to 5 ounces chicken breast, cooked, cooled, and chopped .

cup canned chickpeas (garbanzo beans) .

medium Fuji or McIntosh apple (with skin), chopped .

cup chopped cuc.u.mber (with peel) .

cup chopped tomato .

cup chopped avocado .

cup chopped celery

2.

scallions, finely chopped

1.

tablespoon chopped walnuts

2.

to 4 tablespoons reduced-calorie raspberry vinaigrette

Place the lettuce in a large bowl. Add the chicken, chickpeas, apple, cuc.u.mber, tomato, avocado, celery, scallions, and walnuts. Drizzle with the vinaigrette and toss to coat.

PER SERVING.

569 calories, 44 g protein, 53 g carbohydrate, 23 g fat (2.5 g saturated), 91 mg cholesterol, 700 mg sodium, 14 g fiber; plus 320 mcg folate (80% DV)

CHAPTER 14.

MIGRAINE HEADACHES.

One of my friends describes her migraines as a pain storm that splits her skull across her right temple, liquefying her brain until it feels like it's oozing out through her ears. The sound of a phone ringing is like a cartoon frying pan slamming the top of her head. Bright light is like a paintball gun filled with needles shot straight through her eyeb.a.l.l.s. Once they strike, these intense, throbbing headaches last anywhere from a few hours to three days. For however long the migraine lasts, all she can do is take rescue medication, lie in a darkened room, and wait for the incapacitating pain to resolve.

About one of every ten Americans has had at least one migraine. Some experience an aura aura that presages the coming pain. An aura is typically some unusual visual experience, such as blind spots, distortion, jagged lines running through the visual field, sparkling or flashing lights, or enhanced color or depth perception. But some auras can cause a feeling of pins-and-needles in arms or legs, speech difficulties, excessive thirst, sleepiness, food cravings, or unexplained mood changes, particularly feelings of depression and irritability. More often, however, there is no warning before the pain sets in. that presages the coming pain. An aura is typically some unusual visual experience, such as blind spots, distortion, jagged lines running through the visual field, sparkling or flashing lights, or enhanced color or depth perception. But some auras can cause a feeling of pins-and-needles in arms or legs, speech difficulties, excessive thirst, sleepiness, food cravings, or unexplained mood changes, particularly feelings of depression and irritability. More often, however, there is no warning before the pain sets in.

Migraine headaches usually start on one side, but often spread and encompa.s.s the other hemisphere too. During an episode, most migraine sufferers become extremely sensitive to light and sound, and some may vomit or feel nauseated. Migraines can come just once or twice a year, or several times each month. My friend used to get migraines three times a week. Working with her doctor she was able to find the right preventive medication, and cut the frequency by half. A real improvement, but that still meant six migraines a month. Then, after identifying and eliminating food triggers from her diet, the number fell to about one or two.

You're probably thinking, "That's great for her, but how much pain relief can I I expect?" Unfortunately, no one can say with any certainty. Everyone has different triggers, so what worked for my friend may have no effect on you. However, everything mentioned in this chapter helps some people. I recommend that you try everything, keep what works...and never lose hope that you'll someday be able to avoid or control your headaches. expect?" Unfortunately, no one can say with any certainty. Everyone has different triggers, so what worked for my friend may have no effect on you. However, everything mentioned in this chapter helps some people. I recommend that you try everything, keep what works...and never lose hope that you'll someday be able to avoid or control your headaches.

FAQSI've figured out how to avoid my trigger foods at home, but eating out seems like a ch.o.r.e. Do you have any guidelines for foods to avoid, or foods that are safe to eat in restaurants?

It's safest to avoid the following: cheap buffets that leave food sitting and use suspect ingredients; Chinese food due to added MSG and soy sauce; j.a.panese food due to soy sauce, tofu, and miso; Mexican food due to the a.s.sortment of dishes with beans, cheese, and sour cream (and guacamole!). Your safest bets are high-quality American, seafood, or Italian restaurants. My suggestions for relatively safe ordering include: - Grilled chicken or fish (request no MSG or vinegar, and ensure the dish does not contain citrus juice) - Steamed or sauteed vegetables in olive oil and garlic with a plain baked potato (or sweet potato or rice, preferably brown) - Pasta with broccoli and grilled chicken tossed in an olive oil-based sauce - For dessert, a non-chocolate treat like strawberries with whipped cream, rice pudding, or herbal tea with plain biscotti

WHAT AFFECTS.

MIGRAINE HEADACHES?.

Migraines are a mystery. Scientists don't know precisely what causes them or what exactly happens in the body once a migraine is triggered. They believe that there is a genetic component, and that the headaches are a result of abnormal functions in certain brain structures. Early research suggested that migraine headaches were caused solely by changes in the way blood vessels in the head dilated and constricted. Now, scientists understand that while blood vessels are part of the migraine process, they are just one event in a cascade of events. For example, we know from brain scans that during migraine headaches there is increased blood flow in the brain stem and the cerebral cortex. Inflammatory chemicals, such as substance P, and other substances are released; nerve centers are stimulated; and there are changes in levels of brain chemicals called neurotransmitters. The main lessons are that migraines are physiologically complex, and that they absolutely, positively are not "all in the mind" of the sufferer.

But for our purposes, the more important questions are: What sets off the headache in the first place? And, Can it be stopped? Migraines are triggered by specific factors, many of which are understood...but what triggers one person's headache may not affect you in the least. The most common triggers are: Foods. Many everyday foods are big, Many everyday foods are big, big big triggers. I provide a specific list in the next section. triggers. I provide a specific list in the next section.

Stress. When we are stressed, our bodies react physically-muscles tense, hormones become elevated, and migraines can be triggered. When we are stressed, our bodies react physically-muscles tense, hormones become elevated, and migraines can be triggered.

Hormonal changes. Because estrogen and progesterone are such potent migraine triggers, women are nearly three times more likely than men to experience migraines. In fact, there is a subset of headache known as the Because estrogen and progesterone are such potent migraine triggers, women are nearly three times more likely than men to experience migraines. In fact, there is a subset of headache known as the menstrual migraine menstrual migraine, which can occur one or two days before the start of a woman's period, or during the first day or two of her period. Women with hormone triggers can take comfort in knowing that many women whose migraines are primarily menstrual find that they get complete relief after menopause.

Intense sensory stimuli. Bright light, loud noises, and strong smells-such as cleaning chemicals, cigarette smoke, raw onions, and perfume-can trigger migraines. Bright light, loud noises, and strong smells-such as cleaning chemicals, cigarette smoke, raw onions, and perfume-can trigger migraines.

Physical exertion or abrupt lifestyle changes. Jumping into an extreme exercise program can cause migraines, as can s.e.xual activity, changing sleep patterns, alternating work shifts, or anything else that breaks your body out of its normal rhythms. If you push yourself in a demanding job all week long, you'll be more likely to get a migraine when you finally slow down over the weekend. On the flip side, if you enjoy a weekend with a little too much fun, you may develop a Monday migraine. Jumping into an extreme exercise program can cause migraines, as can s.e.xual activity, changing sleep patterns, alternating work shifts, or anything else that breaks your body out of its normal rhythms. If you push yourself in a demanding job all week long, you'll be more likely to get a migraine when you finally slow down over the weekend. On the flip side, if you enjoy a weekend with a little too much fun, you may develop a Monday migraine.

Environmental factors. Some people get migraines when there are changes in the air...literally. Their headaches coincide with the arrival of thunderstorms, sudden changes in alt.i.tude or barometric pressure, wind storms, seasonal changes, pollen levels. Others are sensitive to the switch to daylight savings time or travel across time zones. Some people get migraines when there are changes in the air...literally. Their headaches coincide with the arrival of thunderstorms, sudden changes in alt.i.tude or barometric pressure, wind storms, seasonal changes, pollen levels. Others are sensitive to the switch to daylight savings time or travel across time zones.

Medications. Medications can have a wide range of side effects, so it is no surprise that some can cause migraines. You need to be especially wary of antihistamines, decongestants, blood pressure medications, oral contraceptives, hormone replacement therapy, and prescription pain medications. Interestingly, migraines can also be triggered if you stop taking prescription or over-the-counter pain medications (such as aspirin, acetaminophen, or ibuprofen), a phenomenon called rebound. Medications can have a wide range of side effects, so it is no surprise that some can cause migraines. You need to be especially wary of antihistamines, decongestants, blood pressure medications, oral contraceptives, hormone replacement therapy, and prescription pain medications. Interestingly, migraines can also be triggered if you stop taking prescription or over-the-counter pain medications (such as aspirin, acetaminophen, or ibuprofen), a phenomenon called rebound.

Some neurologists believe that all those trigger factors can be additive. They theorize that everybody has a tolerance limit for triggers, and once that limit is exceeded, a migraine is in the near future. If you have extreme sensitivity, then a single mild trigger may be enough to cause a headache. But if you have a greater tolerance, it may take two or three triggers occurring in close succession to push you past that limit. So you may be just fine if you have to use strong-smelling cleaning products. But if you clean, and then a thunderstorm hits, that combination of triggers may be enough to send you over the top. That's why it is critical to try to eliminate as many potential "controllable" triggers from your life as possible.

HOW FOOD AFFECTS MIGRAINE HEADACHES.

The most important role food plays in migraines is as a trigger. Not all the foods on my list will cause migraines in all sufferers, and some people have no food sensitivities. In order to determine what your particular triggers are, I recommend keeping a migraine diary for at least three months. If you discover that one of the foods listed here is a trigger for you, then you know that you should avoid that particular food if you want to remain pain free.

It's important to remember, however, that you and your migraines are unique; what causes headaches for someone else might be perfectly safe for you. Don't eliminate foods permanently without confirming that they are triggers...many of the foods on this list contain healthful nutrients.

POSSIBLE TRIGGER FOODS: THE ANTI-GROCERY LISTI tell my new migraine clients to eliminate every potential food trigger from their diets for at least one month. Note whether your migraines improve. Then, add back one food at a time...no more than one new food every two days. If you get a migraine within 24 hours of eating the add-back food, stop eating it again. (When you get through the whole list, you can always test it again if it is a particular favorite.) FRUITApple juice and ciderApples (red-skinned only)BananasCitrus fruits (oranges, grapefruit, lemons, limes, tangerines, clementines, pineapple)Citrus juice (orange, grapefruit, lemonade, pineapple, and other citrus blends)Dried fruits (including apricots, figs, prunes, dates)Grapes (and grape juice)PapayaPa.s.sion fruitPears (red-skinned only)Plums, redRaisinsRaspberries VEGETABLESAvocadoBeans (fava, lima, navy, broad beans, lentils)Canned tomato sauceCanned vegetablesEggplantOnions (can be used for flavoring, but not to eat)PeasPicklesRelishSauerkrautSnow peasTomatoes (not often) FISHALL cured, smoked, canned, pickled, or aged fishAnchoviesCaviarLoxPickled herringSardines MEATSALL cured, smoked, canned, pickled, or aged meatsBacon (including beef, pork, and turkey)Beef (all cured, smoked, canned, pickled, or aged)Beef jerkyBologna (including beef, turkey, and low-fat)Chicken (all cured, smoked, canned, pickled, or aged)Corned beefDeli meats (cured or smoked)Ham (canned, cured, smoked, pickled, or aged)Hot dogs (including chicken, turkey, and soy)Liver and liverwurstOrgan meats (such as kidneys or liver)Pastrami MEATSPatePepperoniPork (all cured, smoked, canned, pickled, or aged)SalamiSausages (including beef, chicken, turkey, and soy)Turkey (all cured, smoked, canned, pickled, or aged)Turkey jerky SOYMisoProducts made with soy protein isolate (check labels!)Soy sauce (including reduced-sodium)TempehTofu NUTS AND SEEDSAll nutsAll nut b.u.t.tersSeeds (pumpkin, sesame, sunflower) DAIRYAged cheese (including Cheddar, bleu, Brie, Camembert, Parmesan, Gouda, Gruyere, mozzarella, provolone, Romano, Roquefort, Swiss, Stilton, and all other aged or "moldy" cheeses)b.u.t.termilkChocolate ice creamChocolate milkChocolate puddingFoods prepared with cheese (check labels)Sour creamYogurt GRAINSBagelsBaked goods with yeast extracts (doughnuts, coffee cake)Yeast bread, freshly baked MISCELLANEOUSAdditives (check labels and avoid if products have MSG, HVP, HPP, kombu extract, or natural flavorings)Alcohol (especially beer, red wine, sherry, and vermouth)ChocolateCocoaCoffeeDiet beverages/products that use the artificial sweetener aspartame (also known as NutraSweet and Equal)Soft drinks (Red Bull, Mountain Dew, c.o.ke, and others; check label for caffeine)Tea (green and black)Vinegar (especially balsamic and red wine vinegar, including salad dressings and condiments made with these vinegars)Yeast extract

NUTRIENTS AND FOODS TO AVOID...

- Chocolate, cheese, and other foods containing tyramine tyramine or or phenylethylamine. phenylethylamine. Although many other foods contain these 2 amino acids, the following specific foods can often be powerful migraine triggers: chocolate (and anything made with cocoa), aged or fermented cheeses (including Cheddar, bleu, brie, and all hard cheeses and "moldy" cheese), yogurt, sour cream, b.u.t.termilk, soy products (including tofu, tempeh, miso, and foods made with soy protein/isolate), soy sauce, red wine vinegar and balsamic vinegar (including salad dressings, and condiments made with vinegar), sauerkraut, relish, pickles, breads made with yeast extracts (including fresh baked bread, bagels, doughnuts, sourdough, pizza dough, soft pretzels, and coffee cake), organ meats (including liver, kidney, and pates), processed meats and fish (any smoked, pickled, cured, aged, or canned), beans (specifically lima, fava, navy, Italian or broad, and lentils), all nuts (including peanuts, cashews, almonds, and nut b.u.t.ters), seeds (specifically pumpkin, sunflower, and sesame), eggplant, avocado, onions, citrus fruits (pineapple, oranges, grapefruit, lemons, limes, tangerines, and clementines-and all of their juices), bananas, grapes, raisins, plums, papaya, pa.s.sion fruit, and raspberries. Although many other foods contain these 2 amino acids, the following specific foods can often be powerful migraine triggers: chocolate (and anything made with cocoa), aged or fermented cheeses (including Cheddar, bleu, brie, and all hard cheeses and "moldy" cheese), yogurt, sour cream, b.u.t.termilk, soy products (including tofu, tempeh, miso, and foods made with soy protein/isolate), soy sauce, red wine vinegar and balsamic vinegar (including salad dressings, and condiments made with vinegar), sauerkraut, relish, pickles, breads made with yeast extracts (including fresh baked bread, bagels, doughnuts, sourdough, pizza dough, soft pretzels, and coffee cake), organ meats (including liver, kidney, and pates), processed meats and fish (any smoked, pickled, cured, aged, or canned), beans (specifically lima, fava, navy, Italian or broad, and lentils), all nuts (including peanuts, cashews, almonds, and nut b.u.t.ters), seeds (specifically pumpkin, sunflower, and sesame), eggplant, avocado, onions, citrus fruits (pineapple, oranges, grapefruit, lemons, limes, tangerines, and clementines-and all of their juices), bananas, grapes, raisins, plums, papaya, pa.s.sion fruit, and raspberries.

- Alcohol. Beer, red wine, sherry, and vermouth contain large amounts of tyramine, which can cause migraines. In addition, all alcohol can cause dehydration, which also can trigger headaches. Beer, red wine, sherry, and vermouth contain large amounts of tyramine, which can cause migraines. In addition, all alcohol can cause dehydration, which also can trigger headaches.

- Avoid eating leftovers: Because tyramine content increases over time, Because tyramine content increases over time, especially especially if food is improperly stored, avoid eating leftovers containing any of the "off limit" foods. if food is improperly stored, avoid eating leftovers containing any of the "off limit" foods.

- Tea, red skinned apples and pears, apple juice and cider, coffee, and red wine, which contain tannins. tannins.

- Deli meats and other food containing nitrites. nitrites. These include pepperoni, bacon, hot dogs, sausages (including chicken, turkey and soy sausages/bacon/hotdogs that list nitrites in their ingredients), bologna, pastrami, jerky (beef and turkey), corned beef, and all other beef/poultry/pork/wild game/fish that have been cured, smoked, pickled, canned, or preserved with nitrites. These include pepperoni, bacon, hot dogs, sausages (including chicken, turkey and soy sausages/bacon/hotdogs that list nitrites in their ingredients), bologna, pastrami, jerky (beef and turkey), corned beef, and all other beef/poultry/pork/wild game/fish that have been cured, smoked, pickled, canned, or preserved with nitrites.

- Wine and other foods containing sulfites. sulfites. This preservative is commonly found in wine (more so in red), most dried fruits are typically preserved with sulfites (including prunes, figs, apricots, etc.), canned vegetables, and many processed foods. This preservative is commonly found in wine (more so in red), most dried fruits are typically preserved with sulfites (including prunes, figs, apricots, etc.), canned vegetables, and many processed foods.

- Additives. Check labels carefully and avoid foods that contain monosodium glutamate (MSG), hydrolyzed vegetable protein (HVP), hydrolyzed plant protein (HPP), kombu extract, any products claiming to have "natural flavor" or "natural flavorings." Check labels carefully and avoid foods that contain monosodium glutamate (MSG), hydrolyzed vegetable protein (HVP), hydrolyzed plant protein (HPP), kombu extract, any products claiming to have "natural flavor" or "natural flavorings."

- Aspartame. Can trigger migraines in some people. Avoid all foods made with this artificial sweetener (also known as Nutrasweet and Equal). Can trigger migraines in some people. Avoid all foods made with this artificial sweetener (also known as Nutrasweet and Equal).

- Caffeine. People with sensitivity to caffeine can develop migraines after drinking black tea, green tea, coffee, cola soft drinks, or other caffeinated soft drinks. But caffeine can also be used to stop a migraine that is just beginning-that's why many over-the-counter migraine medications contain caffeine. Test your personal response to caffeine. If it gives you headaches, avoid it. Otherwise, try drinking one cup of coffee or two cups of strong black tea at the start of your next migraine to see if it helps. In 2005, German researchers reported that when people took a combination of 250 milligrams of aspirin, 200 milligrams of acetaminophen, and 50 milligrams of caffeine (an average 8-ounce mug of coffee has 100 milligrams caffeine) at the start of their migraines, they had better and faster pain relief than people who did not take the caffeine. People with sensitivity to caffeine can develop migraines after drinking black tea, green tea, coffee, cola soft drinks, or other caffeinated soft drinks. But caffeine can also be used to stop a migraine that is just beginning-that's why many over-the-counter migraine medications contain caffeine. Test your personal response to caffeine. If it gives you headaches, avoid it. Otherwise, try drinking one cup of coffee or two cups of strong black tea at the start of your next migraine to see if it helps. In 2005, German researchers reported that when people took a combination of 250 milligrams of aspirin, 200 milligrams of acetaminophen, and 50 milligrams of caffeine (an average 8-ounce mug of coffee has 100 milligrams caffeine) at the start of their migraines, they had better and faster pain relief than people who did not take the caffeine.

NUTRIENTS AND FOODS.

THAT MAY REDUCE MIGRAINE FREQUENCY.

The list of potential trigger foods seems long, I know, but remember it's just a list of possibilities-most likely, when you're done systemically eliminating and then reintroducing these foods, you will find there are just a few things you need avoid. Now for the good news-some nutrients you should try to eat more often: LIQUIDS.

Dehydration is a common migraine trigger. When everyone seems to be rushing from house to work to meeting to the gym and back home again without much thought to food or drink, migraine sufferers need to stay hyper-vigilant about how much liquid they drink. While the latest government guidelines say that most people can allow thirst to guide how much they drink, migraine sufferers should aim to pre-empt thirst. Try to drink about nine 8-ounce cups of liquid a day if you're a woman, or about thirteen 8-ounce cups a day if you're a man. Eight ounces is a lot less than you think! I ask my clients to fill their favorite drinking gla.s.s with water, then transfer to a liquid-measuring cup to see exactly how many ounces they drink each time they fill the gla.s.s. Please remember that water is the single best way to stay hydrated-it is inexpensive, calorie-free, and efficient. The worst hydrating liquids are sodas, sugary fruit drinks, sweetened tea or coffee, and juices because they add too many calories to your daily diet (and in some instances are often migraine triggers).

BEST HYDRATING LIQUIDS: Water, herbal tea, decaffeinated coffee, decaffeinated tea, milk (fat-free, 1% reduced fat) Water, herbal tea, decaffeinated coffee, decaffeinated tea, milk (fat-free, 1% reduced fat) OMEGA-3 FATTY ACIDS AND OLIVE OIL.

Adding some healthy fats into your diet may help reduce inflammation, which is part of what is thought to cause the pain of migraines. Omega-3 fatty acids, found in large quant.i.ties in fatty fish and fortified foods, and monounsaturated fats found in olive oil have both been shown to reduce the frequency, duration, and severity of headaches. I recommend eating fresh wild salmon high in omega-3s two to three times per week, and adding other omega-3 foods as a regular part of your diet. Try to use olive oil or canola oil instead of b.u.t.ter in your cooking whenever possible.

BEST FOODS FOR OMEGA-3 FATTY ACIDS: Fresh wild salmon, Rainbow trout, Pacific oysters, omega-3-fortified eggs, flaxseed (ground and oil), seaweed, walnut oil, canola oil Fresh wild salmon, Rainbow trout, Pacific oysters, omega-3-fortified eggs, flaxseed (ground and oil), seaweed, walnut oil, canola oil

MIGRAINE DIARYSome neurologists believe that becoming too obsessive about tracking migraine triggers can be stressful, and we all know that stress can trigger a migraine. But unless you keep a basic diary, it will be difficult to spot patterns. If you see a doctor, you'll be required to complete a diary, so starting now will put you one step ahead.For each migraine episode, note on a regular calendar or in a journal: - Date and day of the week - The location and type of pain. For example, would you describe the pain as stabbing, throbbing, steady, dull, sharp? Use whatever adjectives come to mind-there is no wrong answer.

- Intensity level, on a scale of 1 to 10, where 1 = mild pain, and 10 = the worst pain you've ever felt - Duration, in number of hours - Any warning signs that the migraine was on its way - Weather, at the time the migraine started and any changes during the subsequent 12 hours - Activities or stress level in the 24 hours prior to the migraine - Foods eaten in the 24 hours prior to the migraine - What you did to try to stop the migraine, and whether those treatments were effective - If you are a woman, where you are in your menstrual cycle

RIBOFLAVIN.

Riboflavin-also called vitamin B2-is involved with the body's production of energy at the level of the cell. Some research suggests that people with migraines may have a genetic defect that makes it difficult for their cells to maintain energy reserves, and this lack of basic energy could trigger migraines. Many neurologists recommend that their migraine patients take riboflavin supplements along with their prescription medications. Although it is difficult to get enough riboflavin to prevent migraines from food sources alone, I recommend adding some additional riboflavin-rich foods to your diet. If you would like to try riboflavin supplements, I recommend a 400 milligram dose or a combination product called MigreLief MigreLief. See the Supplements section, next page, for more information.

BEST FOODS FOR RIBOFLAVIN: Fresh lean beef, whole grain fortified cereal, milk (fat-free, 1% reduced-fat), eggs, mushrooms (portobello, white), asparagus, kale, broccoli, spinach Fresh lean beef, whole grain fortified cereal, milk (fat-free, 1% reduced-fat), eggs, mushrooms (portobello, white), asparagus, kale, broccoli, spinach MAGNESIUM.

Magnesium deficiency has been linked to migraines. Getting enough magnesium through diet or supplements may help to prevent all kinds of migraines, but seems to be particularly valuable for women who get menstrual migraines. Eating a diet high in magnesium is safe, and will contribute to headache prevention. However, studies of the effects of magnesium on migraine have used supplements, not food sources. If you would like to try magnesium supplements, I recommend a combination product called MigreLief MigreLief. See the Supplements section, next page, for more information.

BEST FOODS FOR MAGNESIUM: Spinach, Swiss chard, fresh amaranth, quinoa, sweet potatoes, white potatoes, millet, artichoke hearts (fresh or frozen only, not canned), chickpeas (garbanzo beans), brown rice, whole wheat pasta, whole grains (see best varieties on grocery list), flaxseed, wheat germ Spinach, Swiss chard, fresh amaranth, quinoa, sweet potatoes, white potatoes, millet, artichoke hearts (fresh or frozen only, not canned), chickpeas (garbanzo beans), brown rice, whole wheat pasta, whole grains (see best varieties on grocery list), flaxseed, wheat germ BONUS POINTS.

- Eat regularly. Anyone who skips a meal risks developing a headache, but migraine sufferers are particularly sensitive to the effects of low blood sugar. Don't let a crazy schedule stop you from eating regularly-at least every five hours, but it's possible you need to eat more often than that. Look at it this way...if you don't take the time to eat lunch and then get a migraine, you'll lose a lot more than your lunch hour nursing the headache. My friend who suffers migraines claims to eat like a cow-she grazes all day long, rarely going more than two hours without eating something- Anyone who skips a meal risks developing a headache, but migraine sufferers are particularly sensitive to the effects of low blood sugar. Don't let a crazy schedule stop you from eating regularly-at least every five hours, but it's possible you need to eat more often than that. Look at it this way...if you don't take the time to eat lunch and then get a migraine, you'll lose a lot more than your lunch hour nursing the headache. My friend who suffers migraines claims to eat like a cow-she grazes all day long, rarely going more than two hours without eating something-and like a bird, with just the tiniest portions at each sitting. She carries a small snack and a small bottle of water in her purse at all times so she can keep well-fueled and well-hydrated. Although it took a little experimentation, she has made frequent eating work for her, keeping migraines at bay without weight gain. like a bird, with just the tiniest portions at each sitting. She carries a small snack and a small bottle of water in her purse at all times so she can keep well-fueled and well-hydrated. Although it took a little experimentation, she has made frequent eating work for her, keeping migraines at bay without weight gain.

- Lose weight, if you are overweight. A study published in a 2006 issue of the journal A study published in a 2006 issue of the journal Neurology Neurology looked at the relationship between weight and migraines. After interviewing more than 30,000 people, the researchers discovered that weight had no relation to whether a person suffered migraines. However, people who were overweight had more frequent and severe migraines...and the more overweight, the worse the migraines. This study relied on telephone interviews, so we don't know whether these results would hold up in a clinical setting, where the partic.i.p.ants could be examined and evaluated by a doctor. But the relationship makes sense. Fat creates inflammation, and inflammation contributes to migraines, so it's not a big leap to think that fat could make migraines worse. looked at the relationship between weight and migraines. After interviewing more than 30,000 people, the researchers discovered that weight had no relation to whether a person suffered migraines. However, people who were overweight had more frequent and severe migraines...and the more overweight, the worse the migraines. This study relied on telephone interviews, so we don't know whether these results would hold up in a clinical setting, where the partic.i.p.ants could be examined and evaluated by a doctor. But the relationship makes sense. Fat creates inflammation, and inflammation contributes to migraines, so it's not a big leap to think that fat could make migraines worse.

- Quit smoking. Smoking increases inflammation and can trigger migraines, so quitting could be a quick way to get rid of pain. If you need a more potent reason, how about stroke? Smoking increases the risk of stroke, and some types of migraine-migraine with aura-can also increase the risk of stroke, even in people under age 50. Adding the two together can be disastrous. Smoking increases inflammation and can trigger migraines, so quitting could be a quick way to get rid of pain. If you need a more potent reason, how about stroke? Smoking increases the risk of stroke, and some types of migraine-migraine with aura-can also increase the risk of stroke, even in people under age 50. Adding the two together can be disastrous.

- Exercise gently, but regularly. Intense or unusual exercise can cause migraines...but regular exercise can reduce the frequency or severity of headaches by reducing tension. The trick is to warm up before exercising, and, if you are new to physical activity, to start slowly. Try walking, gentle cycling, or swimming to start. Intense or unusual exercise can cause migraines...but regular exercise can reduce the frequency or severity of headaches by reducing tension. The trick is to warm up before exercising, and, if you are new to physical activity, to start slowly. Try walking, gentle cycling, or swimming to start.

- Practice relaxation. Because stress can trigger migraines, relaxation can help prevent them. Relaxation can be as simple as taking a bubble bath, listening to music, or spending an afternoon fishing. But more structured relaxation programs are custom-designed to put body and mind at ease. I recommend practicing yoga, progressive relaxation, or meditation for at least 30 minutes each day. Look for cla.s.ses at your local community college or hospital wellness center. Because stress can trigger migraines, relaxation can help prevent them. Relaxation can be as simple as taking a bubble bath, listening to music, or spending an afternoon fishing. But more structured relaxation programs are custom-designed to put body and mind at ease. I recommend practicing yoga, progressive relaxation, or meditation for at least 30 minutes each day. Look for cla.s.ses at your local community college or hospital wellness center.

- Get enough sleep, without oversleeping. In these over-busy, over-scheduled times, it is so easy to sleep too little or develop an erratic sleep pattern. But if you suffer with migraines, you need to pay attention to this detail. Both lack of sleep and too much sleep can trigger migraines, so it is important that you make your sleep pattern as regular as possible...no matter how busy you are. In these over-busy, over-scheduled times, it is so easy to sleep too little or develop an erratic sleep pattern. But if you suffer with migraines, you need to pay attention to this detail. Both lack of sleep and too much sleep can trigger migraines, so it is important that you make your sleep pattern as regular as possible...no matter how busy you are.

- Consider physical therapy along with acupuncture, biofeedback, or ma.s.sage. There are lots of different physical treatments that can help control or even prevent migraines. Research shows that physical therapy, when performed by a licensed physical therapist, is effective at treating migraines when paired with acupuncture, biofeedback, or ma.s.sage. Acupuncture is an ancient Asian therapy that involves the placement of hair-thin needles into the skin along energy pathways called There are lots of different physical treatments that can help control or even prevent migraines. Research shows that physical therapy, when performed by a licensed physical therapist, is effective at treating migraines when paired with acupuncture, biofeedback, or ma.s.sage. Acupuncture is an ancient Asian therapy that involves the placement of hair-thin needles into the skin along energy pathways called meridians meridians. The precise placement of needles will reopen blocked energy meridians, thereby reducing pain. Biofeedback uses sensitive electronic measuring devices to teach the body how to control muscle tension, heart rate, and other "automatic" body processes that we usually think are not controllable. It is a way to help disrupt that chain of action and reaction that starts with stress, and ends with a migraine. Ma.s.sage is...well, absolutely relaxing and wonderful. Although more research is needed before a definitive case can be made for any of these treatments, they all look promising.

SUPPLEMENTS.

If you suffer from migraine headaches and want to consider supplements, research suggests that these might be helpful: 1. MigreLief. This supplement is a patented formulation designed specifically for people with migraines. Just two capsules a day-one in the morning and one at night-contain 300 milligrams of magnesium, 400 milligrams of riboflavin, and 100 milligrams of a specific form of the herb This supplement is a patented formulation designed specifically for people with migraines. Just two capsules a day-one in the morning and one at night-contain 300 milligrams of magnesium, 400 milligrams of riboflavin, and 100 milligrams of a specific form of the herb feverfew feverfew, which has been used for centuries to treat headaches. More recent research has found that taking feverfew, particularly in the standardized form found in MigreLief, can reduce the frequency and severity of migraines. People who take it notice improvements after one to three months. This product may cause diarrhea in some people. MigreLief should not be taken by anyone taking pota.s.sium-sparing diuretics, or with renal failure, or by women who are pregnant or nursing. To find stores near you that sell MigreLief, check the store locator at www.migrelief.com, or call 1-877-MIGRELIEF. One additional note of warning, just to prevent an unexpected shock: At these dosages, riboflavin will turn urine a bright fluorescent yellow. It isn't dangerous, just colorful.

2. Omega-3 fish oil. If you can't get enough omega-3 fats through diet alone, try fish oil supplements. I recommend the same amount used by researchers who studied its effects: 1,500 milligrams (1.5 grams). Check the label to ensure the majority of fish oil content is coming from a combination of DHA and EPA. Store in the fridge to prevent rancidity. To prevent fishy burps, take with food, and choose enteric-coated varieties, which are designed to dissolve in the intestines instead of the stomach. Because fish oil acts as a blood thinner, it should not be taken by people who have hemophilia, or who are already taking blood thinning medications or aspirin. People with diabetes should talk with their doctors before trying fish oil supplements because they may affect blood sugar. If you can't get enough omega-3 fats through diet alone, try fish oil supplements. I recommend the same amount used by researchers who studied its effects: 1,500 milligrams (1.5 grams). Check the label to ensure the majority of fish oil content is coming from a combination of DHA and EPA. Store in the fridge to prevent rancidity. To prevent fishy burps, take with food, and choose enteric-coated varieties, which are designed to dissolve in the intestines instead of the stomach. Because fish oil acts as a blood thinner, it should not be taken by people who have hemophilia, or who are already taking blood thinning medications or aspirin. People with diabetes should talk with their doctors before trying fish oil supplements because they may affect blood sugar.

3. Coenzyme Q10 (CoQ (CoQ10). CoQ CoQ10 is a vitamin-like substance that helps enzymes create energy at the cellular level. Without it, cells can't work properly. The first major scientific study of CoQ is a vitamin-like substance that helps enzymes create energy at the cellular level. Without it, cells can't work properly. The first major scientific study of CoQ10 showed that about 60 percent of the partic.i.p.ants who took 150 milligrams per day (at breakfast) were able to cut the frequency of their migraines by more than half. Although there are very few side effects from CoQ showed that about 60 percent of the partic.i.p.ants who took 150 milligrams per day (at breakfast) were able to cut the frequency of their migraines by more than half. Although there are very few side effects from CoQ10, some people may experience flu-like symptoms, itching, rashes, heartburn, lack of appet.i.te, or gastrointestinal distress. If you have liver disease, diabetes, or thyroid disease, see your doctor before trying CoQ10.

JOY'S 4-STEP PROGRAM FOR MIGRAINE HEADACHES Follow this program if you suffer from migraine headaches.

STEP 1...START WITH THE BASICS These are the first things you should do to try to reduce the frequency and intensity of your headaches: - If you haven't been diagnosed, see your doctor. Many disorders can cause severe headaches-everything from a simple sinus infection to a brain tumor. Get a professional evaluation. If you are diagnosed with migraines, your doctor will become your new best friend. Ask if there are medications that might be helpful for preventing or stopping a migraine.