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The influence of regular lifestyle behaviors in migraine



  "Good habits are worth being fanatical about." John Irving

Much is written about lifestyle habits and migraine. Altered sleep patterns, (poor sleep), hunger (skipped meals, fasting, hypoglycemia), dehydration, high- intensity exercise (strenuous), and stress are thought to trigger migraine attacks. Good quality sleep, regular meals, adequate hydration, low-intensity exercise, and low stress (stress management therapies) are believed to be protective for migraine.

Acknowledging the importance of the role lifestyle factors play in promoting wellness and managing disease, in a recent study, "The impact of regular lifestyle behavior in migraine: a prevalence case-referent study," (Woldeamanuel and Cowan, 2016), the study authors aimed to evaluate the differences in migraine occurrence among participants who do and do not maintain the regular lifestyle behaviors (RLBs) of sleep; exercise; and, daily mealtime pattern and hydration status. Since a review of the literature revealed previous studies have investigated each of these factors alone, the purpose of this present study was to examine the connection between these three factors and migraine occurrence.  In this article we take a look at the authors findings and what the results mean to those of us with migraine. 

To begin with, we should know a bit more about the study. Participants were 175 episodic and 175 chronic migraine patients age 15 years and older, with charts regularly documenting RLB.  Electronic medical records were continuously followed and studied for one year (January 1, 2014 to January 1, 2015) at the "Stanford Headache and Facial Pain Clinic".  Patients younger than 15 years, those with primary insomnia, shift workers, and charts not documenting notes on RLB were excluded. Diagnosis was made using the ICHD-3 beta  (International Classification of Headache Disorders) criteria and each diagnosis was confirmed by a Headache Specialist. The potential for effect modification by medication use (abortive and/or preventive), depression, and anxiety was tallied and analyzed in both episodic and chronic migraineurs. 

The study focused on the following three self-report domains: 

  • Maintaining regular sleep hours with consistent-sleep wake time both in weekdays and weekends.
  • Maintaining regular daily mealtime and adequate hydration status (consisted of keeping consistent meal hours with the number of meals personalized to the preference of each patient as the study focused on regularity of mealtimes rather than frequency); adequate hydration consisted of keeping regular amounts of water intake personalized to patient preference.
  • Maintaining daily aerobic exercise of any form for 20 minutes duration that raised heart rate. 


175 patients with episodic migraine and a combined total of 1016 mean monthly headache days and 175 patients with chronic migraine and a combined total of 3786 mean monthly headache days were continuously enrolled: 

  • In both groups, 22% of the patients were males.
  • The mean age was 41 years in the episodic group and 40 years in the chronic migraine group. 
  • The mean monthly migraine frequency for episodic patients was 5 and 25 among chronic patients.
  • All 3 lifestyle behaviors were seen in lower frequency among the chronic migraine group, with a decreasing pattern from regular mealtime, regular sleep, to daily exercise in both groups. When comparing the impact from each lifestyle behavior to the impact of the combined RLB, regular sleep had identical impact. 
  • The group of chronic migraine patients who followed RLB were progressively converting, month after month, into episodic migraineurs, while episodic migraineurs not following RLB , month after month, were converting into chronic migraine.


It is important for those of us with migraine to know: 

  • The mean age and mean frequency of episodic and chronic migraine were representative of migraine patients in the general population 15 years and older
  • The risk of having chronic migraine was significantly reduced for patients with RLB and higher RLB prevalence was protective from developing chronic migraine.
  • Adjusting these results to the possible effect modifier of medication use and depression and/or anxiety showed no significant implications. 

In addition, along with providing evidence for the importance of sleep regulation in headache medicine, the authors of the study suggest evidence is provided for the relevance of: 

  • Employing non-pharmacological evidence-based migraine therapeutic protocols for individual lifestyle behavior modification that are applicable in daily clinical practice and beyond. 
  • Empowering and reinforcing self-management skills and desirable lifestyle behavior modifications for long-term management and prevention.
  • Behavior modification treatment to help revert and unlearn strategies that led to the formation of undesirable and inappropriate behaviors and teach new and appropriate behaviors. 

Limitations and Conclusions 

The authors conclude engaging in RLB is a moderating factor in migraine. Migraine patients who follow all three domains of RLB are more likely to have episodic than chronic migraine. They add, learning self-regulated behavior can enable the person with migraine form favorable lifestyle habits, which can ultimately help control migraine. The authors suggest the positive results from this study indicate the need for a full prospective randomized controlled clinical trial to further investigate and validate the role and impact of RLB in migraine management. These studies will facilitate investigation into:

  • The degree of flexibility in maintaining RLB.
  • Further validation of causality between lack of RLB and chronic migraine, or whether there is an undetermined factor causing both, e.g. high stress level.
  • The need for psychometrically sound measures or wearable tracking devices to track lifestyle behaviors as they relate to migraine to avoid the limitations of self-report and improve accuracy of real-time data and behavior.

"Strength doesn't come from what you can do. It comes from overcoming the things you once thought you couldn't" - Rikki Rogers 

For many of us with migraine, our attacks may increase in frequency during the busiest years of our lives when we are balancing our jobs, family responsibilities, and social obligations. Maintaining lifestyle habits like regular sleep schedules, mealtimes and hydration, along with daily exercise routines, can be a challenge.

However, we need to be aware that as our attacks increase in frequency, so do a host of other problems that can complicate our treatment and contribute to migraine- related disability. That said, when my migraine attacks escalated from episodic to chronic, making substantial changes in what I ate and drank, my eating and drinking habits, my sleep routine, and learning to manage my physiological  stress response, were the most difficult things I did to reduce the frequency of my attacks and remit from chronic to episodic migraine. But, it is important to note, that as my attacks decreased in frequency, I gained a feeling of empowerment (internal locus of control), which motivated me to continue to create an environment conducive to wellness.

Today, although I have learned to manage my disease and and have infrequent attacks, I continue to  use an electronic tool to track my daily trigger management and to remind myself of the importance of regular lifestyle habits. For me, "Good habits are worth being fanatical about". 


Woldeamanuel, Y. W., & Cowan, R.P. (2016).  "The impact of regular lifestyle behavior in migraine: a prevalence case-referent study." Journal of Neurology. pp 1-8. First online: 25 January.

Sharron Murray MS, RN is an author and coauthor CaMEO Study, "Life With Migraine". Currently, Sharron is active in the migraine community as a writer, advocate, American Migraine Foundation Partner, moderator for the American Migraine Foundation "Move Against Migraine" Facebook Group, and member of the National Headache Foundation Patient Leadership Council. 

Follow Sharron on twitter @murraysharron and on facebook, Sharron Murray, MS, RN

This article is not intended as a substitute for medical advice. If you have any specific concerns about your health or nutrition, please see a qualified health professional.

Updated November 27, 2018

Copyright March 3rd, 2016, Sharron E. Murray 















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