Caveat: This is one of those posts geared toward "women of a certain age" (roughly 40 and over) who are dealing with mid-life hormonal changes. But guys, you're welcome to read on as well, of course!
Sick to My Stomach, But Not Truly Sick
I'm what's known as a morning person. I wake up every day around 4:00-4:30 am without an alarm clock and generally eat breakfast right away. It's one of my favorite times of day, as well as my most productive. However, occasionally over the past year or so, I've woken up with a pounding headache and felt queasy for an hour or two, so I've stayed in bed and avoided eating until it passed. At 47, I always figured it was related to the way I slept or possibly hormone-related, but because the symptoms weren't terribly severe and quickly resolved, I didn't give it much thought.
That all changed yesterday. I awoke with a severe, pounding headache accompanied by nausea and decided it was strong enough to warrant taking ibuprofen. (I try to avoid taking pain relievers unless the pain is unbearable). Unfortunately, the glass of water I drank with the tablet didn't stay down. I tried to go back to sleep, but the headache made it impossible. About an hour later, I made some weak tea, thinking the caffeine might help the headache, but I vomited that up as well. Thinking I probably had the flu (even though I was having normal BMs and only throwing up liquid), I returned to bed. I started trying to mentally inventory the contents of my refrigerator and pantry to make sure I had the appropriate supplies for when I felt up to reintroducing liquids.
But in just a few hours, I began feeling pretty normal. The headache was gone, I was no longer nauseated, and I could keep water down, then tea, and then food. In fact, I was hungry! I ate a normal-sized lunch and felt great. It was as though the events of the morning had never happened. And when I woke up today, I hopped out of bed and went down to the kitchen to fix breakfast, feeling perfectly normal. What was going on? I described my experience to a few friends, each of whom said, "That sounds like a migraine."
Migraines During Perimenopause
The decline in estrogen levels during perimenopause, the 5-20 year period leading up to menopause, can have many effects. Although the most common symptoms of estrogen fluctuations are night sweats, hot flashes, and irritability, there are many others that can occur during this transitional period. One of them is an increase in the frequency of migraines or even their onset at perimenopause in women who never had them prior.
What's the difference between a migraine headache and a regular tension headache? It's my understanding that there's no test to distinguish between the two, and diagnosis is based on symptoms. While a migraine typically occurs on one side of the head, this isn't always the case. If a headache is severe enough to cause nausea and vomiting, it's usually considered a migraine. The symptoms experienced by some perimenopausal women are very similar to morning sickness. Just as there are some ladies who have intense nausea and vomiting during their first trimester of pregnancy while others have only mild indigestion or none at all, the same spectrum of symptoms seems to occur during the perimenopausal transition -- and for some, the problems continue into menopause.
Treating Perimenopausal Symptoms with Nutrition and Lifestyle Changes
Whether what happened to me yesterday was a migraine or simply a response to hormonal changes, I decided right away that I needed to figure out how to control it or at least lessen the severity of the symptoms. Losing half a day to nausea and vomiting once every few months might be tolerable but what if it started happening much more frequently, as I've read stories about online? As usual, when something goes wrong -- blood glucose, cholesterol, etc. -- I always try to see if I can remedy it with lifestyle changes prior to looking at medications or hormones.
I did an online search for conventional strategies for morning sickness and found the following:
1. Eat 5-6 small meals daily
2. Have small amount of plain foods like crackers for snacks
3. Avoid fatty foods
4. Try soy isoflavones
None of those sounded appealing or doable, particularly items 2-4.
I found a list of the Top 10 migraine triggers and was disappointed to see that it included some of my staple foods: chocolate, dairy, and nuts. However, I ate all of those yesterday after the episode and again this morning with no problem. So perhaps it's a matter of personal tolerance, as with most nutrition-related issues.
Looking further into tactics to improve nausea and vomiting associated with migraine or pregnancy, it started to get better.
Alpha-linolenic acid (ALA) and gamma-linolenic acid (GLA): These polyunsaturated fatty acids (PUFAs) have anti-inflammatory effects that may decrease the frequency and severity of migraine episodes.
ALA sources: chia seed, flaxseed, walnuts, and ALA supplements
GLA Sources: evening primrose oil and borage oil supplements
Ginger: Ginger has long been considered one of the most effective herbs to control nausea, and there is considerable evidence supporting its use for this purpose.
Sources: fresh ginger, ginger tea, ground ginger, diet ginger ale (I like Hansen's)
Ketogenic diet: Last year, Italian researchers published a study in which twin sisters of perimenopausal age (47 years) experienced a fringe benefit of the cyclical ketogenic diet they were prescribed for weight loss: Their migraines disappeared during the ketogenic portion of the diet. And mild ketosis appears to be sufficient, as the women were prescribed diets containing 1 gram of carbohydrate per kilogram based on their body weights of 73 kilograms and 79 kilograms.
Acupressure: Acupressure may be modestly effective for reducing nausea and migraine symptoms. There's even a sea-band designed specifically for morning sickness, although in reading the reviews on Amazon you'll see there are many people it worked incredibly well for and others whom it didn't help at all.
Sources: traditional acupressure, sea-band for morning sickness, instructional handout
Yoga: Besides being one of the best forms of exercise for flexibility, strength, and stress reduction, yoga has also been shown to provide relief from migraine symptoms.
Sources: classes, DVDs, TV, podcasts
I wrote this post because I know many of my readers are around my age and might be experiencing similar hormonal issues. The above recommendations may or may not be helpful based on your own unique biochemistry. I saw my doctor a couple of weeks ago, and according to all my lab work and her physical exam, I'm very healthy but definitely well into perimenopause. I'm not sure what I had yesterday was a migraine, but I don't see the harm in making the assumption that it was and trying a few of the interventions above to see if they're effective, as well as continuing the things I've been doing with respect to diet and activity. And if you've discovered other effective ways to manage these symptoms without medications or hormones, I'd very much appreciate if you'd share them in the comments section. Thank you!
* Prior to taking making dietary changes or taking any supplements listed above, please speak with your provider, particularly if you are taking medications, herbs, or other supplements.
7/31 Update : After going over my My Fitness Pal food diary Monday trying to figure out if I ate too much dairy, nuts, or chocolate yet seeing nothing out of the ordinary, I realized what the trigger for the migraine might have been. I don't record beverages since the ones I consume are calorie- and carb-free, but I now remember drinking a couple of glasses of water flavored with a generic flavor-enhancer sweetened with sucralose Monday evening. I don't use sucralose/Splenda regularly and I've never had a problem with it or any other artificial sweetener in the past, but perhaps I've developed a sensitivity which may be heightened by hormonal changes. I'm not against artificial sweeteners -- I use saccharin tablets to sweeten hot beverages every day -- but I've always told people that if they develop headaches or other symptoms as a result of AS use, they should discontinue them and/or find a replacement that doesn't cause the problem. A brief online search on potential sucralose side effects suggests it may indeed trigger migraines in some people but not others. Personally, I plan to avoid it from now on, as it seems to be the most likely explanation in my case.
8/1 Update: Although I'd pretty much settled on sucralose as the culprit, I had to investigate further, since I'd used Dasani drops a few weeks prior with no problem. What I purchased on Monday was the Kroger brand, which I assumed had the same ingredients. However, the Kroger brand contains both maltodextrin (source of MSG) and propylene glycol, both of which can be migraine triggers. There's also a lot of other questionable ingredients in both of these drops.
I kept thinking back to how I developed headache and nausea (although no vomiting) the morning after eating at a Chinese restaurant a few months ago, and I'm really thinking it's the MSG that I'm sensitive to, coupled with hormonal issues. I read a few more online accounts of migraines related to sucralose, and most people who have problems seem to experience this only with Splenda (yellow packets), which contains maltodextrin, but can tolerate liquid sucralose, which does not.
Just to be safe, I'm going to try to avoid all three potential triggers: sucralose, maltodexrin/MSG, and propylene glycol. In any event, I feel that saccharin, stevia, and erythritol -- consumed in moderation -- are the best sugar substitutes available.
1. Hodson J, et al. Headache at menopause and in hormone replacement therapy users. Climacteric 2000 Jun;3(2):119-24
2. Chai NC, et al. Migraine and estrogen. Curr Opin Neurol. 2014 Jun;27(3):315-24
3.Wagner W, et al. Prophylactic treatment of migraine with gamma-linolenic and alpha-linolenic acids.
Cephalalgia 1997 Apr;17(2):127-30
4. Ben Arye E, et al. Herbal medicine in women's life cycle. Harefuah. 2006 Oct;145(10):738-42, 782
5. Thomson M, et al. Effects of ginger for nausea and vomiting in early pregnancy: a meta-analysis. J Am Board Fam Med. 2014 Jan-Feb;27(1):115-22
6. Di Lorenzo C, et al. Diet transiently improves migraine in two twin sisters: possible role of ketogenesis?
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7. Allais G, et al. Acupressure in the control of migraine-associated nausea. Neurol Sci. 2012 May;33 Suppl 1:S207-10
8. John, PJ, et al. Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial. Headache 2007 May; 47(5):654-61
A couple of days ago I received an email from the makers of a soy-based protein bar that began:
"Scientific research continues to show that a plant-based diet is a healthy dietary pattern. In fact, previous versions of the Dietary Guidelines for Americans have emphasized plant-based diets, and the 2015 Dietary Guidelines Advisory Committee appears to be supporting these previous conclusions."
I'd heard this before, after the US Dietary Guidelines Advisory Committee (DGAC) held their third public meeting on the subject this past May. The fourth meeting is scheduled to be held on the 17th and 18th of July, and there's an opportunity to participate online, if you're interested.
It does seem that plant-based diets -- which are usually, although not always, synonymous with vegetarian or vegan diets -- are gaining favor in terms of public perception of their health benefits and sustainability. While I value the contribution vegetables, fruits, and nuts make to our diet, I disagree that most people would benefit from adopting a diet consisting solely of plant foods and have written about this before. And I'm disappointed that low-carbohydrate diets aren't being presented as an alternative at this point, particularly for the many groups of people who would benefit from them.
However, I dislike the confrontational and accusatory messages I've seen from many advocates on both sides in blog posts, comments, and social media sites. I'm passionate about carbohydrate restriction (apparently I'm not supposed to use this phrase to describe myself, but I think it fits), and I get upset when people criticize it and make claims about the superiority of plant-based diets too. But in my opinion, being respectful of the other side -- who are often equally committed to their way of eating -- while letting the evidence in favor of low-carbohydrate diets speak for itself, is the best way to go.
You may have already seen the debate between Dr. Eric Westman and Dr. T Colin Campbell held at the University of Alabama held in the spring of 2013. Both of these men have put many years into researching the effect of diet on various aspects of health. Each strongly believes that his way is the healthiest and most sustainable even though they are quite different. Dr. Campbell's view is that a plant-based, low-protein, low-fat, high-carbohydrate diet provides optimal nutrition, while Dr. Westman favors an eating plan that is very low in carbohydrate, moderate in protein, and high in fat. I encourage you to watch the video if you haven't already, or even if you have. Notice how Dr. Westman seeks to find common ground with statements like "There's more than one way to achieve excellent health," and then goes on to present the large body of evidence --including randomized clinical trials -- supporting carbohydrate restriction for diabetes, metabolic syndrome, and obesity, with early but promising research on ketogenic diets for cancer and neurological disease. I strongly agree with this approach and feel it's what will ultimately allow for more flexibility in the Dietary Guidelines -- specifically, including low-carbohydrate diets as an option.
Franziska Spritzler, RD, CDE