Posted on Leave a comment

How can mindfulness practices help with migraine?

Migraine is a common and disabling headache disorder. Painful migraine headaches frequently affect people between the ages of 18 and 44. Many common medication treatments for migraine may cause side effects that are difficult to tolerate, and can lead people to not take their medications as recommended, or to stop taking them altogether. A recent study suggests that up to 20% of patients with migraine have used opioids to treat their pain in the past year. Therefore, there is a great need for better and more tolerable treatments for people who have migraines.

Research has shown that combining behavioral treatments with preventive medication treatments works better for preventing headaches than medications alone. Mindfulness practice has also been associated with improvements in individuals with chronic pain, including migraine. Mindfulness is the mind-body treatment that involves purposely focusing one’s attention on the present momentary awareness and accepting it without judgment.

Stress is a well-known trigger for migraine. Moreover, stressful events have been associated with people experiencing more frequent or chronic migraines versus having them occasionally. Mindfulness can result in stress reduction, reduced emotional response to stress, and improved general happiness. In patients with migraine, pain severity and unpleasant symptoms can be reduced with this treatment.

Mindfulness can potentially strengthen emotional and cognitive control of pain by helping to train someone with migraine to reassess their pain in a nonjudgmental way and modify their evaluation of the pain. In addition, mindfulness practices can help to control depression, anxiety, and pain catastrophizing (an exaggerated negative feeling toward pain experiences), which can play a role in chronic migraine.

The study

In a recent study published in JAMA, a group of researchers investigated whether mindfulness-based stress reduction may provide benefit for people experiencing migraine. The study randomly assigned half of participants with migraine to the mindfulness treatment and the other half to only headache education.

The mindfulness-based stress reduction treatment incorporated eight weeks of two-hour, in-person classes, which included sitting and walking meditation, body scanning (sequential attention to parts of the body), and mindful movement (bodily awareness during gentle stretching using hatha yoga), bringing attention back to the natural rhythm of the breath. In addition, the study participants were encouraged to build their capacity to address physical and mental perceptions of their pain, and they were provided audio files for at-home practice.

The headache education treatment included a standardized protocol of eight weeks of two-hour, in-person classes that contained education about the biological, psychological, and environmental processes associated with migraines, headache triggers, and stress. The patients were also given time for questions, answers, and discussion during each class.

The results

The researchers demonstrated that mindfulness-based stress reduction treatment significantly improved people’s disability, quality of life, self-efficacy, pain catastrophizing, and depression compared to patients who only had headache education. Reductions in monthly migraine days were observed in those with mindfulness-based stress reduction treatment, but were not significantly different from those receiving headache education. The authors of the study explain that the reason they could not demonstrate improvement in the headache frequency could be the use of an active control group such as headache education, which itself may result in improvement of headache frequency.

Most importantly, the study demonstrated that mindfulness-based treatments can reduce the burden of migraine. With mindfulness, the participants of the study may have learned a new way of processing pain that may have a significant effect on their long-term health. The results of this study have major implications for both patients and clinicians, and the research can support a holistic, integrative treatment plan for patients with migraine, with less emphasis on nonmedical treatments.

What you can do

Many healthcare providers, including headache specialists, pain specialists, neurologists, and primary care physicians, have started to incorporate mindfulness-based treatment in their practices, or they have sought mindfulness-based programs or specialists for their patients.

There are also many ways for patients with migraine to practice mindfulness at home. Patients with migraine can integrate some of the following mindfulness-based practices in their daily life, including during a migraine headache:

  • Accept yourself, your present moment.
  • Lie on your back or in a comfortable position with no distractions, and direct your awareness to your body and breathing. Scan your body and observe your feet, legs, hands, arms, and other parts of your body.
  • Try to sit down in a comfortable and quiet place, close your eyes, take a deep breath. Try to do breathing exercises, paying attention to the sensations of your breath while inhaling and exhaling.
  • Sitting or walking meditation done outside in nature may be very relaxing. Focus on the experience of walking, being aware of the sensations of standing and the subtle movements that keep your balance.

Resources

There many are apps and quality resources for mindfulness and migraine learning and practice. Here are few online resources to explore:

Body scan mindfulness exercise for pain (Harvard Health Publishing)

Mindfulness Meditation for Migraine (American Migraine Foundation)

Mindfulness series for Migraine & Headache Disorders (Miles for Migraine)

Mindfulness and Migraine (National Headache Foundation)

Posted on Leave a comment

Skin in the game: Two common skin problems and solutions for men

895ae13d-3d7c-473c-99b8-6add3931098a

When I was on the junior varsity basketball team in high school, I wasn't surprised when I developed a case of itchy, flaky athlete's foot. After all, I was an "athlete," so I assumed it was a sign of dedication and hard work.

I was shocked when my mother told me the truth: it was due to poor foot hygiene, not my dribbling skills.

Fast-forward almost four decades, and I’m much more diligent about skin care. Still, some skin issues plague me at times, like they do many men. Here is a look at two common problems and solutions.

Dry skin

Symptoms of dry skin include scaly patches (with or without redness), itching, and overall dryness. You can get dry skin year-round — from the heavy heat of summer to the bitter cold of winter. Sun exposure damages skin, leaving it thinner and less likely to hold in moisture over time. Also, aging skin produces less of the natural oils that keep skin lubricated.

Treatment. The first line of defense is a moisturizer that softens and smooths skin with water and lipids (fats). Some moisturizers attract water to the skin and seal it in. Others prevent moisture loss by coating skin with a thick, impermeable layer.

  • Petroleum jelly. This waxy, greasy substance stops water loss without clogging pores. It can be used by itself but is also an ingredient in many moisturizers and ointments. Because petroleum jelly doesn’t contain water, it’s best used while the skin is still damp after bathing to seal in moisture.
  • Mineral oil. Mineral oil has the same effect but without a greasy feeling. It also should be used while skin is damp.
  • Moisturizing lotions and creams. These products contain both water and oils. They’re less greasy and more cosmetically appealing than petroleum jelly or oils. Look for moisturizers with at least one of the following ingredients: glycerin, urea, pyroglutamic acid, sorbitol, lactic acid, lactate salts, or alpha hydroxy acids.

Prevention. Try a few changes to help prevent dry skin:

  • Add moisture to the air with a humidifier or a pan of water set atop the radiator.
  • In the shower or bath, use lukewarm water (hot water can dry the skin by stripping it of natural oils).
  • Choose nondrying soaps with no abrasives or irritants. Super-fatted soaps or cleansing bars are less drying than regular, liquid, or antibacterial soaps.
  • To retain the water your skin absorbs while showering or bathing, apply jelly, oil, or moisturizer immediately afterward.

Athlete’s foot

Athlete’s foot is caused by dermatophytes, a group of fungi on the surface of the skin. Tell-tale signs include intense itching; cracked, blistered, or peeling areas of skin, especially between the toes; and redness and scaling on the soles. Dermatophytes thrive in warm, moist environments like pools, showers, and locker rooms where people walk with bare feet. The warm, moist environment of sweaty socks and shoes encourages them to grow.

Treatment. First, try an over-the-counter antifungal ointment, cream, or powder, such as clotrimazole (Lotrimin AF, Mycelex, generic), terbinafine (Lamisil AT, Silka,), or miconazole (Lotrimin AF spray, Micatin). It can take weeks for an infection to improve, and recurrences are common. If symptoms don't improve after several weeks, consult a doctor, who may prescribe antifungal pills.

Prevention. Keeping feet clean and dry is the best way to ward off athlete’s foot. Also, do the following:

  • Wash your feet well every day, and wear a clean pair of socks after your bath or shower.
  • Take time to dry your feet thoroughly (including each toe and especially the web space between the toes) after you bathe, shower, or swim.
  • Wear flip-flops or sandals around public pools and in gym locker rooms and showers.
  • Wear moisture-wicking socks that absorb sweat.
  • Don’t wear the same shoes two days in a row. Give shoes a 24-hour break between wearings to air out and dry.

Posted on Leave a comment

Anti-inflammatory food superstars for every season

473da591-1ddc-4b45-b0d2-0f29dcb59ef0

Berries and watermelon in the summer, kale and beets in the winter. The recipe for anti-inflammatory foods to enjoy can change with the seasons.

Your heart, your brain, and even your joints can benefit from a steady diet of these nutritious foods, and scientists think that their effects on inflammation may be one reason why.

Inflammation: How it helps and harms the body

Inflammation is part of your body’s healing mechanism — the reason why your knee swelled and turned red when you injured it. But this inflammatory repair process can sometimes go awry, lasting too long and harming instead of helping. When inflammation is caused by an ongoing problem, it can contribute to health problems. Over time, inflammation stemming from chronic stress, obesity, or an autoimmune disorder may potentially trigger conditions such as arthritis, heart disease, or cancer. It may also harm the brain. Researchers have found a link between higher levels of inflammation inside the brain and an elevated risk for cognitive decline and impairment. Regularly adding anti-inflammatory foods to your diet may help to switch off this process.

Three diets that emphasize anti-inflammatory patterns

Research hasn’t looked specifically at the anti-inflammatory benefits of eating foods that are in season. “But it’s generally accepted that eating what’s in season is likely to be fresher and obviously there are other benefits, including those for the environment,” says Natalie McCormick, a research fellow in medicine at Harvard Medical School. Eating foods that are in season may also help your grocery bill.

When it comes to anti-inflammatory foods, the goal should be to incorporate as many as you can into your overall diet. “Our emphasis now is on eating patterns, because it seems that interactions between foods and their combinations have a greater effect than individual foods,” says McCormick.

Three diets in particular, she says, contain the right mix of elements: The Mediterranean diet, the DASH diet, and the Alternative Healthy Eating Index. These diets are similar in that they put the emphasis on foods that are also known to be anti-inflammatory, such as colorful fruits and vegetables, whole grains, legumes, and healthy fats such as olive oil and nut butters. But just as importantly, these diets also eliminate foods — such as highly processed snacks, red meat, and sugary drinks — that can increase levels of inflammatory markers inside the body, including a substance called C-reactive protein.

Mixing and matching different foods from these diets can help you tailor an anti-inflammatory approach that fits your personal tastes, as can choosing the freshest in-season offerings. Whole grains, legumes, and heart-healthy oils can be year-round staples, but mix and match your fruits and vegetables for more variety. Below are some great options by season.

Winter anti-inflammatory superstars

In the cold winter months, think green. Many green leafy vegetables star during this season, including kale, collard greens, and swiss chard. Root vegetables like beets are another great and hardy winter option. Reach for sweet potatoes and turnips. Other options to try are kiwi fruit, brussels sprouts, lemons, oranges, and pineapple.

Spring anti-inflammatory superstars

When the spring months arrive, look for asparagus, apricots, avocados, rhubarb, carrots, mushrooms, and celery, as well as fresh herbs.

Summer anti-inflammatory superstars

Summer is prime time for many types of produce, and you’ll have lots of choices. Berries are a great anti-inflammatory option. Try different varieties of blueberries, blackberries, and strawberries. Go local with marionberries, huckleberries, gooseberries, and cloud berries, which grow in different parts of the US. Also reach for cherries, eggplant, zucchini, watermelon, green beans, honeydew melon, okra, peaches, and plums.

Fall anti-inflammatory superstars

Nothing says fall like a crisp, crunchy apple. But there are a host of other anti-inflammatory foods to try as well, such as cabbage, cauliflower, garlic, winter squash, parsnips, peas, ginger, and all types of lettuce.

Whenever possible, when you choose an anti-inflammatory food try to substitute it for a less healthy option. For example, trade a muffin for a fresh-berry fruit salad, or a plate of French fries for a baked sweet potato. Making small trades in your diet can add up to big health benefits over time.

Posted on Leave a comment

Making holiday shopping decisions quicker and with less stress

When faced with buying shoes, some people will be done in five minutes and be totally satisfied. For others, it’ll be a multiday process of reading reviews, comparing prices, consideration, and more consideration before making a decision.

Or not.

People can want to make a choice, but fear of making a bad one or of missing a better deal that might come gets in the way. The upcoming holiday gift-buying only ups the pressure.

“Making decisions is a taxing task,” says Dr. Soo Jeong Youn, clinical psychologist at Massachusetts General Hospital and assistant professor in the department of psychiatry at Harvard Medical School.

We’re doing it constantly, with what to wear and eat. It can also feel agonizing, even paralyzing, because sometimes we don’t know all the information, and so the brain fills in the gaps with worst-case scenarios, which does nothing to lower the stress.

Can we get better at making decisions? The short answer is yes. It takes some organization, but also a mindset shift in which we accept that there is no ideal choice. But before that, it helps to look a little more at why decision-making can be so difficult.

Knowing what to expect

Not all decisions cause the same stress. Big ones, like changing jobs or buying a house, take consideration, which we expect. Everyday choices, like our morning coffee order or groceries, are often automatic. And usually, the prefrontal cortex is in control. That’s the part of the brain behind the forehead, handling executive functioning skills — a term, Youn says, which tries to capture the complexity behind thinking. The prefrontal cortex processes information from the entire brain and puts it together to make a choice.

It’s the midlevel decisions — the new bike, winter jacket, toaster, or shoes — that become troublesome. They’re not huge purchases, but since we don’t make them regularly, we can spend more time weighing cost versus benefit. “We haven’t engaged in the thinking process,” Youn says.

Instead of the prefrontal cortex, the limbic system takes over. It’s the fight-or-flight response part of the brain, and there’s no careful weighing of factors. The goal is simple: survival, and it can cause us to make a less-than-optimal choice just to end the decision-making process — or to avoid the situation altogether by doing nothing, she says.

That’s not necessarily our goal. We want to make a good choice, but often there’s more in play, namely expectations. It’s tied into how we get viewed and what our worth is. If it’s a present, we worry about whether it expresses our feelings appropriately. As Youn says, “That decision is not just about that decision.”

And underlying it all is the fear and regret that you picked the wrong thing.

But to that, Youn poses a question: Wrong for what?

Get your focus

Often, people go into a purchase without being clear on what they need. Is the item for warmth, durability, exercise, style? Does it have to have special features? Do you need it quickly? Establishing a scope gives us something to refer back to and ask, “Does this fit with my purpose?” Conversely, with no parameters, we spend more time and angst making decisions, and sometimes keep looking under the belief that the “perfect” thing exists.

“We want this to check off all the boxes, even though we haven’t defined what all the boxes are,” she says.

For some people, the difficulty is in making the decision, but once done, the stress is over. But for others, the worry continues: the limbic system is still activated, and that’s when regret or buyer’s remorse comes in. Youn says to treat it like that song in your head that won’t go away, and give it some attention.

Examine the worry and name it. If you’re wondering about missing out on something, ask, “Why is that important?” And then with every assumption ask, “And then what would happen?” The process might reduce the magnitude of how much something actually matters. If that doesn’t work and you’re worried that you missed out on a better deal, then do some research. Whatever the result, even if it wasn’t in your favor, take it as a lesson that you can use for the next decision.

Lean on routines

New decisions take energy. That’s why routines are helpful — they remove the uncertainty of what to do in the morning or how to get to work. When possible, Youn says, use previous knowledge instead of constantly reinventing the wheel. If you like a pair of sneakers, there’s no problem with rebuying them if your needs haven’t changed.

If they have, just re-examine the new components, not the stuff you already know. And if you feel like you’re getting stuck in the evaluation process, ask yourself, “Is this worth my time?” The question creates a pause, brings you back into the moment, and allows you to decide how you want to proceed.

More research won’t help with decision-making or decision regret

It helps to realize that when we do our research, there comes a point where we’ve seen everything. In fact, more information becomes overload. What helps is to shrink down options as soon as possible. Maybe start with 10, but quickly get to five, then three, and finally two to compare before picking the winner. What can also help is setting the timer on your phone and giving yourself a certain number of minutes to make a choice. Sometimes that self-imposed deadline can keep us on track, and we can move on to the next decision.

But there can always be a nagging feeling that there’s more to know. In reality there isn’t, and actually we can’t know everything and don’t have to know everything — and that’s all right. As Youn says, “It’s an illusion.”