre-menstrual period being the most frequent trigger. Physical activities caused migraine in 13 percent, sexual activities in 2.5 percent and 64 percent cited emotional stress as a primary trigger. 81 percent reported sleep problems as a trigger. Smells were cited as a trigger by 36.5 percent. (Fukul, 2008) Lets take a closer look at some notorious offenders

The Trigger List Possible migraine triggers include:

1. Bright lights, loud noises, and certain odors or perfumes 2. Physical or emotional stress

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the science

3. Sleep pattern changes, insomnia, hypersomnia (too much sleep) 4. Smoking or exposure to smoke. Studies suggest that smoking more than 5 cigarettes per day can trigger migraine. (Lpez-Mesonero, Mrquez, Parra, 2009) 5. Skipping meals, fasting (especially with dehydration) 6. Alcohol (often red wine) 7. Menstrual cycle fluctuations, birth control pills, hormone fluctuations during menopause onset. Two-thirds of migraines in women are hormone-related. 75 percent of women get migraines at ovulation or near the start of their cycle. Menstrual migraines, which occur within two days before the onset of menses and four days after, are believed to be caused by changes and/or imbalances in estrogen and progesterone levels. Low levels of these hormones, variations in the ratio between them, or a sudden drop in circulating estrogen can all precipitate a migraine. Women who are prone to menstrual migraines may also experience an escalation in frequency as they approach menopause, when hormone fluctuations can intensify.

Tip: Saliva tests can provide fast, accurate answers about hormone levels and track hormone fluctuations levels throughout the month, which can help establish an effective treatment plan.
8. Allergies and allergic reactions, including food allergies (e.g., wheat, sugar, corn and dairy foods) 9. Foods containing tyramine (red wine, aged cheeses, soy products, smoked fish, chicken livers) 10. Foods that contain nitrates, such as hot dogs and lunch meats 11. Foods that contain MSG (monosodium glutamate), a flavor

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the science

enhancer found in fast foods, broths, seasonings, and spices 12. Aspartame sweeteners (NutraSweet and Equal) 13. Bright lights, loud noises, or strong odors 14. Stress and anxiety, or relaxation after stress 15. Caffeine (too much or withdrawal) 16. Hypoglycemia, diabetes and other insulin problems 17. Low serum levels of magnesium 18. Specific weather changes or patterns. Studies show that roughly half of migraine sufferers are affected by weather and may be able to predict the onset of migraine from weather patterns. The most common trigger appears to be low temperature and high humidity, or high temperature and high humidity. The second most common trigger appears to be major weather changes over a 1-2 day period. And the third trigger is high or low barometric pressure. The Canadian Chinook winds have also been shown to trigger migraines in some people, as well as exposure to the bright summer light in arctic countries in the arctic area (86 percent of women with migraine with aura, 59 percent of those without aura).

1.2
What Causes Migraine

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the science

There is no single cause of migraine. The etiology or causes can vary from person to person, and may, in fact, be caused by a combination of factors genetic, chemical, neurobiological, personality, environmental, and psychosocial stress factors. Migraines are most likely caused by an abnormal trigger of chemicals that cause blood vessels to dilate or constrict. But, which chemicals are responsible? What triggers these chemical abnormalities? And most importantly, how can these conditions be conquered, thereby eliminating migraine? First, lets take a look at some known causes
Neurological and Chemical Causes

Brain Chemicals: Neurotransmitters Migraine is believed to result from changes in brain chemistry involving, specifically, the neurotransmitters. Neurotransmitters act as chemical messengers that send messages in the form of an electrical signal from one nerve cell to another, facilitating communication between the brain and the rest of the body.
The neurotransmitter serotonin may hold the key to what goes wrong in a brain in migraine. Serotonin fluctuations alter the pH balance in the brain and cause blood vessel dilation and constriction. Lets say that your nervous system responds to an external trigger (e.g., a certain food), creating a spasm in the nerve-rich arteries at the base of the brain. This spasm closes down or constricts arteries that supply blood to the brain, thus reducing blood flow to the brain. Simultaneously, platelets are clumping together to release serotonin. In fact, unusually high levels of serotonin have been detected in the brain before a migraine episode. But during a migraine attack, serotonin levels dip very low, which causes the blood vessels to dilate or enlarge; this vasodilation causes the throbbing headache, distorted vision and other symptoms.

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the science

Serotonin and its neural receptor 5-HT (5-hydroxytryptamine) are the focus of much of the current migraine research (specifically, the 5-HT1, 5-HT2, and 5-HT3 receptor subtypes especially 5-HT1 are believed to be responsible for most migraine activity). As migraine symptoms worsen, 5-HT levels decrease. Intracranial blood vessels dilate, resulting in a decrease in blood flow. Generating more 5-HT (specifically, 5-HT1) may stop an attack and hasten recovery. Gamma-aminobutyric acid (GABA) is another neurotransmitter thought to play a role in migraine attacks. GABA, working in tandem with serotonin, acts as an inhibitory neurotransmitter that quiets the bodys stress response when were experiencing physical or emotional stress. Imbalances in these neurotransmitters trigger more stress, undermine your immune system and can trigger conditions such as anxiety and depression, which, in turn, create more stressand more migraines. Glutatmate, an excitatory transmitter, has been linked to migraine, as well as other forms of chronic pain, including neuropathic pain, muscle spasticity and rigidity secondary to spinal cord trauma, stroke, and multiple sclerosis. Around 10 percent of people have a genetic abnormality that prevents them from being able to adequately break down glutamate (as in Monosodium Glutamate (MSG)) into glutamine. (You can see why MSG is a headache trigger for some migraineurs.) An increase in the neurotransmitter dopamine may help trigger and maintain a migraine attack since this dopamine is involved in controlling cerebral blood flow, nausea, vomiting, and gastric actions. Some research suggests that migraine syndrome symptoms may be related to dopamine activation, including prodromal symptoms (mood changes, yawning, drowsiness, food craving), headache-accompanying symptoms (nausea, vomiting, hypotension) and postdromal symptoms (mood changes, drowsiness, tiredness).

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the science

Hormonal Triggers In one way or another, hormones control just about every aspect of human physiology, and most hormones are involved in multiple aspects of our functioning. Thats why hormonal imbalances and deficiencies can influence many different aspects of our physical and emotional well-being.
Stress Hormone Cortisol. Stress, which triggers high levels of cortisol and adrenaline, plays a role in triggering migraines. People with chronic migraine have elevated cortisol levels, including notoriously elevated evening cortisone levels. Cortisol is a stress hormone produced by the adrenal glands. While cortisol is a major culprit behind migraine, its important to understand that cortisol is not inherently bad. Its necessary for survival. Your body produces cortisol as a natural response to stress, both physical and emotional. Its part of our fight-or-flight response. Cortisol is a glucocorticoid, which means that part of its job is to increase the flow of glucose (as well as protein and fat) out of your tissues and into your bloodstream, an act that torques energy and physical readiness to better prepare you for handling a stressor. In general, short-term elevations of cortisol in the bloodstream are good theyre simply part of our adaptive response to stress. Short-term stress actually revs up the immune system an adaptive response that prepares our bodies for fighting injury or infection. But long-term elevations of cortisol weakens the immune system and triggers migraine and depression. Chronic stress causes too much wear and tear and the system breaks down.

Heres how cortisol attacks the immune system Every cell in our bodies contains a tiny clock called a telomere, which shortens each time the cell divides. Short telomeres have

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been linked to diseases such as HIV, osteoporosis, heart disease and aging. The telomerase enzyme within each cell keeps immune cells young by preserving their telomere length that is, their ability to keep dividing. Cortisol suppresses immune cells ability to activate telomerase, thus gradually weakening the immune system. Perhaps evolution made a tradeoff. When the emergency stress response is triggered, the body quickly mobilizes its resources for action. Functions that are not on the emergency team temporarily shut down. When hormones are raging preparing for battle energy-consuming components of the immune system, such as white blood cell (T-cell) production, are temporarily suppressed. Excessive cortisol can also lead to a decrease in insulin sensitivity, increased insulin resistance, reduced kidney function, hypertension, suppressed immune function, reduced growth hormone levels, and reduced connective tissue strength. High cortisol levels have also been linked to the storage of body fat, especially visceral abdominal body fat (intra-abdominal fat). Visceral fat is stored deeper in the abdominal cavity and around the internal organs, whereas regular fat is stored below the skin (subcutaneous fat). Visceral fat is dangerous because it puts us at risk for heart disease and diabetes. Now, cortisol is not the mechanism that makes you fat. (We make ourselves fat!) In fact, one of cortisols jobs is to increase the breakdown of stored adipose (fatty) tissue into glycerol and fatty acids so that they can be converted to energy. But cortisol does contribute to storing abdominal fat. Chronically elevated cortisol levels keep our bodies in a state of fight-or-flight, which consumes oxygen and burns energy that the body could be using for the process of breaking down fat and building muscle. Chronically elevated cortisol levels can also cause muscle tissue loss by triggering the process of converting lean tissue into

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glucose. High cortisol levels can increase muscle protein breakdown and inhibit protein synthesis (building up muscle proteins). Thus, chronically elevated cortisol can prevent you from building muscle and decrease your physical strength. The goal is to maintain a healthy, normal level of cortisol. We have many hormones in our bodies, which, in the proper amounts, maintain good health, but when excessive or deficient, have negative effects on our health. For example, Cushings syndrome is associated with high cortisol levels, while Addisons disease is associated with low cortisol levels.

TIP: Want to find out if your cortisol levels are high? Blood, saliva and urine tests can provide the answer. They fluctuate throughout a 24-hour period, so tests must account for the time of day. What is a normal level of cortisol? Cortisol concentrations are generally highest in the early morning from 6 to 8 a.m. and lowest around midnight. (According to Medline Encyclopedia, 6-23 mcg/dl is a normal level of cortisol in the bloodstream at 8 a.m..) Cortisol is also temporarily elevated following exercise; this is a normal bodily response to exercise or stress. Melatonin. Migraine suffers typically have lower than normal melatonin concentrations, as well as delayed nighttime melatonin peaks. Melatonin is an antioxidant hormone thats naturally secreted by the pineal gland in the brain, especially at night. (For more on melatonin, see Chapter 7.) Pituitary Gland. The pituitary gland, located 1-2 inches behind the bridge of your nose, was once referred to as the master gland because it directs all hormone secretion in the body, including, for example, insulin, cortisol and adrenaline three notorious migraine culprits.

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If extra thyroid hormones are needed, the pituitary sends a hormone called thyroid stimulating hormone (TSH) onto the battlefield. If extra adrenal hormones are required to fight stress, the pituitary sends out adrenocorticotropic hormone (ACTH). If a womans progesterone is low, the pituitary sends out luteinizing hormone (LH). If estrogen is low, out goes follicle stimulating hormone (FSH). In other words, when a hormone level drops, the pituitary must kick into gear and increase levels. (Are you beginning to see the link to hormonal migraines?) When a hormone level becomes high, the pituitary must become inactivated or inhibited. But what happens if it doesnt? What happens when the pituitary gland is overstimulated or understimulated and doesnt do its job properly? Most commonly, the pituitary errs on the side of suppression it simply drops the ball, doesnt send out more hormone when its needed. Three of the most common pituitary suppressants are: insulin, white sugar and cortisol. (Note the relationship to many of the triggers on the Trigger List!) When under stress (cortisol increases), we crave and ingest sugary foods, eventually resulting in hypoglycemia (insulin surges) or insulin resistance. Each of these conditions further suppresses the pituitary and throws the endocrine (hormonal) system out of whack. The pituitary can also become suppressed or inhibited when theres too much of a particular hormone. This tends to happen when the detoxification pathways in the liver are inadequate. A sluggish liver results in high hormonal levels. Cells, through a protective mechanism, eventually become resistant to the high hormonal levels, a phenomenon known as hormonal resistance. (To a cell, too much hormone is more damaging than not enough.) Hormonal resistance explains why a woman who has plenty of estrogen may behave as if she has very little (e.g., hot flashes, vaginal dryness). If she takes estrogen supplements, she feels terrible.

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High levels of estrogen and progesterone can deplete the body of the mineral magnesium. Magnesium affects serotonin receptors and has been found to help regulate neuronal excitability, as well as other migraine-related chemicals, such as nitric oxide. Thus, magnesium mitigates PMS symptoms as well as migraine headaches. Whats interesting about several of the foods that are triggers for many migraineurs (e.g., chocolate, red wine, cheeses, processed meats, MSG) is that each of them has a special detoxification pathway in the liver; a pathway that can easily be disrupted by nutritional deficiencies and gene abnormalities. For instance, craving chocolate is often linked to a zinc or magnesium deficiency, the two minerals that are most critical for proper DNA replication via enzyme activation. If enzymes do not perform as designed, the results are mutated DNA strands and the eventual expression of bad genes. Cheeses often contain molds. Mold toxins (known as mycotoxins) are directly linked to poor DNA replication and add a significant stress load on the liver. Processed meats contain sulphites, as do wines. Many people do not have adequate nutrients to aid in the detoxification of sulphites. Molybdenum, a trace mineral needed in only small amounts, can often help this particular detoxification pathway. To stop a migraine, each of these disrupted patterns must be corrected Chemicals must be detoxified; genetic expression must be overcome with enzymatic co-factors (e.g., zinc and magnesium); stress must be reduced; and insulin must be managed with a hypoglycemic diet and proper nutrients.

Is the Medication Curing the Headacheor Causing it? Sometimes in the world of migraine, the treatment actually makes the condition worse. Perhaps the most notable example of this vicious cycle is Medication Overuse Headache (MOH), a disorder caused by frequent use of migraine medications.

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You may know MOH by another name: the rebound headache. How is overuse defined? More than 2-3 days per week, week after week, month after month. MOH creates a headache-worsening pattern more severe headaches occurring more frequently which, in a touch of cruel irony, results in the need to take more medicine. Not only is the pattern itself harmful, but during this vicious cycle, other effective treatments are less likely to work. MOH is believed to affect 3 to 5 percent of the general population, and is widely considered to be the most common culprit behind the progression from episodic migraine to chronic migraine. While the mechanisms underlying MOH remain unknown, we do know that opiates and triptans are associated with the development of MOH. But thats not allover-the-counter medications can also cause MOH. Research suggests that opiates and triptans may be triggering neural adaptations in peripheral sensory fibers (in facial regions, for example) that innervate dura (fibrous membrane covering the brain and spinal cord) that contribute to the increased frequency and occurrence of migraine headaches. In other words, overuse of these meds is actually causing neurons to change over time, and worse, these neuroadaptive changes persist for long periods of time and can continue to cause unpleasant effects, long after the medication is discontinued. These medications have also been shown to influence gene-related peptides (compounds of two or more amino acids) that regulate facial trigeminal nerve cells. (sher, 2009) A large-scale Albert Einstein College of Medicine study of 8000 migraine sufferers showed that overusing medications containing narcotics (e.g., acetaminophen with codeine or Percocet) or barbiturates (e.g., Fiorinal, Fioricet and Esgic) actually makes migraine worse. Overuse of these medications is also associated with an increased risk of transformed migraine (TM) headaches, which are characterized by fifteen or more days of headache per

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month. NSAIDs (e.g., ibuprofen and naproxen sodium) appear to actually be protective against transition to TM for those suffering less than 10 headache days per month, but create an increased risk of transition to TM for those of us with high levels of monthly headache days (lipton, 2009).

The Big Picture If being migraine-free is not enough reason for you to take steps to improve your overall health and wellness, you should be aware that several serious health problems have been strongly linked to migraine.
1. Overweight people between the ages of 20 to 55 are at higher risk for migraine attacks. Excess belly fat is thought to be a higher risk factor than abdominal fat. (American Academy of Neurology, 2009) 2. While migraine without aura has been associated with some increased risk for cardiovascular disease (CVD), migraine with aura more than doubles the risk of heart attack and CVD, increases the risk of angina by 71 percent, and more than doubles the risk of death from ischaemic stroke, particularly for females ages 45 or younger who smoke and use contraceptives containing estrogen. Women who have weekly migraine are significantly more likely to suffer a stroke than those with fewer migraines or no migraine at all. (American Academy of Neurology, 2009),

(Its important to be note, however, that you can dramatically lower cardiovascular risk factors by preventing hypertension, hyperlipidemia [high cholesterol], and not smoking).
3. People with migraines may be more likely to develop blood clots, a condition known as venous thrombosis or thromboembolism. Blood clots limit blood flow and cause swelling and pain. If they dislodge from the vein and travel to the heart and lungs, they can be fatal. Interestingly though, people with migraine have not been

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found to be more likely to have hardening or narrowing of the arteries (atherosclerosis) (kiechl, 2008), 4. Depression, bipolar disorder, generalized anxiety, social anxiety and panic attacks are highly comorbid with migraine, across all populations and age groups. For example, studies show that teens who have migraine are at greater risk for suicide; twenty percent were at high risk of suicide. Nearly 50 percent of teen migraineurs had one or more psychiatric disorders 21 percent had Major Depression, 19 percent had panic disorder. Teens who have migraine with aura were even more likely to have psychiatric disorders and were six times more likely to be at high suicide risk than those without migraine (American Academy of Neurology, 2007). Now, Im not trying to scare you. But I do want to help you become aware of the consequences of not finding the right treatment for migraine. The simple reality is that symptoms, left untreated, tend to escalate. Over time, they last longer and become more severe. A person who might currently be subclinical for migraine (i.e., doesnt meet the full diagnostic criteria for migraine) is at risk for developing full-blown migraine attacks. As symptoms progress and worsen, they become more difficult to treat, which means that you will suffer more and recovery will take longer.

Is it time to take a closer look at your overall health and fitness?

If you ignore your migraine symptoms, or treat them solely with medication (which can lead to rebound), your life and your health may become unmanageable. The key to migraine prevention is pinpointing and treating the causes and triggers, rather than simply continuing to treat the symptoms. As youll learn in upcoming chapters, the first step of migraine prevention is discovering and understanding the unique physiology of your own body, and learning to listen to what its trying to tell you.

1.3
Is It All in the Genes?

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Do genes seal your fate? No. But they do influence who you become from what you look like, the unique talents and skills you will have, and the health conditions that you may have a predisposition for.
How does genetic information help us? Identifying your personal susceptibility to certain conditions and pinpointing the specific factors that interact with this susceptibility to produce certain illnesses can empower you to take more control of your body and your health. Genes can create risk factors, but having a genetic risk for a particular illness does not mean that particular disorder or disease is inevitable. Genes are just one variable in the mix that becomes the unique you. Ultimately, were the product of both nature and nurture: Our genetic inheritance gives us our biological potential. But its our experiences, including culture and lifestyle, that determines how and how much of that potential is realized. Migraine is genetically influenced, but not genetically determined. Each of us has 30,000 genes in our personal genome. Every cell in your body contains DNA (deoxyribonucleic acid), the chemical compound that contains the genetic instructions on how to make you. DNA consists of two long chains of nucleotides twisted into a double helix which is held together by hydrogen bonds. The precise sequence of these nucleotides the genes determines the characteristics you inherit. A gene is one sequence of DNA that occupies a specific location on a chromosome and determines your individual characteristics from the color of your eyes to your propensity for a particular brain chemical deficiency. Throughout our lives, genes express themselves or turn on and off. They must receive electricity to turn on and express their particular proteins. The job of genes, after all, is simply to make proteins. Some genes are only expressed or turned on

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in response to stimuli from the outside world, such as environmental influences and how we treat our bodies. Scientists have actually identified specific genes and pathways that are affected by lifestyle and geography. Environmental factors can play a huge role in turning genes on or off; so for example, people who share the same genetic makeup but live in different environments and treat their bodies differently may express genes differently. We even have epigenetic genes that control other genes; in other words, they can alter gene expression by silencing and regulating other genes (e.g., the KRAB-ZFP family of genes). The bottom line is that genes are never totally to blame for our fortunes, good or bad. And we all have the capacity through our thoughts and behaviors to alter gene expression. That means you have plenty of opportunity to influence your own health and well-being. This is absolutely true of migraine. Migraine genetics help explain why some people develop migraine and some dont. Is there a single primary migraine gene? Possibly, but so far, research suggests that migraine heritability is multifactorial; in other words, we all inherit a mixture of several gene variations, which can combine with external factors, such as stress or toxic substances, to breed migraine. Several emerging patterns in migraine genetics are beginning to erase some of the mystery surrounding why some people suffer migraines and others dont. To illustrate how genes play a role in causing migraine and other co-occurring disorders, heres a sampling of what migraine research is teaching us 70 to 80 percent of migraine sufferers have a family history of migraines. (National Headache Foundation (NHF))
1. People with migraine often have a parental history of early heart attack and an increased risk of high cholesterol and high blood pressure. 2. Studies show that teenagers from low income households

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with no family history of migraine are more likely to suffer migraine than children from upper income families, a factor which may be explained by factors that are associated with low socioeconomic status, such as stress, poor diet or limited access to medical care and psychotherapy. In families with a history of migraine, the rate of migraine among adolescents was nearly the same between both high- and low- income groups, suggesting that in those with a genetic or familial history of migraine, the biological predisposition dominates socioeconomic factors (American Academy of Neurology, 2007). 3. The Cacnl1a gene has been strongly linked to both migraine and epilepsy, which helps explain why epilepsy often cooccurs with migraine. This gene affects the movement of calcium into and out of specific brain cells. Calcium movement regulates the release of neurotransmitters and plays a role in growth and regulation of cells. 4. The ion channels in the membrane of the migraineurs neurons are far more permeable and excitable than the non-migraineurs. (Youll recall that migraine is a state of neuron hyperexcitability.) One study of 4000 migraineurs in Finland and Australia led to the discovery of a mutation in a brain calcium-channel gene (10q23), a gene with particularly strong links to female migraineurs. Several studies of this gene also showed that pulsating and unilateral migraine pain may be directly linked to specific genetic loci (locations). In other words, there may be a genetic explanation for why pain is unilateral in some sufferers and pulsating in others. 5. Familial hemiplegic migraine type-3 (FHM3), a rare and severe form of migraine with aura that often includes a weakness or paralysis of one side of the body, is caused by mutations in a sodium channel gene, SCN1A,

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which has also been linked to epilepsy. The calcium channels of people with FHM3 have also been found to be hyperexcitable by even weak stimuli, which explains their increased susceptibility to cortical spreading depression (CSD). (Vanderbilt University Medical Center) 6. A 2009 University of Iowa study found that an excess of a small protein called RAMP1 appears to turn up the volume of a nerve cell receptors response to the neuropeptide CGRP (calcitonin gene-related peptide), which is elevated during migraine and long believed to be involved in causing migraines. Researchers investigated CGRP receptors in the trigeminal nerve (responsible for relaying almost all sensory perception), including pain and touch for the front of the head, and found that migraineurs may have subtle genetic differences in the RAMP1 gene that increase levels of RAMP1 protein. 7. Around 38 percent of patients with migraine with aura have a patent foramen ovale (PFO), a defect in the wall between the two upper (atrial) chambers of the heart that is present in everyone before birth but seals shut in about 80 percent of people.

Can you find out if you have any of these genetic propensities? Sure. You can have your personal genome mapped for between $1000 to $2000. But before you get out your checkbook, you might want to ask yourself this: Do I really want to know everything I could be at risk for? Even if you understand that genes are not destiny, knowing that you are at high risk for a debilitating illness could conceivably cheat you out of a quality life. And gene scans cannot tell you with certainty whether or not you will develop a particular illness because scientists dont yet know all the possible gene variations which may contribute to (or, on the flip

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side, protect us from) a particular illness. Also, its difficult to measure the degree to which other factors (e.g., lifestyle factors) will contribute to or prevent that illness.
Can We Alter Gene Expression?

Gene research is beginning to focus on epigenetics. Epigenetics refers to a change in gene expression that is caused by something other than a change in the underlying DNA code. The epigenome sits on top of the genome. These epigenetic marks tell your genes to switch on or off, to express themselves strongly or weakly. It is through epigenetic marks that environmental factors such as lifestyle and stress can make an imprint on genes that will be passed from one generation to the next. Were beginning to identify genes that actually have epigenetic functions. For example, the KRAB-ZFP family of genes is involved in regulating the expression of other genes and ultimately, helping us deal with stressors. The KRAB-ZFP genes, which are believed to have appeared fairly recently on the evolutionary scale, serve as epigenetic censors, selectively silencing the expression of other genes (Trono, 2009). Often, several different genes may be involved in slightly increasing or decreasing risk of developing a particular illness. It is believed that these repressor genes make up about 2 percent of our genetic material, and vary from person to person. This variability in the KRAB family of regulators, for example, helps explain why some people are predisposed to anxiety or depression and some are not, or why some people might be predisposed to migraine and others arent. Epigenetic alterations are often long-lasting or even permanent, so your personal history can have a lasting impact on your genetic expression either positively or negatively, and that epigenetic alteration can be passed along to subsequent

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generations. For example, some studies show that lifestyle choices like smoking and overeating can change epigenetic marks in a manner that causes the genes for obesity to express themselves too strongly and the genes for longevity to express themselves too weakly. So bad lifestyle choices not only shorten your life, they may also predispose your current and future children to disease and shorter lives. Epigenetic changes are biological responses to environmental pressure stressors. If the environmental pressure is removed, the epigenetic marks will eventually fade and those genes will revert to their original expression. For better or worse, your lifestyle and environment will have an impact on how your genes express themselves.

PART

The Therapies

2.1
Landing on the Chiropractors Table

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Ill admit, I was skeptical about chiropractic. I viewed it as a rather strange profession, unknown (to me) and unconventional. For the most part, I had always viewed my health, ailments and treatments, in conventional terms. I went to see conventional doctors, I ate conventional foods and I hoped that conventional treatments would help me. Pain drove me to the chiropractors office. Pain drove me to open my eyes and mind to possible treatments beyond conventional medicine. I went because I had to. My back was killing me no matter what position I arranged myself in and I had to feel better fast. Working in the fastpaced mortgage industry, at the end of the most recent housing boom, I had closings to manage, phone calls to juggle. I had to be able to hold myself erect at a desk for 8-9 hours straight. Waiting for the pain to go away on its own was not an option. And I simply did not want to take another drug. I knew overthe-counter painkillers wouldnt do the trick, and I did not want yet-another prescription drug. A friend suggested I see a chiropractor. In his opinion, those physicians were more skilled at interpreting X-rays than primary healthcare practitioners; I wouldnt have to see an endless string of specialists just to have a good set of diagnostic X-rays explained to me. I would save time and could be back at my desk faster. And when youre in pain, you absolutely want to save time. It was then that another friend recalled a chiropractor relieving her back pain, but also shared how a few visits resulted in her not getting any more hangovers. Upon hearing her observation, I stopped in my tracks. I had already known for a while that the physiological mechanisms for a migraine and a hangover were similar. Well, normal people have to really overdo the imbibing to get a hangover. For me, one glass of wine was often all it took to land me in bed, nauseated, suffering

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a throbbing migraine. Now, you may laugh, but I actually found myself clinging hopefully to the notion of cured hangovers. Perhaps a chiropractor could cure my migraines! I wasnt exactly expecting a shaman when I came in, but I took mental notes. My first visit didnt feel like a typical visit to the doctors office. It stood in stark contrast to my usual 3-5 minute consultation with a medical doctor who flew in with his laptop, barely even glancing at me as I detailed my symptoms. What Ive since learned is that many people prefer chiropractic physicians to medical doctors because chiropractors are often perceived as more sensitive and responsive to their needs. Patients report that chiropractors they see are less hurried, more sympathetic, more communicative, and are more likely to treat them as equals. (kane, 1974) These humanitarian considerations are important in all aspects of patient care in every physician-patient relationship, but theyre especially crucial for migraineurs. Theres often little objective information to report in their cases and the subjective factors are critical to accurate diagnosis and treatment. Physician studies of dissatisfied patients show that those patients usually want more diagnostic tests but do not want to see the same doctor again. Why? Because the doctor had failed to provide an adequate explanation of their problem the first time. (deyo and diehl, 1986)

These patients dont trust their doctors. Perhaps you can relate? My chiropractor inspired trust on my first visit. As he treated my lower back, in acute pain at the time, and then adjusted my cervical (neck) vertebrae, he inquired if I had questions and then spent time with me, answering them. I learned that my body was aging, and that my lumbar spine was in the early stages of degenerative disk disease. I was also told that my

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neck muscles were ropy. But I was offered hope and encouragement, instead of another drug prescription. My chiropractor stressed the importance of regular exercise and a healthy diet. I was given exercises for strengthening and stretching the tight muscles around my neck, upper back and below the skull and encouraged to incorporate regular physical activity into my lifestyle. Upon leaving the chiropractors office, I had to demonstrate that I knew exactly what my proper posture should look like. The goal was to retrain my body; specifically to re-train my cervical spine musculature and lower back muscles to better serve me during normal bodily movements. The goal was to reduce biomechanical stress on my spine. For example, contracting your lower back muscles with the technique of abdominal bracing will help stabilize your lumbar spine. If you have weaknesses in your lumbar spine, like I do, its worth exploring. These were my first attempts at changing bad habits I had acquired over the years. The word wellness popped up in the conversations a few times. The idea of focusing on wellness, on health rather than illness, was an entirely new concept to me. And what did wellness actually mean? Im not sure I knew at the time. But what I instinctively felt was that it had been many years since Id experienced it. And those ropy neck muscles Was it possible that they could have anything to do with the headaches Ive experienced since my teenage years? Could there be a connection? There was an obvious link, I understand now, that no other doctor had ever pointed out to me before. No book I ever read on headache recommended spinal manipulation. After a few visits to the chiropractor, I resolved to quit the antidepressant medication, prescribed to me for the treatment of migraines. It was not my chiropractic physicians advice. I simply had to see for myself - and I had a new hope to hang onto.

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What Can Chiropractic Do For Headaches?

Chiropractic care relieves mechanical and functional stress of the bodys muscular and skeletal systems. In conjunction with dietary changes, regular exercise, and your personal commitment, chiropractic care can dramatically improve your overall health. Mechanical and functional stressors can play a role in migranous symptoms, thus, chiropractic treatment, especially when supplemented with massage therapy, may effectively treat these symptoms, as well as pain related to cervicogenic and tension headaches. Chiropractic has been proven to decrease the intensity, duration, and frequency of migraine syndrome. Both peripheral and central nervous systems are susceptible to noxious mechanical and chemical stimulation. But what does that mean to the migraine sufferer, and how can chiropractic help? Lets say that your body is under chronic postural strain you might even be totally unaware of it, like I was. The result is that your muscles grow increasingly tighter, and that tightening impacts vascular and mechanical systems in your neck and head. All our bodily systems are closely intertwined, and imbalance in one inevitably influences the others. Migraines always have a vascular component headaches occur when blood vessels in your head become inflamed. My head, for example, was slightly turned to the right for years, and I started experiencing severe migraines, always in the left hemisphere of my head. Migraine is also the disruption of normal neurological functioning. There is one trigeminal and two upper cervical nerves on each side of your head and neck. These nerves supply areas of the skin along the base of the skull and behind the ear and join with other nerves outside the skull to form a continuous net. Typically, the upper cervical nerves follow a curving

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course that passes through various muscles in the upper back, neck and head; in many, these nerves pass through the cervical spine musculature. When the migraine mechanism becomes activated, pain impulses travel via the trigeminal and/or upper cervical nerves. Since theres one of these nerves supplying each side of your head, your migraine may be unilateral or onesided. Another factor is nutrition, which well discuss more thoroughly in PART III. Pro-inflammatory diets have also been known to produce migraine symptoms. Nociceptors are sensory nerve fibers which, once irritated by noxious mechanical or chemical stimuli, can cause headaches that either are, or can mimic, classic migraine headaches. The medical term used for this phenomenon is sensitization. Typically, nociceptors have a high threshold for nerve impulse activity; in other words, a significant aggravating stimulus is required for these nerve fibers to fire or respond. Under normal physiological conditions, they remain relatively silent. Pro-inflammatory diets change the composition of your body chemistry with increased production of arachidonic acid and prostaglandins both powerful drivers of inflammation. Persistent production of these chemicals can sensitize nociceptors by lowering the nerves firing threshold. Thus, normal functional daily activities that are not typically painful may become increasingly difficult to perform because of this painful sensitization phenomenon. If you find that your migraines are consistently diet-driven like mine were, what it means is that your body is (consistently) trying to communicate a message to you. For any given migraine headache, the cause may be musculoskeletal or dietary or both. Thats why chiropractors use a holistic treatment approach, and thus improve your overall health. And what they most certainly dont do is merely treat your

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symptoms with a drug. Its not enough to temporarily alleviate the symptom. The goal is to pinpoint and treat the primary cause of any imbalance(s) and help your body restore itself to better health.
What the Science Says

Several clinical trials have shown that spinal manipulation is effective in treating migraine. In one study of people with migraines, 22 percent of those who received chiropractic manipulation reported a greater than 90 percent reduction of attacks and 49 percent reported a significant reduction of the intensity of each migraine. In another study, people with migraine were randomly assigned to receive spinal manipulation, a daily medication Elavil (amitriptyline), or a combination of both. Spinal manipulation, interestingly, was as effective as Elavil in reducing migraines. And in nine other studies these researchers reviewed, chiropractic was as effective as medications in preventing migraine headaches. (astin, 2002) A recent clinical trial at Australias Macquarie University indicated that 72 percent of migraine sufferers experienced either substantial or noticeable improvement after a period of chiropractic treatment. Around 50 percent of these patients showed noticeable improvement either lower frequency of migraines, shorter duration, or a significant reduction in the use of medications. (This last result is important because some migraine medications have serious side effects and can even trigger rebound headaches.) Around 22 percent showed substantial improvement (more than 60 percent of their symptoms were reduced during the course of chiropractic treatment). Whats most impressive about this result is that this was a chronic group. Eighteen years was the average length of time theyd had migraines. A change of this magnitude in chronic migraineurs is quite amazing.

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Despite impressive clinical trial results like these, however, some medical practitioners still dispute the ability of chiropractic care to help migraine sufferers. Be forewarned: Youre going to bump into this. Youll probably find that most medical doctors are not likely to refer you to a chiropractor, no matter how loudly your symptoms scream that you might need a spinal adjustment. Unfortunately, many medical doctors have a long-held bias against chiropractic. And organizations like the American Medical Association (AMA) only fuel that controversy. Doctors of chiropractic, after all, are not among dues-paying members of the AMA. Some medical doctors simply dont have a full picture of what chiropractic can do. But a professional discussion between a doctor of chiropractic and your medical doctor regarding the clinical findings and treatment plan, may help your medical doctor feel better about making that referral.

There is great diversity among chiropractors. The chiropractic profession includes specialties, such as:
Diagnosis and Internal Disorders (Chiropractic Internist; the chiropractic equivalent of a primary care physician) Orthopedics Neurology Chiropractic Physiological Therapeutics and Rehabilitation Chiropractic Acupuncture Diagnostic Imaging (Radiology) Nutrition Occupational Health Sports Physician Chiropractic Pediatrics

Its important to take the time to find a chiropractor youre comfortable with, and get results from.

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What to Expect From a Chiropractic Evaluation for Migraine The chiropractor will use his/her hands, X-ray or other advanced diagnostic imaging modalities to analyze your spine and determine if you have any functional musculoskeletal problems. Since migraineurs experience different symptoms, a chiropractor will need to evaluate several aspects of your health. In order to determine the right course of treatment to help relieve your specific migraine syndrome, chiropractors should assess the following:
1. Investigating the history of your present illness, as well as your family history 2. Determining whether the headaches are part of a migraine syndrome or another type of headache 3. Evaluating the type and source of pain; for example, a neuromuscular evaluation, as well as lifestyle or environmentally-related causes, such as diet, exercise, sleep, nutrition, personal or professional stress 4. Musculoskeletal triggers, such as head-neck posture (this is an issue that plagues many, including me), prolonged static positions and frequent repetitions (e.g., car mechanics or data entry operators) 5. Evaluating untreated visual acuity problems, such as myopia (nearsightedness) 6. Assessing whether head pain is a symptom of a more ominous problem, such as brain tumor, intracranial lesion, astrocytoma, vascular bleed, or concussion 7. Assessing whether temporomandibular joint (TMJ) disorder may explain some migraine-like symptoms. TMJ syndrome is a painful, acute or chronic inflammation of the temporomandibular joint, which connects the mandible (jaw) to the skull.

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What to Expect From Treatment Your chiropractor is likely to first address any mechanical or neuromuscular dysfunction of cervical and upper thoracic vertebrae, such as:

Range of motion Muscle spasm Joint dysfunction Postural stress

Correcting unbalanced structure takes tremendous stress off the body. Using special mechanical techniques, your chiropractor will perform a chiropractic spinal adjustment to correct any spinal mechanical dysfunction that may be necessary, which helps to restore joint function, relax musculature, and loosen tight ligaments, moving you one step farther from migraines crazy neural free-for-all.
A standard chiropractic treatment approach might include:

Mobilization Manipulation Traction Stretching and exercise Correcting unhealthy posture Eliminating aggravating activities Passive modalities such as ice, heat, topical ointments, ultrasound Obviously, youll have to rely on the chiropractor for manipulation. But notice that many of these treatments are selftreatments, and a good chiropractor can advise you on how to self-treat for maximum effect; for example, stretching, exercise, posture self-correction and eliminating pain-inducers can be effective. Sometimes, the simplest tactic creates amazing results. It is not suggested here that chiropractic will cure every

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migraineurs headaches. For many migraine sufferers, chiropractic is only one piece of the cure puzzle, not be the be-all, end all migraine treatment. Chiropractic might not necessarily cure your migraines forever, especially if you have severe, chronic migraine symptoms. But for a significant percentage of migraineurs, the neck region is a contributing factor, and for those people, chiropractic treatment can be essential. The odds are pretty good that competent chiropractic will offer some level of relief. And something else: Theres very little to lose. Chiropractic generally has no side effects and treatment is considered extremely safe; however, your chiropractor should certainly exercise caution in treating the cervical spine. A thorough history, examination, and imaging, as indicated, are necessary prior to treatment. Most likely, the worst that could happen is that you might be a little sore for a few hours, depending on the rigorousness of the treatment, and how severe your problem is going into treatment.

2.2
In Morpheus Arms (Sleep)

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Eventually, the news Id been dreading came: I was laid off from my job, sent home with a couple months severance pay. But little did I know that the layoff would be a blessing in disguise. It was an emotionally turbulent time in my life. I was too depressed to actually enjoy my time off from work. Some days, I didnt even feel like getting out of bed. But I took advantage of my predicament. I had time on my hands, so I rested. I read a lot. I did some research. I hadnt had the luxury of free time since high school. All those years, Id never even taken a real vacation. As an immigrant to the US, I was always focused on making it here, getting ahead. But guess what? My body started responding almost immediately to getting lots of rest. I had fewer headaches... yet, I still didnt make the connection between sleep and migraine right away. While the stress of the workweek wore off by Friday night, I sometimes couldnt even enjoy the weekends because they were spent in the grip of a weekend migraine. The stress might go away on Friday night, but the migraines would come back with a vengeance on Saturday. Part of the solution was changing my sleep schedule. Instead of staying up late and sleeping in late, keeping a regular sleep schedule helped defeat the headaches. Looking back on my life now, its clear that Id been sleep-deprived since high school. Some people seem to get by with less sleep (though, arguably, no one really gets by with it), but not a migraine sufferer. Migraineurs never get away with sleep deprivation. Getting adequate sleep and quality sleep is one simple step that everyone can take today to start beating migraine.

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If you were a giraffe, youd only need 2 hours sleep. (Wouldnt that be great?) Pythons, on the other hand, need 18 hours sleep per day. How much sleep do humans need? Adults need 7-8 hours; adolescents, 9-10 hours; and babies, 16-18 hours. Contrary to popular myth, we do not adapt to getting less sleep than our bodies actually need. And worse, the amount of sleep we need increases when weve been deprived of sleep.
What Does Sleep Actually Do For You?

Quality sleep improves the brains ability to learn, remember information, maintain emotional stability and make decisions; thus, sleep deprivation impairs learning, memory and thought processes. Sleep has a tremendous impact on our ability to properly assess a situation and make wise decisions. Sleep deprivation can be particularly dangerous when you have to make high-stakes decisions, which, in a twist of irony, are the very decisions that tend to keep us awake at night! Sleep consolidates memory. Fresh impressions of daily events are first stored as short-term memories in the brains hippocampus, then moved within hours (or days) usually during deep, dreamless sleep into the an area in the cerebral cortex known as the neocortex, or new bark, where they are stored in long-term memory. Sleep also strengthens and reinforces our procedural or how to memories (e.g., learning musical compositions), as well as declarative or what memory (e.g., learning new words or concepts). Sleep deprivation is a notorious migraine trigger and it feeds mental health problems such as depression and anxiety, which can further exacerbate stress, and ultimately trigger more frequent and more intense migraines. Youre probably already aware that sleep has a dramatic impact on mood. Insufficient sleep makes you irritable and tired

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and more likely to have trouble with relationships. Chronic insomnia makes us more vulnerable to depression (and depression makes us more vulnerable to insomnia). Sleep deprivation can make you seem and feel depressed (e.g., irritable, moody, apathetic, flat) and rachet up anxiety levels. Why? Because youre less mentally and physically capable of coping with daily stressors. And sleep deprivation influences overall neurotransmitter imbalances and fluctuations, including the feel-good neurotransmitter serotonin that is responsible for feelings of well-being, calmness, personal security, relaxation, confidence and concentration. Some of the brains serotonin is converted in the pineal gland to melatonin, an antioxidant hormone that regulates sleep patterns and helps you get a good nights sleep. Frequently called the hormone of darkness, melatonin regulates our circadian rhythm (sleeping and waking) patterns: It tells the body when its time to sleep. The bodys natural levels are high during the evening and low during the day. Melatonins antioxidant properties help fight the damage wreaked on us by free radicals; for example, melatonin can help stop wear-and-tear damage to DNA. Melatonin has been shown to decrease headache frequency and intensity and help reduce analgesic and triptan consumption. In addition to what the body produces naturally, some migraineurs take melatonin supplements to fight jet lag, mitigate seasonal affective disorder and regulate nighttime dementia. But its important to be aware that melatonin supplementation is not without its share of controversy. Recent research suggests that excess melatonin may actually be hurting you at night. Memories of the days events are consolidated during sleep, and melatonin directly inhibits memory formation. And one recent study by Louisiana State University chemists suggests that melatonin reacts with free radical chemicals in the

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body to form unhealthy metabolite compounds that can contribute to disorders such as depression. LSU researchers claim that the antioxidant properties of melatonin are modest at best and that metabolizing excess melatonin may cause more harm than good.
As in all things, balance is the key!

Sleep deprivation also increases pain perception. In other words, if anything hurts, it will hurt worse when you havent had enough sleep. This can be especially significant during migraine syndrome. Sleep is one of the most important gifts we can give our bodies. A good nights sleep is often one of the best ways to cope with stress, solve problems, and recover from illness. We regenerate and rejuvenate during sleep. Our bodies literally engage in healing processes during sleep. During the deepest stages of early sleep, the body goes to work repairing and regenerating tissues, building bone and muscle, and recharging the immune system. Thus, sleep deprivation actually decreases the bodys immune response, rendering us less capable of warding off illness, and less capable of healing naturally. Studies show that not getting enough sleep or getting poor quality sleep on a regular basis increases the risk of high blood pressure, heart disease, and other medical conditions. During healthy sleep, cerebral blood flow increases. Some sleep disorders (e.g., apnea) have long been associated with reductions in middle cerebral artery (MCA) blood flow. Sleeplessness ages you. Aging is associated with shorter time spans of sleep. After a couple of months of regular and sufficient sleep, a friend commented on my disappearing wrinkles. (See, they dont call it beauty sleep for nothing!).

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The Hormone Connection

Your body produces critical hormones during sleep; for example, deep sleep increases the release of growth hormone, which fuels cell growth, helps build muscle mass and repair cells and tissues. Sleep increases infection-fighting hormones, as well as hormones that affect how the body uses energy. Sleep deprivation slows your metabolism. Ive found that I eat more when I havent had sufficient sleep. Studies have shown that the less people sleep, the more likely they are to be overweight or obese, to develop diabetes, and to prefer foods that are high in calories and carbohydrates. Sleep deprivation makes us crave stimulants like caffeine and sugar. Chronic sleep deprivation makes it easier for stimulants to become habitual cravings. Those stimulants give us an energy boost, but its just shortterm energy, borrowed energy, and ultimately leads to a state known as adrenal exhaustion or adrenal fatigue. Heres how it happens Our adrenal glands produce an androgen steroid called DHEA (dehydroepiandrosterone), which, in part, offsets the negative effects of excessive cortisol. When we first experience adrenal fatigue, cortisol elevates, and the body self-medicates by increasing DHEA levels to offset the negative impact of high cortisol. This compensation creates temporary improvements in energy, vitality, sleep, PMS symptoms and cognitive abilities. But it doesnt last long. Insulin surges, triggering cravings for sugar, carbohydrates and hydrogenated oils. Once we move into the adrenal exhaustion phase, cortisol levels remain high, but cortisols balancing partner DHEA decreases, and this is when the trouble begins. We may experience symptoms such as anxiety attacks, mood swings, onset insomnia, restless leg syndrome and an overall stressed feeling.

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Higher cortisol levels can trigger epic dreaming for many, which is exhausting. Increased cortisol levels extend the length of REM cycle sleep, allowing less time for Delta Wave sleep, which is the phase of sleep during which healing, repair and growth occurs. The result? Our healing capacity diminishes and our immune system is compromised. In the exhaustion phase, cortisol and DHEA both become depleted. Your body now enters the conservation mode in a state of chronic fatigue, depression, insomnia and exhaustion. Sleep becomes disturbed youll wake up frequently and find it difficult or even impossible to go back to sleep. Cortisol surges have lost their proper timed response, surges that will be made worse by hypoglycemia issues. Its important to understand that simply reducing cortisol is not the answer. That would create more problems than solutions. For example, when the immuno-suppresive effects of cortisol reduce as cortisol levels drop, histamine levels can rise. Allergies can develop, as a direct result of adrenal fatigue. If youre a migraineur with food allergies, you can see the vicious cycle that could develop. Cortisol levels are part of a well-timed, balanced system of the bodys homeostasis and just one component of balanced adrenal function. Good health is about balance. And quality sleep helps restore that balance.
Are You Getting Enough Sleep?

Do you wake up naturally before the alarm clock sounds? That may be one measure of whether youre getting enough sleep. If you need an alarm clock to drag you out of bed kicking and screaming most mornings, start monitoring the relationship between your migraines and sleep patterns. Notice whether you experience less frequent and less intense headaches when youre getting enough sleep.

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However, its also important to be aware of your own personal circadian rhythm. Everyones biological clock is different. Some of us are morning people and some of us are night owls. And unfortunately, some of us night owls have to crawl out of bed at the crack of dawn to get to work on time. In a perfect world, youd have an occupation that would allow you to wake up and go to sleep in perfect synchronicity with your personal internal clock. Why is your biological clock different from someone elses? We have our genes to thank for that. In fact, 10 to 15 percent of our genome is regulated by circadian rhythms, another reason why you dont want to let your natural body clock get out of whack. Your internal body-clock is regulated by a pair of genes: CLOCK and BMAL1. A single amino acid is the chemical switch that triggers this genetic mechanism. (Amino acids, youll recall, are the building blocks of proteins, which are essential to metabolic health.) Maintaining a regular sleep cycle is a simple strategy that will dramatically improve mental and physical health. If you go to sleep each night at the same time and get up each morning at the same time, your biological clock wont be forced to reset itself again and again.

TIP: Keep a Sleep Diary to monitor the relationship between your migraine syndrome and your sleep patterns.
Whats keeping you awake?

What you ingest in a days time always has a significant impact on the quality of your sleep how well you sleep, how easily you fall asleep and stay asleep, and how rested you are when you awaken the next morning. Its no secret that caffeine is the enemy of sleep. Caffeine is a drug a psychoactive stimulant whose job, after all, is to

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increase alertness. But the last thing you want to do is idle high when youre supposed to be idling down and going to sleep. Caffeine is a vasodilator (enlarges blood vessels), a diuretic, and it can even increase blood pressure. Caffeine is broken down by the liver into three different compounds, 12 percent of which is theobromine. Theobromine is an alkaloid that dilates the blood vessels and is involved in increasing urine volume, which can contribute to depleting the bodys magnesium supply. (This can be particularly problematic for migraineurs who have low magnesium levels.) Caffeine also elevates cortisol levels. Its difficult to fall asleep when your cortisol levels are elevated. Elevated cortisol levels, remember, keep the body in fight-or-flight mode. When its time to go to bed, you dont need to fight or flee you need to sleep. For most of us, cortisol is naturally at its highest from 6:00 to 8:00 am and at its lowest around midnight. When we follow the natural cycle, its easier to wind down and fall asleep faster. Caffeine, alcohol and sugar are all stimulants. And while they may temporarily overcome the effects of sleep deprivation (by propping you up!), they cant boost energy for extended periods of time. Sugar and alcohol pick you up, but drop you quickly, ultimately leading to an energy crash, and for some: a migraine attack.
How to Get a Good Nights Sleep Here are some recommendations for getting a good nights sleep 1. Dont go to bed stressing about how much work you have to do tomorrow, what you didnt get done today that you should have, or obsessing about something you did wrong.

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Odds are, you cant do anything about it that second, so instead of letting it keep you awake, jot it on your to-do list, and give yourself permission to deal with it tomorrow. 2. Wind down before going to bed. Find a bedtime routine that relaxes you this will lower blood pressure, and cortisol blood sugar levels. For example, drink a decaffeinated herbal tea, listening to soothing music, read (not thrillers or anxiety-provoking news!), stretch, meditate, pray, do breathing and/or relaxation exercises, soak in a warm tub. 3. Avoid caffeine, alcohol, sugar and other stimulants within 4 hours of bedtime. Alcohol is not a sleep aid, and it shouldnt be used to help you relax. Alcohol actually interferes with sleeps natural restorative processes, and all but ensures that you wont be fully restored in the morning. Sleep deprivation actually magnifies alcohols effects on the body a fatigued person who drinks will be more impaired. A nightcap might help you get to sleep, but alcohol keeps you in the lighter stages of sleep. You will also tend to wake up in the middle of the night when the sedating effects of the alcohol have worn off. 4. Avoid eating late meals in the evening, especially overeating. Heavy foods that take longer to digest (e.g., steak) should also be avoided. Foods that are absorbed slowly by the body keep the digestive system working overtime. Its hard for your body to fall asleep with all this racket going on! And eating too close to bedtime may even cause indigestion, which will almost certainly interfere with quality sleep. 5. Exercise regularly. Youll sleep better at night. Dont exercise within two hours of bedtime (preferably, exercise six hours before bedtime). Strenuous exercise kicks endorphins and brain opioids into overdrive and stimulates energy. You dont want energy. You want rest. 6. Get enough natural sunlight (ideally, a minimum of 30

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minutes per day). Daylight is key to regulating daily sleep patterns keeping your circadian rhythm in sync. 7. Dont lie in bed awake. If youre still awake after 20 minutes, get up and do a relaxing activity until you feel sleepy. The anxiety of not being able to fall sleep is likely to only make it harder to fall asleep. 8. Create a sound sleeping chamber. Get rid of distractions, such as noises, bright lights, an uncomfortable mattress, or a TV or computer. You may find that a cooler bedroom temperature helps you sleep better. 9. Try to avoid medicines that delay or disrupt sleep; for example, many commonly prescribed cardiac and asthma medications, over-the-counter medications and herbal remedies for coughs, colds, or allergies can disrupt sleep patterns.

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The Punk at the Gym

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I was a punk. At least thats what my trainer called me

I was a resister. I refused to do most of the exercises my trainer recommended, offering one excuse after the other, justifying my excuses by reminding him that I was not used to exercising. Problem was, the exercises he was forcing me to do (that I didnt want to do) were working My first full month without a debilitating full-blown migraine came after four months of chiropractic treatment of my cervical spine and neck muscles, three months of virtually unlimited sleep, and one month of regular exercise. Clearly, lifestyle changes were making a difference. In this miraculous month, I didnt experience a pre-menstrual or menstrual migraine. I exercised right through those days that were usually a period of misery and deep frustration. This time, I noticed a difference and it felt liberating. I could see the first glimpse of light at the end of the tunnel. I was embarking on a journey that would help me reclaim my health, as well as my youth. When I first showed up at the gym, I didnt even know how to locate the ON switch on the treadmill. An occasional swim was the only exercise Id gotten since high school. And even at school, I cut PE classes every chance I got. (I saw myself as an intellectual, after all what possible good could physical education do me?) I needed to learn how to properly perform the exercises that my chiropractor had prescribed (in particular, exercising my neck, shoulder and back muscles). I hired a personal trainer and showed up for my first training session, armed with a notebook. I had an initial Body Age evaluation done. Its a test that determines your general fitness level and biological age by assessing several factors: body composition, cardiovascular score, strength ranking, and flexibility. (Overall fitness is the combination of all these.) The scores are based on population averages.

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These measurements are not rigidly scientific, but they do give you a pretty good idea of how you stack up against other people of the same gender, age, height, weight, et cetera. My Body Age was 33. My real (chronological) age at that time was 31. That was unsettling. My Flexibility score was my worst score I was still recovering from my lower back episode. But I could see the handwriting on the wall. My body was functionally older than it was supposed to be. It was high time to get to the gym. After about ten months of regular exercise, my Body Age was reevaluated this time my score was 25! My body had actually gotten younger, younger, in fact, than I was. So, you could actually slow aging? You could literally be your old (or rather, young) self again? Once you experience this feeling of getting your youth and vitality back, theres no turning back! Exercise is one of the best ways I know of to guarantee a good nights sleep. Exercise helps you sleep better (quality sleep) and fall asleep faster. When I exercise regularly, I usually fall asleep in less than five minutes. No pill has ever accomplished this for me. Exercise also reduces your bodys cortisol levels. High cortisol levels can work against your weight maintenance goals. High cortisol actually increases obesity by increasing fat deposition and the loss of lean muscle mass. It also has an antagonistic effect on insulin production. Now, you may have heard that some migraineurs have successfully used oxygen therapy to help thwart migraine syndrome. My recommendation is to first try to create your own natural oxygen therapy. Regular exercise can go a long way towards regulating and circulating oxygen. If you exercise on a regular basis, oxygen is properly distributed and balanced in your body. Your capillaries grow stronger and healthier, not to mention that you significantly reduce the risk of cardiovascular disease a nice bonus!

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Capillaries are microvessels (tiny blood vessels) that connect arteries and veins and enable the exchange of water, oxygen, carbon dioxide, and other nutrients and waste chemicals between blood and surrounding tissues. Exercise helps improve microcirculation, including oxygenation through capillaries, and optimize vascular function (which, as you know, can have a significant impact on migraine recurrence). The two general types of exercise are aerobic exercise and resistance (strength) training. Its important to develop a workout routine that includes both aerobic and strength training. Lets look at the specific benefits of each
Benefits of Aerobic Exercise Perhaps the most common reason people take up exercise is to lose weight (and keep it off). Losing weight requires burning excess fat and speeding up your metabolism. Aerobic exercise (helps you) accomplish these goals, as well as others, such as:

improved cardiovascular health increased energy enhanced quality of sleep better stress, anxiety and mood management

Research has shown that physically inactive people have generally lower mood than active people. Energetic aerobic exercise, such as jogging, short walks, working out at the gym or playing sports, helps ensure a healthy mind and body and provides an outlet for releasing stress, anxiety and negative emotions. Exercise endows us with a sense of well-being by stimulating mood-related neurotransmitters, such as serotonin and dopamine, and boosts feel-good endorphins that energize the mind and body. Endorphins are natural mood lifters that induce a calming effect when were stressed. And physical fitness, of course, also boosts self-image and confidence, which in

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turn boosts self-esteem. Physical fitness can be an effective antidote to negative, anxious or depressive thought patterns.
Benefits of Resistance Training

Exercising the right muscles, which a chiropractor and perhaps a personal trainer can help you pinpoint, can help prevent headaches and migraine syndrome.
Here are just some of the benefits that resistance training offers:

tones and shapes your body, which enhances personal selfesteem improves overall musculoskeletal and nervous system function helps you build greater muscle mass, which in turn helps you burn more calories, even when you dont exercise decreases your resting blood pressure stimulates growth hormone, which helps slow aging, decrease body fat, and increase exercise capacity, bone density and muscle mass strengthens your lower back muscles, which makes you less prone to low-back injuries A migraineurs workout may need to focus on developing specific muscle groups (e.g., traps), but in truth, all muscle groups deserve a good workout, at least three times per week. Its particularly important for migraine sufferers to pay attention to their posture while working out. Make sure your head is properly aligned, not tilted in any way right, left or down and that your neck muscles get a good workout. (Its a good idea to get a massage on a regular basis, as well!) Luckily, both my chiropractor and personal trainer continued to adamantly remind me to properly align my body: head high, shoulders straight, and back straightened. I changed my old bad habits.

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My hunching days are over. As you build and tone muscles and increase stamina, youll feel more empowered. And the more you exercise, the more likely youll be to stick to it. Shedding unwanted pounds, boosting energy levels and feeling better about yourself are not the only reasons to exercise, but these are the tangible results you that youll notice quickly.
The Invisible Benefits of Exercise (Whats Going On Under the Hood)

Theres more to the value of exercise than meets the eye. In addition to looking great, exercise impacts your body, literally, on a cellular level.
Everything You Ever Wanted to Know About Metabolism But Were Afraid to Ask

The term metabolism refers to the chemical processes that occur within a living cell or organism that are necessary for the maintenance of life. Metabolism is the process by which your body breaks down or synthesizes substances and regulates energy, giving you the ability to function and move through life every day. Youll often hear the term metabolism paired with another term to describe the processing of a particular substance within the body; for example, water metabolism or iodine metabolism.

Now you may be wondering: Why should I care about metabolism? A healthy metabolism is critical for:
ensuring that you have plenty of energy ensuring that all bodily functions work optimally making your body be lean and look healthy efficiently breaking down and using substances such as water, sugars and fats.

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The human body burns fuel in order to keep going, not unlike a car engine. A car engine converts fuel plus oxygen into energy, and releases waste byproducts in the form of carbon monoxide exhaust. Humans convert fuel plus oxygen into energy, and release waste byproducts in the form of carbon dioxide and water. When your body runs out of fuel, it effectively stops running. If the fuel is of low quality, your body doesnt run well. Your digestive system functions as a sort of energy refinery. Fats are broken down into fatty acids, carbohydrates into glucose, protein into amino-acids Nutrients minerals, vitamins are transported throughout the bloodstream for use by our cells. The human body burns two types of fuel: fatty acids and glucose. Both glucose and fatty acids are constantly circulating in small amounts throughout the bloodstream. Glucose (blood sugar) is a simple carbohydrate thats ultimately stored in muscle cells and in the liver in its simplest form: glycogen. Fatty acids are the simple form of fats, which cluster into large molecules and are stored in our fat cells. You can think of fat cells as storage tanks for long-lasting fuel. Fat cells contain two types of enzymes: Fat-storing enzymes, which draw fatty acids from the bloodstream and clump them together to be stored as longlasting fuel, Fat-releasing enzymes, which break apart the larger fatty acids and release them back into the bloodstream so that they can travel to the muscle cells to be burnt for energy. Enzymes are catalysts: Their job is to accelerate the rate of chemical reactions within cells. All enzymes are made of protein. The glycogen stored in muscle cells is used for quick energy. The main job of muscle cells, which are often referred to

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as engines is to break down glucose and/or fatty acids and power the body.

Muscle cells contain three types of enzymes:

Fat-burning enzymes, which requires oxygen for processing, break down fatty acids into smaller molecules called pyruvic acid to produce energy Glucose-burning enzymes, which do not require oxygen, break down glucose to produce energy and pyruvic acid Mitochondrial enzymes, which further break down the combination of pyruvic acid and oxygen into water and carbon dioxide to produce more energy. (Mitochondia, often referred to as the power plants of the cell, are tiny organelle or structures found in every cell). The heart pumps fuel and oxygen throughout the body via veins, arteries and capillaries. Heres a quick snapshot of how the circulatory system plays a role in metabolism Our lungs take in air and oxygen is delivered into the muscle cells via hemoglobin, the red, iron-containing respiratory pigment in our red blood cells. Myoglobin, an iron-containing protein subunit of hemoglobin, carries oxygen to muscle cells. Muscle cells draw in fatty acids from the capillaries.
Heres how fatty acids and glucose are metabolized

Fatty acids are either burned in our muscle cells to produce energy, or theyre stored in our fat cells. Fatty acids enter the bloodstream either from the foods we eat or theyre released by the fat cells. Fat-burning enzymes break down fatty acids and oxygen into pyruvic acid to produce energy. Mitochondrial enzymes then take pyruvic acid and oxygen and break those substances down into carbon dioxide and water to produce a substantial amount of energy. Notice that the entire fat metabolism process requires oxygen

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(a process known as aerobic metabolism, which means in the presence of air or oxygen). So when we exercise aerobically, the release of stored fat molecules is accelerated. Aerobic exercise burns a significant amount of fat. Thats why it requires a substantial amount of oxygen to produce energy.

Our other body fuel, glucose, can follow these paths:

it can be stored in the muscle cells and liver in the form of glycogen, it can be burnt for energy in the muscle cells, it can be converted into fat and stored in the fat cells. If you eat a meal which includes a large intake of carbohydrates, but you dont require immediate energy, your muscle cells can store some of the unneeded glucose as glycogen, until those cells reach capacity. Your liver can also store some of the unneeded glycogen. Glucose is the easiest fuel source for the muscle cells to break down and utilize for energy. Glucose-burning enzymes within the muscles cells break the glucose molecules down into pyruvic acid. This energy-producing process is anaerobic, meaning it does not require any oxygen.

Once the glucose becomes pyruvic acid, it goes in one of two directions:
If oxygen is available in the muscle cell, pyruvic acid can give us additional energy and be further broken down, If oxygen isnt present, pyruvic acid cannot be broken down any further; instead, it turns into lactic acid, the substance that creates the burning sensation you may feel during highintensity activities. After exercise, oxygen is replenished in the muscle cells and the lactic acid is converted back into pyruvic acid; the burning sensation then subsides. The first phase of glucose breakdown is anaerobic, which allows muscle cells to produce power for a short period of time

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when theres no oxygen available in the muscle cells. The second phase of glucose break down is aerobic. If you eat a substantial amount of carbohydrates, particularly simple carbohydrates (such as candy, soda, or ice-cream), and your activity level is low, there will be a rush of glucose into the bloodstream causing your blood sugar level to elevate. The glucose level in your blood must remain within certain boundaries in order for your body to function properly. Your body continuously monitors and adjusts your blood sugar level in an effort to keep it within those boundaries. When your blood sugar level elevates, your body releases insulin to bring your glucose level back down. The release of insulin into your bloodstream makes your muscles more receptive to storing glucose as glycogen. Insulin also makes your fat cells more receptive to storing fat, and it inhibits the release of fat out of the fat cells. With a rush of glucose, the glycogen capacity within your muscles cells and liver is quickly filled. So, the remaining glucose molecules must be converted into fat and stored in the fat cells for long-lasting fuel. While, the human body has a limited capacity for storing glycogen in the muscle cells and liver, theres virtually no limit to the amount of fat that we can store in our fat cells. (Unfortunately, this also means theres virtually no limit to how fat we can get!) Fat is long lasting fuel; glucose is quick energy. Throughout the day, our muscles cells continuously burn both fat and sugar. Protein also plays a role in metabolism. Proteins primary function is to generate new cells and repair old cells. Proteins are broken down into amino acids, which are the building blocks of all enzymes. A long as you have adequate protein available in your bloodstream, your body will respond well to exercise. The protein you eat is only available in its useful form (amino-acids) for a short period of time. Protein can be used as an

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energy source, but only if fat and glucose are also available in the bloodstream. Protein must first be converted into glucose, since muscle cells only burn fatty acids and glucose. A balanced diet includes enough carbohydrates and fat to provide fuel, and enough protein for use as building blocks. It is possible to consume too much protein. If theres an excess of protein in your bloodstream, it will eventually be converted into fat and stored in your fat cells. Your bodys rate of metabolism accelerates or decelerates, depending on your activity level. In order to have a speedy metabolism, you must be capable of burning large amounts of fuel, especially fat fuel. Exercise can stimulate fat-burning enzymes. When you exercise aerobically at the proper intensity, youre signaling your body that you want to burn a substantial amount of fat. Its important to have well-developed fat-burning enzymes. The process of burning high amounts of fatty acids through aerobic activity stimulates fat-burning enzymes and they respond to the challenge they become larger and more capable. As you burn more fat, you must deliver more oxygen to your muscle cells. This means that you must develop more hemoglobin, more myoglobin and more capillaries. The most effective way to signal your body that you need to be capable of delivering more oxygen is by pushing yourself to your limits during aerobic training. Where is that magic point? Its the point where if you were to increase your exercise intensity any further, youd be out of breath. Your body will then recognize the need to improve oxygen delivery, and will adapt by building more of the necessary enzymes. Since all enzymes are made of protein, this adaptation can only occur if theres an adequate amount of protein available in your bloodstream. With more oxygen delivered to the muscle cells and more fat being burnt, a higher demand is placed on the fat-releasing enzymes in the fat cells. As these enzymes are stimulated

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to release more fat, they increase in size and capability. That means that more fat can be released out of the fat cells, which causes them to shrink. A consistent exercise program that repeatedly utilizes your stored glycogen to near-depletion signals your body to develop greater glycogen capacity in your liver and muscle cells. Your body responds by enhancing its capacity. A person whos in excellent physical condition can consume large amounts of carbohydrates without getting fat. But for a person whos not physically fit, the glycogen storage capacity fills up quickly. That extra glucose must go somewhere, so it ends up being stored as fat. Low glycogen storage capacity leads to yo-yo sugar fluctuations and a chronic release of insulin. And over time, the bodys cells become resistant to insulin. This inability to maintain blood sugar level within the critical range can lead to serious health problems, as well as weight gain, food cravings and energy fluctuations. Diabetes can result from the bodys inability to regulate the blood sugar level through insufficient release of insulin and/or the resistance of the bodys cells to insulin. The two types of diabetes are:
type 1 primarily a genetic condition type 2 primarily caused by lifestyle but can include a genetic component.

You can see how a high glycogen storage capacity can help you maintain a lean body, as well as reduce your risk of type 2 diabetes.

A fast metabolism also improves liver function.

A fit body is generally a reflection of a fit liver. Your liver also plays a vital role in processing cholesterol, a type of fat or lipid. Cholesterol gets a bad rap these days, but our bodies actually

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need and use cholesterol. Since cholesterol doesnt mix with the blood in the pure fat form, the liver wraps the cholesterol with protein, creating lipo-protein.

A thin layer of protein is known as low-density lipo-protein or LDL. LDL is bad cholesterol. A thicker layer of protein is known as high-density lipo-protein or HDL, or good cholesterol. While LDL has a purpose, a high level of LDL can cause plaque to build up in the arteries. High levels of HDL, on the other hand, can actually pick up cholesterol molecules in the blood stream and reduce the plaque build-up from excessive LDL. Fit livers produce more HDL, which helps protect them from heart disease. Your ratio of LDL to HDL is a benchmark of your overall cardiovascular health. Generally, the lower your ratio, the lower your risk of coronary heart disease. Heres how the LDL/HDL risk ratios compare:
5/1 high risk 4/1 average/moderate risk 3/1 youre in great shape

Endurance exercise at the proper intensity, frequency and duration can significantly elevate HDL and may lower your total cholesterol level.
(Source: Portions of this section on metabolism were excerpted from Lean Source: Speed Up Your Metabolism by life time fitness) Is Exercise Dangerous for Migraineurs?

Some migraineurs tend to avoid aerobic exercise because theyre afraid that the physical exertion may trigger a migraine attack. If youre one of them, you can take heart in knowing that there are exercise options that are unlikely to trigger

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attacks or increase frequency of attacks. For example, research at the Sahlgrenska Academy, University of Gothenburg, Sweden showed that using an exercise bike under the guidance of a physiotherapist was generally safe. The study also showed that these migraineurs were much more physically fit after the training period because their ability to absorb oxygen increased considerably. If youre anxious about whether exercise can trigger a migraine, start by simply walking. Walk around the block, walk a couple of miles, walk as much as your body will comfortably let you. Few migraineurs experience problems with a good 15to 20-minute daily walk. Humans were designed to walk, after all. (Running was only for short-term usage, in case you were, for example, being chased by a bear!). Simply taking a few laps around the block can do wonders for blowing off steam, reducing depression, anxiety, and stress levels. And incidentally, research shows that a fifteen-minute walk dramatically reduces cravings (chocolate cravings, in particular), and that two fifteen-minute walks each day doubles your odds of success.
Tips for Sticking to the Program

Identify what you enjoy doing and work out a way to fit this activity into your schedule. Doing something you enjoy will help you stick with it over time, Set reasonable goals. Start with a realistic, attainable exercise goal and build up to your ideal, as opposed to setting unrealistic goals which may add to your stress, Prepare for obstacles or contingencies. If your daily exercise is an outdoor activity, consider buying indoor equipment that will allow you to exercise on rainy days or days that you cant get to the gym (e.g., an elliptical bike), View exercise as part of your migraine treatment plan, rather

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than a burden, If youre having trouble sticking to the exercise program dont fall into the trap of viewing it as a personal failure. Figure out whats stopping you from exercising. For instance, if you feel self-conscious in a gym, exercise in the privacy of your own home. Hire a personal trainer and/or enlist a work-out partner to help you stay motivated. And give yourself credit for every step in the right direction, no matter how small. If you skip exercise one day, it doesnt mean youre a failure! Just try again the next day. I recommend hiring a professional trainer to work with you in the beginning if you dont have much experience with exercise regimens. Typically, its not that expensive, and youll benefit from having a professional help you chart the course thats right for you. It also helps you stay motivated. A good trainer will hold you accountable and push you to get results. Incidentally, massage therapy is a great post-work-out followup treatment to relieve muscle soreness. (More on the benefits of massage on both mind and body in Chapter 10.)

Heres a tip: Drink plenty of water before work-outs and after. Water helps flush lactic acid, which can result from anaerobic/ anaerobic metabolism, out of the body. Lactic acid is the culprit behind soreness.
And dont wait until youre parched to drink water. As my trainer likes to say: If youre thirsty, its too late! In other words, you should be hydrating throughout the day.
(See Chapter 17 for more on hydration)

2.4
Body Posture Vade mecum

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When you exercise with incorrect posture, you reinforce poor posture. When you lift weights or work out on a treadmill with hunched neck and shoulders - youve just created a bad posture thats harder to correct.
Joe Gutierrez, Personal Trainer

Your mother probably nagged you about your posture when you were growing up. Stand up straight! Dont slump! But aside from the fact that slumping is visually unappealing, have you ever actually known why good posture is so important to your health? There are plenty of reasons. Good posture ensures even pressure along your spine and prevents any one muscle group from having to work too hard or overcompensate for others. Proper structural alignment helps keep your whole body in balance. Its a good idea to observe yourself in the mirror as you work out to ensure that your posture is correct both when you lift weights and do cardio exercises. What does good posture look like? Heres a technique that will help you evaluate and correct your own posture, courtesy of Janice Novaks DVD Posture, Get It Straight!

When you are standing, from the side view, your ear, your shoulder, your hip, your knee and your ankle should be in a straight line. When your body lines up like that, the S-shape curve of your spine is right along your bodys center of gravity.
SOURCE: www.ImproveYourPosture.com

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It took me a couple of years to get into the habit of correcting my own posture. Its much easier now for me to catch myself slumping and slip, naturally, into a balanced, aligned posture. It becomes almost like slipping seamlessly into a new skin. Before I became aware of the importance of correct posture, not only did I not know how incorrect my posture was, I didnt have any idea how to fix it. I recommend that you have your posture evaluated by an experienced personal trainer before you start a serious workout regime, especially before you start resistance training. When you stand naturally (whatever feels natural to you) fairly relaxed, with your eyes closed this is how your true posture may look. Try this in front of a mirror at the gym and/ or have a friend observe you. When you open your eyes, observe your stance. Are you slumping or stooped? Is your body tilted to one side or the other? There are different body imbalances that can occur. One common imbalance is upper cross syndrome (UCS), which I personally had to conquer. UCS leads to forward-tilted head posture and rounded, rolled-in shoulders you have a tucked-in appearance. UCS weakens and lengthens your neck and upper back muscles and tightens opposing muscle groups (e.g., upper chest muscles). As a migraneur, you cant afford to risk straining or weakening your neck muscles. And if you do resistance training with this type of bodily imbalance, you may exacerbate the problem.

How do you correct upper cross syndrome? By strengthening your weak mid-back and shoulder muscles and stretching the opposing muscle group the tight pectoral muscles across the chest. Start with the lightest weights and focus on proper alignment first, not building muscle. In order to restore proper alignment, you must strengthen the muscles of all relevant joints especially neck joints.

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Its also important to pay attention to your breathing. During resistance training, you wont have good posture unless you breathe properly. Also, while lifting weights, every muscle of your core should be contracted this allows you to practice overall good posture, as well as train individual muscles. Core muscles include not only abdominal muscles, but all other muscles (except limb muscles), as well. Strong core muscles help you maintain proper spinal alignment.
I believe that UCS was part of my own big picture imbalance, and a contributing factor to my migraine headaches. But dont take my word for it. Hire a professional to evaluate your posture, correct your postural misalignments, and observe the results for yourself. Once you integrate healthy postural alignment into your everyday life, youll move more confidently, look and feel better and improve your overall health. You will have also just removed one more migraine risk factor.

2.5
Allow Your Neck to Be Free: Alexander Technique

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As is often said, when we are ready for something to come into our lives and are open to accepting it, it often presents itself. Quite by accident, I stumbled upon a postural re-education technique that I would have never considered, had it been presented to me at a different time. With the intention to brush up on some long-forgotten stage skills, I signed up for some theater classes. I originally attended an Alexander Technique class to learn how to properly move onstage. But I ended up learning a far more important lesson on how to take care of my body how to, literally, properly align my body. The Alexander Technique is an educational process that helps you conquer bad habits and makes it easier for your body to heal itself. The Alexander Technique was originally developed by Frederick Matthias Alexander, an actor whose career was endangered by strange bouts of hoarseness that no doctor could satisfactorily explain. One day, he made an important discovery. Using two mirrors to observe his profile, he was surprised to learn that each time he spoke, his head moved back and downward on his neck as his neck thrust forward, and that he was gulping awkwardly for air. Merely thinking about speaking was evoking excess tension in Alexanders body. He resolved to cease this odd mannerism, but was startled to discover that he couldnt. It was as if his muscles were tensing unconsciously completely beyond his control and without his awareness. He discovered that this way of moving his head and neck were like a current running through him, accompanying his every movement. This is true of all of us, every day. Unconscious tension damages our bodies. Not only are we unaware of our tension habits, we dont have an accurate perception of what our bodies are doing. But our minds and bodies are inextricably bound: For better or worse, our manner of speaking and moving is tied to our

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minds interpretation of physical sensations. Observe yourself in the mirror. Imagine that youre about to make a presentation in a meeting at workdoes your physical alignment automatically change? Chances are, it does. With that physical change, your brain is entering a higher state of neural excitation, which can stimulate muscle contraction. When you relax, tension melts away and some neural activity is inhibited. One important aspect of the Alexander Technique is inhibition, a process of stopping or interrupting a habitual pattern of movement. Once we understand the quality of movement, we learn a process of direction a thought process that supports the new quality of movement. But what does inhibited mean? And why is that a good thing?
My AT instructor offers this definition of inhibition:

Inhibition is the ceasing or pausing of stressful muscle function in the human body. In the moment of pausing and mindfully listening inward to the bodys response, the body will inform the person as to the new quality of muscular function. This mindful experience is a rich moment of learning.
Claudia Peyton, M.AmSAT Nationally Certified Teacher of the Alexander Technique

Now, were not talking about the kind of emotional inhibition that Sigmund Freud was so fond of exploring (such as suppressing a desire). Inhibition, in the Alexander context, means stopping wrong or harmful habits so that your body can function properly. After all, how can the right posture happen if youre still doing the wrong thing? We have to stop the wrong thing at its source, in the same way that Alexander learned to Stop, look and listen to his mind and body to determine why he was

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unconsciously gulping awkwardly for air before speaking. And what he learned was that merely thinking about speaking was provoking enormous tension in his body. Inhibition does not mean freezing or suppressing spontaneity. It means stopping the misuse of our bodies. As author Michael Gelb pointed out in his book, Body Learning: An Introduction to the Alexander Technique, inhibition is the process of stripping away the things we have imposed on ourselves so that the organism can work naturally and our reason can function without distraction. These days, we are constantly stimulated by whats going on in our environment. Our lives are filled with crowds of people and so much electronic gadgetry that were constantly bombarded by noise and other sensory stimulation of one kind or another. We spend hours in cramped cars, stuck in traffic. We sit in cramped cubicles all day, deadlines to meet, phones ringing off the hook. We have forgotten what a natural lifestyle means. This constant stimulation tends to make us tense. When something makes us tense up, we tend to respond by stiffening our necks and throwing our alignment off balance. We must learn to respond discriminately to this overstimulation, which means learning to inhibit unnecessary tension reactions. Once you become aware of habitual tension patterns, improved body alignment can become second nature. To Alexander, inhibition was the foundation of this re-education. Boiled down, he said, it all comes to inhibiting a particular reaction to a given stimulus. But no one will see it that way. They will see it as getting in and out of a chair the right way. It is nothing of the kind! It is that a pupil decides what he will or will not consent to do! In other words, it may not be so much about focusing on getting in and out of a chair the right way; it may be more about

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inhibiting your habit of doing it the wrong way. The Alexander Technique helps develop your inhibitory power in a whole-body holistic way. The calming, relaxing effects of the Alexander Technique can provide a valuable form of therapy in itself, but its real value and purpose is derived from applying the Technique to your daily life. The Alexander Technique is an objective system of self-study that teaches you how to consciously direct your body to align itself in a manner that prevents tension and physical stress, which improves the overall functioning of your body. Youll be amazed what you can learn about yourself through selfobservation and experimentation. Youll experience a new mind-body connection that brings about a whole new level of consciousness. My first Alexander Technique class at the Victory Garden Theatre in Chicago was a completely new experience. I was simply told to stay in touch with my body, to feel it, and to allow. In class, I always felt relaxed, calm, and in touch with my body. Id float out of class feeling taller, lighter; it was as if I could simply glide through life. I felt like a ballerina, inside and out. I wanted to hang onto that lightness of being as long as possible, but it would invariably fade away. Id lose focus and revert to my old bad posture habits yet-another example of how I was simply continuing to abuse my body, day after day. As adults, we depart from that natural ease with which we moved as children. We perpetually organize our bodies into positions that are unhealthy, and even structurally damaging. We spend eight, ten, twelve hours hunched over in front of our computers, tensely gripping the steering wheel during rushhour traffic, tilting our heads unhealthily for long periods of time during phone conversations. And we dont realize the longterm effects that these simple acts can have on our overall system.

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For a migraine sufferer, its not only important whether (and how) you exercise and stretch, but how you move how you physically comport yourself throughout the day. Remember, everything is connected spine, nerves, tissues, blood vessels, organs. Inflaming and compressing nerves and blood vessels can set the stage for migraine syndrome. When your body is under chronic physical stress, youre eventually going to feel tension or pain somewhere usually, at the weakest link in your body. Under stress, the brains amygdala (Alert Central) stimulates your glands to produce stress hormones such as cortisol. In the short term, this response helps fight inflammation, injury and pain. But chronic stimulation produces an array of harmful secondary effects (e.g., impaired memory, poor decision making, compromised sleep quality). Chronic pain alters your brains somatosensory cortex. The brain learns to interpret a variety of bodily sensations as painful, in much the same way that the somatosensory cortex is altered during a migraine headache. Chronic overstimulation of the amygdala and the subsequent overproduction of stress hormones turns your body into a toxic waste dump. As the amygdala processes stress and anxiety, it produces a neurochemical change in the mind and body and we prepare to defend ourselves. Our sympathetic nervous system revs; specifically, the sympathetic locomotor system, which guides movements, goes on the defense. The four primary defenses are: withdrawal, freezing, attack, surrender. Accompanying each of these defenses are concomitant movements and behaviors; for example, we may tense up, fight back physically, look down at the floor, freeze, hunch our necks, laugh nervously. In response to a perceived threat, nerves, muscles, bones and joints do something. Even our facial expressions kick into defensive gear, we engage in defensive messaging, and often without even realizing it.

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For example, we might hunch forward, scowling, jaw clenched; or we might pull back, stiffening our necks and backs. Over time, our personal defensive messaging systems tend to become fixed. We no longer retain the neutral, open expressions we displayed as children. We become committed to sending nonverbal messages. We are adopting, more often than we may realize, quite literally, a defensive posture. It is practically tantamount to living in a war zone, in terms of what it can do to our minds and bodies. These maladaptive locomotor patterns send their sensory imprints back to the brain, a phenomenon that some researchers refer to as learning-induced representational catastrophe. When this kind of sensory response is repeated again and again, it becomes a fixed behavioral loop unconscious and hard to control. The Alexander Technique can help you reprogram this unhealthy loop. As you practice Alexander, first observe, then allow. It will feel like a period of meditation and will leave you rested and refreshed. You can do this at any time of day, but its probably best done at the end of the day, when your cortisol levels are naturally at their lowest. And remember: this is your Self Time. Pay attention to how you move throughout the day, to your sleep positions, to how long you remain in static positions. Be aware of and feel how you breathe we actually breathe with our backs. The Alexander Technique will help improve your breathing, and breathing is essential to your vitality, overall health, and well-being. Simple experiential education offered by the Alexander Technique is important to our understanding of breathing, and how it effects and influences our day-to-day life. Take note of your old patterns, correcting misalignment, and youll soon find that proper alignment becomes reflexive your new habit.

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I recommend that you investigate the Alexander Technique for yourself. Buy a DVD, find a class in your area, or better yet, find a teacher who offers private lessons. Alexander is a handson process that you may experience in a private lesson or in a group session. Group classes are a different experience from private lessons. Private lessons allow for more activity and hands-on assistance from the instructor.

Heres what you might expect to learn Private lessons generally include some initial time on a massage table. Next, youll explore standing, sitting, walking, and other appropriate activities. A class setting may explore floor work, standing, sitting, walking and activities appropriate to the class.
Each instructor has unique talents and abilities for creating a context to explore the principles and concepts of the Alexander Technique. The hands-on process of the teacher is important to the experience. The certified Alexander Technique teacher has been trained to give the student a direct experience of F.M. Alexanders process of inhibition and direction. Your teacher can guide you through procedures so that you acquire and embody the process.

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Resources: To read an educational Blog by Claudia Peyton on the benefits of the Alexander Technique visit: claudiapeyton.wordpress.com/ And here are some other helpful resources: Alexander Technique: From Stress to Freedom by Anthony Kingsley (DVD, 2007) How You Stand, How You Move, How You Live: Learning the Alexander Technique to Explore Your Mind-Body Connection and Achieve Self-Mastery by Missy Vineyard (2007) Body Learning: an Introduction to the Alexander Technique by Michael Gelb (1996)

2.6
Happy Points Therapy Massage

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Touch therapies, such as massage therapy, are a way to integrate the benefits of human touch in our lives. Human beings are hardwired for touch we were born to touch and to be touched. Sensory stimulation is one of the ways in which we feel. Our bodies respond physiologically to tactile stimulation, and we function better physically and mentally when we receive it from infancy to adulthood. Many studies, for example, have established that children who are touch-deprived in infancy show tendencies toward aggressiveness and violent behavior. Consistent nurturing touch reduces accumulated stress, activates relaxation and improves our coping skills. And our need for touch does not diminish with age. Massage therapy is a nurturing touch therapy that has a demonstrable impact on our minds and bodies. Its important to choose a highly skilled professional massage therapist with whom you have a connection. My own massage therapist, in fact, says that the most important part of the massage is the connection between the client and herself. I can tell you that I tried several massage therapists before I finally found the one who was right for me. Under her touch, its not only my muscles that relax; my mind relaxes, as well. Its actually a little vacation I get to take a break from the days stresses and forget about my problems. Massage is a true healing therapy for my body, and it helps adjust my mental and emotional state, as well. Massages designed to prevent my headaches include the techniques of myofacial release and trigger point therapy. Trigger point therapy can have tremendous benefits for migraineurs. Some of the migraine-relevant trigger points are located in the suboccipital region the upper back part of the neck below the occipital region of the head and above the level of the second

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cervical vertebra (the axis). Over time, its become clear to me how tension in this area (including aggravated trigger points) was contributing to my headaches and migraines. My therapist targets trigger points in my suboccipital region and upper trapezius muscles, as well as the sternocleidomastoid a mouthful at first, but luckily, you dont have to know the fancy anatomical names to reap the benefits of the massage!
But thats not all

The benefit of a migraine prevention massage is two-fold. As my therapists fingers move in a slow, circular motion, bringing relief to the tight and ropy muscles of my neck, she is simultaneously massaging areas that she calls happy points areas at the base of the skull on the left and right side at the first spinal vertebrae (the atlas). Skillful massage of that region stimulates the production of: 1) endorphins (natural pain relievers); 2) the neurotransmitter serotonin (mood-elevator and energy-booster); and 3) oxytocin, a feel-good hormone which is released by the pituitary gland. Balanced levels of these brain chemicals helps calm and relax us, and foster an overall sense of well-being. (And I have yet to see a migraine sufferer who couldnt use a little more of that!) And the fact that my head is, to the trained eye, turned a bit to the right may well help explain all those years of having migraines in the left hemisphere of my head. The muscles on the left side of my neck were working overtime, constantly strained. Today, I consciously and constantly work to correct that imbalance through simple techniques, such as chiropractic, postural re-education (such as the Alexander Technique), and massage. The relief on the left side of my body is substantial, which seems to make a real difference in preventing migraine syndrome.

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You may have already discovered specific muscles that are frequently tense and are contributing to your headaches. An experienced massage therapist can certainly help you identify specific imbalances and recommend simple strategies for selfcorrection.
The impact of diet on musculature

The overall well-being of your muscles is also directly related to diet and exercise. During my transition to the raw food lifestyle, my massage therapist, to my great surprise, commented on how relaxed my muscles were, comparatively speaking. She had been documenting my condition all along, noting the tight muscles in my problem areas (neck and lower back), and was impressed with my bodys healing progress. Her notes from this discovery session read: All muscles very relaxed and toned. I didnt connect the dots right away, but when she kept insisting that there was a significant difference, it finally it dawned on me it was the raw food diet! This was the first time that her assessment of my musculature had ever been so positive. Changes were happening in my body from the inside out. A healthy diet impacts your body, literally, on the cellular level. When you adopt a healthy lifestyle, your body will start responding at its own pace, and sometimes, the response is immediate. This muscular improvement happened within the first month of my transition to the raw food lifestyle. It was a further proof to me that the raw food lifestyle brings results. Note that Im not trying to convince you that you should go raw this was my experience. Try it yourself to determine how a diet that includes a substantial amount of raw food impacts your own overall state of well-being. And be prepared for some surprises if you make serious dietary and lifestyle changes. These changes may just work for you, even if nothing else has.

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How often should you get massages?

The need varies for each of us; for those of us with structural or musculoskeletal problems, more is better. My therapist recommends a bimonthly massage at a minimum for people who suffer from chronic and/or severe migraines, and a weekly session is ideal your best ongoing insurance policy against migraine. I now get a massage once a month, just to keep my muscles toned and relaxed. Regular massage therapy, in the scheme of things, is really not that expensive. And for many migraineurs, its not a luxury. Its therapy a preventive treatment. As in evaluating all other treatments, its hard to put a price on good health, not to mention the cost of all that time spent lying in bed nauseated, with a splitting migraine. Suffering is time lost from your life from work, from your family and friends. And time is money.

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Nutrition

3.1
Cravings

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What Are Cravings and Why Do We Have Them?

Cravings are natural and unavoidable. We all have them sometimes, though women appear to be more vulnerable than men. Ninety-seven percent of women and 68 percent of men regularly experience food cravings. Women experience more hardcore cravings, and are three times more likely to indulge their cravings.
Do you have cravings? Quick quiz:

When youre eating something you really like, do you have trouble stopping? Do you feel guilty when eating something you really want to eat? Are you often compelled to eat when bored, angry, stressed or sad?
If any of these scenarios is a frequent occurrence for you, youve got cravings. Sometimes we know exactly what triggered a craving. Sometimes we have no idea. Understanding how cravings seduce you into surrendering can help you conquer them, maintain a healthy weight and improve your overall health. This is particularly important for migraineurs because, unfortunately, many of the most commonly craved substances are common migraine triggers. Is craving the same as addiction? Not necessarily. Addiction is a compulsive physiological and psychological need for a habit-forming substance. A craving is an intense desire for a substance that may or may not be physically addictive.

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To determine whether a substance is addictive (as opposed to just a craving), look for all three of the classic elements of addiction:

Increased intake and changes in your brain chemistry Upon deprivation, signs of withdrawal and changes in brain chemistry Signs of craving and, once withdrawal has ended, relapse
The most difficult cravings to kick are cravings for an addictive substance (yes, that includes caffeine!) and cravings triggered by strong pleasure memories and conditioned cues (e.g., at the end of a long workday, you reward yourself with a huge bowl of ice cream). In order to kick cravings, you must understand how cravings gain power over you
There are two types of addiction-related craving: 1 Physical, such as withdrawal-based craving

2 Memory-based craving, which is a desire thats triggered by strong pleasure memories of a particular food or substance. Those positive pleasure memories may even be superimposed upon a negative emotional state, such as depression or anxiety; in fact, we are often most vulnerable to cravings when were depressed, anxious or stressed. Negative emotions can trigger a blow-out, during which we gobble an excessive amount of food or an unhealthy substance in a matter of minutes, even as we sense that were out of control. Memory-based cravings can persist long after withdrawal has subsided. Coffeeholics who have kicked the habit might pass a Starbucks, smell that tantalizing aroma of coffee and find themselves in the throes of a craving. Alcoholics who have abstained from drinking for months or even years are still vulnerable to their own contextual drinking memories.

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For example, hanging around in their favorite neighborhood bar with their old drinking buddies can increase the craving for alcohol and trigger a relapse. Craving, which has an obsessive component, influences thoughts. Thoughts become cravings. What you continually think about, you bring about. Thoughts accumulate in a swift current that leaks into the realm of form and substance, and sometimes that substance manifests in the form of chocolate. Or potato chips. Or ice cream. Or coffee.
The most common food cravings, roughly in order of popularity are: Chocolate Ice Cream Other high-carb confectionaries (e.g., doughnuts, cookies) Salty snacks (e.g., chips, French fries, peanuts) Caffeine (e.g., coffee, carbonated soft drinks) Spicy foods (e.g., pizza, curried foods) Peanut butter

Sometimes we have combo craves. Fat + salt. Chocolate + fat.

But chocolate is, by far, the most widely craved food. Why is chocolate so alluring? Well, theres the obvious: It tastes good. But beyond that, chocolate also has powerful chemistry. Chocolate contains psychoactive (mood-enhancing) ingredients that influence serotonin production. Some researchers even claim that chocolate is an aphrodisiac, a reputation that stems from its phenylethylamine content. Phenylethylamine is a chemical that elevates blood pressure and blood glucose levels and regulates the brains release of b-endorphin, which is an opioid peptide. Opiods make us feel more alert and have a greater sense of well-being and contentment.

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Endorphins are natural mood lifters that induce a calming effect on us when were stressed. (You can see why chocolate is a favorite stress-related crave!) Chocolate also contains traces of tetrahydrocannabinol (THC), the high-inducing substance found in marijuana. THC interacts with brain cells to trigger the release of dopamine, a neurotransmitter involved in the release of endorphins. Chocolate also contains a significant amount of iron. Bottom line: a brain under the influence of chocolate is, for some period of time, a brain on drugs. Now, its only fair to mention that dark chocolate contains more antioxidants and healthier fatty acids than milk chocolate. And, according to University of Copenhagen studies, dark chocolate is far more filling than milk chocolate, and actually dulls our cravings for additional sweet, salty or fatty foods. So if you must indulge, dark chocolate may at least offer the built-in efficiency of limiting other cravings.
Whats Causing Those Emotional Cravings?

The most powerful cravings are usually triggered by either internal or external cues or stimuli or a combination of both. Our brains have natural conditioning or connection-forging tendencies. We mentally connect the anticipation and enjoyment of certain foods with seemingly unrelated stimuli, and once we solder in that connection to the brains reward circuitry, its hard to disconnect it. Responding to cues usually has nothing to do with intelligence. We often respond subconsciously, even unconsciously. This explains why cravings that are triggered by cues, such as the sight, smell, taste or other sensory stimuli associated with a favorite crave, can lead to addiction. Addiction tends to happen without our awareness, and certainly without our consent.

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Heres how the brain responds to cues Cravings have a chemical signature. Weve long known that drug and alcohol cravings increase brain dopamine, a neurotransmitter associated with feelings of pleasure and reward. This chemical signal motivates us to do something about our craving, and eventually, with repetition, cravings trigger addiction. Increased dopamine in the reward center of the brain the nucleus accumbens has been linked to drug dependency and addiction. And dopamine also plays a role in our conditioned response to food. In fact, foods activation of the brains dopamine motivation circuits is similar to what addicts experience when craving drugs. In the human brain, food-seeking behaviors (triggered by conditioned cues) are motivated by the same neurobiological mechanisms that motivate drug addiction. No wonder its so easy to cave to those food cravings! Cues are pretty powerful motivators.
Eating is a highly reinforcing behavior, just like taking illicit drugs. But the latest research shows that cues seeing, smelling, or tasting an enjoyable food increase the desire for the reward, without necessarily enhancing the pleasure of the reward itself. In a study where subjects were allowed to observe and smell their favorite foods but not actually eat them, fMRI (functional Magnetic Resonance Imaging) scans showed that the more the subjects desired the foods, the higher their dopamine levels skyrocketed. The dopamine system can be triggered by mere thoughts of a favorite food, even if there is no pleasure associated with it. A food stimulus increases dopamine in the dorsal striatum (a part of the brain involved with desire and motivation), but not in the nucleus accumbens, the brains reward center. In other words, eating it as not as much fun as wanting it, and wanting craving is a more powerful motivator than the actual reward or pleasure of eating it.

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What Sweetness Are You Really Craving?

I used to cave in to my cravings indiscriminately. I just indulged the urge and didnt think about the consequences. But my quest for wellness has taught me to ask one simple but important question first: Why? Now when I feel the urge for something sweet, I ask myself why Im craving it. I first ask myself whether Im actually hungry I always try to distinguish between craving and a healthy desire to eat. If Im hungry, I eat a date or a few raisins. But if I know Ive eaten an adequate amount of food, then I ask myself: What is it that Im really craving? In those moments when youre under the influence of a craving, ask yourself: Will I be comfortable after I eat this treat? Ask yourself if theres anything that you would rather do in that moment than eat, if you had a choice. Instead of caving to your cravings, choose that other thing. Do it in the moment, if possible; if its not immediately attainable, take the first step(s) toward attaining it. Ask yourself if emotion is driving your craving. Fear? Anxiety? Stress? Depression? Is your craving perhaps a yearning for something else, an emotional need that is not being fulfilled? If so, food will not fill that void. Look for behavioral patterns. Pinpoint your psychological needs and choose strategies that will help you fulfill the underlying need thats driving your craving.
(Youll find lots of helpful strategies for building resilience in Chapter 20.)

I recommend changes in diet, primarily, but also encourage you to seek any additional support that you may need. One person may find, for example, that her sugar cravings are

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related to her alcohol cravings. Theres no shame in seeking support. Look at it this way: Its better to seek support than to be unhealthy, overweight, or feel powerless in the face of an addiction. But changes on the bio-chemical level must come first, which is why dietary changes must be made first. I should also mention that dealing with cravings is much easier for me now that Ive eliminated all processed sugars from my diet. I am no longer a sugar junkie, and have, for the most part, eliminated any physiological dependency on sugar. I may still psychologically crave sugar at times, so I dont deny myself fresh, sweet fruits whenever I have the desire to eat them. But I no longer try to fulfill my emotional needs with food or stuff my feelings with food. Set your own boundaries. That fine line is different for all of us. As long as youre happy with the amount of craved foods you consume, youre on the right track.

3.2
Chamomile Tea at Starbucks?? (Caffeine)

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In my quest for wellness, the natural next step was pinpointing what really gave me energy, especially in the mornings. For a number of years the answer was (or so I thought) that first morning cup of coffee. I had always known that caffeine exacerbated my headaches, and as with sugar, I was always secretly uncomfortable about caffeine being a big part of my diet. But kicking caffeine was a real challenge. I would dutifully quit, then, within weeks, Id be back at the office coffee machine looking for an energy jumpstart, back to the old habit, wondering if Id ever be able to quit coffee. I simply couldnt do it, except on the rare occasions that I managed to successfully substitute black tea for coffee. I kept circling back to that old coffee habit, even after I was absolutely certain that it was one of my primary migraine triggers. I tried removing coffee from my home. Didnt do much good, not with a Starbucks coffee shop on every street corner in Chicago. Transitioning to the raw food lifestyle (discussed in greater detail in Chapter 15) is what made it easy for me to quit caffeine-containing drinks. Ultimately, it was the only thing that made coffee a thing of the past for me for good. Today, I can walk into any Starbucks and enjoy the wonderful aroma of coffee with no craving!
The Truth on Coffee and Migraines:

Caffeine is a powerful vasoconstrictor. For some, if its used infrequently and in small amounts, it can actually help relieve a headache, especially at onset. But when its consumed habitually and in large quantities, it significantly increases blood fat levels, including cholesterol. It also increases platelet clustering, which damages platelet walls and causes chemicals such

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as serotonin to leak into the bloodstream and temporarily constrict blood vessels. (Platelets are disklike white blood cells that promote blood clotting.) High blood fat and platelet clustering contribute to the degradation of serotonin, which can lead to vasodilation and a migraine. Habitual caffeine users often find that caffeine withdrawal can trigger headaches. The body adapts to caffeines presence in the bloodstream by compensating for its constricting effect. Suddenly cutting off that caffeine supply results in excessive vasodilation and a headache. What about drinking caffeine with meals? Caffeine stifles digestion. Vitamins and minerals such as calcium, magnesium, potassium, iron and zinc are not absorbed as easily in the body when caffeine is present in the body. Caffeine is a diuretic, which can contribute to depleting the bodys magnesium supply (particularly problematic for migraineurs who have low magnesium levels) and it can even increase blood pressure. And, as youve already learned, caffeine elevates cortisol levels, which keeps us in an amped fight-or-flight state that ultimately steals energy that the body needs for other tasks, which can eventually lead to adrenal exhaustion. Caffeine makes us jittery and anxious, but we forgive it and love it, anyway. We love our coffee, tea, colas and sports and energy drinks. Why? Caffeine excites neurons and stimulates brain activity, which triggers the release of the hormone adrenaline. But after the first dose of caffeine wears off, the brain develops a craving for additional caffeine to recreate the effect hence the addiction. In fact, some research suggests that caffeine can elevate dopamine levels and interact with brain opioid receptors, which may reinforce the motivation to use more and more caffeine. Heres the simple truth: Caffeine is addictive, but for a migraine sufferer, it can be more than an addiction. It can become

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a trigger for more pain. I recommend that you ask yourself: Am I addicted to caffeine? If you are, wean yourself from it over the period of a few days, then quit completely. If youre not addicted, but know that caffeine is impacting your health, stop using it. If youve been using caffeine habitually for a long time, its only fair to warn you that, as your body detoxes from caffeine overload, you may experience withdrawal symptoms; for example, headache, fatigue or energy loss. Some people experience more serious symptoms, such as nausea, vomiting or feeling blue or irritable. Caffeine sneaks into your bloodstream pretty quickly, within 10-15 minutes. The average cup of coffee has 100-250 milligrams of caffeine. The average half-life of caffeine is 3 to 4 hours. (Half-life is the length of time required for half the quantity of a substance to be metabolized or eliminated by the body.)
Heres how the math would work

If you take 250 mg, in 3 to 4 hours, youll have 125 mg left in your system. In another 3 to 4 hours (6 to 8 from the original dose), youll have about 60 mg in your system. If you take 400 mg at once, you still have 200 mg in your system 3 to 4 hours later. At 500-700 mg per day, youre probably going to experience symptoms of anxiety, nervousness, hypertension and insomnia.
After two to three days of such a diet, I sometimes felt restless, unable to sleep. And by the third day (if not sooner), I would inevitably end up with a throbbing migraine. I dont have a high tolerance for caffeine, and my guess is that you dont, either, since youre reading this book.

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Note: For a complete picture of the impact caffeine can have on your body and mind, I highly recommend that you read the book Caffeine Blues, written by clinical nutritionist, Stephen Cherniske, M.S.
What to Keep in Mind

A Grande Caff Latte from Starbucks contains at least 150 mg of caffeine, which means that after 3 to 4 hours, you will still have 75 mg in your system and after 6 to 8 hours you will still have approximately half of that amount (37.50 mg) in your system. For comparison, a 12-oz. Coca-Cola contains 34 mg of caffeine. (See chapter 17 on hydration for more the hidden impact of soda on our bodies.) I was never a big soda drinker. I grew up in Europe, where people tend to eat a little healthier (not much healthier though!). How much soda do you drink each day, each week? Start counting; you may be surprised to find that its worse than you thought! Low levels of caffeine dont seem to have a negative impact on me. I still drink black tea, especially in the morning. But I made a conscious decision not to drink coffee any more. But perhaps its different for you. Your body might be more or less sensitive than mine. We have different thresholds for what our bodies can safely metabolize without triggering the chain reaction that will bring on a splitting headache. Personally, I might have a cup of black tea (caffeinated) in the morning or early afternoon hours, and chamomile or mint tea in the evening. I have found that the low levels of caffeine found in black, white or green tea do not affect my body adversely. Its your call. How much caffeine can your body tolerate? How much caffeine does it take to trigger a migraine? My advice to you is: replace your morning coffee with black tea; your

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afternoon coffee with green or white tea. There are endless varieties of tea on the market right now. Drink it plain, if you can. Savor the true flavor of the tea. Adding sugar is just asking for trouble. (In Chapter 13, youll learn what sugar does to your body!). And try replacing soft drinks with natural spring water or an herbal, no sugar added, caffeine-free drink. Your head will thank you!

3.3
Sugar Junkie

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When I first started going to the gym, my primary focus was improving my health, not losing weight. My exercise routine did help me lose several pounds. I was already lean, but I was still carrying weight around my hips that wasnt muscle. I decided I wanted to lose those pounds. But strangely, I had reached a plateau my weight simply wouldnt budge. There had to be another way besides just sweating it off, and exercise wasnt enough, anyway. The extra weight simply stopped coming off naturally and I wanted to understand why. I resolved to learn more about my body and nutrition. I started doing research. I also hired a nutritionist to give me an overview of what I needed to do to shed those unwanted pounds. The nutritionist told me not to consume more than 35 grams of added sugars per day. But what were added sugars? I hadnt been in the habit of reading labels. I quickly learned that, when consuming anything other than produce, reading labels is one of the first steps you must take to develop a diet thats healthy for you. Well, the granola bars I ate after exercising at the gym contained at least 10 grams of added sugars. My favorite White Chocolate Mocha at Starbucks had 58 grams of sugar (size: grande, and also 150 mg of caffeine and 400 calories, according to the Nutrition by the Cup). And one Godiva chocolate apparently contained 19 grams of sugar. But who really stops at one piece? At the least, Id consume three pieces (and that was on a day when I rationed myself). Those three little pieces of chocolate candy tacked on an additional 220 calories. This seemingly wasnt a problem with the active lifestyle I had adopted or was it? And then theres soda pop. According to the U.S. Department of Agriculture, our per capita soft-drink consumption has increased by almost 500% in the past 50 years (Putnam and

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Allhouse, 1999). If youre trying to lose weight, its important to note that one 12-ounce can of soda per day burns up your entire allowed daily dose of added sugars if you are on a program to lose weight. Soda contains around 8 teaspoons (33 grams) of added sugar, which, according to the American Heart Association, equals approximately 130 calories. And according to the American Dietetic Association, one gram of sugar equals 4 calories. For quick calculations: 4 teaspoons of table sugar equals roughly 20 grams of sugar (1 teaspoon of granulated white sugar = 4.2 grams of sugar). 20 grams of sugar equals about 80 calories. So, if you drink a bottle of cola with 44 grams of sugar, youd divide 44 by 4.2 which is equal to 10 teaspoons of sugar. One can of cola is equivalent to 10 teaspoons of sugar? Once I really grasped this, I never viewed sodas the same way again. Today, I believe that its not healthy to consume any added (processed) sugar(s) at all. (In the next chapter, youll learn how to obtain all the sugar your body needs to function well from fresh and dried fruit.) Some will disagree with me, but what I can tell you is that youll be amazed how much better youll feel if you even significantly reduce the amount of added sugars you consume. Its not easy to kick a sugar habit I know. I tried and failed several times. Sugar kept creeping back into my life. It made me feel better, or so I thought.
Sugar Facts

Sugar is a carbohydrate. The two main forms of carbohydrates are: simple sugars (simple carbohydrates), such as fructose, glucose, and lactose, and also found in whole fruits starches (complex carbohydrates), found in foods such as

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starchy vegetables, grains, rice, and breads and cereals

In the body, all carbohydrates are broken down into simple sugars, which are then absorbed into the bloodstream. As the sugar level rises, beta cells in the pancreas releases a peptide hormone called insulin, which transports sugar from the bloodstream into the cells where the sugar can be converted to glycogen and used as a source of energy. As blood sugar rises, triglycerides rise. Excess sugar (sugar you cant burn quickly enough) is stored as fat. The carbohydrates in some foods (mostly those that contain simple sugars and highly refined grains, such as white flour and white rice) are easily broken down and cause your blood sugar level to rise quickly. Complex carbohydrates (e.g., whole grains) are broken down more slowly, allowing blood sugar to rise more gradually. Eating too many foods that cause a rapid rise in blood sugar can increase a persons risk of developing medical conditions like diabetes and heart disease. Some quick definitions to help you understand the various forms of sugar: Glucose (blood sugar) is a monosaccharide sugar that is found in plant and animal tissue. Its the principal circulating sugar in the blood; living cells must have it to produce energy. Glycemic index (GI) is the numerical index (a scale from 1 to 100) given to a carbohydrate-rich food that is based on the average increase in blood glucose levels occurring after the food is eaten. The glycemic index is the amount that it increases your blood sugar compared to the amount that the same quantity of white bread would increase your blood sugar. (An example, watermelon, which has a high sugar content, has a glycemic index of 75 compared to grapefruit, which has a glycemic index of 25 or a doughnut which has an index of 108.)

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Sucrose, also called table sugar or saccharose, is a crystalline disaccharide of fructose and glucose thats found in many plants but extracted as ordinary sugar mainly from sugar cane and sugar beets, widely used as a sweetener or preservative, and in the manufacture of plastics and soaps. Lactose (milk sugar) A disaccharide found in milk that is hydrolyzed to yield glucose and galactose. Also obtained from whey. Dextrose (also known as glucose) is a monosaccharide or simple sugar that is about 20% less sweet compared to cane sugar. Its derived entirely from corn, is low cost and contains no fructose or lactose. Fructose (fruit sugar) is the natural sugar found in fruit and honey. Fructose has different metabolic effects on the body than glucose or sucrose. Fructose is absorbed further down in the intestine, and whereas circulating glucose releases insulin from the pancreas, fructose stimulates insulin synthesis but does not release it. High-fructose corn syrup, however, can reduce circulating insulin and leptin levels, contributing to increased body weight. Thus, fructose intake may not result in the degree of satiety (feeling full) that an equally caloric meal of glucose or sucrose would. High-fructose corn syrup, unfortunately, has become a major component of the American diet and is producing obesity. So far, research does not suggest a dependency on fructose, though research does indicate that its sweet taste elicits the repeated release of dopamine in the nucleus accumbens (the brains reward center), which makes it a candidate for dependence especially when consumed in a binge-like manner.

Sugars to Avoid:
1. Refined (table) sugar

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2. All artificial sweeteners 3. High Fructose Corn Syrup

Sugars to Include in Your Diet:

1. Natural sugar occurring in fresh and dried fruit (e.g. dates, figs) 2. Honey (raw, unpasteurized) 3. Raw organic agave nectar (a natural sweetener derived from the Agave cactus plant)

If you are concerned about fructose intolerance, opt for the fruit most kind to the intestines, such as white grapes, strawberries, raspberries, blackberries, pineapples, or oranges. The ratio of fructose to glucose in the fruit, as well as the fiber content, determines how well the sugar is digested. The higher the glucose-to-fructose ratio, the more intestinal-friendly the fruit. When consuming dried fruit, always read the label it may contain added refined sugar. Also bear in mind that dried fruit contains concentrated amounts of naturally occurring sugars. Lets take dates for example One medjool date contains 16 grams of naturally occurring sugars (fructose, glucose and sucrose), which translates to roughly 64 calories. One date does contain 2 grams of fiber that you wont find in table sugar. Dates also contain minerals such as calcium, iron, phosphorous, magnesium, and potassium. A recommended serving size for an energy boosting snack is two dates. Stevia is a natural, plant-derived sweetener that has been used for centuries, but its not without its share of controversy. Some research has shown that if you consume something sweetened with Stevia when you have very little sugar in your

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blood, your body may produce too much insulin. It takes time to produce insulin, so the digestive process is actually triggered by your taste buds, which send the message to the pancreas that its time to start synthesizing insulin. So, if you consume food sweetened with Stevia, make sure you also have some other sugar circulating! Some research suggests that our brains have learned over time to equate the taste of sweet with a rapid infusion of energy and pleasure, so when we eat sweetened foods, special taste buds may trigger enzymes that prime our brain to anticipate this extra boost.
How Sugar Behaves in Your Brain

When we crave carbohydrates, we usually crave carb-rich foods comprised of refined sugars and white flour, ingredients which spark a rapid rise in blood-sugar. You may find that carb cravings often occur in mid-afternoon, or whenever your energy level is at its lowest. Sugar carbs temporarily enhance mood and boost energy levels, but subsequently send both energy and mood plummeting, which, of course, encourages yet more unhealthy craves. You can see the vicious cycle! If youre struggling to manage those sugary cravings, it may make you feel better to learn that sugar triggers production of the brains natural feel-good opioids thats why we cant wait for the next fix. Your brain can become addicted to its own natural opioids just like it can become addicted to morphine or heroin. The worst part is that a hard-core food craving goes beyond hunger. You dont have to be hungry to have a ferocious craving. When satiety (satisfaction or fullness) and a high YUM factor of a particular food are pitted against each other, high YUM will overrule satiety every time, as anyone who has ever binged

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their way through a gallon of chocolate chip cookie dough ice cream knows. The yummier the food, the stronger the craving, and the harder it is to simply stop eating, even after we feel full. As weve discussed, some of the same neural machinery that motivates and reinforces food intake also underlies drug-seeking and drug-taking. Many of us claim that we feel compelled to eat sweet foods, similar, in some respects, to how an alcoholic may feel compelled to drink. A well-known characteristic of addictive drugs is their ability to activate dopamine in the reward areas of the brain, such as the nucleus accumbens (NAc). The reward circuitry of the NAc includes behavior reinforcement components, such as foodseeking behavior and reinforcement of learning, incentive motivation, stimulus salience (noticing a particular stimulus; e.g., paying attention to a fast food restaurant while driving or to a chocolate commercial on TV). In other words, excessive intake of sugar can trigger dopaminergic, cholinergic and opioid effects that are similar to the effects of stimulants and opiates, albeit smaller in magnitude. The overall effect of these sugar-related neurochemical adaptations is mild compared to, for example, cocaine, but they may still evolve to dependency. Eating yummy foods stimulates our brain opioids in a variety of brain areas and makes us crave other palatable foods, such as those rich in fat or sugar. Some studies suggest that opioids in the NAc influence hedonic reactions we are more likely to seek instant gratification. We want more and we want it now. Some studies have suggested that abstaining from sugar after consuming it excessively can lead to withdrawal symptoms. When dopamine decreases, the neurotransmitter acetylcholine (the down chemical that allows us to sleep) can increase, which can cause a sort of short-term behavioral depression similar to that which has long been associated with drug or alcohol

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withdrawal. People who claim to suffer withdrawal symptoms report strong food cravings, particularly for carbohydrates, chocolate, and sugar, which can trigger relapse and impulsive eating. For these people, sudden and total sugar abstinence can lead to bingeing and eating more sugar than they did prior to abstinence, a phenomenon known as the deprivation effect. In fact, they may be more highly motivated than ever to get sugar. During the abstinence period, they also may be more likely to seek stimulants, such as caffeine or other substances. The tremendous rise in the incidence of obesity is directly linked to our increased sugar consumption. Sugar intake may lead to an increased number of and/or affinity for opioid receptors, which in turn leads to further ingestion of sugar and may ultimately contribute to obesity and poor health. Is sugar addictive? Food is not ordinarily like a substance of abuse, but most research suggests that, as with drugs and alcohol, intermittent bingeing and deprivation changes that. Changes in limbic system (the emotional system) neurochemistry are similar for drugs and sugar. The behavioral and neurochemical parallels suggests that sugar, as common as it is, may be a substance of abuse and may be even be addictive for some individuals when consumed in a binge-like manner. Obese and bulimic patients in particular, can easily develop an unhealthy dependence on sugary foods that significantly interferes with their well-being.
What Sugar Does to Your Body

Sugar is necessary for the body to function properly. But how much sugar do you need circulating throughout your bloodstream to function properly? 25 grams. So, for example, two medjool dates contain 32 grams of sugar, more than

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the minimum necessary amount. If you exercise, of course, you might be able to safely consume much more natural sugar without gaining weight. Sugar may be fun going in, but, as with caffeine, once the first dose wears off, you crash, and your brain wants additional sugar to recreate the fun. More and more of us are developing insulin resistance; so many, in fact, that you could argue that insulin resistance has practically become a cultural disease. Sugar is everywhere we turn, often craftily included in foods that we wouldnt have guessed, especially processed foods. High-fructose corn syrup is a major culprit, owing in part to the plethora of fast food restaurants. Insulin resistance occurs if your body cannot respond to and use the supply of insulin that it produces. Insulin resistance in fat cells results in elevated hydrolysis of stored triglycerides. Insulin resistance in muscle cells reduces glucose uptake and thus, storage of glucose as glycogen. Insulin resistance in liver cells results in impaired glycogen synthesis and a failure to suppress glucose production. Elevated blood fatty-acid concentrations, reduced muscle glucose uptake, and increased liver glucose production all contribute to elevated blood glucose concentration in other words, you have too much sugar in your blood. High plasma levels of insulin and glucose due to insulin resistance are believed to trigger conditions like metabolic syndrome and type-2 diabetes.
Sugar Compromises Your Immune System

Even if increasing sucrose intake increases the neurotransmitter serotonin and makes us temporarily feel better, we pay a steep price. Increased sugar intake dramatically decreases our immune response. Short-term hyperglycemia (elevated blood

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sugar) affects all major components of our innate immunity and impairs our ability to fight infection, injury and disease. Hyperglycemia has also been shown to decrease neutrophil activity. Neutrophils are a type of white blood cell that act as an important first-line defense by engulfing (phagocytizing) pathogens. In fact, one study showed a significant decrease in neutrophil activity in healthy adults within 30 to 60 minutes following ingestion of 75 grams of glucose. (Bernstein, Nauss, 1977) Another study examined the activity of neutrophils after a 100gram dose of various simple carbohydrates including glucose, fructose, sucrose, honey, and orange juice. The results indicated that these particular simple carbohydrates significantly decreased the capacity of neutrophils to engulf bacteria. In this study, the greatest effects occurred between 1 to 2 hours after ingestion of the carbohydrates, and the values were still significantly below the fasting control values five hours after glucose ingestion. (Sanchez, Reeser 1973)

Tips for Beating Sugar 1. Read labels. How much sugar is in the foods you habitually consume? Know exactly what youre consuming in each food you eat. 2. Dont keep sweets in the house. Keep dried fruit (no sugar added) on hand, for emergencies. 3. Ask yourself: What sweetness am I really craving? Tell yourself that you will not have that sweet right now, but if you still want it tomorrow, you can have it then. Today, have a bowl of fresh fruit instead. It might actually work!

3.4
Going raw: The Giant Leap

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In the end, there was only one thing that made it easy for me to quit coffee and refined sugar: Transitioning to the raw food lifestyle. I had learned about the raw food diet three years before I actually began to take steps to incorporate it into my own lifestyle. I dont mind telling you, I thought the idea was crazy at first. How could raw food possibly give me enough energy to get through the day? How could my body possibly get all the vitamins and minerals that it needed to function properly? How would I be ever able to control caffeine and sugar cravings? But I found those answers. Today, I am a raw vegan, and I attribute my wellness primarily to the raw food lifestyle. In the past, I wasnt ready to accept certain truths, and as a consequence, I continued to have migraines (as well as regular headaches) for a couple more years. I simply wasnt openminded enough to try this thing called the raw food lifestyle. I didnt understand it well. It was a scary unknown. On my journey to wellness however, I continued to look for materials to read and places to go to learn more about staying healthy. I went to the annual Health Freedom Expo in Chicago and attended various lectures. I read a brief overview of the lecture on Raw Foods in Health Expos booklet and walked into the lecture with some preconceived notions (This is not for me, but Ill at least listen to what they have to say). This was the first time I heard Brenda Cobb, the founder of the Living Foods Institute in Georgia, speak on the raw lifestyle. At the end of the lecture, I stood in line and waited my turn to ask Brenda whether raw food diet could relieve headaches and migraines. I already knew that natural therapies could help alleviate them, but I was curious to know what Brenda had to say. (Not a lot, as it turned out.) Headaches? she asked. Headaches are the easiest to cure! Thats it. Thats all she had to say. She turned to the next

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person in line who inquired about a more serious disease. Brenda herself has cured breast and cervical cancer with a detoxification process and dietary changes. Leaving the Expo, I reflected on my 15-plus years of suffering from headaches. I bought Brendas book the first day of the Expo. By the time I returned to the Expo the next day, I had already read half of it. That day was the last day I ate meat. The second conversation I had with Brenda was life-changing for me. I decided to give this new raw food strategy a try, just to see if it might work for me. It did. And it has been working ever since.
So what does being raw vegan mean?

The raw vegan lifestyle is much more than not eating meat or dairy products this is only a part of the picture. Raw vegan is a lifestyle; for example, as people transition to eating raw, live, fresh, whole and organic foods (vegetables, fruits, sprouts, raw nuts and seeds), they usually experience tremendous boosts in energy and a miraculous freedom from cravings. Much has been written about the raw vegan diet, and its not the purpose of this book to provide a comprehensive treatise on the lifestyle or the detoxification process. I do want to share my belief that the only way to achieve good health is to learn what it is that your body really needs to function at optimum level. I hope to help you accomplish that by presenting the strategies that worked for me. I believe that we have to return to the way of life we were designed to live to experience true health and yes, to cure the insidious cultural diseases that are increasingly plaguing modern society. (Hint: Supersized fast food!). I didnt even have to undertake a detoxification process to achieve a huge shift in how I felt. When I started eating

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a healthy raw vegan diet, my headaches went away. PMS symptoms vanished, and along with it, my hormonal migraines. When I combined a raw food diet with sufficient sleep and regular exercise, the results were miraculous. I literally felt that I had experienced a miracle. At last, a breakthrough!

My journey to a new lifestyle

Going raw may seem like a giant leap to you. Wondering where to start how to make changes that will make a difference? Ill tell you what I did In the beginning, I turned to books, DVDs and online resources to learn how to transition to this lifestyle. And I encourage you to do the same. Dont just take my word for it. Do your own research. You need to feel comfortable about your choices in order to make the commitment to a lifestyle change. Initially, I gave myself a year to transition. I thought it would be a daunting, complicated process that required mountains of sheer willpower. None of this was true. I did not debate the pros and cons. But I did have an overnight change of heart with respect to eating meat. I quit cold turkey. Over a two-week period, I phased out dairy products. I became overwhelmed by curiosity as to whether I could actually help my body heal disease. I committed. My strong desire to be well motivated me to take the first steps. The day the Health Expo ended, I practically ran to the local Fresh Market and headed straight for the produce department. I decided I would simply observe my body and draw my own conclusions. Besides, if it didnt work, I could always revert to my old eating habits anytime I wanted to, right? I had nothing to lose. It had worked for others it might work for me. I had tried so many tactics already. Some led me to a state of a better health, but left me wanting (and needing) more.

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I focused on eating lots of raw vegetables and fruits. As my diet and focus changed, so did my food interests. My taste buds adjusted. My entire digestive system responded to my diet changes. I did some research on meat consumption and the Standard American Diet (SAD). (And as it turns out, SAD is an appropriate acronym!) I read accounts written by raving raw vegan diet fans. I shared what I learned with family and friends. Inevitably, someone would say: But you need animal protein! Do I? It appears that I dont. My body builds its own protein from the amino acids provided to it through a healthy plant-based diet. It is actually a much simpler digestive process for my body than having to first break down animal protein into amino acids so that those amino acids can be used to build human protein. I had always been a carnivore my entire life and had never even considered becoming a vegetarian or a vegan. Before I went raw, I simply could not imagine my life without meat. Like many people, I thought meat provided me with protein I needed, and I never questioned that belief. Within a couple of weeks of going vegan, I already knew I was on the right path, and I was fired up about the lifestyle. I had much more energy than Id ever had in my life. I happily arose at 4:00 am every morning, went to the gym to exercise, then went to my full-time job something I could have never pulled off before on a daily basis. I felt lighter and more energetic. I could hardly believe the changes. I slept better. As I learned how to nourish my body, I started losing pounds, without even trying. Before changing my diet, I had exercised regularly for about a year and a half. I lost some weight and built muscle. But, during the transition to the raw food lifestyle, I effortlessly lost another 10 pounds it was just excess body fat that my body didnt need. What a bonus!

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The evidence was mounting. I was seeing clear proof that my body appreciated the nutrition I was giving it and was responding positively. I was also beginning to accumulate proof about which foods had been triggering headaches all those years. About a month into my transition, my office had a little pizza party and my manager ordered a vegetarian pizza for me. At that time I was probably 50% raw, still eating bread and cooked foods. I ate a lot of pizza and developed a bad headache within about 45 minutes of eating. I was astonished. Could the cure be really be so simple? Today, I realize that it was probably the fat in the pizza that triggered the headache. I had another similar experience during my transitional period with roasted and flavored nuts. Today I only eat raw nuts (soaked) and Im careful not to overeat, or theyll feel heavy on my stomach. I enjoy them in moderate amounts (not more than roughly 50 grams or approximately 2 ounces per day) and they provide me with a healthy amounts of fats, protein, fiber and minerals.
Transitioning to a Raw Food Lifestyle

Want to see for yourself whether a raw vegan diet may resolve your headache? Its easy to find out. As you eliminate refined and cooked foods, you will incorporate more raw fruits and vegetables into your diet. My best advice and something other raw foodies would probably tell you is this: Dont deny yourself any food that you really want to eat; rather, slowly start incorporating raw foods every day and see how your body reacts. In my opinion, a diet consisting of 50% raw is sufficient for most people to experience a big difference in how they feel. The more raw you eat, the more raw your body will desire. You wont feel that youre depriving yourself of foods you want.

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Rather, youll feel that youre actually being presented with a choice and you actually may not desire a food that you might have craved uncontrollably in the past (like that bag of chips or candy or soda or that morning cup of coffee). If you have a busy life, it may be hard to find time to chew all those dark, leafy greens. Your body will need greens for protein, enzymes, vitamins and minerals, as well as making your body alkaline. You might start by making green smoothies to substitute for one meal a day. It could be a green smoothie in the morning or a green smoothie that you take to work for lunch. Or you might want to end your day with one drink a smoothie for dinner. There are several good smoothie recipe books on the market and available on the Internet. I recommend Victorias Boutenkos book, Green for Life, which, in addition to offering great green smoothie recipes, will give you a good understanding why its essential that green, leafy vegetables be a big part of your diet. Incidentally, youll probably quickly realize that you need a highspeed blender to prepare your smoothies. If you dont already have one, Vita-Mix is my recommendation.
To get free shipping on a Vita-Mix blender, click here: www.vitamix.com/

As you progress during your transition, eat raw foods only for two meals a day (or one meal and one snack). For example, drink a green smoothie for breakfast and eat a fruit snack. You might choose to drink a smoothie for dinner. Or as you wind down and prepare for a night of healthy sleep, you might eat a light meal, such as a salad, with an apple or banana for dessert. You may prefer your green smoothies sweeter at the beginning of your transition. Go ahead, add as much fruit as you like!

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In time, you may find that you desire (and require) less sweetness. Personally, I have yet to follow a recipe for a green smoothie. I tend to create my own variations, and rarely do they taste exactly alike. I do have a couple of reliable favorites that have become staples. I might add parsley, cilantro or dill to my smoothie one day, and basil or mint the next. The possibilities are endless. You will never get bored with the raw vegan lifestyle, as long as you also chew vegetables. Human beings were designed to chew. Chewing keeps our jaw bones strong and our teeth healthy. As you discover more raw options, youll discover many new opportunities to chew as you graze on vegetables, nuts and seeds, and sprouts, which are true live foods (they can still grow even while refrigerated). And by the way, chewing your food well is important because saliva contains enzymes that actually start the process of digestion in our mouths. The less you combine different foods, the quicker your body will digest what you eat. Youll also have more energy, fall asleep faster, and wake up more rested in the morning. And something else: general raw vegan wisdom holds that the more you eat, the more sleep youll need. Digestion burns a lot of energy. Thats why its smart to eat a small raw dinner if you plan to get up early in the morning and head to the gym with energy to spare. Since enzymes are at peak levels around lunchtime, lunch should be your biggest meal. So, if you choose lunch as your raw meal, you might eat a salad, a green smoothie and finish off with a banana for dessert. You could have a handful of raw nuts or seeds with your salad. Remember, though, nuts will sit heavier on your stomach, so ration your nut intake at first. Listen to your body; let it guide you. At the beginning of your transition, you may find that you feel like eating lots of nuts to increase your caloric intake. Nuts however, should not exceed

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more than 10% of your diet. And they should be eaten raw and unsalted, preferably soaked, not roasted in oils. (Note: If specific nuts are an allergen and/or migraine trigger for you, be sure to consume with caution.) The true raw lifestyle includes no conventional dressings, but you can make your own. Youll find plenty of raw vegan dressing recipes online. Once I adopted the raw lifestyle, I personally found that I didnt need any dressing, practically from the beginning. As my taste buds adjusted, I began to savor and appreciate the true flavor of the vegetables, unadorned. When you start your transition, try to eat different vegetables every day for variety. I dont have to employ any tricks to stay raw, but you may find that you need such strategies to help you adjust. Remember, youre not depriving yourself. Youre experimenting! Think of the transition as an experiment thats going to help you determine what your body wants, so that you can ultimately prevent migraine attacks. If youre still hungry after finishing your raw meal, feel free to eat more raw. But its a good idea to wait a few minutes to give your brain time to tell you whether youre actually still hungry or are simply eating because you have a habit of stuffing yourself full. And if you exercise, your post-workout meal may very well need to include generous portions, especially after a strenuous and/or strength-training exercise. Your muscle cells need all the nutrients they can get to grow stronger. Now, youll be thrilled to hear what Im about to tell you next If your diet consists of roughly 90% raw foods, you can eat as much as you want and you will not gain a pound! Your body will start balancing naturally. And theres more: Youll actually lose weight if your body needs to shed some extra pounds to bring itself into natural balance. No more counting calories! Youll never have to focus

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on losing weight again. Now, if youd like to gain a little weight, exercise. Exercise helps you gain muscle mass, as opposed to fat tissue. In the beginning, you may prefer some vegetables and find others to be bland. Feel free to eat as much of your favorites as you want, and gradually incorporate other less flavorful vegetables over time. For example, sugar peas have pretty high sugar content, so most people tend to find them more highly palatable than, say, zucchini. In time, youll come to savor most vegetables and you may be surprised to discover that a formerly boring, bland-tasting vegetable now seems full of flavor. Anytime you get hungry, feel free to eat fresh fruit snacks, graze on nuts and seeds. When I simply need fuel and am on the go, one or two bananas will usually satisfy my hunger for a couple of hours. Bananas give you energy. They also contain the essential amino acid tryptophan that the body converts into the neurotransmitter serotonin, which may help elevate mood, and without making you sleepy as is often the case when we eat a simple carbohydrate-rich meal. On the contrary, you may actually feel more alert and focused. Bananas are also a great preworkout snack. If, during the course of the day, your body tells you that you still need more calories for fuel, add raw nuts. No doubt youve found that its important to vary your diet; well, the same rule applies to nuts. If you vary the nuts you eat, youll never get bored. Whatever changes you incorporate, make them happen at your own pace. Dont force yourself to eat raw when you absolutely feel like eating cooked. Always remember, when youre unhappy with what youve just eaten, youre actually loading in more stress and potentially setting yourself up for binge-eating and craving-surrender, and thats unhealthy no matter how you slice it.

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After several weeks of making an effort to eat raw, you might start noticing that your body actually chooses a raw meal, when given a choice. Experiment! This is an adventure that may just speed your journey to wellness. As you progress through your transition, you may be surprised to find yourself going raw at a very rapid pace. I gave myself a year to transition, but was almost 100% raw within three months. For me, and for many others who take the Giant Leap, the raw food lifestyle does not require willpower, but it does require commitment. Fresh vegetables and fruits do require a little preparation time. This is your only challenge. Sometimes circumstances will present challenges; for example, workplace functions where doughnuts and coffee abound or lunch is catered. My advice is to come prepared BYOB (Bring Your Own Bounty). Or keep some dried fruit (no sugar added) and nuts in your desk drawer at all times to ensure that you always have something to eat in a pinch. You can also buy raw snacks in the marketplace, which contain, for example, cacao. If youre used to eating a lot of chocolate and other foods that contain processed sugars, cacao may help ease your raw transition.
Raw Cacao: Natures Caffeinated Superfood

Next time you have the urge to grab a chocolate snack, have some natural chocolate instead cacao. Chocolate begins with a bean: a cacao bean. The cacao bean is the seed of the fruit, or culinary nut. The seeds are dried and roasted, then processed to form cocoa, the basic ingredient in chocolate and chocolate products. Cacao (Genus Theobroma, species Cacao) is available in various forms, such as cocoa butter, cocoa powder and nibs (raw or roasted).

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Raw cacao can be used to make raw food chocolate treats or added to smoothies. Some people add sweeteners to their raw treats, such as raw organic agave nectar, which has a low glycemic index. Other treats might be sweetened with honey or dates. Cacao contains minerals such as sulfur and magnesium, which help increase alertness and focus, as well as iron and flavanol antioxidants. Iron is found in hemoglobin, the protein in red blood cells that carries oxygen to tissues. Antioxidants help guard against oxidative stress and inflammation and neutralize free radicals that cause cell damage. Cacao also contains feel-good nutrients, such as phenylethylamine and theobromine (a chemical related to caffeine). Theobromine may act as a diuretic, and has a stimulating or excitatory action not possessed by chocolate itself. Theobromine and theophylline, like caffeine, are used by modern medicine as an anti-asthmatic. Raw organic cacao is a healthy way to satisfy that craving for chocolate, and without eating chocolates frequent (and unhealthy) companion processed sugar. If youre trying to wean yourself from coffee, you may find cacao to be a good substitute. But since cacao does contain some caffeine, I recommend exercising caution at first. For me, cacao is a treat. I occasionally eat raw snacks containing raw organic cacao and sometimes add it to my morning smoothies. But I dont make cacao a habit. I dont eat it every day because it does contain some caffeine, though not a significant amount. It doesnt trigger headaches for me, but you should test the waters with small amounts of cacao to make sure it isnt a problem for you. Listen to your own body. Youll quickly figure out what works for you. Ive found that very low levels of caffeine do not affect my body adversely, but I dont have a high threshold, and I am

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grateful to my body for being so sensitive. Note: If you try to quit coffee at the same time you transition to raw foods, you might in fact, probably will experience withdrawal headaches. This doesnt necessarily mean that the raw food lifestyle isnt right for you. What it probably means is that your body is addicted to caffeine. This is the only instance in which I would advise you to stick to your medication, survive the withdrawals, and simply quit coffee at all costs.
Tips for a Successful Transition

Here are some final tips to ease your transition Dont stock processed foods at home. If you experience a moment of doubt or hesitation, when youre tempted to consume something that will not provide your body with maximum nutrition, ask yourself if theres anything raw that you might like to have. Then have both. Or simply go for the raw, even if it means making a trip to a produce store or local supermarket. That trip is reinforcing healthy habits, and you wont regret making that extra effort. When you find that you crave sweets, eat a banana. If one isnt enough to satisfy the craving, eat two. Give your body a few minutes to begin the digestive process, and youll notice that your craving miraculously wanes. Even if the craving lingers a bit, it wont be a fierce one, thus, it will be easier to resist. When you crave fatty foods (e.g., French fries), eat an avocado. When you satisfy your bodys need for fats, your craving for unhealthy fatty foods subsides. When you attend parties where you dont have control over the food thats served, you may need a special strategy. During my transition, foods like salsa and guacamole were ideal foods to go for. I would still have

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tortilla chips from time to time, and I found that I actually enjoyed changing my views about how much (or how little) I actually needed to eat to satisfy my hunger. Go for whole-grain tortilla chips and raw veggies and fruit platters theyre ever-present at parties. Its easy to stay raw if you just take a moment to look for the best strategy to accomplish your goal. If you share the underlying reasons for your dietary changes (remember, youre not doing this for vanitys sake, youre doing it for health reasons), youre likely to find that your host(ess) will be understanding and possibly even willing to find more fresh produce just for you. Always be prepared. Its the Boy Scout motto, and it should be yours, too. When you leave the house, grab a bottle of water and a snack-to-go, be it a banana or a little bag of raw nuts.
Can you stay on a cooked diet and remain headache-free?

Yes, I believe you can, as long as you abstain from caffeine, alcohol, a lot of processed foods, aged cheeses, excessive fat or any other dietary triggers that may be a personal problem for you. However, remember that the more cooked (or fried, processed, pasteurized, etc.) foods you eat, the fewer nutrients you will provide to your body, in general. Such food tends to lack enzymes, vitamins, antioxidants and phytonutrients. When you start paying more attention to your overall health, you may notice that certain foods dont necessarily trigger a headache, but they may overwhelm your system in ways that you find uncomfortable. This will be especially true once you get used to a healthier lifestyle. Diet is a crucial component of wellness, but it is only one element. For most migraineurs, being migraine-free full remission requires a more comprehensive lifestyle change and

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a deeper commitment to wellness that includes all the elements, from exercising and getting a good nights sleep to managing stress and maintaining good mental health. If youre diabetic, hypoglycemic, or have any other medical condition that requires a special dietary regimen, be sure to design your food lifestyle in consultation with your physician. Your goal is to relieve migraine syndrome and achieve total wellness by using strategies that dont create other health problems. I can tell you this with certainty: The more raw foods you eat, the easier it will be for you to resist unhealthy, processed foods. I dont advise you to transition to a 100% raw food diet overnight. Design a transition that works for you. You may find that following the raw rules for 50% of your meals is more than enough to help you pinpoint your dietary triggers and eliminate your headaches.

3.5
Why Eat Raw

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The importance of enzymes in the body

The zealous biochemical activity of metabolism owes a lot to enzymes. The majority of these biochemical reactions dont happen spontaneously theyre the result of catalysis, which is the acceleration of a chemical reaction by some substance which itself undergoes no permanent chemical change. Enzymes are the catalysts the drivers of these biochemical reactions. Every biological function requires enzymatic activity. Enzymes are responsible for triggering almost all of the chemical reactions in living organisms. Without enzymes, these reactions couldnt keep up with the pace of metabolism. The body produces over 20,000 enzymes; in fact, each cell contains over 500 enzymes that are involved in assimilating nutrients, either by releasing energy or incorporating nutrient material into the body. The body produces its own endogenous enzymes and we ingest the rest in the form of exogenous enzymes; that is, enzymes which are produced outside the body. The body uses digestive enzymes to drive the digestive processes and systemic enzymes for all other bodily systems. Digestion represents the majority of enzyme activity. As we age, the production of endogeneous enzymes slows down, so it becomes especially important to pay attention to the enzymatic value of the foods you eat exogenous enzymes will become the greater source of supply. In a test tube, the oxidation of a fatty acid to carbon dioxide and water is quite volatile. pH extremes, high temperatures and corrosive chemicals are required for oxidation. But in the body, oxidation occurs smoothly and rapidly within a narrow range of pH and temperature. In the lab, the process of complete oxidation could take many hours; in the body, it generally takes four hours or less, even under mild temperature and pH.

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Processing, cooking, and freezing food deactivates some of the foods enzymes, which makes the digestion process less efficient. Some enzymes are adversely affected by high temperatures many animal enzymes, for example. Others deactivate when frozen. As with most chemical reactions, the rate of an enzyme-catalyzed reaction increases with higher temperatures; in other words, heat speeds up enzymatic action. For example, a 10C rise in temperature is estimated to increase the activity of most enzymes by 50 to 100 percent. Even a 1-2 degree increase in temperature can speed up enzyme activity by a few percentage points. Over time, some enzymes can deactivate at even moderate temperatures. Thats why the fresher the food youre eating, the higher the enzymatic activity. And fresh fruits, vegetables, nuts and seeds contain all the enzymes necessary for completing their own ripening processes. Enzyme efficiency ensures rapid, efficient digestion. When nutrients are extracted from the food faster, the food can be eliminated faster, reducing the risk that toxins will settle in the bodys excretory system and spread throughout the body.
Why is pH balance important?

Its vital that acidity and alkalinity within the body remained balanced. This balance within the body is called pH balance. pH represents the potential of hydrogen. The pH balance of the body is measured on a scale from pH 1 (the most acidic) to pH 14 (the most alkaline). Balanced or neutral pH is 7.0. All your cells are swimming in a sea of fluid that is, in any given moment, either alkaline, neutral, or acidic. If the bodys pH level is too high or too low, the bodys immune system can become compromised and the risk of health problems greatly increases. The corrosive sulfuric acid of hyperacidity (acidosis) poses many serious health threats, as does the ammonia produced by hyperalkalinity or alkalosis. Each, pushed to extremes, can be deadly.

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Migraine prevention may actually depend on your body operating at an optimal pH. Foods that are popular these days are primarily acid-forming, as opposed to alkaline-forming, which can make it easier to tilt your bodys pH toward acidity. Such acidic foods include pizza, burgers, French fries, soft drinks, doughnuts, potato chips, pretzels. Some research has suggested that acidosis (low pH) may be linked to some migraine attacks, so its to your advantage to monitor your pH balance regularly with an inexpensive pH kit, purchased from your local drugstore. As a migraineur, you may find that a very slightly alkaline pH is optimal for you. In truth, diet can only alter our pH balance in small degrees since the body has self-buffering capabilities. It does its best to remain pH-balanced, until you tilt your diet too far toward acidity or alkalinity. But those small degrees can make a significant difference in your health. The acid produced by food metabolism is strong and needs to be buffered (combined with something alkaline) before it is eliminated, which is why its important to pay attention to the amount of alkaline-forming foods in your diet. Its also worth mentioning that stress has an acidifying effect on your body. You can eat the most carefully devised alkaline diet in the world and wipe out its positive effects by allowing yourself to live with prolonged stress. Eating lots of fresh fruits and vegetables is an easy way to introduce more alkaline-forming foods into your diet and increase your bodys alkalinity.
How do we get our protein?

Every protein molecule consists of a chain of amino acids. If your body lacks certain amino acids, you may develop mental and physiological imbalances. Essential amino acids must be supplied by diet. The body doesnt have to work as hard to digest vegetable sources of protein.

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The amount of protein you need varies, depending on your age, activity level and any illness you may have. Young athletes, for example, need a lot of protein, while older, sedentary people require less. Practically all fruits and vegetables contain some protein. Beans, nuts, and whole grains and greens are excellent sources of protein, plus they contain healthy fiber, vitamins and minerals. Following are some suggestions for plant-based sources of protein:

Vegetables: artichokes, beets, broccoli, Brussels sprouts, cabbage, cauliflower, cucumbers, eggplant, green peas, green pepper, kale, lettuce, mushrooms, mustard green, onions, potatoes, spinach, tomatoes, turnip greens, watercress, yams, zucchini, Legumes: garbanzo beans (chick peas), kidney beans, lentils. (Today I eat beans in the sprouted form only.) Grains: barley, brown rice, buckwheat, oatmeal, quinoa, rye, wheat germ, wheat, hard red, wild rice. Grains can be sprouted as well. Nuts and Seeds: almonds, cashews, peanuts, pumpkin seeds, sesame seeds, sunflower seeds, walnuts, pecans, hazelnuts, Brazil nuts, macadamias
While fruit, in general, contains less protein than vegetables, most fruits do contain some protein; for example, apple, banana, cantaloupe, grape, grapefruit, honeydew melon, orange, papaya, peach, pear, pineapple, strawberry, tangerine, watermelonbasically, anything youd find in the produce section!
Why do we eat leafy greens?

Leafy greens provide alkalinity for the body and theyre an excellent source of protein. They provide protein in the form of

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individual amino acids, which are more efficient for the body to digest than complex proteins. Greens help the digestive system digest other foods more efficiently. And greens stimulate the secretion of digestive enzymes, thus they combine well with all other foods. For migraineurs who have a magnesium deficiency, green vegetables such as spinach serve as good sources of magnesium because the center of the chlorophyll molecule contains magnesium. Some legumes (beans and peas), nuts and seeds, and whole unrefined grains are also good sources of magnesium. (Refined grains are generally low in magnesium.) Its important that the produce you eat is grown in high-quality soil. We consume essential minerals from the soil through plants; in other words, the original source of our nutrition comes from the soil. Thus soil quality has a direct influence on nutrition, and ultimately, our health. Thats why organically grown produce is likely to have higher nutritional value than conventional produce often twice as high. Organically-grown produce is likely to contain more mineral ash, phosporous, calcium, magnesium, potassium and sodium. The soil is likely to contain 20-25% organic (live) matter as compared to the 2-5% organic soil used to grow conventional commercial produce. Chemical fertilizers are typically missing live enzymes that create living soil.
What about fermented foods?

Rejuvelac is a fermented liquid that helps improve digestion of food. Its prepared by fermenting grains such as whole wheat, rye, quinoa, oats, barley, millet, buckwheat or rice. The grain is sprouted, then soaked in water for a couple of days at room temperature. Rejuvelac can be consumed as a digestive aid or used as

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a starter for other fermented foods such as raw nut and seed sauces, cheeses, and breads such as sourdough. Rejuvelac contains eight of the B vitamins, vitamin E, K and a variety of proteins, dextrines, carbohydrates, phosphates, saccarides and amylases. It is rich in enzymes that aid digestion, as well as good bacteria, such as probiotics and lactobacilli.
Why do we soak nuts and seeds?

Soaking nuts and seeds before eating them increases their nutritional value and enhances their digestibility. Nuts and seeds contain natural enzyme inhibitors, and in soaking them, you not only release the toxic enzyme inhibitors but also increase the life and vitality contained within them. The purpose of these enzyme inhibitors is to protect the nut and/or seed until it has what it needs for growing (e.g., sunlight, water, soil, etc.). Soak your nuts and seeds for at least four hours, if possible. And be sure to rinse and drain your nuts and seeds well after soaking because the soaking water will contain the enzyme inhibitors, which are highly acidic.
Why do we eat live foods?

Sprouts are considered to be true live foods. They will continue to grow slowly and their vitamin content will actually increase, even while refrigerated. They are literally still alive, and thus one of the most complete and nutritional foods. Fresh sprouts are rich with vitamins, minerals, proteins, and enzymes. The sprout, new growth from a germinating seed, is a transitional phase in the life cycle of a plant. The sprout relies on the nutrients contained within the seed for rapid growth fuel. Its a natural source of enzymes. During the sprouts growth, digestive enzyme inhibitors are expelled, proteins are converted to amino acids and fats to essential fatty acids, making for a very

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efficient food. Sprouts also have a high pH level, thus providing a source of alkalinity. Growing sprouts is economical and can be done anytime anywhere. Most grains, legumes, nuts and seeds are good candidates for sprouting. Common seeds for sprouting include alfalfa, garbanzos, quinoa, fenugreek, peas, lentils, radish and red clover. Where do you get seeds for sprouting? Check out stores such as Whole Foods, health food stores or Internet stores such as www.sproutpeople.com.

3.6
The Truth About Fats

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Six months after going raw, I had a Live Blood Analysis (also known as live cell analysis or nutritional blood analysis). This type of blood analysis, typically conducted by a certified health counselor, uses high resolution microscopy to observe live blood cells in vitro (outside the body) and project cellular activity onto a TV screen. (The session can even be recorded to a DVD that you can take home!) I was in awe as I observed my own live blood pricked from my finger just a couple of minutes earlier under the microscope. I could see my disk-shaped red blood cells, which give our blood its color and transport oxygen and carbon dioxide to and from tissues. I could see my white blood cells, which help our bodies fight disease and infection. And I could observe my platelet cells and blood lipids, commonly referred to as blood fat(s). In order to reach a bacteria or virus and attempt to destroy it, white blood cells can stretch, change shape and migrate by ameboid movements. As these immunity cells carry the intruder to the bodys sewage system (the lymphatic system), they can even engulf the intruder if they are unable to destroy it. Observing my white blood cells in action, alive, still moving and changing shape even on the microscope slide helped sharpen my own focus on wellness and make me even more resolved to achieve it. In that moment, I understood how important it was to do everything I could to help my body maintain good health. The blood fat aspect of the analysis was perhaps the most important aspect for me. My blood lipids were few and far between. (My counselor had to literally hunt for the blood lipids to find them under the microscope!) That was good news! But observing the blood lipids in my bloodstream little white dots

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bouncing around in my still-live blood helped me imagine a higher concentration of fats in my blood on a regular basis and reinforce my belief that a raw food diet was the right path for me.

How to Tell Good Fats from Bad Fats When we hear the word fat, we tend to think bad! But fat is a necessary source of energy and good fat (well get to that in a minute) is essential to our survival.
How is fat useful to the body? Fat is essential for the proper functioning of the endocrine glands, which produce the bodys hormones. Fat helps the body use carbohydrates and proteins more efficiently and aids the absorption of vitamins A, D, E and K in the intestines. It helps insulate and protect the body. It coats nerve tissue to facilitate the conduction of electrical current. And fat is integrated into the membrane of every cell, providing a double-sided moisture barrier between intracellular and extracellular contents it helps hold cells together.
The primary types of fats are:

Saturated (e.g. coconut oil, fat found in butter and animal products) Unsaturated includes:
polyunsaturated (e.g., fats found in nuts, seeds, as well as vegetable oils like corn oil and safflower oil; the best known are omega-6 and omega-3) monounsaturated fats (e.g., olive oil, canola oil and fat found in avocados) Saturated fats derived from animal products tend to either contain cholesterol or elevate blood cholesterol, conditions which contribute to heart disease. Both monounsaturated and polyunsaturated fats can help promote good heart health by

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modestly increasing HDL (good) cholesterol and lowering LDL (bad) cholesterol. The idea that we should deprive ourselves of fats is a myth. What matters is that you eat good fats and dont consume excessive amounts. Healthy fats supply us with essential fatty acids (EFAs), such as linoleic acid (omega-6) and alpha-linolenic acid (omega-3). Your body cannot produce essential fatty acids, thus they must be obtained through diet. Essential fatty acids are precursors to hormones such as prostaglandins, which help regulate metabolism. Prostaglandins also cause aggregation or disaggregation of platelets, as well as constriction or dilation of vascular smooth muscle cells. Linoleic acid (unsaturated omega-6 fatty acid) helps regulate platelet aggregation. This can be important for migraineurs because some research has suggested that the serotonin thats released from platelets may help counteract migraine headaches. Many studies have linked omega-3 deficiencies to depression and bipolar disorders, and have shown that eating more natural sources of omega-3, as well as omega-3 supplementation, when necessary, can have a beneficial impact on mood. The healthy ratio of omega-6 to omega-3 is 1:1, but many diets these days tend to be much higher in omega-6 than omega-3 fatty acids. Any ratio higher than 4:1 is thought to be pro-inflammatory for the body. Essential fatty acids are polyunsaturated fats. Excellent natural sources of omega- 3 essential fatty acids are hemp and flax seeds. From 1994 to 1996, Zuzana Bic conducted a study of headaches at Loma Linda Universitys School of Public Health in California. Her goal was to determine whether a low-fat, high-complexcarbohydrate diet could lower the frequency, intensity, and duration of migraine headaches. In her book, No More Headaches, No More Migraines, she talks about how blood flow comes to a crawl after a meal. Fat particles, carried by the bloodstream,

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are literally forced through the blood vessels, creating a traffic jam. This traffic jam increases platelet clustering, which lowers serotonin levels and causes headaches. (Bic, 1999) Saturated fats are primarily found in animal products, some dairy products, and a few vegetable products (e.g., coconut and palm oils), as well as food products that have been partially or completely hydrogenated. Hydrogenation is the process in which an unsaturated oil is combined with hydrogen to produce a solid fat. The body can more efficiently utilize fats that are not saturated because our digestive system has difficulty breaking the bonds of saturated fats. If hydrogen cant be removed from saturated fats to convert them back into digestible unsaturated fats, the fats become chemically inert. This fat circulates in the blood as globules that cannot be efficiently metabolized, which impedes the bodys ability to uptake, transport and deliver oxygen to the cells. The result, over time, can be clogged arteries. Trans fats are bad fats that have been linked to raising low density lipoproteins (bad cholesterol, LDL), lowering high density lipoproteins (good cholesterol, HDL), and contributing to heart disease. Trans fats (also known as partially hydrogenated fats or trans fatty acids - TFAs) do not occur naturally; theyre formed during hydrogenation and used primarily to add texture and extend a foods shelf life. Trans fats are, in other words, a negative byproduct of food processing that can actually block effective utilization of essential fatty acids. And guess what any food that doesnt spoil on the shelf will be more difficult for your body to digest. Its not natural and your body doesnt know what to do with it! Fat can become an habitual craving, just like sugar. And unfortunately, when we crave fat, we tend to go for the saturated fats, such as those found in potato chips. Or we grab a combo supplier like ice cream, which satisfies both sugar and fat cravings. It is true that we may sometimes crave high-fat foods to

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correct a deficit in essential fatty acids. But saturated fats dont satisfy that need, so the body will continue to crave the unsaturated fat it really needs. This phenomenon probably explains why eating a whole bag of potato chips doesnt kill the craving. Your body still wants the essential fatty acids it didnt get from the saturated fat you fed it. Instead of reaching for the potato chips, try a healthier fat snack like a flax seed cracker! The fat that I consume comes primarily from avocadoes, raw nuts (including coconut) and seeds these are good fats. Pure high quality extra virgin oils such as olive oil, hemp seed oil, flax seed oil, sesame seed oil and coconut oil are all healthy fat sources, especially if youre physically active. I no longer consume animal cholesterol in my diet, as my own body continuously synthesizes cholesterol in my liver. My body uses cholesterol to produce vitamin D when I am exposed to sunlight. Cholesterol serves an important function in our bodies it is a precursor for the synthesis of various hormones. And as long as I remain on a healthy diet, Im not in danger of elevating my blood cholesterol and increasing my risk of cardiovascular disease. My body will balance itself. Your goal is to help your body bring itself back to balance. I recommend that you have your own Nutritional Blood Analysis done to help you determine whether you need better nutritional balancing. Live Blood Cell Analysis does not diagnose, treat or heal any disease. But its a powerful illustration that enables you to literally see the quality of your blood and to better understand how your nutrition and lifestyle are impacting the condition of your blood and your health. If you decide to research the raw food lifestyle further, one of the common misconceptions that you may encounter is that raw food heals disease. Its not true. It is your own body that heals itself. Your body already has built-in self-healing mechanisms.

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All you have to do is provide it with the right nutrition, as well as adequate hydration, physical activity and rest. Lifestyle is a personal choice and I would never discourage you from choosing your own path. I would simply like to intrigue you with the possibilities so that you can do your own research, find your own answers, and make your own informed choices. There is no cookie-cutter approach to self-care that works for all migraineurs. But once you learn to stop, look and listen to your own body, youll quickly discover what works for you. One things for sure: If you work to replace unhealthy fats with healthy fats, youll see an improvement in your overall health.

3.7
Hydration Is Not Just For Plants!

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Drinking water is not just about quenching thirst. We literally need water to survive. We can go without food for around 40 days, but we can only survive without water for a few days. Water is both a life-giver and a life-sustainer. The human body, in fact, is composed of roughly 70-75% water. Brain tissue consists of 80-85% water. Next to air, water is the element most necessary for our survival. We need water to breathe. Our lungs must remain moist in order to take in oxygen and excrete carbon dioxide. In fact, we lose up to a pint of water each day simply through exhalation. Water is the source of energy for creation of life, playing a starring role in all aspects of body metabolism. The hydrolytic property of water drives all chemical reactions that create and sustain life. Water is vital for digestive and metabolic efficiency and organ function. It carries nutrients and oxygen to the cells through the bloodstream and cools the body through perspiration. It lubricates our joints, preventing joint and muscle soreness. Water (moisture) hydrates skin tissue, improving elasticity. (Yes, sufficient water intake helps keep you looking younger and makes your skin more radiant!) Water helps detoxify our bodies in fact, water is a natural body purifier. Without water, wed literally be poisoned to death by our own waste products. If our bodies dont maintain sufficient water reserves, our kidneys cant efficiently remove toxic waste such as uric acid and urea, which can lead to conditions such as kidney stones. If youre not drinking enough water, your body, ironically, may retain water to compensate; fluid retention, in fact, can sometimes be eliminated by drinking more water, not less. And fluid retention actually increases overall body weight and makes

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it difficult to shed those extra pounds. If youre trying to lose weight but dont drink enough water, your body wont be able to metabolize fat sufficiently. The bottom line is that hydration impacts every cell of your body and every aspect of your physiology. And just to set the record straight, sodas or soft drinks dont count as hydration! Why not? Its a beverage, after all. Well, lest you think Im engaging in unwarranted soda-bashing, take a look at the ingredients found in a 12-ounce can of Coke.
1. Caffeine, which is a diuretic; in other words, caffeine increases the discharge of urine and actually dehydrates your body. 2. 55 grams of sodium (aka, salt!). This is the equivalent of drinking a pizza, as was so pithily pointed out by Dr. Robert Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology at the Osher Center for Integrative Medicine in a July 2009 lecture. *(See footnote) 3. Soda contains around 8 teaspoons (33 grams) of added sugar. The sugar helps disguise the taste of the salt. Sugar plays a trick on your tongue you dont even notice that the salt is there.

Bottom line: What happens when you take in sodium and lose water? Thats right. You get thirstier. So that can of soda is not hydrating you at all; its sneakily stealing your bodys water reserves.
What Does Hydration Have to Do with Migraine?

I used to not pay much attention to my daily water intake, or, for that matter, to whether I was sufficiently hydrated or not. I occasionally drank mineral water (largely a leftover European habit), and I drank caffeinated beverages whenever I wanted them.

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Then I figured out that two glasses of water could literally chase away a growing headache. Thats right, drinking water has actually been known to prevent my migraines. This is purely anecdotal; I certainly couldnt promise you that water alone can cure your migraines. But what I have found to be crucial to migraine prevention is staying hydrated at all times. Let hydration help prevent your headaches. Dont wait until migraine attacks it may be too late. Look at it this way: Water cant hurt you. It can only help your body and increase your odds of wellness. And its one of the cheapest, simplest therapies money can buy. Dehydration causes headaches. Inadequate water reserves can have an effect on migraineurs similar to that of chronic alcohol abuse and conditions such as hangovers. (See Chapter 18.) Keeping yourself perpetually hydrated helps ensure that the peripheral vessels involved in migraine syndrome dont become dilated.
How Much Water Do You Need?

Many of us actually live in a state of perpetual dehydration and dont realize it, partly because we have no idea how much water we should drink to maintain a healthy level of hydration. The rule of thumb is that you should drink 5075% of your body weight in ounces each day 50%, if youre sedentary; 75% if youre physically active. So, if you weigh 120 pounds, you should drink 60 ounces of water each day, which equals about seven and a half 8-ounce glasses of water. The International Sports Medicine Institute recommends this formula for daily water intake: 1/2 ounce per pound of body weight if youre not physically active (if you weigh 160 pounds, thats ten 8-ounce glasses), and 2/3 ounce per pound if youre athletic (at 160 pounds, thats 13 to 14 glasses a day).

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Simple Strategies For Staying Hydrated

If you are historically not a big water-drinker, heres a quick and painless way to begin integrating water in your life: Drink at least one glass of water every single day. Within a couple of days, you may be surprised to find that your body actually wants more than one glass. And buy good water (yes, there is such a thing as good water and bad water!). Drink natural spring water. Investigate whether mineral water is right for you, within the framework of your own body chemistry. Dont drink straight tap water without cooking it first. Tap water often travels through lead pipes, and even after purification, still contains a government-mandated safe level of contaminants chemical, physical, microbial and radiological. If you ever viewed slides of your tap water under the microscope, youd probably be horrified by all the little microorganisms that are swimming around in there. Thatll make you a believer! Not to mention the chlorine and fluoride and any other purifying agents that have been used to purify the water it may not be much healthier for you than drinking swimming pool water. Not all bottled waters are created equal. Just because the bottle label has a pretty picture of a refreshing mountain spring and a natural-sounding name doesnt mean its good for you. You may also consider investing in a good home water filtration system, but do your homework carefully. Most systems dont remove every harmful contaminant. Your best bet is to start with pure, clean water in the first place. You weight-conscious readers can take heart in knowing that drinking lots of water helps you eat less! When you get hungry between meals, try drinking 8 16 ounces of water first and waitobserve your bodys reactions. If youre truly hungry, youll remain hungry. But you may find that you were simply thirsty. If so, once youve satisfied your thirst, that sensation of

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hunger might subside. If you drink several glasses of water throughout the day, youll be on your way to a healthier, leaner body. And you may just find that those migraines become more and more scarce, or even nonexistent.
For more on the benefits of hydration, check out F. Batmanghelidj, M.D.s book, Your Bodys Many Cries For Water. Whats Salt Got to Do With It?

Water and salt are inextricably bound together. Water and sodium are both necessary for metabolism, detoxification and transportation. Sodium regulates electrical charges nerve impulses throughout the body. If sodium levels are too high or too low, abnormal electrical signals erupt; in fact, abnormal sodium levels can even trigger seizures. And migraine, dont forget, is a state of abnormal electrical activity, a disturbance in the delicate balance between neuronal (nerve cell) states of excitation and inhibition. How much sodium should we have in our bodies? The adult human body contains around 250 grams of salt; a babys body contains around 14 grams of sodium. Sodium can be obtained from salt; however, while refined salt contains adequate sodium and chloride, it is sorely lacking in over 80 minerals. The use of refined salt can exacerbate a mineral deficit in our bodies, and mineral deficits tend to increase the severity of any chronic disorder, including migraine. Refined salt (e.g., table salt) contains 97.5% sodium chloride and 2.5% ingredients such as iodine or other moisture absorbents. The refining or drying process involves heating salt to over 1200 degrees Farenheit, which alters its natural chemical structure. What remains after salt is chemically cleaned is sodium chloride salt in its devitalized form. This form of salt is whats found in most preserved and processed products.

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So, if you add more salt to this already-salted processed food, your body may receive more salt than it can dispose of. Inorganic sodium chloride can cause bodily fluid balances and overburden your elimination systems. And were not just getting too much refined salt in our food. Beverages such as caffeinated soda and juices high in sugar also contain refined salt, thus will dehydrate you. Unrefined salt nourishes both intracellular activity (organelles and structures inside cells) and extracellular activity (e.g., both white and red blood cells, vitamins and minerals). When cells produce waste products, those waste products are released into the extracellular fluid for discharge by the kidneys. A lack of water or salt can block this elimination process and lead to cellular decline or death. Unrefined salt contains important trace minerals and elements such as potassium, calcium and magnesium that help balance electrolytes, which helps maintain and replenish fluids and keep your body (as well as your cells) in homeostasis or physiological equilibrium. Chronic overuse of refined salt can eventually lead to adrenal problems. Adrenal exhaustion is often associated with immune system disorders. One contributing factor may be the lack of unrefined salt in our diet and the excess use of refined salt. The adrenal cortex produces hormones aimed at regulating blood sugar, blood pressure and water and salt distribution, as well as muscle strength and energy. Adequate salt and mineral intake is essential for optimum adrenal gland functioning. Perhaps most importantly for migraineurs who have low magnesium levels, unrefined salt contains large amounts of magnesium, whereas refined salt contains none. Magnesium is one of the bodys natural relaxing agent. Ive personally stopped using refined (table) salt altogether.

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For healthier sources of sodium, you might check out salts such as Himalayan salt or Celtic Sea Salt, which contain no bleaching agents.
Resouce *Robert Lustigs lecture is a valuable source of information on the harmful effects of sugar on our bodies, as well. It can be viewed at: www.uctv.tv/

3.8
Cheese and Whine? (Alcohol)

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Over the years, I would enjoy a glass of wine from time to time. I usually got a migraine (or at least a regular headache) when I drank more than one glass, especially if I combined alcohol with coffee. Thats a double whammy! Alcohol is a major migraine trigger for me, and ultimately, I made a personal choice to simply stop drinking it altogether. Heres why
How Alcohol Punishes Migraineurs

For most people, alcohol is a sedative-hypnotic in the acute intoxication phase, though, ironically, it diminishes sleep quality. For others, alcohol may act as a stimulant triggering, for example, violent and abusive behavior. At intoxicating levels, alcohol is a vasodilator (relaxing and expanding blood vessels), but at even higher levels, it becomes a vasoconstrictor, shrinking the vessels and increasing blood pressure. Guess what can happen to the migraineur? Thats right, your body gets out of whack and a migraine is triggered. And if you already had headache symptoms before you drank, alcohol is almost certain to exacerbate them. Many people drink alcohol because they believe that it promotes relaxation, communication and a sense of well-being. What its actually doing is putting just enough of our anxious neurons into just enough of a slump to allow others to emerge from the shadow of inhibition. Problem is, alcohol is one of the worst depressant drugs because the body breaks it down into byproducts that are toxic. That middle-of-the night awakening to a sick feeling occurs because the liver is busy knocking hydrogen off the ethanol molecules and turning them into formaldehyde yes, formaldehyde! (Theres a reason inebriation is referred to as being pickled!) And then theres the hangover, which, for the migraneur, can

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be ferocious. What is a hangover? Simple: Dehydration. Alcohol can lead to dehydration and the more you consume, the more dehydrated you get. Ironic, isnt it? One drink doesnt necessarily do much damage. But heavy drinking goes to work on you in sneaky ways; for example, it destroys all hope of quality sleep. By 3 am after a night of drinking, your brain stem neurons are awash in toxins. Theyre so unhappy that they go on sleep strike: they refuse to create REM sleep. The alcohol and its toxic byproducts prevent the cholinergic system (the down system) from discharging the neurotransmitter acetylcholine in the uninhibited way that it does during REM sleep. After prolonged REM suppression, the cholinergic system is under serious pressure. The problems arise not because REM sleep is lost, but because its suppressed. Alcohol does not allow the amines (the energy or up system) to rest. For even the healthiest person, if REM sleep is lost for a night or two, its paid back with interest on subsequent nights. In chronic drinkers, constant suppression of REM sleep causes the tension in the cholinergic system to mount until finally, REM sleep comes crashing through in the form of hallucination. Sleep becomes completely dominated by REM periods that may be filled with random bizarre or even terrifying hallucinations. And just to be clear: Alcohol is not food. It does not provide any essential nutrients whatsoever. Your body can use the calories for energy, but it cant convert the alcohol itself into glucose. Calories from alcohol that arent used for immediate energy are processed similarly to how fat is processed and stored as triglycerides. Alcohol actually brings about a rise in blood-fat levels. Alcohol can trigger blood sugar fluctuations, which is why diabetics (and hypoglycemics) are always warned to use alcohol with care. It inhibits the liver from making glucose, which can lower blood glucose and even trigger hypoglycemia. While a moderate

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amount of alcohol can cause blood sugar to rise, excessive alcohol can actually decrease your blood sugar, even causing it to drop to dangerous levels. Beer and sweet wine contain carbohydrates and can raise blood sugar levels, especially if used to excess. Some research suggests that beer and wine trigger cravings for sugar in some people. National Institute on Alcohol Abuse and Alcoholism studies found that when people drink heavily for several months, cortisol increases dramatically, both during intoxication and during withdrawal; in fact, cortisol levels jump even higher when the drinking stops. And these alcohol-induced cortisol spikes happen quickly, even before the alcohol is gone from the body. The daily, heavy drinker may have levels of cortisol 2 to 3 times higher than normal throughout the day and night. Alcohol can increase cortisol through a variety of mechanisms. For example, alcohol directly affects many brain chemicals that signal the adrenal glands to produce and secrete cortisol. High levels of intoxication may be interpreted by the body as general stress, which would stimulate cortisol release. And after drinking a lot of alcohol for a long time, the sudden cessation of drinking can produce a physically stressful withdrawal state, which would also increase cortisol production. Chronic alcohol use ages you. Alcohol is a dehydrator; ethyl, after all, is a cousin to formaldehyde. Alcohol dehydrates tissue and reduces its elasticity. High levels of alcohol can cause significant oxidation and free-radical damage, which contributes to aging and hardening of the arteries. The aging effects of alcohol seem to be worse for women than men. In fact, alcohol affects women more dramatically, overall, than men. And alcohol abuse certainly takes a heavier physical toll on women than on men. Alcohol dependence and related medical problems, such as brain, heart, and liver damage, progress more rapidly in women than in men. Women become more

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impaired than men do after drinking the same amount of alcohol, even when differences in body weight are taken into account. Why? Because womens bodies contain less water than mens. Alcohol mixes with body water, and if a given amount of alcohol becomes more highly concentrated in a womans body than in a mans body its like dropping the same amount of alcohol into a much smaller pail of water. Studies show that abstinence from heavy alcohol consumption sparks a burst of new brain cell growth. Chronic alcohol consumption prevents growth of new neurons in the brains hippocampus, which can impair learning, memory and perception, and prevent appropriate adaptive emotional responses. People who drink chronically tend to have difficulty coping and adapting because they lose emotional perspective and the ability to make sound, rational judgments. Chronic alcohol use frequently leads to depression; in fact, it literally doubles the risk of depression in people of all ages. Alcohol is, after all, a depressant drug, a downer it can trigger depressed mood. And it always exacerbates co-existing depression. Some research has suggested that alcohol may even trigger a genetic marker for depression. Is alcohol a trigger for you? It is for many perhaps most migraineurs who use it. My advice is to monitor the relationship between alcohol and migraine in your own life. If you find that you can tolerate a limited amount of alcohol without triggering migraine symptoms, and are simply not willing to give it up, pinpoint your Stopping Point very carefully and stick to it. My advice is to remove alcohol from your life altogether. That may seem radical to you, but the reality is that most migraineurs cannot drink alcohol without setting themselves up for a headache. That means theyre running the risk of having a migraine every time they drink. If youre one of them, its up to you to decide whether its worth the risk.

PART

Mind And Body

4.1
Migraine and the Psyche

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Migraine is classified under the broad umbrella of medical condition, but physical disorders take a psychological toll on us, as well. In fact, recurrent and co-occurring illnesses can become such a vicious cycle that the line between cause and effect blurs. Is the psychological symptom causing the physical symptom? Or is the physical symptom causing the psychological symptom? Mental health problems typically present with both psychological (mind and emotions) and somatic (biological and physiological) symptoms. The same is true of most medical conditions, including migraine. Some migraineurs experience depression, bipolar disorder, generalized anxiety, social anxiety and panic attacks. Psychological problems can occur before migraine attacks, during attacks, or after attacks. And migraine, co-occurring with emotional problems, is a double whammy. Psychological problems can steal minds, souls and lives sometimes overtly, and sometimes like a thief in the nightday by day, week by week. And the ripple effect can be devastating. Mental health problems lay waste to relationships and careers, wreaking havoc with what makes us most human our emotions, our relationships, our ability to trust our judgments about those closest to us. We fall victim to our own cognitive distortions we lose the ability to objectively evaluate ourselves, a symptom which often manifests as low self-esteem, feelings of worthlessness, and guilt. Thoughts, beliefs and fears can get blown out of proportion so easily. We no longer remember what normal feels like. We dont remember what it felt like to feel good. It becomes easier to slip into a persistent negative feedback loop constantly circling our personal misfortunes, misinterpreting neutral or trivial daily events as yet more evidence of

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our personal defects perhaps even assuming guilt and responsibility for negative situations that are completely beyond our control. These negative ruminations trigger chronic stress. Increased stress loads can drive us toward unhealthy stress management behaviors that further fuel health problems; for example, smoking, using alcohol or drugs, junk food and comfort eating any of which is likely to put a migraineur at greater risk for a migraine attack. Handling stress in unhealthy ways might alleviate symptoms of stress in the short term, but, over time, we end up creating serious mental and physical health problems and, ironically, more stress. See the vicious cycle? Chronic stress elevates cortisol levels and depletes serotonin, thus it can trigger depression, anxiety and more migraine attacks. Heres how it works Changes in brain chemistry influence mood and thought processes. During a period of significant depression, for example, quantities of the neurotransmitter serotonin, in particular, are significantly reduced for many people. Serotonin promotes social confidence and a feeling of well-being. If serotonin levels are high, your confidence soars, and you feel less vulnerable. If serotonin levels are low, you may feel helpless, become defensive and less willing to take risks. Serotonin also plays a key role in helping us maintain a proper perspective of events. (For example, serotonin modulates rejection sensitivity. Lower serotonin levels can cause depressed or anxious people to be acutely sensitive to rejection.) Now, cortisol has actually been shown to have a positive effect immediately following a traumatic psychological stressor: it can lessen the stressors emotional impact. But chronic stress creates long-term elevations of cortisol that trigger depression or anxiety again and again and make you more vulnerable to migraine attacks and a host of other illnesses.

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Gamma-aminobutyric acid (GABA) is another neurotransmitter thought to play a role in causing depression. GABA, working in tandem with serotonin, acts as an inhibitory neurotransmitter that quiets the stress response when a person thinks about stressful events. In people who are depressed, cortisol is produced in excess. Cortisol is responsible for much of the physiological damage caused by long-term stress. Often, depressed people arent even aware of what triggered their depression because when a memory or live event triggers depression, feeling is separated from thought. We lose the thought, but the feeling keeps on churning. This is why youll often hear depressed people say it just came out of the blue, when, in fact, depression never comes out of the blue. Theres always a trigger. Heres how this psychological discontinuity happens neurologically The conscious, second-by-second processing of verbal conversation happens in one part of the brain (the prefrontal lobes of the neocortex), while your emotional evaluations are happening in another part of the brain the limbic system, which is a network of brain structures involved in learning, memory, motivation and generating emotions.
When you hear a stress-inducing sentence, two things happen: 1 Your language and working memory centers decode the meaning and insert the meaning into your conscious mind; 2 A subcortical system triggers a stress response your limbic system launches a cascade of events that sends chemicals including the stress hormone cortisol racing throughout your body.

Prefrontal lobe activity conscious, intelligent processing of the sentence happens in nanoseconds. But the emotional system lags behind for seconds, even minutes. So, theres still cortisol floating in the bloodstream thirty seconds after the news vanishes from working memory, yet you no longer remember

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what triggered the depressed mood. For example, someone could hear the same song on the radio that was playing in the background five years ago in the moment that he was told that a loved one had died in a car accident. He unconsciously associates the memory of this past traumatic experience with the song, triggering a depressed mood. We often have unresolved emotional issues that can dramatically increase the risk of migraine, as well as other health problems. And instead of learning to feel what we feel and work through those emotions, we may do our best to avoid emotional extremes because were desperately afraid of being completely consumed by emotion. The irony is, its the fear that causes most of our suffering. Natural healing therapies such as the Alexander Technique, which allow you to stop, look and listen to your mind and body, can help you begin to deep-process your feelings. And in the next chapter, youll learn strategies for improving self-awareness, keeping emotional reactions in perspective and controlling the negative thought patterns that drive self-damaging behaviors. A technique known as systematic desensitization can also help you make anxious feelings that might normally be associated with a particular stressful event begin to fade and eventually disappear. The key is to imagine the specific fear or anxiety while youre in a state of deep relaxation. Often, once we face a painful memory or an anxiety-provoking situation, the reality is not as bad as we feared. Ultimately, it is only through awareness that healing can emerge.
Take time to do a reality check. Sometimes its helpful to pinpoint the range and magnitude of fears that may be contributing to depression and anxiety. Heres a technique that can help put things in perspective:

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1. List the current situations in your life that arouse anxiety. Put the most anxiety-provoking situation at the top and arrange all other situations in decreasing order of their capacity to evoke anxiety, 2. While in a state of relaxation, imagine yourself successfully conquering the situation at the bottom of the list (the one that arouses the least anxiety). Keep re-imagining this situation until you no longer experience tension when evoking the mental imagery of the situation, 3. Move on to the next highest fear-arouser on your list. Practice desensitizing yourself for a few minutes each day, knocking each item off the list, one by one. The Relationship Between Migraine and Mental Health Problems Modern research has shown us that psychological disorders result from a combination of factors environment, neurochemistry, genes, personality, and other developmental factors. So, the important thing to keep in mind is that preventing emotional problems reduces the risk of migraine, and preventing migraine reduces the risk of emotional distress. The wellness strategies in this book (including the psychological resilience strategies in the next chapter) are designed to help you prevent both mental and physical health problems. Three psychological disorders that commonly plague migraineurs are: depression, bipolar disorders and anxiety. Certainly, not all migraineurs suffer from depression, mania or anxiety. But as we explore the statistical relationships between migraine and psychological distress below, youll see that a significant number of migraineurs do, and others suffer mild symptoms from time to time.

Depression
Many studies have shown that around 47 percent of migraineurs are affected by depression. In people ages 25 to

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55 (the migraine window), depression increases the risk for migraine, and migraine increases the risk for depression. Interestingly, this bidirectional association, with each disorder increasing the risk for first onset of the other, has not been observed with respect to other severe headaches. In other words, people with migraine have a higher incidence of firstonset major depression than people who have non-migraine headaches or no headaches at all. (Breslau, 2003) Depression can actually be a trigger for some migraineurs, and migraine can be a trigger for depression. Its not surprising, since the two disorders have a common neurobiology: Cortisol elevation or wild serotonin fluctuations alone would create a breeding ground for both depression and migraine.

Anxiety
Roughly one-fourth of migraineurs suffer from some form of anxiety disorder. Anxiety disorders are characterized by: 1) the presence of anxiety; and 2) the avoidance behaviors calculated to ward it off. While each anxiety disorder has different symptoms, all the symptoms cluster around excessive, irrational fear and anxiety, apprehensiveness and dread. Its easy to understand the connection between anxiety and migraine. After all, its not only the migraine attacks themselves that can destroy the migraineurs quality of life. Its also the simple fact of living in anxious anticipation not being able to plan our lives, always apprehensive, waiting for that other shoe to fall, waiting for the next symptom to surface and gradually become more severe. Migraine can be painful, even traumatic. We become anxious and stressed when we anticipate pain. Everyone feels anxious from time to time, and a certain level of anxiety is normal even adaptive. For example, if youre about to take a test, the fear of failure drives you to study harder. But excessive anxiety can be terrifying, paralyzing, and debilitating.

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Now that weve talked about the psychological hurdles that many migraineurs face, lets look at strategies for dealing with them. Whether youve experienced serious mental health symptoms in the past or just need to strengthen your resilience to stress and enhance your ability to cope with problems on a daily basis, the next chapter will provide you with holistic strategies for managing lifes challenges and improving your overall health in the process.

4.2
The Answer to Stress: Psychological Resilience

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Modern life requires us to juggle work, family, and community obligations on a daily basis, and lets face it not always as competently as wed like. This juggling act can dramatically increase stress. Stress is a popular topic of conversation these days. Most of us casually sling around phrases like: Im stressed. Im burned out. Im losing it.
How stressed are you? See if any of these symptoms sound familiar

You have a hard time concentrating and making even small decisions You often feel as if youre literally being pulled in ten directions all at once You dont sleep well at night, or you sleep too long You experience appetite changes marked decrease or increase Youre prone to sudden emotional outbursts; you often feel on edge, frustrated, easily annoyed, impatient You make mistakes that are uncharacteristic of you you forget appointments, forget to pay a bill You dont get as much pleasure out of things you used to enjoy Your alcohol intake increases; you drink more to relax You develop nervous habits or tics You often catch yourself sighing (big tip-off!)
If any of these symptoms sound familiar, chances are, youre stressed. But what is stress, really? And what qualifies as a stressor? Anything we consider to be threatening to us in some way,

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either physically or emotionally, is a stressor. But its important to understand that actual stress only occurs when we have doubts about our ability to deal with that stressor. Starting a new job, for example, can be stressful because we havent yet convinced ourselves we can do the job. Or worrying about how well be able to pay bills this month because we dont know if we can come up with enough money. In other words, stress only becomes a problem when we have too much stress and not enough resources to cope with it. Stress can sneak up on you. Stressors can pop up without warning, and sometimes, unfortunately, all at once. Change, in one form or another, is the culprit behind most stress. Whether that change is the death of a loved one, starting a new job or being served with divorce papers, adjusting to a new situation requires a lot of energy and good coping skills. All stress is not created equal. Part of managing stress is learning to pinpoint your stressors all of them and view each one in the proper perspective. Often, our real stressors the ones that are the most damaging arent even the obvious ones were aware of.

Stressors generally fall into one of six categories:

Acute time-limited or brief stressors. A public speaking engagement or a job interview, Stressful event sequences. A major disaster such as the death of a spouse or child or the U.S. terrorist attack of September 11, 2001 events that create a series of new challenges, but will eventually end, Chronic stressors. Pervasive, recurring demands that force you to change your role or behavior and have no clear endpoint; e.g., caring for a child with a permanent disability or coping with a chronically depressed spouse, Distant stressors. Traumatic experiences that occurred in the

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distant past but still have emotional and cognitive consequences for you; e.g., childhood abuse or neglect Background stressors. Traffic jams, a baby crying in the background while youre trying to focus on an important task And then theres anticipatory stress. We can get stressed before change even happens. If you catch yourself worrying about something that hasnt happened yet (and may never happen), the healthy response is to channel that energy into anticipatory coping. Review similar past experiences to remind yourself of mistakes to avoid repeating and figure out what you can do to cope more effectively than you have in the past. Remember, we only actually experience stress when we dont feel confident that we can cope. Worrying will only increase your stress, but anticipatory coping will help you prepare for future stressful events.
When Does Stress Become Dangerous?

Stress contributes to most psychological and physical health problems in one way or another. If you have good coping skills, you can minimize the impact of stress on your health (not to mention your relationships). Stress becomes dangerous when it interferes with your ability for an extended period of time to live a normal life. An example would be feeling out of control and unable to fix even relatively minor problems. This feeling of overwhelm and helplessness can cause us to feel continually fatigued, unable to concentrate, or irritable. Over time, chronic stress consumes more energy resources than your body can produce. Stress directly impacts your neuroendocrine stress pathways, changing your bodys nervous system and hormone levels, and ultimately weakening your bodys natural ability to cope with emotional stress and physical illness.

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Your hormones effectively burn out. This emotional burnout, coupled with feelings of despair, can easily trigger (or worsen existing) chronic depression or anxiety. And it can most certainly trigger migraine syndrome, especially if you are susceptible to hormonal migraines. Stress triggers your bodys built-in response mechanisms; for example, have you ever found yourself literally sweating because you were about to miss a critical deadline? This reaction is caused by hormones that help your body cope with threats and uncertainties. Its not all bad. This natural physiological reaction can kick you into gear and give you that extra boost of energy to race across the finish line. But heres where it becomes dangerous: The longer your mind feels stressed, the longer your physiological reaction systems remain activated. Your body gets stuck in crisis mode, which can lead to serious health problems both mental and physical. Severe, prolonged stress ages you. Some studies, for instance, have shown that people who spend many years in the role of caregiver for severely ill or disabled family members are physically a decade older than their chronological age. Why? Their bodies were no longer able to fully regenerate blood cells. Chronic or long-term activation of the bodys stress response leads to what is called allostatic load, which is a prolonged wear-and-tear on the body, similar to what happens to a car or appliance after years of wear-and-tear. Because it creates chronically high levels of havoc-wreaking cortisol and atrophy of nerve cells in the brain, allostatic load is associated with impaired immunity and several severe medical conditions, such as atherosclerosis, type 2 diabetes, obesity, hypertension (high blood pressure), hyperlipidemia (excess of fats in the blood), osteoporosis (bone demineralization). Allostatic load levels are also known to be high in depressed and anxious people. This stress load includes inflammatory

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chemicals like cytokines, which have a significant impact on behavior and emotion. (Cytokines are a regulatory protein that is released by the cells of the immune system and acts as a mediator between cells when the body is generating an immune response.) Cytokines can both produce symptoms of depression and depress the immune system; in fact, depression is known to occur more frequently in those with immune disorders. Activation of the immune system induces sickness behavior such as apathy, lethargy, lack of motivation and appetite dysregulation all of which may also be symptoms of depression.
Stress and the mind-body connection

Ultimately, there is no such thing as a mind-body split. Under prolonged stress whether physical or emotional an interesting neurological phenomenon occurs; the communication between the brain and the rest of the body becomes distorted. Our psychological or cognitive state of mind what we think about has just as much impact as our physical (somatic) condition does on how well we function every day, and how susceptible we are to illnesses such as migraine syndrome. Its no wonder that a startling 75 to 90 percent of all physician office visits are for stress-related ailments and complaints. Handling stress in unhealthy ways (e.g., caving in to unhealthy cravings, overeating or alcohol abuse) may alleviate symptoms of stress in the short term, but end up creating significant health problems over time, and, ironically, more stress. While carrying a high stress load doesnt guarantee that youll have a migraine attack or develop any other illness, it certainly increases the risk. And stress can diminish your ability to recover from illness. Many studies have shown that people who have suffered heart attacks, for example, tend to have a much harder

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time bouncing back when theyre experiencing major stressors, such as financial worries or alcohol abuse. You may have noticed, for example, that heavy stress and sleep deprivation can increase migraine recovery time and even trigger another attack. A triptan might fix the headache, but if you continue to be stressed and sleep deprived, the likelihood of another attack increases. And since the triptan interferes with natural serotonin functioning, a period of regular (frequent) triptan use can cause rebound. On the other hand, the ability to effectively cope with stress can significantly speed recovery from illness. Stress literally attacks every cell in our bodies. Specifically, we know that stress plays a major role in triggering and worsening cardiovascular disease, cardiovascular disease, osteoporosis, inflammatory arthritis, type 2 diabetes, some (e.g., viral) cancers and infectious diseases. The good news is that we can significantly impact our bodys response to stress by, for instance, manufacturing more natural killer cells (called T-cells). These amazing fighting units have the ability to recognize and selectively kill cancer cells and virus-infected cells. Researchers have actually measured variations in T-cell activity based on subjects interactions between stress and attitude. Dr. Steven Locke at Harvard Medical School questioned subjects about stressful events in their lives and their symptoms of distress. He found that the T-cell activity level of the group with high stress and low symptoms was three times higher than those with high stress and high symptoms. In other words: People under stress who know how to deal with it emotionally actually have greater immunity than people who have low stress levels but poor coping skills. We can live with daily stress. But in order to remain emotionally and physically healthy, we must be able to manage it. We must be able to cope.

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Coping and stress have an inverse relationship: When one goes up the other goes down.
How to Boost Your Coping Skills

Stress management coping is a learned behavior. That means you can start taking small steps today to boost your coping skills and build emotional resilience.
Heres how coping works

When were confronted with stress that threatens our stability, we appraise the situation to decide whether we can manage it or whether its beyond our coping resources. Coping is any strategy you use to deal with a situation that strains or overwhelms your emotional or physical resources. For example, lets say that your boyfriend dumps you At first, you might feel angry and hurt, spend a couple of days alone moping, even fantasizing about revenge. But then you call a friend and treat yourself to a nice evening on the town. While you probably havent worked through all the emotional issues yet, youre beginning to cope. Many stressors have both controllable and uncontrollable aspects. Its always helpful to break down the problem and identify what you can control and what you cant. For example, if someone you care about has an illness believed to be terminal, you can seek the best possible medical care, but you cant change the diagnosis. So you must find ways to cope with your fear, anger and sadness. Different stressors require different coping strategies; grieving the loss of a child, for example, requires different coping strategies from handling a chronically critical boss. Coping strategies usually fall into one of two categories: Problem-focused coping or emotion-focused coping.

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In problem-focused coping, you deal directly with the stressor to change it or eliminate it; for example, you confront your husband directly about the long hours hes been working and the toll its taking on your marriage. Problem-focused coping works best when the stressor is controllable; in other words, you can actually change your situation by either changing or eliminating the stressor. In emotion-focused coping, you try to change your emotional reaction about the stressor. For example, when your boss is critical, you may not chew him out because you need to keep your job. But you might seek emotional support from empathetic friends and co-workers. Technically, theres a third category of coping: avoidance coping. Common avoidance tactics include denial or pretending theres no problem, distraction, venting, and sedation or numbing (e.g., through drugs, alcohol, overeating). As youve probably already figured out, avoidance coping has a pretty low success rate! And worse, it tends to cause even more stress. Sometimes optimism is the simple but effective cure. Maintaining an optimistic outlook reduces the risk of health problems and helps us recover from a major life stressor. Finnish workplace studies of 5007 employees showed that the increase in sick days taken after a major life event was smaller for those who scored higher on optimism questionnaires than for those with low optimism scores (Kivmaki, Vahtera, Elovainio, 2008). Sick leave has long been considered an indicator of whether a person will retire early due to disability, as well as predict whether theres a higher likelihood of cardiovascular disease, cancer, alcohol-related illness or suicide. Having pessimistic expectations, on the other hand, increases our vulnerability to both mental and physical illness. Why? Pessimists tend to cope with stress by detaching themselves from emotional events, rather than actively engaging in problem-focused coping.

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Youll probably find that your own personal coping strategies will require a number of resources: external problem-solving skills, internal emotional skills, and social support from others.

Here are some tips for monitoring your stress levels and manage your stress more effectively: Identify how you experience stress. We all experience stress differently. How do you know when youre stressed? Learn to recognize when your own stress level is hitting the danger zone. Notice how your thoughts and behaviors are different when you dont feel stressed. Know your stressors. What events or situations trigger stressful feelings? Are they related to your spouse, children, friends family health, financial decisions, work, or something intensely personal? Pinpointing all your stressors helps you identify patterns. You may discover that much of your stress stems from problems that are easy to solve. Or you may find that youre letting brief situational stress get the best of you (e.g., getting stuck in a traffic jam). Monitor your moods and emotions. As you notice yourself feeling stressed, jot notes about your moods, along with the thoughts, feelings or events that triggered your stress. Do you feel sad? Tired? Anxious? Angry? Helpless? Resentful? Afraid? Or do you feel flat, indifferent, apathetic? Understand how you deal with stress. Are you using unhealthy behaviors to cope with stress? Is this coping mechanism a routine behavior? Or is it specific to certain situations or stressors? Do you make unhealthy choices as a result of feeling rushed and overwhelmed, such as stopping for junk food while running errands? A keen awareness of your own behavior can help you put things in perspective.

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Find healthy ways to manage stress. Insert healthy, stress-reducing activities into your daily life aerobic exercise, a short walk, or discussing your problems with friends and family. Unhealthy behaviors develop over time, which is what makes them more difficult to change. Dont try to tackle too much at once. Focus on changing one thought pattern at a time, one behavior at a time. Prioritize make time for whats really important and put the rest on the back burner. Delegate responsibilities. Identify ways that your family and friends can help lessen your load. Walk away when youre angry. When youre feeling stressed, dont take it out on your spouse or kids. Thats the most dangerous thing you can do and no good can come from it. Count to 10 before you speak. Better yet, walk away. Engage in a physical activity to work off some steam. If you need to communicate your stress and anger to someone, do it when youre not stressed or angry. Reach out for support. Accepting help from supportive friends and family can improve your ability to persevere during stressful times. If you continue to feel overwhelmed by stress, consider talking to a psychotherapist who can help you manage your stress, develop healthy coping mechanisms and change unhealthy behaviors.
How Resilient Are You?

We all experience stressful or even traumatic events in our lives, but the reason that some people are able to cope with stress and trauma and others arent may be resilience. You may have heard the phrases emotional resilience and psychological resilience. Both describe the same quality: A capacity to adapt to and cope with stress, and to overcome

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adversity without becoming psychologically dysfunctional (such as slipping into a persistent negative mood or true clinical disorder, such as an anxiety or mood disorder). Resilience is a kind of emotional hardiness that helps you not only cope with the stresses of everyday life, but protects you when youre confronted by stressful situations or traumatic events in the future. People with low resilience often find themselves worn down and adversely affected by lifes stressors, whereas people with high resilience are not only able to cope with and manage severe stressors, they actually experience those stressors as learning and growth opportunities. For instance, a low-resilient who loses his job might sink into a helpless depression, while a high-resilient may be able to view the loss as an opportunity to reinvent himself, expand his horizons. The high-resilient may even look forward to change and challenge.

How resilient are you? Take a look at some characteristics commonly associated with high-resilience individuals Has a where theres a will, theres a way attitude, Can bounce back quickly during hard times; recovers from traumatic experiences, Can manage anxiety effectively and use it to solve problems, Able to process through loss or grief without developing serious mental health problems, Optimism, embraces life, instead of engaging in harsh selfcriticisms or dwelling on negative self-images, Maintains better physical health they pay attention to their own needs and feelings and remember to take care of themselves. They find effective ways to relax, recharge and boost energy,

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Ability to adapt and competently handle a wide variety of problems, Ability to persevere and navigate through the aftermath of a crisis, Possesses strong self-efficacy: Has confidence in his/her own ability to cope with adversity, whether independently or with assistance from others, Tends to view problems as opportunities, and make the most of those opportunities, Often has a deep-rooted faith in a system of meaning; for example, the bond of close relationships, spiritual, philosophical or psychological, A healthy, reliable support network (e.g., significant other, family, friends, work friends).
Is Emotional Resilience Genetic?

Research is teaching us that resilience may have a genetic component. But its important to remember that behavior is always changeable, and its always affected by environment and experience. Several genetic studies have found that a gene called 5-HT T can moderate the influence of stressful life events on depression; in other words, your genetic makeup may help determine how much impact stress has on you. The 5-HT T gene makes a protein that modifies a nerve cells use of the chemical messenger serotonin, which is involved in regulating mood. 5-HT T has two variant forms, long and short. The short version of the gene has been linked to depression and anxiety. The long variant has been linked to emotional resilience. In other words, the 5-HT T gene may predispose us to depression, but it may also help protect us from depression. Studies have shown that people with either one or two short genes

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are likely to become depressed in response to multiple stressful experiences like death, divorce or assault, but and this is important research shows that they dont become depressed as long as they dont experience severe environmental stressors. In people with two long variants of 5-HT T, stress does not trigger depression, even if, for example, the person has been severely mistreated in early childhood or suffered catastrophic financial loss, poor health or deaths in the family. The more stress-free your environment and lifestyle, the more resilient youll be. Chronic depression or anxiety can produce marked changes in the brain; certain structures begin to shrink or show structural disorganization over time. Resilience factors perhaps including the protein produced by the 5-HT T gene, as well as conscious thought and behavioral modifications can mitigate that damage, and gradually allow the gene to repair itself. Now, if youre hoping that youre one of the lucky ones who has two long genes, your odds are around 30 percent. Research so far indicates that about 70 percent of us have at least one short 5-HT T gene, which may help explain why so people are vulnerable to depression. But we also know that depression emerges from the interaction between genes and experience. Other genes have been linked to depression, anxiety and resilience, and more genetic links will no doubt be discovered in the future. For example, researchers have identified gene variants that affect the expression of a signaling molecule called neuropeptide Y (NPY) thats known to be triggered by stress. NPYs release interacts with opioid compounds to help reduce anxiety and relieve pain. And NPY effects appetite, weight control and emotional responses. People with the gene variant yielding the lowest NPY levels tend to react with heightened or excessive emotion to stressful events, which may help explain why we vary so widely in terms of our natural resilience (Goldman, 2008).

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The bottom line is that good genes may give us resources for coping with our environment, but a stressful environment can challenge even the most resilient genes. On the other hand, a stress-free environment can help alter gene expression in a positive way. How do you develop resilience in yourself? Before we explore specific strategies for boosting resilience, lets take a look at some of the thought patterns that provoke self-damaging behaviors and obstruct the path to resilience.
Thoughts Drive Behavior

Behaviors dont just happen. Thought is always in the drivers seat, whether youre consciously aware of it or not. So, in order to alter self-damaging behaviors, you must alter the thought patterns (such as beliefs and attitudes) that provoke those behaviorsbeliefs, attitudes, mental imagery. Once you learn to recognize distorted perceptions, its easier to break bad habits and stop reacting to events in destructive ways.
Faulty, negative thinking tends to fall into these patterns 1. Polarized or Black-and-White thinking: Things are either black or white, good or bad. If youre not perfect, you must be a failure. Theres no middle ground; coming in second is not good enough. (I should have gotten an A instead of a B! All lawyers are crooks!). We try to force things to be black or white because it makes us feel that our decisions are correct and justified because deepdown, we have doubts. Black-and-white thinkers tend to use language like always and never and view the world in terms of extremes. Black-and-white thinking is primitive because its exactly the kind of behavior we expect from children. When were young, we can only

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express our thoughts in black and white terms. We havent yet learned that the world is full of gray areas. A child, for example, who feels unloved assumes that she must be hated; she cant understand that love and hate can coexist together, and cant reconcile feelings that fall in between. When feeling stressed and emotionally overwhelmed, some of us may slip into this kind of primitive, immature thinking, even as adults. Were essentially regressing to the way we saw the world when we were kids. 2. Filtering: A tendency to look for threats and dangers in a situation, rather than looking for opportunity. Magnifying negative details while filtering out the positive aspects. (My boss only supported my promotion to get me out of his department!) 3. Catastrophizing: Always expecting disaster around every corner, exaggerating stress or the significance of an event, making mountains out of molehills. (Its the end of the world! My life is ruined!) 4. Personalization: A tendency to think that everything people do or say is a reaction to you. Constantly comparing yourself to others, trying to determine whos smarter, richer, better looking, etc. (My sister got all the talent. Theyre staring at me because they dont think I belong here). 5. Blaming others: A tendency to blame others for your problems when things dont go like you wanted them to. (Its my wifes fault I stayed out late drinking with the boys last night she was nagging me. Its my bosss fault I didnt meet the deadline he didnt give me clear instructions.) 6. Ruminating about the past: The term rumination is derived from the mammal suborder Ruminantia (cows, sheep, goats, deer, and giraffes), who are prone to continuously chewing a cud of regurgitated, partially digested food. We ruminate by dwelling negatively in the past (e.g., If

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only I had). Working through past problems is one thing, but focusing on the past over and over again and again is not constructive. Whats done is done. You cant move forward if you remain stuck in the past. Obsessing about things you cant change (and you cant change the past!) provokes chronic stress. Chronic stress provokes chronic rumination its a vicious cycle that can lead to depression and anxiety. Churning the negative feelings associated with a past trauma over and over again helps perpetuate chronic stress because it depletes your resilience reserves of motivation, perseverance, and problem-solving skills all of which are required to facilitate positive change and move forward into a peaceful, content future. Strategies for Boosting Your Emotional Resilience

Building resilience is an ongoing journey. For some of us, it just takes a little more work. But the great news is that anyone can do it. We all have the capacity within us to become more resilient. And resilience is a dynamic quality, not a permanent capacity. You can never have too much resilience!

Can you see negative patterns in your life that are making it difficult for you to be happy? Here are some practical strategies that will enhance emotional growth and boost your resilience for life
Keep the problem in perspective. You cant always stop stressful events from happening, but you can change how you interpret and respond to those events. When youre dealing with painful events, try to view them in a broader context. Take a long-term perspective. Avoid blowing any single event out of proportion or seeing it as an insurmountable problem. It may help to compare your problems to the serious problems around the world or even reflect on the challenges of others in your life. Jot down a list of things youre

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thankful for. This may help you also put the current crisis in perspective. Look beyond the present focus on the ways in which future circumstances will be better and what you can do to make them better. Pay attention to what makes you feel better, as you deal with trying situations, including small, seemingly insignificant subtleties that make you feel even a little bit better. Maybe its a massage. Or a walk in the park. Accept that change is a part of life. Accepting circumstances that cannot be changed will leave your mind free to focus on circumstances you can change, and on strategies for changing the way you respond to adverse events. Some adverse situations may mean that certain goals are simply no longer realistically attainable. True coping skills help you get to the root of the problem and focus on changing what you can change and making peace with what you cant. Let go of the past. Process it, work through it and let go. Dont waste time and energy on things that dont benefit you. Forgive yourself, forgive others. If you cant change it or have no control over it, let it go. Be flexible. Flexibility is part of resilience. Life never stays the same. Accept that life is about choices, and is always bringing change to you to which requires adjustment. See the changes as an opportunity to grow and learn new things. Take action. When confronted with an adverse situation, take decisive action as soon as possible, instead of detaching from the situation, avoiding it, or denying that its a problem. Keep moving toward your goals. Have a plan for the future. Develop long-range goals for yourself,

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but work on them one day at a time. Develop goals that are realistic, and perform goal-oriented tasks regularly, even if theyre only small steps. Dont set yourself up to become overwhelmed by trying to tackle too much at once. Ask yourself: Whats one thing I know I can accomplish today that moves me closer to achieving my goal? Seek opportunities for self-discovery. In times of adversity or loss, we learn something about ourselves, and theres usually an opportunity for growth. Going through tragedy and hardship can strengthen our relationships, increase insight and our sense of self-worth, and allow us to walk away from the experience with a heightened appreciation for life. Nurture a positive view of yourself. When you solve a problem, take a moment to congratulate and reward yourself, and do the same for others in your life. Part of building resilience is developing confidence in your ability to solve problems, and learning to trust your instincts. Talk positively to yourself. Dont beat up yourself with negative self-talk. Let yourself experience strong emotions, but learn to recognize when you may need to avoid re-experiencing them in order to continue functioning. Maintain a hopeful outlook. Very often in life, we get exactly what we expect to get. An optimistic outlook means that you will begin to expect good things to happen in your life. And guess what? Youll attract more good things into your life. Visualize what you want, rather than focusing on what you fear. Make connections. Humans are social creatures by nature. And we need close relationships with other supportive humans in order to maintain a healthy, optimistic outlook on life. Develop one or two close

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relationships that allow you to be honest about your thoughts and feelings. Spending time with loved ones is nurturing youll gain support and encouragement. Close, positive relationships with family members, friends and others are critical to boosting your resilience. Be willing to accept help from positive, supportive people who care about you and will listen to you. For example, you may find that talking to trusted friends or to a psychotherapist and being active in civic groups, faith-based organizations, or other community groups provides social support and instills you with optimism and helps you make wise choices. And sometimes, helping others in their time of need can also help you. Pinpoint the strategies that strengthen your personal resilience. Resilience strategies vary from person to person, so its important to pay attention to what works for you. For example, it may help you to write your most personal thoughts and feelings in a journal, particularly thoughts that are related to stressful events. Or you may find that time spent with friends, meditation or spiritual exercises will help you feel plugged in, build supportive connections and renew hope and optimism. Remove yourself from hurtful or damaging situations. Walk away from a situation or relationship for awhile if its getting out of control. Give yourself some space to problem-solve and develop a positive approach. Reach out for help, if necessary. Allowing yourself to remain in a problematic relationship or environment without resolving the problem will only make the problem worse. Take care of yourself. Pay attention to your own needs and feelings. Get plenty of sleep. Engage in activities that you enjoy and find relaxing. Taking care of yourself helps keep your mind and body recharged and ready to cope with situations that will require resilience.

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Explore natural healing therapies that help boost resilience by elevating mood, relieving stress, reducing anxiety, and restoring energy and an overall sense of well-being Exercise. Energetic, aerobic exercise stimulates neurotransmitters, and serves as an outlet for releasing negative emotions. Exercise produces endorphins, which are effectively an endogenous or natural drug that energizes the body and mind and endows a sense of well-being. Physical fitness also boosts self-image, selfesteem and confidence. Nutrition. Diet influences mood, energy and sense of well-being. For example, high-fiber foods boost energy and metabolism and the omega-3 fatty acids (found in walnuts, flax, hemp, and pumpkin seeds) help bolster mood. Some research suggests that high intake of caffeine, sugar and alcohol contributes to depressed mood, as well as mood swings. Meditation. A growing body of research shows that the regular practice of meditation can have a significant health impact. We now know that meditation, which has often been promoted as a technique for reducing anxiety and stress, can also have a physiological impact that improves our overall resilience.
Important highlights include:

Emory University studies show that Compassion meditation (meditation practices designed to foster compassion) may impact physiological pathways that are modulated by stress, reducing inflammatory and behavioral responses commonly linked to depression and other medical conditions (Pace, 2008). University of Wisconsin-Madison researchers found that even a short program in mindfulness meditation may produce lasting positive changes in both the brain and

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immune system function. Older women who regularly practice meditation have a reduced cortisol response to stress and are less likely to react to stress with high levels of blood cortisol (Walton, 2004). A 2009 neuroimaging study at Massachusetts General Hospital showed that meditation can help slow the agingrelated atrophy of some brain areas. Meditation techniques used during the daytime can help prevent insomnia at night (Gourineni, 2009).
Prayer. I have personally found that prayer helps relieve my stress, especially prayer that is affirmative and includes expressions of thanks and gratitude for all the positive things in my life. Sleep. Sleep improves the brains ability to learn, remember information, maintain emotional stability, make decisions and produce infection-fighting hormones. Deep sleep increases the release of growth hormone, which fuels cell growth, helps build muscle mass and repair cells and tissues. Sleep increases infectionfighting hormones, as well as hormones that affect how the body uses energy. Sleep deprivation can trigger overall neurotransmitter imbalances and fluctuations (e.g., serotonin). Aromatherapy. Some research suggests that mild depression can be migitated by applying certain essential oils to the skin: basil, bergamot, cedarwood, clary sage, frankincense, geranium, grapefruit, lavender, lemon, jasmine, myrrh, neroli, rose, sandalwood, spruce, orange, and ylang ylang. Buy the best and purest essential oils you can find and make it a ritual to apply an oil that has calming properties (e.g., lavender) on your wrist or pillow before going to sleep.

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Dedicate daily Self Time.

Often, were so focused on our responsibilities and roles in life that we forget to devote time solely to ourselves until weve already crashed and burned. Making time for yourself is a critical part of building resilience. Its important to step up to the plate to deal with your problems and meet the demands of daily living. But its also important to step back to rest and reenergize your Self. Self Time can help refresh your mental outlook and calm your bodys stress response systems. No matter how busy your schedule is or how hectic life gets, carve out Self Time slots at least two or three times a week. At a bare minimum, allow yourself fifteen minutes of Self Time each day. Self Time can be simple or as complicated as you like. Identify activities that nurture you and make you feel good, and make a pact with yourself to choose the one each day that sounds just right. Turn off the phone, the computer, the TV. Enjoy the silence of meditation. Listen to soothing music. Spend a few minutes sitting in a park, a garden or by a seashore. Exercise get those feel-good endorphins up. Read a good book, jot your thoughts in a journal, listen to your favorite music, or simply take a fifteen-minute break from work. The choice is yours. The important thing to remember is you must make time for yourself, every day time that belongs to you and only you. Rely on others, but, ultimately, learn to rely on yourself. Be respectful and responsible. Dont get caught up in blaming other people for the challenges in your life. Do whats right for you, instead of worrying about whether others will approve of your decisions.

One final word: Your must make your health your number one priority in life in order to build a reservoir of resilience that will allow you to consistently manage stress.

4.3
Emergency Measures

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What should you do if you feel a migraine coming on?

First, dont panic. There are strategies that can help halt the syndrome or greatly mitigate the symptoms. The key is to take proactive steps immediately to reduce the risk of a full-blown attack. Here are my suggestions, roughly prioritized Start drinking water. Its usually not a good idea to eat, even if you have the sensation that youre hungry. If you dont eat, you reduce the odds of vomiting. If you know you havent had enough sleep, go back to sleep as soon as possible. If youre able to get to sleep, sleep it off. Lie down with an ice pack or heat pack if either has been helpful for you in the past. (For me, these were half-measures that only further irritated me, but they do seem to help some people.) Switch off the TV and other noise and do not focus on your problems remove all possible stressors. Relaxing is important. Dont engage in strenuous exercise. If you can stand to be in motion, try taking a short walk. I remember trying to walk off a couple of attacks; simply focusing on the outdoors was helpful. If you focus on the pain, it grows. If you feel the need to medicate, try taking an ibuprofen first not a triptan or an opioid. More often than not, the ibuprofen didnt work for me. But sometimes it did if I drank enough water and stepped outside to get a little fresh air. I would like to tell you not to take a pharmaceutical medication like triptans, but I cant. If the attack is coming on with a vengeance, I would never discourage you from doing what you have to do when youre in the midst of an attack. Ive been there I know. Nothing really helps a full-blown attack except a triptan or simply suffering through the attack. (Your goal, of course, is to pay attention to the early warning signs and nip the attack in the bud. Better yet, identify the lifestyle changes you need to make to prevent the syndrome in the first place).

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The rest of managing the attack is recuperation. And preventing the next one. And the nextand the next. If you dont abuse your body, it will be less likely to rebel against you. Your final step is an honest assessment of this experience. What did you learn? Did you confirm any suspicions that you may have had about whats triggering your migraine attacks? Is something mentally and physically out of balance in your life? The only good thing about a migraine attack is that, if youll only pay attention, each one will teach you a lesson, provide clues as to whats causing your particular migraine syndrome, and point to strategies that will eliminate the cause(s) and prevent future attacks. In the next chapter, well talk about prevention how to set goals, prioritize your action plan, and monitor your progress.

4.4
Prevention: Developing Your Treatment Plan

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Obviously, the best way to avoid needing Emergency Measures is to develop a healthy lifestyle that prevents attacks in the first place. Successful management of migraine syndrome is best measured not by merely being able to stop an attack, but by overall health management and prevention. Where do you start? Here are some suggestions for prioritizing your Prevention Plan Start with your weakest link. Are you a couch potato who hasnt exercised since third grade and bounces from one sugary bowl (bucket?) of ice cream to another? Or perhaps youre quite disciplined about exercising, but you have trouble sleeping, youre constantly stressed, and tend to take on a heavier workload than you can possibly handle. Start working on the aspects of your lifestyle that you already know need improvement. Are you eating or drinking too much sugar? Caffeine? Fat? Salt? Alcohol? Any of these is a good place to start. Know thy triggers all of them. You probably already know at least one or two of your triggers, but others may be sneakier, harder to pinpoint. It sometimes takes migraineurs years to pinpoint every trigger because theyre not closely monitoring themselves. Become a high self-monitor. If you dont know your triggers, if migraine attacks still seem mysterious and totally unprovoked, just know that theyre not. There are always contributing causes; in fact, almost always more than one. Remember that different attacks may have different triggers. If you need help investigating possible triggers and causes, take another look at Chapters 1 and 2, and rule out common culprits first. Do you have food allergens? Sleep problems? A possible hormonal trigger? Back or neck pain that suggests a musculoskeletal problem? Problems coping with stress on a regular basis? Do you skip meals or hydrate insufficiently?

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Often, choosing the right approach to cure is as much about ruling out as it is about ruling in.
Keep a Headache Diary

Look for relationships between your migraine syndrome symptoms and your physical activity level, mood, energy level, sleep patterns and diet. Keeping a Headache Diary can help you pinpoint your migraine triggers. Document each migraine headache, including these details: the time of day your headache started where you were and what you were doing when the migraine started what you ate or drank during the 24 hours before the attack each day you have your menstrual period (if youre female), not just the first day. (This can allow you to determine if your headaches are concurrent with your period.)
Dont push the limits. You can only push your body so far before it pushes back. Dont think of migraine prevention in terms of identifying how much you can get by with. For example:

Can I get by with just another half-glass of wine? Can I get by with 7 hours sleep instead of 8? What if I just eat half the candy bar?
Okay, I know 3 cups of coffee is bad news, but can I get by with 2 cups?

This rule will be especially important when it comes to craved substances that have addictive or habit-forming properties, such as alcohol, sugar or caffeine. Its worth mentioning that every alcoholic, chocoholic and caffeine junkie started with one

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drink, one serving. And from there, the cravings escalated, the habit was formed, the desire for more and more increased. Its so easy to gradually slip across that line to Too Much, without even noticing.
Mapping Your Treatment Goals

Mapping your goals is the first step in the healing process. After all, in order to figure out how to get where youre going, you need a map a treatment plan. Your treatment plan will help you choose therapies wisely, assess your progress and hold yourself accountable. Curing Migraine must be more than a New Years resolution that you roll forward every year because you didnt accomplish it last year. It must be a specific, aggressive, proactive endeavor. Jotting a list of goals is easy. Commitment and follow-through are lets face it always a little more work. You must commit to accomplishing each goal, one by one, and stay focused on each specific outcome you intend to achieve. But you are now armed with a solid understanding of migraine syndrome and proven strategies to try. That coupled with an intimate understanding of your own body will guide you in combining therapies to achieve the optimal outcome vanquishing migraine. You may want to start by breaking your goals into physical and mental health goals. Then break each of those broad categories into short-term and long-term lists. Its important to distinguish between short-term and long-term goals. Thats the key to establishing realistic and achievable goals. Setting realistic expectations for both the short term and the long term will help you make decisions that are right for you, one by one, and help give you the patience and resilience to stick to them. To get the most out of this journey of self-discovery, its

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a good idea to include personal, professional, relationship and wellness goals theyre all interrelated. Since emotional health and physical health are so integrally related, you may have some overlap between these two categories. Thats okay. Look at it as killing two birds with one stone. No goal is too small. If the process of setting goals causes any anxiety, start out by setting small goals that you feel confident you can achieve and work your way up to more complicated or difficult goals. Your hopes and dreams for living a healthy, fulfilled life may include goals that are intensely personal; if so, be sure to include those in your lists, too. Here are some examples to get you started. Your own treatment plan may be completely different longer or shorter, simpler or more complex. Your plan should be designed to work for you.
Physical Health Goals

Short-term goals could include:

1. Sleep tight, every night. starting tonight, 2. Eliminate known triggers (e.g., alcohol, caffeine), 3. Introduce more fresh, raw produce into your diet, 4. Improve immune system by removing the elements that are compromising it; for example, eliminate stressful situations theyre elevating cortisol levels, 5. Choose an exercise regime, even if its just taking a daily walk around the neighborhood. Long-term goals could include: 6. Restore stability and functionality (e.g., correcting physiological imbalances such as nutritional, hormonal), 7. Eliminate migraine attacks for the long term, starting with long remissions and eventually,

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working up to permanent remission, 8. Develop a total-body healthy living regime improve nutrition, sleep quality and increase energy and stamina. Mental Health Goals Short-term goals could include: 1. Restore stability and functionality (e.g., improving work performance, improving relationships, eliminating depression or anxiety, ceasing faulty negative thinking) 2. Relieve symptoms that are causing the most distress; (e.g., sleeping difficulties, fatigue, headaches, prolonged sadness, ) 3. Make good decisions that put you on the path to accomplishing your long-term goals 4. Reduce daily stress, systematically eliminate every possible stressor. 5. Set aside 30 minutes per day of Self Time Long-term goals could include: 6. Maintain an ongoing sleep diary and headache diary or migraine journal. Note your triggers and monitor the effectiveness of each therapy you try. 7. Make the emotional pain go away. This one can take time. Recovering from loss, working through old pain and rebuilding relationships requires reflection and processing time. 8. Improve self-esteem, sense of self-worth and increase feelings of confidence 9. Improve problem-solving and decision-making skills 10. Improve coping skills and feel more in control 11. Learn how to grieve your losses, then release the pain and

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move on. (e.g., loss of a relationship, job, career, money) 12. Restructure thought patterns and eliminate negative self-talk or faulty internal patter and dialogue 13. Develop a better support system, such as family, friends, community groups, support groups 14. Enhance self-actualization the drive that directs your growth and development to achieve your highest potential and live a fulfilled life 15. Become emotionally resilient so that you can weather any storm.

What to Do If Youre Not Accomplishing Your Goals

First, assess your goals and determine whether they were realistic. Are your goals are specific, measurable, attainable, realistic, timely? For example, did you set too short a time frame for an exercise or weight loss goal? If youre stuck, here are some some strategies that may help you move forward First, dont allow yourself to fall into the Whats the use? trap! If, at any point, you feel that youre in over your head, if you feel overwhelmed and hopeless, seek support from others or even professional help. Dont wait until your emotional health becomes a serious problem (e.g., you become severely depressed or anxious) because getting back on the path and getting better becomes that much harder. Identify which areas of your life you need help with and reach out for the best possible support. Start making phone calls. Are you having trouble coping with stress, need help becoming more resilient? Find a psychotherapist whos experienced at addressing your specific concerns. Is your exercise plan not accomplishing what you want it to, or do you need help staying motivated to exercise? Find a personal trainer who can help

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you develop a program that gets results. Schedule that first appointment and schedule it for the earliest possible date. Now youre one closer to achieving your desired outcome. Youre no longer stuck in the mud of Ill start next week When you reach out for help, ask for help from someone whos qualified to help you learn how to help yourself. Not to mention that its never a bad idea to have someone knowledgeable objectively evaluate your progress. Harness fear to your advantage. No one is immune to fear no one. Everyone feels fear in the face of change or uncertainty. But the truth is, either you control fear, or it controls you. (And either you control migraine or it controls you.) More often than not, fear is rooted in a lack of confidence or low self-esteem. Its just a false emotion that feels real. How do you conquer fear? First, discard your old self-defeating vocabulary. When you say, I cant, youre really saying I wont. Convert I cant to I can. Convert I hope to I know. Fear is, perhaps, the most powerful motivator of all human emotions. If you dont believe it, lets see how fast you can run if a big grisly bear suddenly materializes ten feet away. (See, you just thought you werent cut out to be a runner!) Fear can be your greatest enemy or your greatest ally. Fear is energy, raw and real. Use that energy to fuel growth and empowerment to take the next forward step. Dont procrastinate. Do something. Resolve to take one action step toward your goal every day no matter how small. As long as youre moving forward, youre one step closer to your desired outcome, and one step farther away from paralysis. Make organization a habit. Good organizational habits reduce stress and make completing tasks much easier. Use a planner, calendar, or personal digital assistant (PDA) thats organized to best suit your lifestyle, needs and goals. Dont forget to

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schedule Self Time. For some, this may be one of the most critical strategies in the treatment plan. Focus on achieving one goal at a time, one step at a time. Get one successful outcome each day or each week and move on to the next one. Dont focus on the unfinished items on your list. You can focus on those tomorrow. Break large goals into smaller goals, if necessary. For example, break your 30-minute daily exercise goal into 2-3 shorter sessions. Or lets say that youre having trouble making yourself drink enough water each day. Dont try to drink a full glass. Drink half a glass, then drink the other half an hour later. Dont let perfectionism get in the way of progress. While high expectations are a good thing, sometimes we cant achieve our goals in the exact way we meant to in the time frame we meant to. Sometimes life simply doesnt go as planned for reasons beyond your control. Dont beat up on yourself when you dont achieve your preconceived notion of perfection. None of us is perfect, thus, the result of perfectionism is that you set yourself up for constantly feeling like a failure. Perfectionism can be a form of polarized, black-and-white thinking that will probably not serve your healing process. Migraine syndrome is not black-and-white; neither are its treatments. Navigating the sea of migraine therapies is an imperfect world. But with commitment and a little effort, you will find the combination thats right for you. Right now, progress is more important than perfection. Perfection is the end result of lots of progress. Be patient with yourself. Unfortunately, immediate cure only happens in the movies; real treatment solutions take time to work their magic. Look at it this way it took longer than 24 hours to create the problem youre dealing with, so doesnt it make sense that it will take longer than 24 hours to fix it?

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Assess your overall resilience factor. Reread the characteristics that resilient people tend to have and Strategies for Boosting Emotional Resilience in Chapter 20. Those strategies will boost your physical resilience, too. Resilience fosters focus and perseverance itll keep you on track when youre having trouble crossing the goal line. Reward yourself. Reward yourself for each goal you achieve, no matter how small the goal. Each positive result is a progress milestone.

Thank Your Body For Your Migraine Epilogue

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Thats right: You should actually be thankful for migraine. Migraine is a warning that something is wrong, a (not so gentle) reminder that you are not on the path to cure, and that you need to change course. The sooner, the better thats the watch phrase for treating every disease and disorder in the world. Facing and acknowledging your problems early almost certainly guarantees that any therapy will be more effective and take less time to work its magic.
Within each of us lies tremendous potential for transformation of our physical and emotional health and stability. The healing capacity of our minds and bodies can amaze us when we cooperate with them. Its true, what they say: If you take care of your body, it will take care of you. If you ignore it, when its trying to tell you what it needs, it will rebel. Some of the recommendations in this book are reinforced by the current clinical research and practice wisdom of certain healthcare practitioners. But I have also shared with you my own anecdotal experiences. I wholeheartedly encourage you to choose strategies that work for you. Maintaining your health is more important than maintaining a philosophy. Dont be afraid to make lifestyle changes. What have you got to lose? You can always adjust your strategies or simply revert to your old lifestyle. On the other hand, if you dont take steps toward healing, you can never expect to be free of migraine. In order to succeed, you have to try. Monitor your progress, and dont be afraid to adjust and refine when necessary. Reversing chronic illness is a process. And that process is never exactly the same for any two people. Dont settle for less. Dont be satisfied with simply masking the symptoms with medication and hoping they wont attack you again in the future. Focus on curing chronic migraine syndrome once and for all.

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Part of taking control of your health is building the right support system. I encourage you to consult with natural healing therapists, if necessary, and consult with them first. Pharmaceuticals should be seen as last resort. Consider talking to professionals that you believe may be relevant to your specific issues, such as a naturopath, chiropractor, or psychotherapist. Seek help from professionals who can help you work through the problems that are keeping you stuck and preventing you from living a healthy, fulfilled life. Your willingness to seek solutions demonstrates your capacity for making choices that will ultimately facilitate healing. If youve read this book in its entirety, its likely that you now have a solid understanding of your migraine syndrome and some ideas on how to conquer it. It is my hope that reading this book has been a transformative process for you, and that your newfound knowledge will provide you with healing energy and confidence in making decisions from choosing the right therapies to making any necessary lifestyle changes.

Ill leave you with these thoughts Yes, you can eliminate chronic headaches and migraines. And you can do it in a simple, organic way that allows your body to naturally heal itself. That, in the end, is the overarching message of this book. I hope your path to wellness will be as fascinating and rewarding as mine has been. I encourage you to journey forth with an open mind. Find the treatments that are best for you.

Bibliography

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1. Astin JA., Ernst E. The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials. Cephalagia. 2002;22(8):617-623. 2. Bernstein J, Alpert S, Nauss KM, et al. Depression of lymphocyte transformation following oral glucoseingestion. Am J Clin Nutr. 1977;30:613 (abstract). Bic, Zuzana. No More Headaches, No More Migraines. (1999) Breslau, Naomi, M.D.. Comorbidity of Migraine and Depression, Neurology. 2003;60:1308-1312. Buchholz, David and Reich, Stephen G., M.D. Heal Your Headache: The 1-2-3 Program For Taking Charge of Your Pain by (2002) Centofanti, Marjorie, JHMI. Johns Hopkins Gazette, Migraine Pain: Not Mainly in the Brain. VOL. 28, NO. 33. May 3, 1999. Deyo, R. A., and Diehl, A.K.: Patient satisfaction with medical care for back pain. Spine: 11:28, 1986. Fukui P.T. Trigger Factors in Migraine Patients, Arq Neuropsiquiatr. 2008 Sep;66(3A):494-9. Gourineni, Ramadevi, M.D. Effects of Meditation on Sleep in Individuals with Chronic Insomnia, June 9, 2009 Annual Meeting of the Associated Professional Sleep Societies. Kane, R.L., et al Manipulating the patient. A comparison of the effectiveness of physician and chiropractic care. Lancet 1: 1333, 1974.

3. 4. 5.

6. 7. 8. 9.

10.

11. Kiechl, Stefan, M.D. Neurology, the medical journal of the American Academy of Neurology. September 16, 2008. 12. Lipton, Richard, M.D. Headache. 2008. 13. Lipton RB, Stewart WF, Simon D. Medical consultation for migraine: results from the American Migraine Study. Headache

225

bibliogr aphy

1998;38:87-96. 14. Lipton, R. B., MD, S. W. Hamelsky, MPH, K. B. Kolodner, ScD, T. J. Steiner, MB, PhD and W. F. Stewart, PhD, MPH. Migraine, quality of life, and depression. Neurology 2000;55:629-635. 15. Lpez-Mesonero, L, S. Mrquez, P. Parra, G. Gmez-Leyva, P. Muoz y Julio Pascual. Smoking as a precipitating factor for migraine: a survey in medical students. The Journal of Headache and Pain 10(2):101-103, abril de 2009. 16. Low, Nancy C. P., du Fort, Guillaume Galbaud & Cervantes, Pablo (2003) Prevalence, Clinical Correlates, and Treatment of Migraine in Bipolar Disorder. Headache: The Journal of Head and Face Pain 43 (9), 940-949. doi: 10.1046/j.15264610.2003.03184. 17. McIntyre, Roger S., Konarski, Jakub Z., Wilkins, Kathryn, Bouffard, Beverley, Soczynska, Joanna K. & Kennedy, Sidney H. (2006) The Prevalence and Impact of Migraine Headache in Bipolar Disorder: Results From the Canadian Community Health Survey. Headache: The Journal of Head and Face Pain. 46 (6), 973-982. doi: 10.1111/j.1526-4610.2006.00469. 18. Merikangas, K, D. Stevens. Comorbidity of Migraine and Psychiatric Disorders, Neurologic Clinics, Volume 15, Issue 1, Pages 115-123. 19. Orme-Johnson, David, PhD. NeuroReport, Lippincott Williams & Wilkins (Vol.17 No.12; 21 August 2006:1359-1363. 20. Pace, Thaddeus W.W., PhD. Psychoneuroendocrinology, 2008; doi: 10.1016/j. psyneuen, 2008.08.011. 21. Peterlin, B. Lee, D.O. American Academy of Neurology, http:// www.aan.com. April, 2009. 22. Sanchez A, Reeser JL, Lau HS, et al. Role of sugars in human

226

bibliogr aphy

neutrophilic phagocytosis. Am J Clin Nutr. 1973 Nov;26(11):1180-4. 23. Scher, Ann, PhD. Migraine in Middle Age and Late Life: A Longitudinal Analysis of Factors, Journal of the American Medical Association, Volume 301, Issue 24, June 2009. 24. Walton, Kenneth. Lowering Cortisol and CVD Risk in Postmenopausal Women. Annals of the New York Academy of Sciences (2004; [1032], 21115).

wholly design
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