There is only one thing worse than a migraine and that’s a migraine attack while traveling.
Travel is a perfect storm of factors that can trigger attacks in even those who do not frequently get migraine. Why is that?
- 1 How Travel Causes Migraine Attacks
- 2 Triggers When Traveling
- 3 How To Avoid A Migraine When Travelling
- 4 Before You Go
- 4.1 (1) Raise Your Migraine Threshold
- 4.2 (2) Plan Ahead
- 4.3 (3) Refill Your Medications
- 4.4 (4) Pack A Migraine Bag
- 4.5 (5) Use A Personalized Mobile Emergency Kit
- 4.6 (6) Letter From Your Doctor
- 4.7 (7) Check Your Travel Insurance
- 4.8 (8) Allow Extra Time
- 4.9 (9) Pack healthy, filling snacks
- 4.10 (10) Polarized Sunglasses
- 4.11 (11) Eye Mask
- 4.12 (12) Ice Pack
- 4.13 (13) Neck Pillow
- 4.14 (14) Pack Your Migraine Device
- 4.15 (15) Exercise Before You Leave
- 4.16 (16) Consider A Preventive Treatment
- 5 While Traveling
- 6 What To Do If You Have A Migraine Attack While Travelling
How Travel Causes Migraine Attacks
Travel might be by car, boat, bus, train or while flying and all of these involve potential triggers. Travel can cause a migraine attack because there are so many potential triggers involved.
The migraine brain likes routine: including regular sleep-wake cycles, regular stress levels, eating timetables, exercise, and movement. Travel is a disruption to the routine for most people and significant disruptions can cause an attack in those vulnerable.
Triggers When Traveling
Travel is stressful. You need to remember everything to pack. You may be helping to organize others or kids. You need to run on time. Delays result in missed connections. All of this can be stressful. This change in stress level is enough to trigger an attack.
Others may be familiar with high levels of stress and not bothered by the level of stress involved in travel. When they arrive at their holiday destination their stress levels may fall significantly. This fall in stress has also been known to trigger attacks. Teachers, for example, may report migraine attacks on weekends after an intense week in the classroom full of students.
It is the change in stress, not the absolute level of stress which is a trigger factor for many.
Sleep and Jet Lag
Lost sleep and jet lag are very common triggers for those who cross time zones.
The more dramatic the change in the time zone the more likely the risk of an attack when all else is constant. Jet lag often takes several days to recover from which can be a vulnerable period for someone with migraine.
When we travel we are often forced to eat what is available or nearby in the rush to our destination. This change in diet is often towards quick, takeaway and heavily processed foods. Many processed foods contain harmful chemicals, compounds, and ingredients which can stack up and trigger a migraine attack.
Bright Lights and Glare
Whether you’re traveling by air, sea, or land, bright lights are everywhere. In the air, the glare from the sun through the plane window and in the airport can be a strong irritant. Window shades are also usually required to be open for landing and take off which make it difficult to avoid.
By sea, the sun shining on the water can feel as strong as staring directly at the sun. On a train, bus, or car, there can also be a significant amount of light affecting the traveler. This is especially if the sunlight flickers through a treeline alongside the road or train tracks.
Traveling by public transport of any kind involves noise. There are announcements over the loudspeakers in terminals and in-cabin announcements. Boat and plane engines can roar for the entire journey while the horn and breaks on a squeaky train can be deafening.
Passengers can talk for lengthy periods in loud voices which can be irritants. Stations and restaurants in airports and other terminals can also play loud music.
Lack of Movement
Typically when we are traveling, we are not moving much or exercising. We are typically sitting or standing still for an extended period of time. Being sedentary for a long time is not ideal for the body.
Flying for long periods of time increases the risk of deep vein thrombosis or in rare cases a blood clot in high-risk individuals. For most people the risk is low but it demonstrates an important lesson. Our body thrives on movement. Exercise releases endorphins, it can reduce pain, increase our pain threshold, and make us feel good (1)
We are often inevitably subjected to strange and unpleasant smells while traveling:
- The smell of the engine or fuel from the plane or boat.
- The cigarette cloud of smokers lingering outside the terminal.
- The overly strong perfume of people in the crowd.
These can act as triggers for migraine patients who are sensitive to odor.
Flying in a plane inevitably changes the atmospheric pressure around us as the plane gains altitude. This pressure change is another trigger which can lead to an attack in those with migraine.
Dehydration is one of the most common health problems of passengers flying and is also a migraine trigger. Dehydration occurs due to a lack of humidity in the air. Planes bring in outside air to circulate the air in the plane. At 30,000 feet the air is cold and does not much moisture which results in lower humidity within the plane for passengers.
Travel disrupts our schedule and may cause missed meals, hunger or insufficient food. All of these can be contributing factors to a migraine attack.
Changes in altitude, climate, temperature, air pressure or even humidity may all act as potential triggers for those vulnerable.
A holiday may be a great time to relax and celebrate with your friends or family, but alcohol can also cause problems for those with migraine.
Alcohol might help you unwind on your break but it can also make several of the above triggers worse. Alcohol leads to dehydration. Drinking in excess can prevent quality sleep no matter how long you sleep after consumption. This can exacerbate jetlag and sleep disruption. Alcohol also increases appetite which may lead to an increased consumption of heavily processed foods full of potential trigger ingredients.
Given this collection of potential migraine triggers, it might seem completely overwhelming to be able to enjoy a holiday or trip without a migraine attack. Should we all simply give up trying to travel?
The good news is that with some preparation and preventive strategies, traveling frequently without migraine is very possible. See the next section for tips.
How To Avoid A Migraine When Travelling
There are many things we can do to reduce the risk of an attack while we are traveling. These tips are broken up into 3 sections.
- Before You Go
- While Traveling
- What To Do If You Have An Attack
Before You Go
(1) Raise Your Migraine Threshold
Migraine is a moving a target. The nature of this disease means that it can change over time. Triggers can evolve. Attacks can change and our overall resilience can improve or decline based on a number of genetic and environmental factors.
Fortunately, we can control many factors that help protect us from a migraine attack.
It’s important to understand that migraine triggers can stack up. One trigger might not trigger an attack but three triggers all at once may. When the triggers lead to a migraine attack it crossed our migraine threshold.
The ‘migraine threshold’ refers to our resilience. It’s the level at which we can endure potential triggers without having a migraine attack. Once that level is exceeded, then a migraine attack occurs.
The good news is that our migraine threshold can be improved. Some preventive medications can help such as these. Other things we can control directly.
This includes having good sleep hygiene.
It’s about quality, consistency, and duration of sleep. Get at least 8 hours and go to bed at the same time each night.
Diet is another very important part that is not often discussed by doctors. There are several reasons for this. One is because diet is hard for doctors to manage in their patients and they are not trained extensively in diet and preventive health. For more information about the best migraine diet visit this article.
Sitting is the new smoking. Our sedentary lifestyles are as bad or worse than smoking or obesity to our longevity according to the Mayo Clinic.
Exercise is a powerful migraine prevention tool. Studies have compared regular exercise to a billion dollar migraine preventive drug Topamax and found that exercise was just as effective with only positive side effects. (1)
Not only are these habits or practices good for migraine but they’re also good for our brain health and our longevity. Build up your resilience so that when some of the triggers you can’t control like weather or timezone changes become a factor, you are strong enough to withstand them without an attack.
(2) Plan Ahead
“If you fail to plan you plan to fail.” – Benjamin Franklin
Write A List
Write a list of everything you need to travel including all your documents, medications, vitamins, devices or therapies you need to prevent or treat a potential attack.
Having a list with everything takes the stress out of travel preparation. Once you’ve got your list you simply tick off each item once it’s packed and ready. After some practice, it will feel great ticking things off your to do and packaging list.
Be prepared and give yourself time to see a doctor, obtain refills, get polarized sunglasses, etc. When you have done this once, it will be easier in the future.
Leave with plenty of time to arrive at the airport, train or bus terminal. Rushing is stressful and it’s what makes it easy to forget or lose items.
Keep Copies of Your Travel Itinerary
Secure your travel arrangements well in advance. Print the details and keep a copy on you while traveling.
Book Transfers In Advance
Arrange your transportation to and from hotels or locations in advance rather than upon arrival.
A little planning can go a long way to ensuring your trip is as stress free as possible.
(3) Refill Your Medications
If you’re away for a week or a month you’ll need a ready supply of medications. Refill your current scripts and ensure you have sufficient stock. That way you are prepared if the worst-case scenario erupts.
(4) Pack A Migraine Bag
Your migraine bag could be a toiletries bag which contains everything you need to manage your migraine condition. It will include things like your:
- daily preventive medications
- medications for an acute attack
- your backup or rescue treatments when your abortive medications fail
- supplements or vitamins
- any oils or small migraine related items
- pill cutter if needed
Keep this bag in your carry-on so that there is no risk it will end up as lost luggage.
(5) Use A Personalized Mobile Emergency Kit
In addition to your migraine bag, carry a small pill box or small plastic container that contains everything you need to survive one migraine attack or a close encounter.
This is something to keep in your purse, wallet, jacket or backpack. Along with a water bottle. This way you’ll never be caught unprepared and you’ll always be able to intervene early if you feel especially vulnerable or at risk.
If you are wondering what you can possibly do every time you feel at risk? One research has shown that ginger powder (or ginger root capsules) is as effective as Sumatriptan when taken at the first signs of an attack. Yet its much cheaper and has fewer side effects. See this article and refer to the study citation. (2)
Another option might be a high quality peppermint or lavender oil for the forehead, temples, neck or wherever you feel an attack coming on. Others who’ve learned biofeedback or meditation can intervene early through mindfulness or breathing techniques to help calm the nervous system potentially avert an attack.
(6) Letter From Your Doctor
Different countries have different rules and regulations. Customs officials may be highly suspicious and try to confiscate the small pharmacy packed in our luggage.
That’s why a letter from the doctor listing all our medications, devices, vitamins and supplements and explaining that you have been diagnosed with migraine or chronic migraine is very helpful for these situations.
Take at least two copies of this letter and be prepared to show it at customs or inspection if required.
If you have severe attacks that do not respond to conventional treatment or a status migraine where you could end up in hospital then you should also have added to this letter or a separate note from your doctor something that describes what you should be given to help you abort the severe attack or status migraine in a clinic or hospital setting. The doctor should also provide their credentials and contact information.
It is unlikely they will be called but it is important for hospital staff to be able to authenticate and check if required by their own internal compliance process for certain treatments.
(7) Check Your Travel Insurance
Travel insurance and hospital cover may sometimes be provided by your credit card or health plan but sometimes it is not. Now is the time to check before you travel to insure you’re covered if a hospitalization or doctor visit is needed.
(8) Allow Extra Time
If you’re traveling across continents or have several stops, build in some downtime. Consider staying a night or two halfway rather than trying to tackle a long journey all at once.
Give yourself plenty of time to make flight connections. Remember that delays are common and weather can plays havoc with flights in vulnerable areas.
Larger airports and busy travel hubs require more time to transfer between flights. You may also have to go through customs again when transferring at overseas airports.
(9) Pack healthy, filling snacks
To the extent possible, manage what you eat.
If you are gluten free you can often request this in advance. Pack healthy, filling foods that do not contain triggers or potentially problematic ingredients.
These are will vary by person but good options are often single ingredient, whole foods such as unprocessed nuts, seeds, fruit, some dried fruits and minimal ingredient protein bars and even dark (85%+) chocolate.
Listen to your body. Take foods and snacks you know are safe. Note that some countries don’t allow you to bring in any fresh foods so plan to eat them before you arrive. Packaged nuts or seeds are generally ok.
If you know you are going to be forced to eat a potential trigger food try eating and drinking something prior. Some patients report less sensitivity to trigger foods if they are not eaten on an empty stomach.
(10) Polarized Sunglasses
If you have good weather on your trip then you are likely to see plenty of sunlight. Pack a hat, cap and quality pair of polarized sunglasses. Many sunglasses still today are not polarized. Polarization makes a noticeable difference in reducing the glare which can be especially unpleasant for those with migraine.
(11) Eye Mask
Make sure you pack an eye mask. This will help facilitate rest or sleeping while in transit.
At your new location you are likely to have different levels of light coming into your room at potentially early hours of the morning. A sleeping eye mask comes in very handy when the shades are lighter than what you are used to back home.
(12) Ice Pack
Take an ice pack that you use. There are lots of variations designed specifcally for migraine patients that can wrap around the head. Ice and a dark quiet room are some of the most popular and effective natural treatments to reduce the pain of a migraine attack.
(13) Neck Pillow
If you are sitting down for a long period of time in the same position then a neck pillow can prevent neck strain or discomfort which can be a trigger factor for many people.
Try a few options for comfort before buying.
(14) Pack Your Migraine Device
If you use any migraine devices like the Cefaly, Spring TMS or the Vagal Nerve Stimulator they should be packed and kept on hand in case they are needed.
(15) Exercise Before You Leave
Regular exercise is important but if you have a great workout at the gym, or go for a long walk or jog before you travel then sitting down and being sedentary is much easier to do. Your body can recuperate from the exercise while in transit and you will be more likely to find rest in an otherwise tricky environment.
(16) Consider A Preventive Treatment
Many of the tips shared above are preventive strategies to prevent an attack from occurring. Their are also medications that can effectively prevent migraine attacks.
If travel guarantees a migraine attack then it may be worth discussing preventive treatment options with your doctor in preparation for the trip. Some preventive treatments may require you build up ahead of the trip while others may be able to be taken just while traveling.
Your doctor is the best person to discuss options that suit you.
(17) Conquer Jetlag
Some amount of jet lag is inevitable if you travel to a significantly different time zone but jetlag can be managed.
For example, melatonin is a natural hormone and sleep aid. In times of jet lag you may not be producing melatonin naturally when you need it because your body clock is out of sync. Melatonin supplements can help. There has also been evidence that 3mg of melatonin can help migraine patients in general. (3) Speak to your doctor about melatonin for the trip to help you sleep through the first few nights.
Another option is a drowsy antihistamine which may also help you sleep through the night whilst traveling. If you often wake during the night during the first few days of a trip then this may also be worth discussing with your doctor or pharmacist.
(18) Use Earplugs Or Headphones
When traveling on a plane, train, or bus, a pair of earplugs can go a long way. Just be careful not to miss any important announcements, like your stop.
Headphones technically have improved dramatically in recent years and can let in ambient sound on-demand through hand gestures or setting configurations. They also can come with plane plug adaptors giving you great sound quality in-flight entertainment. Regular travelers should consider this a worthy travel companion.
(19) Wear Tinted Lenses Inside For Fluorescent Lights
Fluorescent lights are still widely used in many transport terminals, in cabin, in hotels, shopping centers, and public venues.
Avoid wearing sunglasses indoors. You can dark-adapt your eyes and make yourself even more sensitive to light.
(20) Expect Strong Odors
Sometimes there is not a whole lot you can do with the strong odors from the plane, boat or from other people’s perfume.
One tactic that might help is by rubbing peppermint, eucalyptus or lavender oil under your nose or above your top lip to temporarily block strong odors. Make sure you use a pleasant scent that you have tested before.
(21) Minimize Ear Pressure
Ear pressure from the airplane cabin can quickly turn into a headache or migraine if left unchecked. To minimize the impact of cabin pressure try:
- Taking an antihistamine. This may help reduce mucus accumulating and prevent the pressure from building.
- Swallow or yawn during takeoff.
- Chew something like a piece of gum or snack. Choose healthier alternatives where possible.
- Pop your ears gently, by pinching your nose, closing your mouth and blowing gently.
(22) Stay Hydrated
This is self-explanatory but often tricky to do in practice.
If you’re not sitting in an aisle seat, drinking regularly may cause you to get up often. To avoid this consider a high-quality hydration electrolyte option like Total Hydration’s Natural Himalayan Replacement Capsules or Hydralyte.
Not all hydration electrolyte mixes are equal, some contain potential trigger ingredients, sugars, and additives while others are more naturally based. Check the ingredients before making your selection.
(23) Consider If Alcohol Is Worth The Risk
If it’s your holiday you may feel like celebrating by drinking but few celebrations are worth a migraine attack especially while traveling.
Alcohol reduces your tolerance to withstand other migraine triggers and enhances other trigger factors like sleep disruption, jet lag, and dehydration.
Alcohol is really only for the very experienced patient who knows what their limits are. If you have chronic migraine or are not sure, play it safe and find another way to safely indulge on your trip. How about a gentle massage after you arrive?
(24) Recuperate Upon Arrival
Give yourself time to decompress when you arrive at your destination. A gentle stroll outside in the sun with some fresh air can help you recalibrate to your new time zone and climate.
What To Do If You Have A Migraine Attack While Travelling
The above tips will put you in an excellent position to better control your condition while traveling. But we should still be prepared if an attack does occur.
If it occurs while traveling and we are not prepared, it can cause further stress, turmoil, and pain.
To prepare, utilize your emergency migraine kit (see tip no.5 above) and take your medication immediately. The sooner the medication is taken during a migraine attack the more effective it is likely to be. Timing is key which is why tip no. 5 is so important.
One of the worst places to have a migraine is the hospital. It’s often crowded, flooded with bright lights and you are often waiting for a long time surrounded by other sick or injured people.
Not to mention the potential cost or hassle of filling out a travel insurance claim.
Therefore as much as responsibly possible, we want to avoid the hospital. We can do this by having a strategy to abort a migraine when it arrives and, if possible, returning to the hotel room early. A dark quiet room with our medication, ice, bed or couch to lay down is going to be the most conducive environment to recover from an attack.
If for some reason the treatment fails or the attack lasts longer than usual then we should have a backup plan in place. A second line of treatment may be employed in this scenario. This treatment is different from the first line abortive treatment. Both options should be discussed before you leave with your doctor.
Rescue medication is not designed for use with every attack but only for the most severe or unresponsive attacks. These are designed to keep you out of the hospital. For example instead of taking the oral Sumatriptan you might take the more expensive but also far more effective format of Sumatriptan which is an injection to help relieve your attack.
If you are traveling with friends or family who offer help, let them. Delegate responsibility if appropriate. Let them bring you a fresh towel or ice and make them feel useful rather than helpless.
With forward planning, we can manage many of the triggers and prepare for attacks if they do occur. We can’t expect perfection and shouldn’t be frustrated if an attack does occur. All we can do is our best.
Travel can be a wonderful experience that offers an entire world of adventure, culture, and experience. It can also give us a new appreciation for our home, family and to be grateful for what we have. That is all something worth striving for.
What strategies do you find the most helpful when you travel? Let me know in the comments below.
- Varkey, Emma, et al. “Exercise as migraine prophylaxis: a randomized study using relaxation and topiramate as controls.” Cephalalgia 31.14 (2011): 1428-1438.
- Maghbooli, Mehdi, et al. “Comparison between the efficacy of ginger and sumatriptan in the ablative treatment of the common migraine.” Phytotherapy research 28.3 (2014): 412-415.
- Peres, MFP et al. Melatonin, 3 mg, is effective for migraine prevention. Neurology 63.4 (2004): 757-757.