Migraines: The 1-2-3 Program In 13 Steps

The 1-2-3 program referred to in the title of David Bucholtz‘ book is actually this, at least in abbreviated form:

1. Get of all medications that you possibly can be off, especially medications which are “rescue” drugs and not taken on a regular schedule.
2. The diet, which is the bit everybody talks about.
3. Preventative medications. if the diet doesn’t help you enough (and only then) find a preventative med which works for you and use that too. He mentions a lot of different preventative medication options, and advocates experimenting until you find a med or combination that works for you.

Personally I think the 1-2-3 are out of order and incomplete for those with frequent migraine or chronic daily headache type pain. It’s virtually impossible for chronic severe pain sufferers to wean off all pain medications until the pain itself is less severe and/or frequent. Or, if we can manage it, the pain is so incapacitating that we can’t function at all and most people can’t afford to take several weeks out of their life to be incapacitated.

What I did, and would recommend to anybody else if they can cope with the more complicated method, is this order of things:

1. Read ALL of the book, every single word. You don’t have to agree with it all, but you do need to understand where he’s coming from. If it takes a few weeks, that’s OK. While you’re reading, slowly wean yourself off anything containing caffeine (tea, coffee, cola, etc.) – this might take a while as they’re likely to cause rebound headaches if you lower your intake quickly.
2. Start the diet, but remember that you don’t need to start all at once. Start with “low hanging fruit” items which are easy to switch out and get more strict as you go along and get used to it. Definitely stop all caffeine at this point. You can start planning for how you’ll deal with the full diet, too.
3. Start weaning off medications – take smaller doses when you take them, try to put off taking rescue drugs if you can, etc. Wean off anything that might cause rebound headaches especially – see list in book. Steady-state meds which you take on a regular basis regardless of pain levels are least important at this point I think.
4. Start journaling as much about migraine triggers and pain symptoms (all pain symptoms – not just ones you call migraines) as you can. Record everything that might be a trigger or a symptom, and all meds/ supplements taken. Keep journaling every day as you go along the next steps.
5. Work up to full strict diet as prescribed in the book, being utterly careful that everything is as strict as possible. Watch for additives in ANYTHING that comes with a packet and keep checking them – companies change ingredients without notice quite often.
6. If you know of any non-food triggers which are controllable, do your best to control your exposure to these.
7. Wean off all rescue drugs, and as much of the steady-dose preventatives as you can manage. Your pain/headaches should be significantly less at this point.
8. Stay at this state, being super strict about the diet and journaling everything you can.
9. When you do have pain/migraine, can you pinpoint what’s caused it? At this point, I got migraines when there was storm front hit (abrupt barometric pressure change), when I was exposed to certain aerosols, and when there was acute emotional or physical stress, but could almost always pinpoint the stressor or weather event that caused it. The feeling of control just from knowing what caused the pain was amazing! If you discover more non-food triggers then work on controlling your exposure to those rigorously too.
10. Stay at this point, ideally, for several months to give your body a rest from migrainous pain and a chance to get less “trigger happy”. I found things continued to improve for several months even though I wasn’t doing anything differently. I think the nervous system needs time to settle and heal.
11. If you are still getting pain you can’t deal with, work with increasing preventative/steady-state meds until things are at a level where you can function. (His step 3). If you needed to do this, go back to step 9 and do it again – your body NEEDS the break.
12. Start to make diet less strict, journaling any food change to assist you. Any food will stay in your system for about 4 days so don’t do trials closer together than 4 days apart. Remember the “bucket of triggers” idea from the book and if you react to a food but it’s one you really like, see if you can tolerate a smaller amount.
13. Find a state where your diet, your preventative and rescue medications, and your pain levels are all something you can cope with. The pain won’t be zero and you’ll still have a lot of food limitations, but there will be a level of compromise that you find acceptable. Personally, I found that I would have been happy to stay on the über strict version of the diet forever, it reduced my migrainous pain levels about 95% – if the price for that was the strict diet, it was totally worth it!

I must admit, “Heal Your Headache: The 1-2-3-4-5-6-7-8-9-10-11-12-13 Program” just doesn’t have the same ring about it. Perhaps Bucholtz was onto something after all?

- Ricky