There is at least a subgroup of patients who achieve marked improvement in the frequency and severity of their migraine attacks by lifestyle modification changes. For each individual patient, various aspects are more important than others.[5]Oskoui M, Pringsheim T, Billinghurst L, et al. Practice guideline update summary: pharmacologic treatment for pediatric migraine prevention. Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2019 Sep 10;93(11):500-9.
https://www.neurology.org/doi/10.1212/WNL.0000000000008105
http://www.ncbi.nlm.nih.gov/pubmed/31413170?tool=bestpractice.com
[36]Raucci U, Boni A, Evangelisti M, et al. Lifestyle modifications to help prevent headache at a developmental age. Front Neurol. 2021 Feb 2;11:618375.
https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.618375/full
http://www.ncbi.nlm.nih.gov/pubmed/33603708?tool=bestpractice.com
It is widely accepted that poor sleep and psychological stress are major aggravating factors for migraine, responsible at least in part for increased frequency and severity as well as the transformation from episodic migraine into chronic migraine.[37]Guidetti V, Dosi C, Bruni O. The relationship between sleep and headache in children: implications for treatment. Cephalalgia. 2014 Sep;34(10):767-76.
https://journals.sagepub.com/doi/10.1177/0333102414541817
http://www.ncbi.nlm.nih.gov/pubmed/24973419?tool=bestpractice.com
This is especially true for adolescents. Probing these areas and incorporating meaningful lifestyle changes into the treatment plan are needed for medium- and long-term success.
Psychological stress, as it pertains to migraine, arises most often from academic challenges or expectations and social conflict at school or at home.[21]Passchier J, Orlebeke JF. Headaches and stress in schoolchildren: an epidemiological study. Cephalalgia. 1985 Sep;5(3):167-76.
http://www.ncbi.nlm.nih.gov/pubmed/4042154?tool=bestpractice.com
Not infrequently, there are elements of anxiety and depression involved as well. The stress mitigation plans could range from a simple temporary adjustment of the school demands, to an intensive psychologist intervention and the involvement of a pediatric psychiatrist and/or psychologist.
Skipping meals, an overly disorganized lifestyle, poor hydration, lack of exercise, too much caffeine, and too much screen time are other lifestyle factors that may play a role in a patient's migraine frequency and severity.[5]Oskoui M, Pringsheim T, Billinghurst L, et al. Practice guideline update summary: pharmacologic treatment for pediatric migraine prevention. Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2019 Sep 10;93(11):500-9.
https://www.neurology.org/doi/10.1212/WNL.0000000000008105
http://www.ncbi.nlm.nih.gov/pubmed/31413170?tool=bestpractice.com