Health Behaviors in Episodic Migraine: Why Behavior Change Matters

DOI: https://doi.org/10.1007/s11916- 018- 0721- 5

Abstract-Summary Everyday behavioral patterns are associated with migraine attacks and disability.

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This paper reviews health behaviors that can be targeted in people with episodic

migraine to enhance migraine-related outcomes.

Sleep deprivation, fatigue, and poor quality sleep have demonstrated relation- ships with migraine attack onset, as well as headache frequency and headache- related disability in people with episodic migraine.

The health behaviors implicated in episodic migraine are part of everyday pat- terns and can be targeted routinely in clinical practice to improve migraine management.

Extended: This paper briefly summarizes existing behavior change techniques

and areas for future research.

Introduction Further, people with episodic migraine are at risk for increases in headache fre- quency and meeting criteria for chronic migraine (15 or more headache days/month). Episodic migraine progresses into chronic migraine in approximately 2.5% of

people, which is associated with even poorer quality of life [338, 541].

Behavior change can play a key role in the prevention of migraine attacks and the

quality of life of people with episodic migraine.

This review will describe recent evidence for the association between behavioral

factors and migraine frequency, severity, and disability, in episodic migraine.

Evidence for the connection between consistency in daily behavioral patterns (sleep, eating, and hydration) and migraine activity in episodic migraine is growing. Psychiatric symptoms are briefly discussed as they are associated with migraine symptoms and disability and are commonly targeted in behavioral treatments for episodic migraine.

Stress People with migraine often report both stressful events and perceived stress as a trigger for migraine attack onset and increases in migraine attack frequency [181, 542].

A recent electronic daily diary study of 95 people with episodic migraine and found a simple forecasting model including the presence of stressful events was able to predict headache attack within the following 24 h period (training sample AUC 0.73, 95% CI = 0.71–0.75; validation sample AUC 0.65, 95% CI = 0.60–0.67) [543].

This study suggests that people with migraine may be able to have some fore- knowledge of the likelihood of migraine in the next day given the presence of stress- ful events, providing an opportunity to prepare for a possible migraine attack.

People with episodic and chronic migraine may differ in the types of stressful

events that are associated with perceived stress.

Consistent Daily Patterns A Korean electronic daily diary study in 62 people with episodic migraine found that stress (58%), sleep deprivation (55%), and fatigue (49%), had the strongest associations with a migraine attack on the following day among 62 factors evalu- ated [544].

2.4 Lifestyle

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Several recent studies suggest that people with episodic migraine experience

poor sleep, and that sleep is associated with headache frequency and severity.

Further, among students with episodic migraine, poor sleep quality was associ-

ated with higher headache frequency and headache-related disability [545].

Another recent cross-sectional study (n = 378) found that sleep quality is more

highly associated with migraine than sleep duration [546].

A recent daily diary study among 34 people with episodic migraine found that nighttime snacking was associated with a 40% reduction in the odds of experiencing a headache compared to no food (p = 0.013) [547].

Medication Adherence Medication adherence is integral to the management of episodic migraine.

Migraine medication adherence is the extent to which a patient abides by the medication-taking behaviors and treatment regimen, which are agreed upon collab- oratively with their health care provider [548].

The behavioral component of acute migraine medication adherence is three- fold: a migraine-specific medication should be taken first during a moderate or severe migraine attack (a simple analgesic may be taken first for a mild migraine attack), the acute medication should be taken early in the attack when the pain is mild, and use of acute medications of all types should be limited to prevent medi- cation overuse headache and to reduce the risk of increasing migraine attack fre- quency [549].

Although adherence to acute and preventive medication is essential to managing

migraine, it can be challenging for patients [550, 551].

Assessing medication adherence, and addressing suboptimal medication adher- ence, is recommended for any patient who uses medication to manage episodic migraine [552].

Behavior Change All treatment of episodic migraine includes some behavior change on the part of the patient.

Understanding the science and practice behind behavior change can help all pro- viders who treat people with episodic migraine develop a behavior change treatment toolkit and referral network.

The first step to successful behavior change is helping the patient choose a

behavior to change.

Choose a single behavior change goal for patients to work on at a time; attempt- ing to change multiple behaviors at a time can undercut the success of a behavior change intervention.

Self-monitoring helps patients assess their current levels of a behavior, identify barriers to changing the behavior, and monitor the success of the interventions they use to improve the behavior.

Headache providers who recommend behavior change as an intervention for patients with migraine should incorporate monitoring of that behavior in the patient’s headache diary, and should review that diary upon the return visit.

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Conclusions Behavioral factors including levels of stress, consistency in daily patterns such as sleep and eating, and medication adherence, have demonstrated relationships with migraine symptoms and disability in people with episodic migraine.

Future research should focus on (1) evaluating specific behavior change inter- ventions to reduce migraine frequency and disability specifically in people with episodic migraine, particularly those that can be translated to wide dissemination formats, and (2) evaluating the relative impact of behaviors and behavior change on migraine activity across the wide range of headache frequency experienced by peo- ple with episodic migraine.

At one end of the spectrum, some people meeting criteria for episodic migraine experience fewer than one migraine attack per year; at the other end of the spec- trum, some people meeting criteria for episodic migraine experience a headache day almost half of the days of the month.

Evaluating relationships between health behaviors and migraine outcomes among people with high and low frequency episodic migraine is a reasonable next step in this literature.

Acknowledgement A machine generated summary based on the work of Rosenberg, Lauren; Butler, Nicole; Seng, Elizabeth K. 2018 in Current Pain and Headache Reports.

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