The potential use of statins for the prevention of migraine was first proposed in a case report a decade ago. A 58-year-old man was prescribed a statin for high cholesterol . He had a history of recurrent typical aura with migraine (approximately two episodes per month) since he was 20 years old. After he began statin therapy, his migraine attacks disappeared.

An open-label study followed with propranolol ( a beta bloker often used for prevention of migraine) daily in women with more than six migraine attacks per month and a statin in women with high cholesterol and more than six migraine attacks per month. Both drugs had a high efficacy (possibly owing to factors such as high expectation for cure); the response rate for propranolol was 88% with a 50% decrease in attacks and 83% for the statin.

A cross-sectional population study of nearly 6000 people found that statin use was associated with a lower prevalence of severe headache or migraine . When the variable of vitamin D status was analyzed, statin use among participants who had optimal blood vitamin D level ( >57 nmol/L )had a much lower risk for severe headache or migraine , while no association was found with people with lower vitamin D levels.

A double-blind, controlled study randomly assigned 57 adults with episodic migraine to either a daily statin plus vitamin D3 1000 IU twice daily or identical placebo for 24 weeks. In the statin/vitamin D group, eight patients (25%) experienced 50% reduction in the number of migraine days at 12 weeks and nine patients (29%) at 24 weeks; only one patient (3%) in the placebo group experienced a reduction in migraine days.

Statins have other biochemical effects in addition to lowering cholesterol, effects that may play a role in reducing migraine attacks. Statins might reduce migraine attack frequency by improving endothelial function, arterial stiffness, and vascular tone. Other actions, such as reducing inflammatory responses and decreasing platelet aggregation and thrombosis, also could contribute to the beneficial effect on migraine.

My opinion;

Firstly, from my perspective the constant use of any drugs to prevent headache/migraine should only be considered when all other conservative treatments have failed.

Also it is important to remember that Statin drugs are currently not recommended or mentioned in guidelines for migraine/headache prevention.

That having been said however, for patients who do not respond to the more common migraine prevention treatments, a statin might be worth a try based on limited evidence and a good safety profile ( although there is an ongoing debate as to whether statins cause side effects such as muscle aches & pains).

Some evidence also suggests that statins might be more effective with adequate vitamin D levels, so determining adequacy of vitamin D would be a sensible first step. Whether one statin is more effective than another for migraine is unknown. More research is required in larger numbers of patients to establish the place of statins in migraine prevention.


Many people have heard of ‘Tension-type’ headaches (TTH), and lots of headpain sufferers will have been given this diagnosis. The name would suggest the headaches are either due to physical ‘tension’(for example in the muscles of the neck), or psychological ‘tension’ (stress/anxiety). However research in the past has shown little correlation between TTH & muscle tenderness/tightness &/or anxiety/depression.

Frequently the diagnosis/label is used as a ‘catch all’, based on whether;
1) the headpain has certain characteristics’
2) that other types of headpain have been excluded.

Thus TTH is a relatively non-specific diagnosis & the actual cause may be hard to ascertain.

I was therefore interested in the following article published in Medscape;

A new study shows that patients with tension-type headache (TTH) have relatively weak neck extension muscles ( these are the muscles that bend your neck backwards & also contribute to keeping the head upright).

Researchers found that these patients are 26% weaker than controls with respect to neck extension muscles, that they have a 12% smaller extension/flexion ratio, and that they have a borderline significant difference in the ability to generate muscle force over the shoulder joint.

“We found that patients with tension-type headache exhibited decreased muscle strength in the neck extensor muscles, which caused this reduced ratio between extension and flexion,” said lead study author Bjarne Madsen, a physiotherapist and PhD student in the Department of Sports Science and Clinical Biomechanics, University of Southern Denmark and Danish Headache Center Glostrup Hospital.
With this reduced ratio, the muscles in the front of the neck pull the head forward, which causes continuous muscular activity in the neck, explained Madsen. “This can lead to pain and, over time, it can cause tension-type headache.”
This lower ratio “indicates that a higher relative loading of the neck extensor muscles could be present in everyday activities,” write the authors. “This possibly contributes to additional tension in the extensor muscles as well as disturbed stabilization in the neck and coordination of head movements.”

A reduced extension/flexion ratio may contribute to TTH onset and eventually to the development of chronic TTH, said the authors


As mentioned at the beginning of this post TTH is poorly understood & is often used as a bit of an ‘umbrella’ type label, covering a variety of headpain types which may be subtly different & have different causes (including among others muscle tension, psychological factors etc.). In my opinion with some cases it may even be a mild ‘version’ of migraine-type headpain.

So once again a detailed history & examination is important to establish the best approach regarding management + treatment of TTH, and yes, this may include exercises to strengthen the neck muscles !

I thought I would reproduce the following research findings (published in Medscape Medical News.) as it is relevant to both my osteopathic practice when examining patients with limb pain, which is frequently (but as the following article shows, not always), caused by trapped nerves in the neck & also to my work as a specialist in Migraine.

From a joint British-Chilean study;

Although limb pain is not included as a manifestation of migraine in international headache classifications, children and adults may experience recurrent limb pain as part of the migraine spectrum, a new study suggests. The four-generation study reveals a familial form of limb pain and migraine.

Researchers performed a prospective clinical and pedigree analysis involving a 27-member family followed for 8 years. They defined migraine limb pain as intermittent arm or leg pain during a migraine episode, cluster headache, or cluster migraine with no other explanation but that may also occur in the absence of headache. The pedigree analysis showed an autosomal dominant inheritance pattern manifesting mainly as limb pain in children and as migraine in adults.

“It’s common in adults. It’s as common as hemiplegic migraine, and in children, one third of children will have some periodic syndrome like limb pain associated with their migraines,” Heather Angus-Leppan, MD, MSc, consultant neurologist at the Royal Free Hospital and senior lecturer at University College London, United Kingdom, and immediate past president of clinical neurosciences at the Royal Society of Medicine, told Medscape Medical News.

Eight of the 27 members of this family had benign recurrent limb and/or body pain. Pain began as early as age 8 years and as late as age 30, and it recurred over 5 to 52 years. Sites of pain were the arm, hand, shoulder, chest, and neck. Limb pain was unilateral but could vary sides from episode to episode. Headache (7 of 8 members with some form of aura) occurred before, during, or after limb pain, and limb pain in adults could occur without headache.

The spectrum of manifestations of the condition may change over the lifetime. Children frequently have limb pain without headache. “The limb pain in children acts like migraine in that the person is often pale with it, they often withdraw from activity, and then they get completely better,” Dr Angus-Leppan said. For many children, episodes become less frequent as they age, but migraine headache or other manifestations may develop.
Elderly people may have less severe headache and more visual aura. Therefore, she says, taking a good history is important to be able to categorize symptoms as part of a migraine syndrome, which can lead to effective treatment.

Limb Pain With Migraine Amenable to Treatment

Dr Angus-Leppan emphasized that recognition of limb pain in migraine is important for preventing unnecessary investigations and getting people on appropriate treatments.
In adults, a migrainous cause of limb pain may be mistaken for nerve entrapment, radiculopathy, thoracic outlet syndrome, chronic fatigue syndrome, functional symptoms, or arthritis. In children, possible red herrings are growing pains, bone or joint pathology, and school avoidance.
Once recognized, “this syndrome responds very well to acute treatment and to migraine prophylaxis,” Dr Angus-Leppan said. “It works as well as in other migraine manifestations.”

In terms of diagnosis, if the limb pain occurs in a clear-cut attack of migraine, it should be fairly obvious to make the connection. “But my impression is that sometimes patients don’t mention limb pain or other somatic pain manifestations,” he said.
Other pains on a migraine spectrum may include pseudoangina with headache, and patients may end up in the intensive care unit for suspected coronary thrombosis,
Young children also may have abdominal pain and often are suspected of having appendicitis, “and many children will have had their appendices removed, and in fact, they’ve been having a migrainous equivalent,” probably accounting for a considerable proportion of normal appendices being removed, he cautioned.

Migraine may present with other unusual symptoms, such as Reynaud’s phenomenon and syncope (fainting), and these cases respond “rather spectacularly to calcium antagonists.” So a good medical history may reveal such cases and lead to very effective therapy, as well as avoid unnecessary testing, referrals, misdiagnosis, delayed diagnosis, and suffering.

The study was funded by the National Fund for Scientific and Technological Development of the Government of Chile.

Mr Katesmark comments; “ When a patient presents with symptoms it is important to consider ALL the possible causes, in my experience migraine is often NOT considered by many health professionals if the presentation is not typical (i.e. severe headache with visual disturbance). Luckily my work as a migraine specialist has helped me diagnose & successfully treat these rare cases in my general osteopathic clinic. “

Reported in Medscape. October 2015 (

Children and adolescents with migraine are more than three times as likely as those without headaches to have a mood disorder, such as depression, and almost three times more likely to have other neurologic conditions, such as epilepsy, a new American study shows.

The overlap between headache and mood disorders was particularly “striking” and highlights the need for neurologists to screen for such disorders, according to lead study author, Tara Lateef, MD, assistant professor, George Washington School of Medicine, who is also affiliated with Children’s National Health System, Washington, DC, and Pediatric Specialists of Virginia, Fairfax.

“Doctors should be doing a strong, thorough evaluation to assess for mood disorders,” said Dr Lateef. “These are young kids and if we are seeing that this migraine population is also at risk for having mental health problems, maybe we should be diagnosing this early. I don’t think anybody needs to be reminded of how severe the consequences are if we don’t treat mental illness in a timely fashion.”

Dr Lateef presented her research at the 44th Child Neurology Society (CNS) Annual Meeting.

The study sample included 9014 young people aged 8 to 21 years.

Overlapping Conditions

The study found that children with any headache, and specifically those with migraine, reported higher rates of other neurologic conditions. Epilepsy was “a big one,” said Dr Lateef, adding that the connection between headache and epilepsy could be causal — for example, seizure medications leading to headaches — or the two conditions could share a common cause.
Tic disorders were also relatively common among pediatric patients with headaches.
These overlaps are “not entirely surprising” given the “rich neuronal circuitry” in the developing brain, commented Dr Lateef.

Kids with headache had more developmental disorders, too. This includes the neurodevelopmental attention-deficit/hyperactivity disorder.
“When migraine kids do poorly in school, people are often quick to dismiss it, saying it’s probably because of the headaches,” said Dr Lateef. “But research shows that we should be screening these kids for attention-deficit/hyperactivity disorder because it could be an independent comorbidity*.” (*ie conditions that frequently present simultaneously in a patient & that may or may not linked in some way)

Children with migraine were also more than three times as likely to have a mood disorder and twice as likely to have anxiety compared with young nonmigraineurs.
This overlap was “unique to migraine,”. That raises the question of whether it’s an inflammatory pathophysiology for both.”
Another possibility is that both disorders are caused by certain neurotransmitters being elevated or diminished, she said. “But we still don’t know what makes a brain depressed.”

The overlap was “striking” to researchers because they were able to show it in such young children, who are a “pure population” in that they don’t have features that “cloud the issues,” said Dr Lateef.
She stressed that it’s not just psychiatrists who encounter patients with mood disorders and that neurologists and primary care doctors should also look for these conditions.

Richard Katesmark comments “ Firstly it is important to realise that just because a child or adolescent has migraine DOES NOT mean they are necessarily going to develop epilepsy or any of the other conditions mentioned above.

However the above research findings are no surprise to me. Anyone who has read some of my previous posts, or consulted me regarding their migraines and headaches, will know that I consider migraine a type of neurological ‘storm’ reflecting disregulated nerve function within the brain. It is not surprising that this disregulated neurological activity may result in sub optimal function in other areas of the brain controlling, for example, mood.

In the past it has been generally accepted that these coexisting conditions may be cause & effect, so migraine might cause people to be depressed/anxious, or that being depressed means you are more likely to experience headaches. Of course this is possible and in some cases maybe true. However increasing evidence is suggesting possible underlying common brain mechanisms that may result in multiple symptoms of neurological distress ; headpain, epilepsy, vertigo, mood disorders, chronic pain syndromes, etc etc.

The question remains whether these mechanisms are genetic, inflammatory, vascular, or as I’ve mentioned above, neurological. Most likely it is a combination of these factors, not to mention some currently undiscovered factors!”

Interestingly there is increasing evidence that coffee (and tea) may confer certain health benefits, so where does this leave the migraine sufferer?


Earlier this year, the American Dietary Guidelines Advisory Committee released a report[1] stating that up to five cups of coffee per day, or up to 400 mg of caffeine, is not associated with long-term health risks. Not only that, they highlighted observational evidence that coffee consumption is associated with reduced risk for several diseases, including type 2 diabetes, cardiovascular disease (CVD), and neurodegenerative disorders. The data suggesting that moderate coffee (and, in all likelihood, tea) consumption is not only safe but beneficial in a variety of mental and medical conditions is growing.
For instance, Caffeine consumption can cause a short-lived increase in blood pressure, and regular use has been linked to a longer-term increase. However, it seems when caffeine is ingested via coffee, enduring blood pressure elevations are small and cardiovascular risks may be balanced by protective properties. Coffee beans contain antioxidant compounds that reduce oxidation of low-density lipoprotein (LDL) cholesterol, and coffee consumption has been associated with reduced concentrations of inflammatory markers.[4-9] Moderate coffee intake is associated with a lower risk for coronary heart disease (data).
A meta-analysis presented at the 2012 European Meeting on Hypertension and Cardiovascular Protection found that one to three cups per day may actually protect against ischemic stroke in the general population.

Studies have also linked regular coffee drinking with improved glucose metabolism, insulin secretion, and a significantly reduced risk for diabetes.[16-19] Most recently, findings from a long-term study published this year[20] suggest that coffee drinkers are roughly half as likely to develop type 2 diabetes as are nonconsumers, even after accounting for smoking, high blood pressure, and family history of diabetes.

Furthermore a 2012 study suggested coffee may slow the progression of dementia & Parkinson’s & a 2011 study concluded that a boost in coffee consumption might also benefit our mental health in other ways such as providing some protection against depression.
Other studies have suggested many other possible benefits; for example on the liver, or by helping with symptoms of gout…..


Firstly it’s important to note that much of the evidence on the potential health effects of coffee/caffeine, is associational and doesn’t prove causality—observational investigations come with limitations and often rely on error-prone methods such as patient questionnaires : Correlation DOES NOT necessarily mean causation!

Secondly there are also risks, and coffee consumption certainly has negative medical and psychiatric effects to consider. Besides the obvious as a trigger for headaches/migraines coffee has the potential to increase in blood pressure, can incite or worsen anxiety, insomnia, and tremor and potentially elevate glaucoma risk [50]


Perhaps one of the most common triggers I encounter for headache & migraine is caffeine. This is present it many foodstuffs & I have discussed it at length in a previous article Caffeine as a trigger to migraine/headaches? ,

So the first thing to do is decide if caffeine is trigger for your own personal headache or migraine.
Clues that caffeine may be playing a role are that your headaches occur in the evening or upon awakening, when it has been the longest since your last dose of caffeine. Weekend headaches, when people may sleep in and delay their caffeine drinking, may also be a caffeine-withdrawal pattern. Also, if taking caffeine treats the headache, you are likely managing the caffeine withdrawal!
It takes at least two weeks for the caffeine withdrawal symptoms to go away ( sometimes longer). I generally like to give my patients a caffeine-free trial for two to three months at least to see what their baseline headaches/migraines are like without caffeine.

It is also worth noting that whilst caffeine may not directly trigger your headache it may contribute to either insomnia or anxiety that may in turn play an important part in predisposing you to your headache/migraines.


If you are SURE caffeine is not playing a part in your headache or contributing to it via insomnia or anxiety, then it seems a few cups of coffee and/or tea may well be good for you !

The Sphenopalatine Ganglion (SPG) is a group of nerve cells that is linked to the trigeminal nerve, one of the main nerves that has been shown to be involved in various forms of head pain such as migraine. The SPG is located behind the nose/nasal cavity and carries information about sensation, including pain. It also plays a role in autonomic (involuntary) functions, such as tearing and nasal congestion.

It is thought that the link between the SPG and the trigeminal nerve may be important in in some cases of headache/migraine & that if you apply local anesthetics/numbing medications to block or partially block the SPG it may be helpful in reducing head and facial pain.

SPG blocks were first described in the 1900’s using a technique involving the application of numbing medication on to cotton swabs then placed into the back of the nose.
However in the last few years’ newer, more specific techniques are being tested. These involve placing a very thin plastic tube into the nose to insert numbing medication (such as the local anaesthetic lidocaine) in and around the SPG.

Initial trials in America (on 112 migraine suffers) have shown that even after the initial numbing created by the anaesthetic wears off, 88% patients experienced some reduction in migraine frequency, &/or severity, for at least a month.

Clearly this is only a small trial & it remains to be seen if improvements are maintained over time &/or whether the procedure has to be repeated to ensure continued pain relief.

Research into other techniques, such as using lasers instead of anaesthetics, may be as, or more, effective & indeed whether more permanent blocks to the SPG may be helpful in certain cases.

Interestingly there is also some evidence to show that electrical stimulation to the SPG may also relieve some forms of head/face pain. Studies are ongoing, and results should be out within the next few years. This procedure typically requires implantation of a neurostimulator device through the mouth under general anesthesia & positioned at the SPG. However as with other oral and facial surgery, the procedure carries surgical risks, and numbness, pain and sensitivity in the face, gums and teeth is be more common than in SPG blocks (though typically are temporary side effects).

My personal view is that further studies are required before one can say if the above techniques have an important part to play in the management of headaches & migraine. However, they may well be worth considering in cases that are resistant to other forms of treatment &/or may be of particular benefit for those sufferers whose migraines are specifically triggered, or aggravated, by strong smells or whose symptom picture includes those of nasal congestion/discharge.

Once again evidence from modern imaging techniques of the brain in migraine sufferers are revealing intriguing results. In this case the research was into why migraineurs are frequently sensitive to light & sound.

The study was published in the March 10 issue of Neurology.

Using functional fMRI, researchers looked at areas of the brain responsible for processing vision and hearing. They found that in those migraine patients with sensitivity to light & sound had distinct differences in the way these areas of the brain were connected up/communicating . Basically there were exaggerated/heightened links between these brain areas; notably these were present even during periods when the patient was migraine free.

This provides further evidence that Migraineurs brains are working differently even during pain free periods. However whether they are born with these differences or whether the changes are a result of the recurrent migraines is still unknown.
My personal feeling is it is probably a bit of both.


I wrote the article below originally on the website for my osteopathic clinic but it is also relevant to headache & migraine sufferers, so I have reproduced it here.

Beware of text neck !

An article by spinal specialist in New York ,Dr K Hansaraj, caught my eye recently. He was warning of the dangers of spending too much time texting.

Here too at at cheyhamlodge osteopathic clinic we have been aware that the introduction and widespread use of smart phones/tablets and laptops (when used on the lap) has to be taken into consideration when managing patients with neck and upper back pain.

The problem is leverage: our heads weigh between 10 and 12lb but as we angle it down the effective weight, and therefore strain on the neck, goes up exponentially. For example at 15° the effective weight is 27lb and at 60° -the usual angle of the neck when looking at a smart phone in the lap- it rises to as much as 60lb! This puts a significantly increased tension on the spine and surrounding muscles.

Of course this is also true if reading a book in your lap, but it is clear that all these different electronic devices have resulted in people spending more time with their neck at this unnatural angle and a corresponding increase in neck and upper back pain.

Of course there are other mechanical factors that may make an individual more prone to this problem and these often need to be managed with treatment and exercises. But as prevention is always better than cure it makes sense to limit the amount of time you spend on these devices and where possible place laptops on tables or hold mobile devices higher (more level with the eye) to reduce the strain on the neck .

N.b. As head clinician at a headache and migraine clinic it is also worth noting that increased use of the above devices and resultant neck tension is also responsible for many patients headaches & may also be an aggravating factor in migraine.

Medical providers have known for over a century that there is an association between poor sleep and the frequency and intensity of migraine and other pain syndromes. There are 2 types of insomnia ;
Type 1; difficulty falling asleep (initiation or onset of sleep)
Type 2 ; difficulty staying asleep, early morning waking,
Insomnia, of one or both types, is a common finding amongst individuals with chronic migraine. In many cases, insomnia may stem from other medical problems which cause chronic pain (making it difficult to sleep comfortably) or which disrupts normal sleeping patterns.

Information from Research .

Researchers studied this association by interviewing 147 adults with chronic migraine (i.e. people suffering from migraines on at least 15 days per month for more than 3 months). None of the patients reported feeling “refreshed” upon awaking and four out of five regularly felt “tired” upon waking. This compares to responses of individuals with infrequent migraines – approximately one in four felt “refreshed” upon waking and only about one in three awakened feeling “tired.”

In this survey insomnia was a complaint of the majority of those who had chronic migraine with two-thirds having type 1. When asked about their sleep habits, almost 80% watch TV or read in bed, 70% get up in the middle of the night to use the bathroom, approximately 60% regularly nap during the day, and a little over 50% regularly use sleeping pills. Interestingly, less than one in ten used caffeine within 8 hours of bedtime. This poor quality of sleep and the suboptimal sleep habits reported by these researchers represent typical sleep issues for those with frequent, severe migraine.

The researchers attempted to see if making changes in sleep patterns could have an effect on migraine frequency and intensity. Forty-three women with chronic migraine were randomly placed into one of two groups. The first group received formal instructions on how to improve their sleep habits. The other received neutral instructions unrelated to improving sleep. They were asked to keep a diary of their headaches. Six weeks later at follow-up women who changed their sleep behavior saw a significant improvement in headache frequency and intensity. Dramatic improvement was seen in one of three, to the extent that they no longer met criteria for chronic migraine. None of the placebo group had such a dramatic change. However, this placebo group was then given the formal teaching that the other group received and followed for another six weeks. At the final visit, six weeks later, almost 50% of all subjects who followed the sleep suggestion experienced headache improvement so that they no longer met criteria for chronic migraine.

Risk Factors for a Sleep Disorder

So what factors place people at risk for developing a sleep disorder? Potential risk factors for insomnia include:
• Stressful life events, such as death of a loved one, divorce, or the loss of a job.
• Day-to-day life stresses such as concerns about school, work, family, and finances may lead to disruptive sleep.
• Depression, anxiety and other mental health disorders can lead to fragmented sleep patterns, and these individuals can have trouble sleeping or may even sleep too much.
• Medications including prescription drugs and medications available over-the-counter. Many prescription drugs, including antidepressants, corticosteroids, allergy medications, pain medications, and blood pressure medications can interfere with sleep patterns. Other over-the-counter medications, including those for allergies, cough and cold, pain, and weight loss can also disrupt sleep. Many can leave you feeling groggy; others contain caffeine and other stimulants that prevent you from getting a good night’s sleep.
• Using caffeine, nicotine, alcohol – especially before bed. Caffeine and nicotine contain stimulants that can keep you up at night. Alcohol can initially lead to sedation, but it prevents you from reaching deeper stages of sleep, can lead to wakening in the middle of the night, and a feeling of not being refreshed in the morning.
• Medical conditions associated with chronic pain, breathing difficulties, or frequent urination can lead to sleeping difficulties. Medical conditions that have been linked with insomnia include arthritis, gastro-esophageal reflux disease (GERD), cancer, lung diseases, congestive heart failure, overactive thyroid, obstructive sleep apnea, and Parkinson’s disease.
• Change in environment or work schedule, such as jet lag from changing time zones, working nights, or shift work.
• Eating too much or too late in the evening can lead to trouble sleeping due to heartburn.
• Poor sleep habits, including irregular sleep times, stimulating activities before bed, and reading, watching TV, or studying/working in bed can all contribute to insomnia.
• Female gender – women can experience hormonal shifts during their menstrual cycle and during menopause that can lead to trouble sleeping. Lack of estrogen is thought to play a role.
• Age over 60 – As sleeping patterns change with age, insomnia often becomes more common. It is estimated that nearly half of elderly individuals suffer from sleep problems.

Basic advice to improve sleep


1. As far as possible maintain a regular sleep pattern; going to bed at the same time and getting up at the same time.
2. Ensure adequate exposure to natural light. This is particularly important for older people who may not venture outside as frequently as children and adults. Light exposure helps maintain a healthy sleep-wake cycle.
3. Have a small snack an hour before bedtime, perhaps some warm milk.
4. Try to develop a regular `stress free` pre-bedtime routine (warm bath, listening to relaxing music/radio, relaxation exercises*, `Declutter` brain*, non-challenging reading etc).
5. Make sure your mattress is comfortable and bedding suitable for the temperature. (plus; `tidy`, clean, & sweet smelling !).
6. Bedroom should be quiet, dark, well ventilated, with `coolish` ambient temperature.
7. If necessary use earplugs/eye patches/blackout blinds etc
8. Certain supplements, herbal remedies &/or homeopathic preparations can be helpful; please discuss with your therapist .
9. Attend/seek help regarding any breathing problems.
10. Check if any medication you are taking contains caffeine or has sleep disturbance listed as a side effect; if so ask your doctor regarding alternatives.
11. Try to get some fresh air &/or exercise during day/early evening.
12. Consider throwing out the bedroom clock!(or at least turn so you are not constantly checking time!)
13. Seek help with any other health conditions or other factors which you feel may be contributing to your insomnia (pain, hot flushes, teeth grinding, anxiety, depression, breathing difficulties, etc).
14. Check your medications to see if they have possible side effects which may be contributing to sleep problems
15. Adequately treat/seek advice about any other pain so that it’s not keeping disturbing your sleep.
16. Discuss situation with your partner/bedfellow if their habits are affecting your sleep!
17. Some Neuromodulatory devices seem to aid sleep in some people; please discuss with your therapist.

1. Avoid stimulants such as caffeine and nicotine too close to bedtime. Individuals vary in their sensitivity to caffeine but generally if you are having sleep problems it should not be consumed after 4pm.( remember caffeine is found not only in tea and coffee but also other `energy` drinks and some foods and medications ; check the labels) .
2. Avoid excessive alcohol prior to sleep. While alcohol is well known to speed the onset of sleep, it disrupts sleep in the second half as the body begins to metabolize the alcohol.
3. Do not go to bed hungry or thirsty. BUT:
4. Do not drink too much fluid within 2 hours of bedtime, frequent waking to go to the toilet results in disturbed sleep.
5. Avoid eating heavy meals within two hours of bedtime. Also dietary changes can cause sleep problems, you are struggling with a sleep problem, it’s not a good time to start experimenting with spicy dishes or `crash` diets.(nb. Avoid a diet that is excessively high in processed foods, animal protein and additives)
6. Try not to use sleeping medications regularly.( especially if you wakeup in the middle of the night)
7. Don’t work/ plan/organize/e-mail etc within an hour of bedtime
8. Avoid watching exciting films/playing video games/ or listening to `stressful` radio shows etc.
9. Try not to argue/shout before bedtime!
10. Do not partake in vigorous Exercise within two hours of bedtime (A relaxing exercise, like yoga, can be done before bed to help initiate a restful night’s sleep. )
11. Don’t have long lie-ins
12. Avoid naps in the late afternoon or early evening*
13. Do not use recreational drugs of any sort.

*additional information/advice required.

RE; relaxation exercises, use of light boxes, taking supplements/herbs, biofeedback, counseling & other possibly beneficial therapies; please contact Clinic for further information.

The following Supplements may be worth trying BUT always check with your G.P first especially if you are on any other medications or have any other health problem.

Vitamin B complex 50mg per day
Calcium 500mg per day
Magnesium 500mg per day
5-HTP (L-5 Hydroxytryptophan) try taking two (2 x 100mg) before bed
Valerian – available as tablet or tea

Further advice can be found at &


A new study published last month in the journal Headache suggests meditation and yogic breathing can help mitigate migraine pain — specifically a routine called mindfulness-based stress reduction (MBSR) that combines elements of meditation and yoga.

The study involved 19 patients afflicted by chronic migraine pain being divided into two groups. One group of 10 were instructed in the methods of the MBSR intervention. These patients attended weekly classes and were instructed to meditate 45 minutes on their own, five days a week. The other nine patients received standard medical care including prescriptions and follow-up visits. All study participants were asked to keep headache journals and to record the frequency of migraine incidents, as well as pain levels and the time duration of each headache.

Results showed that the MBSR participants had trends of fewer migraines and were less severe, also the headaches were shorter in duration and less disabling compared to the group receiving standard medical care.

Despite the fact that Stress/anxiety is a well-known trigger for headaches (and research supports the general benefits of mind/body interventions for migraines), surprisingly there hasn’t been much research to evaluate specific standardized meditation interventions.

Although this is a very small study, hopefully it will lead to some further larger trials to confirm what I consider an important part of migraine treatment, which is the management of Stress/anxiety without using medication. This is an area we focus on at the clinic using various approaches including relaxation techniques, counselling, CBT or neuromodulation systems such as EEG biofeedback or HEG pIR ( see previous post).

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