The Migraine Renaissance Podcast

When the "Cure" Becomes the Cause: Escaping the Medication Over-Use Headache Trap

If you have ever felt the crushing weight of a migraine attack, you know that the word “pain” barely does it justice. In clinical studies and patient surveys, severe migraine attacks are frequently rated as more debilitating than kidney stones, fractures, or even childbirth. When you are in the middle of that storm, you will do almost anything to make it stop. I know I used to! You reach for the box of triptans or the bottle of NSAIDs because you simply need to survive the day. But I want to ask you a very important, though perhaps frustrating question: Could the very thing you are relying on to manage this awful pain actually be worsening the severity of it for you? Yes, this is a very real possibility, and it affects far more people than most realize. It is called Medication-overuse headache (MOH), and today, we are going to look at the science of why this happens and, more importantly, how we can break the cycle and start your Renaissance. An important note before we dive in: I do not mean that medication doesn’t have a valuable play a role here. In fact, preventative medication use can be critical for some people’s recovery journey. The Hidden Global Burden We used to think of medication overuse as a sort of “side issue.” We now know it is a significant driver of disability worldwide. According to the Global Burden of Disease (GBD) Study 2023 [https://pubmed.ncbi.nlm.nih.gov/41240916], the numbers are staggering. In the general adult population, about 1% to 2% of people live with MOH, but a recent meta-analyses by Husøy et al. [https://pubmed.ncbi.nlm.nih.gov/41057756] indicates that the global prevalence of MOH may be as high as 4.1% in adults aged 18–65. This comes out to tens to hundreds of millions of people seriously (and needlessly I might add) suffering world wide. Perhaps the most impactful finding from the GBD 2023 study is this: more than 20% of all health loss attributed to all headache types was actually due to medication overuse. Specifically, over 15% of health loss attributed to migraine and more than 50% for tension-type headache is driven by overconsumption of acute pain relief meds. In our Migraine Bucket [https://movewells.substack.com/p/why-simply-avoiding-triggers-isnt] https://movewells.substack.com/p/why-simply-avoiding-triggers-isntFramework [https://movewells.substack.com/p/why-simply-avoiding-triggers-isnt], imagine your “rescue” meds are meant to bail water out of the bucket (or perhaps prevent some water from flowing in). But in MOH, the medication eventually starts acting like a leaky faucet that stays on 24/7. Your bucket never gets a chance to empty because the medicine itself is keeping the water level high and even can shrink your bucket over time, making your trigeminal system highly “sensitized”. Are You in the “Overuse” Zone? So, how do doctors actually diagnose this? The ICHD-3 (the International Classification of Headache Disorders) sets clear criteria: * (A) Headache occurring on 15 or more days per month in a patient with a pre-existing headache disorder. * (B) Regular overuse for more than 3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache. * (C) Not better accounted for by another ICHD-3 diagnosis. But “overuse” can look different depending on the drug! Not all medications are created equal here. According to the Department of Veterans Affairs [https://www.healthquality.va.gov/guidelines/pain/headache/VA-DOD-CPG-Headache-Full-CPG.pdf] and EAN guidelines [https://pubmed.ncbi.nlm.nih.gov/32430926]: * The 10-Day Threshold: Triptans, ergotamines, and combination analgesics (like those containing caffeine) only take 10 days per month to trigger MOH. * The 15-Day Threshold: Simple analgesics like NSAIDs (Ibuprofen, Naproxen) or Acetaminophen are recognized to take around 15 days per month. * The High-Risk Red Zones: The VA guidelines highlight that opioids can induce MOH in as few as 8 days per month, and butalbital-containing medications (short acting barbiturates like Fioricet) can do it in just 5 days per month. Important note: MOH doesn’t affect everyone equally! It disproportionately affects females (with ratios ranging from 2:1 to 3.6:1, female:male) and typically peaks during the busiest years of life, between ages 35 and 54. Also individual variance can play a role in MOH issues too. Risk Factors and the Path to Chronification So now we know that medication overuse is a serious issue, but how do we better understand the risk of this developing so we can get ahead of it? It is critical to proactively focus on early identification before episodic migraine turns into a chronic struggle. The Department of Veterans Affairs notes several associations that significantly increase the odds of developing MOH: * High Headache Frequency: Having 7–14 headache days (tension type, cervicogenic, migraine attacks, etc.) per month (OR: 19.4; aka risk is 19.4X higher). * History of Migraine: (OR: 8.1). * Use of Other Medications: Using anxiolytics (anxiety meds; OR: 5.2), analgesics for any other condition (OR; 3.0), and sleep-inducing medications (OR: 2.5) are all linked to higher risk. As a general recommendation, The American Headache Society recommends that people should limit acute medication use to an average of two headache days per week, but as you can tell this does not account for the much higher risk medications such as opioids or butalbital-containing medications. If you find yourself exceeding this, it should be a prompt to consider more proactive preventive therapeutic approaches rather than just more rescue meds. Yes this can include medications, but also the 7-Pillars of Migraine Renaissance [https://movewells.substack.com/p/from-3-migraines-a-week-to-almost] are critical here too. The Science of MOH Sensitization: Why Rescue Becomes Trigger Now you might be wondering, “Why would a painkiller cause more pain?” It comes down to how these drugs interact with your nervous system over time. While the mechanisms differ between drugs, the risky medications share a common destructive path: they promote sensitization of the trigeminal nerve and facilitate central sensitization; basically shrinking your migraine bucket. Essentially, your brain becomes extra effective at experiencing pain and becomes more effective at having headaches. The threshold for what triggers an attack drops lower and lower. In Robin’s case, which we’ll look at in a moment, her brain was essentially “learning” to be in more pain because of a variety of interconnected factors, but also the constant presence of these drugs altered her brain’s chemistry and pain-processing pathways . A Narrative Journey: Robin’s Downward Spiral To understand how this can progress, let’s look at “Robin,” a composite case that mirrors so many people I speak with. (I was going to use a specific client story, but sometimes these cases are so specific that I had a hard time keeping it anonymous and protecting their privacy). Robin’s headache story started when she was about 26 years old after having her second son. She had experienced some random, infrequent headaches in the past, but it wasn’t until this last pregnancy that she started having diagnosed migraine attacks. She started with about two migraines a month on average. They were painful, but manageable with a triptan. Then, life got stressful. Her new baby added a wonderful, but challenging extra variable to life. Sleep quality, duration, and consistency dropped off as she was up throughout the night helping calm her newborn. Her visits to the gym dropped, then stopped all together, she felt like if she didn’t have time for a full workout, there wasn’t any point in going. Neck pain started creeping in, making it hard to find a comfortable nursing position, let alone work station posture. Over the course of the next 6 months or so as she fought to return to working while navigating this major life change, her migraine attack frequency increased to one a week. She started taking Ibuprofen on the “off” days for what she thought were tension or “stress” headaches. She needed to power through the day and this seemed like the logical way to do it at the time. By the end of that year, Sarah was waking up with a dull, “muddy” headache almost every day. She assumed her migraine condition was just naturally progressing and she wasn’t having much luck getting answers from her medical providers. Robin’s MRI and CT scans were normal; she should be in perfect health according to those pictures, right? This pain hides behind functional neurological changes that are invisible to most imaging types. To get through her morning work meetings, she took a triptan. By the afternoon, the “rebound” would hit, and she’d reach for a combination analgesic. Without realizing it, she was now taking acute meds 22 days a month. She knew that it wasn’t the best to take over the counter pain meds, but she thought that was just for stomach ulcers or something like that and her stomach felt fine. So she just pushed on. That the “muddy” daily headache wasn’t her original migraine, it was the withdrawal symptom from yesterday’s medicine. She found herself trapped in a loop where she was treating the side effect of her last dose with her next dose. Robin’s Migraine Bucket was shrinking and perpetually overflowing. Her trigeminovascular system was now in a constant state of high alert. The Gold Standard for Reclaiming Your Life If Robin’s story sounds familiar, please know there are fairly clear, evidence-based paths out. The European Academy of Neurology (EAN) and VA guidelines highlight a “Gold Standard” approach that integrates education, withdrawal, and prevention: 1. Education and Counseling The first step is not always necessarily a new pill. We need to find some clarity. It is critical to recognize the “cyclical nature” of MOH. You need to know the rationale for withdrawal and the expected timeline. As the EAN guidelines emphasize, education must precede any pharmacologic intervention, so here we are! But, you should also consult your trusted medical provider if you suspect that this is something you’re facing! 2. Withdrawal Protocols and Bridging * Abrupt Withdrawal: For those overusing simple analgesics (such as ibuprofen or acetaminophen), triptans (such as Maxalt, Imitrex), or ergot derivatives (such as Migranal, Cafergot), evidence supports the safety and efficacy of stopping “cold turkey” in most outpatient cases, however, this might not be optimal for many people and careful conversation with your provider is critical here. Tapering, bridging therapy, or preventative medication use at the same time might be better options. * Gradual Taper: For people overusing opioids, barbiturates, or benzodiazepines, a gradual taper is advised to avoid complications like anxiety or sometimes very serious drug withdrawal symptoms/syndromes. * Bridging Therapy: Often used for reducing the symptoms. Bridging therapies like short courses of corticosteroids (prednisone/prednisolone) and/or antiemetics (meds that aim to prevent nausea/vomiting) can help manage the temporary spike in headache and other related symtoms during withdrawal. 3. The Role of Preventive Medication Therapy A 2020 randomized controlled trial published in JAMA [https://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2020.1179?utm_source=openevidence&utm_medium=referral] found that starting preventive medication is a cornerstone for reducing the burden of MOH management, aligning well with the growing body of literature on the subject. Their study showed that combined withdrawal plus preventive medication led to the fastest reduction in headache days and the highest rate of reversion to episodic headache (74.2% at 6 months), compared with preventive medication alone (60.0%) or withdrawal alone (41.7%). * Topiramate: Has moderate evidence specifically for chronic migraine with medication overuse, though can carry relatively high side effect burden. * Anti-CGRP Monoclonal Antibodies: This represents the most significant advancement in recent years for chronic migraine and MOH. Temper et al. found [https://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2024.3043?utm_source=openevidence&utm_medium=referral] that Erenumab has significantly higher rates of “absence of MOH” compared to placebo and CGRP meds carry little to no risk of MOH. * These medications also generally offer a superior safety and tolerability profile compared to topiramate for migraine prevention, with significantly lower rates of stopping their use because of side effects, though the rates of improved headache days and migraine related disability are comparable. * OnabotulinumtoxinA (Botox): FDA-approved and demonstrated to reduce headache days by approximately 8 days per month on average in MOH populations. The 7-Pillars: Your Support System for Withdrawal While medications absolutely have their place in comprehensive migraine management, they are only a relatively small part of the story when we zoom out and consider people with migraines as more than just someone struggling with headaches. These medication strategies can help to manage symptoms, but they miss the mark when it comes to an effective total health perspective and actually getting people back to doing what they love and supporting a long, health, and vibrant life. The 7-Pillars of Migraine Renaissance are critical for managing migraine AND MOH because they provide the infrastructure to support your nervous system through the withdrawal phase, but are also critical foundational pieces of rebuilding capacity and resilience. For example: * Pillar 1 (Efficient, Effective Exercise): Tailored, progressive movement helps build resilience. It provides a natural endorphin release that, when done correctly, doesn’t trigger a rebound. * Pillar 2 (Sleep Optimization) & Pillar 4 (Stress Management and Nervous System Resilience): These are your natural “anti-sensitization” tools. When you withdraw from medication, your systems hyper-sensitive state is poorly regulated. * Prioritizing effective support of your circadian rhythm and nervous system regulation (like effective stress management, breathwork, HRV training, biofeedback, etc) helps rebuild your migraine bucket, setting the stage for the other pillars to do their work. * Pillar 7 (Sustainable Behavior Change): This is the “how”. Pulling from frameworks like the Transtheoretical model of change, the COM-B model, and S.M.A.R.T. goals, while having the support and structure to put it all together effectively into your life, help you have the highest odds of successfully making it through the withdrawal process even when it inevitably gets challenging. Really, integrating all of these 7-Pillars of Migraine Renaissance effectively creates a combined health AND migraine management strategy that addresses you as a whole person, not just a headache with a body. Actionable Steps: Your Medication Audit To move from “thinking” to “doing,” try these steps this week: * Conduct a 30-Day Audit: Look at your calendar or tracking app. On exactly how many days did you take any acute medication (triptans, NSAIDs, Acetaminophen, etc)? * Identify “Double-Dipping”: Are you using multiple medications (like an NSAID and a triptan) to try to avoid crossing the threshold? Remember, they all count toward the total days of medication use. * Seek Clarity, Not Just Relief: If you find you are bordering on overuse, schedule a visit with a trusted medical provider to discuss a formal withdrawal and prevention plan. Managing this is complex and often best done with clinical support to make sure you’re safe in this process. Building the Renaissance Collective Breaking the MOH cycle can be one of the most challenging first steps a person with migraine can do. It requires the courage to stand at the foot of that (often daunting) recovery mountain and choosing to take the first step. I am currently building a dedicated community for those of you who are actively fighting back and searching for social support. I’m calling it The Migraine Renaissance Collective. It will be a space for shared experience, community connection and support, and embodying the frameworks needed to make these changes stick. I want to know... What is the #1 thing that stops you from reducing your rescue medication use? Is it the fear of pain, the demands of your job, simply not knowing what else to use, or something else entirely? Reply to this email or comment below and let me know! I really do read every single reply, and your feedback is shaping how I build this community. Keep your eyes on your inbox! I’ll be unveiling the Collective very soon! With you on your journey to recovery,Dr. Dylan Wells, PT, DPT, OCS, CSCS Founder of MoveWells LLC | Creator of Migraine Renaissance Weekly 👋 P.S. If you’re feeling stuck in the daily cycle and want more personalized support to navigate your migraine recovery journey, you can click here to book a free demo call [https://move-wells.com/book-a-call] with me. You don’t have to do this alone! ✉️ P.P.S. If someone you know is struggling with issues like this, please consider sending it to them. It could be the thing they’ve been missing in their recovery for years. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit movewells.substack.com [https://movewells.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

Episode 6 - Insights Into Movement, Stress, and the Powerful Overlap with Therapist Ashley Brown

Episode 6 - Movement, Stress, and the Powerful Overlap: Insights from a Therapist Ashley Brown Host: Dr. Dylan Wells, PT, DPT, OCS, CSCSGuest: Ashley Brown, LCMHC, Psychotherapist & Running Coach, Founder of Move Talk Zen Episode Summary: In this episode, Dr. Wells welcomes Ashley Brown, a psychotherapist and running coach, to explore the deep connections between movement, stress, and mental health plus how this all fits into the migraine recovery puzzle. Ashley shares her journey of blending psychotherapy with movement, the science behind stress management, and shares some of her favorite practical strategies for managing stress and building resilience. Key Topics Covered: What is stress? Breaking down the physiological and psychological components. The difference between eustress (beneficial stress) and distress. How movement and exercise can be used as tools for mental health and migraine recovery. The role of mindfulness and intentionality in exercise—using movement to reflect, not just deflect. Maladaptive vs. adaptive coping strategies, and how to rewire for resilience. Understanding allostatic load and how cumulative stress impacts health. Individual differences in stress response: genetics, upbringing, and cultural factors. The importance of self-awareness, curiosity, and compassion in personal growth. The power of community and support systems in thriving, not just surviving. Practical breathing and meditation techniques for stress reduction. The interplay between medication, therapy, and lifestyle changes in holistic wellness. Notable Quotes: “Exercise is a superpower when mind and body are connected.” “Self-awareness is key, and curiosity is how we get there.” “You don’t have to do it alone—community and support are essential for thriving.” "Medications are like a life jacket.  Sometimes you need it to help keep you afloat, but you still absolutely have to do the swimming." Connect with Ashley Brown: Instagram: @move.talk.zen [https://www.instagram.com/move.talk.zen] Website: movetalkzen.com [https://www.instagram.com/move.talk.zen] Email: Ashley@movetalkzen.com [https://www.instagram.com/move.talk.zen] Available for therapy in North Carolina (in-person in Charlotte, NC and via telehealth) Resources Mentioned: Holmes-Rahe Life Stress Inventory Breathing techniques: Physiological sigh, 4-7-8 breathing This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit movewells.substack.com [https://movewells.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

The Strategic Process of Rebuilding Your Migraine Resilience

Hey, I hope you had a good weekend and are getting your week started off alright so far! Last, week we dove into what I believe is the central “why” behind the issues with much of our medical system’s approach to migraine management and my personal “why” for dropping everything to focus exclusively on helping people overcome their migraines. This week, I want to delve a little bit more deeply into the ways that we can address many of these systemic short comings. If your migraine system easily “overflows,” that sensitivity can feel frustrating, lonely, and often very misunderstood. (If you haven’t read my previous newsletter and the word “overflow” here doesn’t make much sense, click here to learn about The Migraine-Bucket Framework [https://movewells.substack.com/p/why-simply-avoiding-triggers-isnt]). Over time, as your brain adapts to repeated migraine activity, it can start to “learn” the migraine process, making the pattern more frequent and feel even harder to escape. That growing feeling of futility and frustration often deepens when people around you don’t fully grasp the gravity of what you’re facing, leaving you without clear guidance or companionship on the road to recovery. The good news is that brains can change. With the right inputs, a steady plan, and tactful support, your migraine systems can become less reactive, more resilient, and a lot more forgiving of real life. The first step is to recognize this: No, you’re not broken. You’re sensitized. This means that your system is just tuned a little bit differently than is ideal right now. Sure you might have a genetic predisposition or an injury history that makes you more likely to get migraines than the next person, but that does NOT mean that you have to just lay back and accept that high frequency debilitating migraines will be a part of your life forever. Today we’re connecting the dots between migraine science, several parts of the 7-Pillars of the Migraine Renaissance, and why sustainable behavior change is the foundation that makes all of it work. Then I’ll show you a brief example of what worked for my client “John,” and how coaching and community support can make the harder parts more doable, so this actually sticks. From “why it hurts” to “what actually helps” Let’s start with a quick recap tour of what’s happening behind the scenes during the migraine cascade: Certain areas of the brain develop a sort of instability and they have a hard time regulating their activity for a variety of reasons. When they’re in this state, they have a lower threshold of reactivity and they can get stimulated by triggers. This can cause them erupt into a slow, wave-like storm of neurological activity called cortical spreading depression (or subcortical spreading depression if it’s deeper inside the brain). This can sweep across different parts of the migraine-susceptible brain, disrupting normal brain communication, increasing sensitivity in some areas, and decreasing activity in others. When this hits the brain stem it can kick off the trigeminovascular system. The trigeminal nerve is the main sensory nerve of the face and much of the head and is the center of a lot of the migraine process. That switch getting flipped in this nerve causes it to releases inflammatory messengers (like CGRP/PACAP-38), dilates the blood vessels in the protective coating around your brain (the dura mater/meninges), and winds up the nerve sensitivity here as well as in the brain and brainstem. Repetition of this sequence of events kind of primes the system to fire sooner next time (sensitization) and rewires the system to get better at having migraines (through neuroplasticity). That’s why “small stuff” can start to feel big and more problematic. So what’s at the core of unwinding this process? * Supporting stability in the brain’s cellular energy production * Managing chronic low-grade inflammation * Improving heart and blood vessel health * Managing “allostatic load” (or the various stressors we face on a daily basis, more on this coming soon) * Re-connect brain regions that need to work better together (yes, also through neuroplasticity) * Promote “top-down” neurological pain control Delivered consistently enough, this allows our brains to create new defaults and enhance the ability of the brain to regulate itself and reduce susceptibility to these migraine processes. Those inputs live inside the 7-Pillars: movement, sleep, nutrition, stress regulation, neck/jaw/shoulder care, smarter trigger tracking, and, holding it all together, sustainable behavior change & community. We use The Migraine-Bucket Framework to simplify and organize our migraine fighting efforts even further. Think of your trigeminal system as a bucket. Triggers pour water in, the size represents your resilience, and overflow represents the migraine kicking off. Trigger management prevents water from getting into your bucket and resilience building practices make the bucket bigger. The secret here is that really effective migraine recovery isn’t just about avoiding all of the potential triggers of life forever and it definitely isn’t just managing migraine pain when it’s already hit you full force in the face. The magic of Migraine Renaissance is found in the strategic process of rebuilding resilience. How the 7-Pillars plug into the science (in plain English) * Pillar 1: Efficient, Effective Exercise * Right-dose movement boosts BDNF (your brain’s primary “grow & connect” signaling protein), boosts mitochondrial health (the parts of our cells that produce energy), steadies blood sugar swings, improves blood vessel health, and raises the threshold for that migraine triggering cascade over time. * We program brain-friendly, individualized progressions so that exercise prevents attacks instead of triggering them. * Pillar 2: Sleep Optimization * Sleep sits at the center of most human health systems. The areas of the brain responsible for your sleep patterns are also critically integrated into the migraine process. * Consistent circadian rhythm patterns promote improved brain stability and fully body health. * Strategic support systems stabilize the ways that you are able to make the most of your sleep and turn it into a migraine fighting tool instead of a migraine triggering burden. * Pillar 3: Nutrition & Hydration * We’re aiming for steady energy production (brain cells love this). We need adequate protein, fiber, healthy fats (like omega-3s), complex carbohydrates, and evidence-backed supplements, while keeping an eye out for your personal food tolerances. * Some foods are extra special and come with substances called phytochemicals, which are often the colorful stuff like the blue in blueberries. These can help a ton with fighting oxidative stress, which plays a major role in disrupting brain energy production and provoking the migraine processes. * Pillar 4: Stress & Nervous System Resilience * Stress or allostatic load management play a major role in stabilizing the migraine susceptible brain. * Not all stress is bad, but poor regulation of all of life’s stressors can be one of the most prominent triggers for migraines. * Self-regulation strategies such as breath work and mindfulness practices, increase vagal tone (basically increase the activity of our rest and digest systems), manage stress hormone levels, and calm the “always on” threat circuitry that lowers migraine triggering thresholds. * Pillar 5: Neck, Jaw & Shoulder Management * Because of the neurological connection between the trigeminal nerve and the upper parts of the neck (aka cervicotrigeminal convergence), local irritation can frequently directly provoke the already sensitized trigeminovascular system. * We create personalized strategies for managing pain, then we rebuild load tolerance, mobility, and resilience, so daily life stops poking the bear all the time. * Pillar 6: Trigger Tracking and Navigation (with the MigraineMetrix System) * Effectively identifying triggers is a critical first step for helping to manage your exposure to them. * We move beyond vague diaries to strategic, efficient pattern recognition that guides decisions (what to remove, what to add, and when). * Pillar 7: Sustainable Behavior Change & Community * This is the foundation and the glue that holds it all together. * Without a system to install and maintain habits, even the best plans with all the right intentions fail. * We use neuroscience and behavioral science-backed tools, personal preferences, accountability, and group support, so changes actually stick. Remember: Information alone won’t change your brain! Repeated, right-sized actions do. The 7-Pillar’s provide the structure to figure out the “what”; the Migraine-Bucket Framework provides the “why”; behavior science backed expert coaching and proven systems provide the “how” it actually shows up in your week. Client Snapshot: From Yo-Yo Efforts to Steady Wins John had 12–15 migraine days/month, felt scared of exercise, and had tried “all the things” for 2–3 weeks at a time. Nothing ever seemed to stick. We started with four main levers for 8 weeks: * A 10–20 minute Zone-2 walk most days (Pillar 1 + 4) * A simple meal focus (protein + fiber + color goals for 2 of 3 meals; Pillar 3) * A 5-minute “long exhale” practice after lunch (for a stress down-shift; Pillar 4) * 1 gentle neck routine for pain (Pillar 5). We eventually found that his MigraineMetrix flagged poor sleep after late-night screens, so we added in a 60-minute wind-down reminder (Pillar 2). At 10 weeks, John averaged about 6 migraine days/month, faster recovery, and felt confident enough to begin light strength work. The magic wasn’t one hack; it was fewer, high-value things, done consistently, with my support along the way (Pillar 7). Actionable Steps for This Week * Breath + Walk Habit Anchor (daily)After lunch, 5 minutes of slow breathing (inhale easy, longer exhale), then a 10–15 minute brisk walk. Connects Pillars 1, 3, and 4 in one micro-routine. * Plate-Check (each meal)Protein? Fiber? Color? (The first 3 of the big 5) If one is missing, add a small fix—e.g., berries, beans, a pack of frozen veg, or a protein add-on. (Pillar 3) * Sleep Boundary (nightly)Pick one: no screens 60 minutes before bed, or same wake-time every day. (Pillar 2) Sometimes small boundaries = big payouts. Listen/Watch With Me: New podcast Out Today! This newsletter pairs up with my newest episode breaking down some of the science above in an approachable way a little deeper and starts to uncover the remarkably impactful connections between several of the 7-Pillars of Migraine Renaissance. Ranging from exercise to weight loss to oral health there’s a lot of valuable nuggets in this one!Click the link below to watch the deeper dive into the remarkable world of building your migraine bucket. Why coaching/community makes this easier (and faster) Change is a skill, not a personality trait. It simply takes clarity on the most valuable steps to take, deep connection to your “why,” the right supportive systems, and intentional repetition over time. In studies investigating effective behavior change interventions, we see that across the board, people do better with structured, personalized guidance and community support rather than going at it alone. On my side I operationalize that with a consistent Monday cadence, a predictable format, approachable language, and clear actionable information, so you always have as much clarity and evidence-backed direction as you need. How You Can Work With Me If you’re ready for more support and an expert guide who has been through this and that will actually walk the path to recovery with you, I have two routs you can take: the 8-Week MoveWells Migraine Foundations Program (group; coming soon) and MoveWells Migraine Unlimited 1:1 Coaching for deeper, highly personalized work. Whatever you choose, I’m here to support you. Don’t let this condition rule your life. One day is a wish. Day one is a decision. When you take action, it likely won’t be perfect, but that’s ok. It doesn’t need to be. The progress you want to see takes the accumulation actions that build over time. Before you go—one quick question… Which single pillar will you emphasize this week and what’s the smallest action that supports it? Hit reply, I really do read every message. Until next time,Dr. Dylan Wells, PT, DPT, OCS, CSCSFounder of MoveWells LLC | Creator of Migraine Renaissance Weekly and Podcast P.S. If you haven’t already, don’t forget to download my free 7-Pillars of Migraine Renaissance Starter Guide. It’s packed full of ways you can start approaching the 7-Pillars. Click here and scroll to the bottom to download it! [https://movewells.substack.com/p/from-3-migraines-a-week-to-almost] This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit movewells.substack.com [https://movewells.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

Episode 5 - Migraines Unraveled: Science, Lifestyle, and Real Solutions

Episode Summary This episode of The Migraine Renaissance Podcast offers a deep exploration of the neurological, physiological, and many of the lifestyle factors underlying migraines. The host explains the science behind migraine triggers, the role of inflammation, the importance of brain connectivity, and practical strategies for long-term management. Listeners will gain actionable insights into nutrition, exercise, stress management, and the value of community support in reducing migraine frequency and severity. Time-Stamped Sections * [0:05] The Science of Migraines * Explanation of cortical spreading depression and its role in migraine onset. * The trigeminovascular system and release of inflammatory chemicals (CGRP, PACAP-38). * [1:10] Sensitization and Neuroplasticity * How repeated migraines lead to increased brain and nerve sensitivity. * The process of peripheral and central sensitization. * [3:45] Pain Pathways and Emotional Processing * The connection between pain, emotional centers, and the prefrontal cortex. * Migraines are a “connectopathy” and the importance of brain region connectivity. * [8:50] Nutrition and Brain Health * The role of nutrients (magnesium, B2, CoQ10, omega-3s) and phytonutrients. * The impact of fiber, colorful foods, and blood glucose management. * [16:00] Caloric Balance and Inflammation * How caloric surplus and fat (especially the visceral variety) influence inflammation and migraine severity. * The importance of maintaining a healthy weight. * [20:00] Stress and Migraine Threshold * The effects of chronic stress on migraine susceptibility. * Mindfulness, meditation, and breathing exercises for stress reduction. * [23:00] The Vagus Nerve and Gut-Brain Connection * The vagus nerve’s role in digestion and migraine management. * Breathing techniques to stimulate the vagus nerve. * [25:00] Neck, Jaw, and Oral Health * “Cervicaotrigeminal convergence” and how it explains the neck/migraine connection. * The importance of managing neck, jaw, and oral health. * [28:00] Long-Term Behavior Change * The necessity of sustainable lifestyle changes for migraine management. * Introducing global exercise guidelines targets and the value of gradual habit formation. * [32:00] Community and Support Systems * The role of accountability, coaching, and community in sustaining change. * Scientific evidence supporting group support for better outcomes. * [36:00] The Seven Pillars of Migraine Management * Recap of foundational strategies for lasting improvement. * Encouragement to implement small, consistent changes. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit movewells.substack.com [https://movewells.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

Emergency-era medicine wasn't built for migraine recovery

You learned to smile through the pain because “I get migraines” doesn’t land the way you hope it will. It sounds sort of small to people who haven’t lost days, weeks, months, maybe years to thundering, nauseating neurological storms that steal your sleep, your patience, and your plans. So you nod, you wave off concerned looks, you try to keep moving. Meanwhile, it progressively worsens over time. Your world shrinks: fewer dinners with friends, fewer workouts, and making plans just feels like setting yourself up for failure. Why bother making plans if you’re just going to have to cancel yet again? You start to tiptoe around life, instead of living in it. If that story feels familiar, I want you to know I’m not just piecing this together from things I’ve heard from my clients (though it lines up well with that too). I’m writing because I’ve lived through this myself. My Migraine Story and The System That Left Us Hangin’ Several years ago, migraines played a major role in my life. At the worst, it progressed to the point that I was having multiple migraine attacks per week. At first I couldn’t recognize the subconscious feelings of fear tightening the world around me; subtly starting to avoid all the brightly lit rooms, strong smells, loud places, long days, or certain foods. I remember frequently pretending that everything was fine when my visual aura was completely erasing the face of the person I was supposed to be having a connected conversation with, causing me to lose track of the discussion. Attacks often hit hard enough to make me lose days and nights to hiding in a dark room writhing in pain. They often felt so intense they would make me vomit from what felt like the severity of the pain. I did what most people do at first. I walked the medical maze, hoping for an answer that would explain everything and fix enough of it to let me breathe, but that clarity never made it’s way to me from that path. The clinicians I met with were truly very good people AND very good providers. They cared and they tried what they could within the constraints of the system we’re in, but I kept leaving with puzzle pieces and a vague instruction to “manage stress,” “eat better,” or “get more sleep.” None of that is wrong exactly. It just wasn’t a plan and it definitely didn’t support me in getting from where I was then to where I wanted to go. It’s was an obscure set of generalized strategies that didn’t answer any of my burning questions: “What is causing all of this to happen to me? Why should I be doing these things? How does any of that relate to my migraines? What does “eating better” even mean exactly? Surely these things are too simple and general to help my migraines, don’t you know how awful they are?” It took me longer than I’d like to admit, to understand the bigger problem: The system that I was asking to rescue me from this condition wasn’t built for what I needed. It couldn’t walk by my side on the path to recovery and show me the way. Modern healthcare evolved to stop bleeding, fight infection, and triage emergencies. Genuinely heroic work, and we’re all better for it. But migraines don’t usually behave like a lacerated artery. They live at the intersection between a sensitive nervous system with sleep architecture, nutrient availability, neuromusculoskeletal input from the neck and jaw, stress physiology, etc. and the habits that either stabilize or destabilize the whole arrangement. No single specialty pulls all of this together and shows you what to do, why and when to do it, and helps you troubleshoot when things don’t work according to plan. So you’re handed some of the parts to your health and are asked to assemble it yourself without the set of instructions that you need. I’m not interested at all in blaming the clinicians inside that system; I am one. I’ve seen the long days. The hours spent battling with insurance to reinstate coverage for the client that desperately needs more care. I’ve shared their constraints. The point isn’t that “people don’t care.” The point is that we’ve organized our care around emergencies while the things that plague us most as a society are now chronic, layered, and stubborn. If we want a different result, we need a fundamentally different structure to approach these problems. My Vision for the Future, How I Got Here and the Support You Deserve My story exploring this “different way” began out of mix of desperation and luck. I grew up in a medical family. Long conversations about case studies and learning about human health around the dinner table started when I was very young. I remember listening to medical audio books on our longer drives and I developed a deep interest in sports and fitness from an early age too. During my doctoral training in physical therapy, I started reading everything I could get my hands on about human health because I started to recognize the powerful overlap that much of our pains have with our other branches of health. I started exploring the science of exercise, nutrition, sleep, autonomic regulation, pain experience, migraine pathophysiology, etc. This set the stage for my intensive residency training where my passion and skills really began to develop. I was remarkably fortunate enough to have a handful of incredibly talented and insightful mentors in my early career and through my residency training. They helped to guide me during my rapidly growing experience and challenge my beliefs, allowing for a much deeper and richer immersion into clinical expertise than I believe I would have been able to collect almost anywhere else. As I gained clinical experience and worked through my residency training, I stopped asking, “What can I do to fix this?” and started asking, “What are the levers that we can pull together that will actually drive the adaptations needed for a specific goal and how can we implement these sustainably into the life of individual that I am partnered with.” I have now partnered in so many people’s journey’s toward health and wellness in a way that few professions other than physical therapists have the chance to do. Throughout my career I have found what it often takes to help someone to actually rediscover lasting health, from even some of the darkest corners of health decline. I’ve seen people run again after coming to me wheel chair bound, barely able to simply stand after years of disuse and horrific hospitalizations. I’ve seen people beat the odds and lose over half their body weight, overcome their type 2 diabetes, and leave their walker behind. I saw one man return from having more than 10 years of constant 7/10 headache to “barely noticeable” 2/10 pain. I’ve seen people having 3 migraines per week get to the point where they “can’t remember the last time they had one.” Throughout this process I began to recognize that the core of these changes was built around partnership with my clients and the science of effectively facilitating behavior change that is grounded in evidence, but tailored for individual, personalized goals. The core of this shift in my approach revolves around this belief: All of the knowledge about health sciences in the world is useless unless it can actually be translated into the next steps that someone can take today, next month, and a year from now that connects where they are now with where they want to go. My clients started reporting inspiring results. Their migraine frequency fell. Intensity often softened. The gaps between attacks grew. Eventually, many would report that months passed without incident, unless something majorly slipped up on their basic support routine or health habits. Now I’m fully focused on helping people with migraines because it should not be the case that migraines remain the number one cause of disability in people under 50yo. I really believe this can change. Believe That Change is Possible First, I want to shift our focus to the first step in this entire process. It’s the most crucial part to understand and something I wish I had believed sooner: Believe that change is possible. It absolutely is. You don’t have to stay stuck in this cycle forever. If you need a simple picture to anchor with, imagine your trigeminal system as a bucket. Everything you throw at it (fragmented sleep, skipped meals, neck tension, hormones, heat waves, stress spikes) pours water in or even change the size of the bucket. Overflow of this bucket represents an attack. Click here [https://movewells.substack.com/p/why-simply-avoiding-triggers-isnt] if you want to read more about that framework in depth. You can spend years playing whack-a-mole with individual streams, or you can learn two moves that always matter: pour in less water and intentionally make the bucket bigger. When people hear that, they often ask for a list. But lists can feel like another set of pieces. What you need is a greater depth of understanding and a program that makes those things livable. That’s where my work now lives. I call it the Migraine Renaissance not because I’m in love with titles but because renaissance captures what I’ve watched happen: a very practical rebirth of capacity. We build it through movement that regulates instead of overwhelms; sleep quality that’s intentionally trained to deepen and enrich, not left to chance; nutrition and hydration that makes a high-demand brain feel safe and supported; accessible nervous-system regulation practices that shift you from threat to steadiness; attention to the neck, jaw, and shoulders that can often provoke the same migraine pain circuits; pattern-tracking that replaces guesswork with signals we can follow; and behavior design that makes all of this small enough to implement and repeat until it becomes a part of who you are. Those are the pillars. Not exactly a checklist to tick off, but a place to start and focus your self-assessment efforts more efficiently. I originally encountered this framework piece by piece in the literature, but it was solidified in the clinic. Now I’ve had the rare privilege of walking the journey to recovery with people multiple times a week for months to years. You learn things about human motivation and behavior change in that kind of intentional proximity: how much effort a person can afford on a busy Tuesday, what they’ll actually do when they’re overwhelmed, which support systems survive contact with a real job, real kids, real bodies. After watching people who came in to my clinic as wheelchair users run again, watching daily pounding headaches fade to background noise, seeing three-migraines-a-week become almost none, I realized that these changes didn’t just come from heroic willpower or from one perfect pill. They came from narrowing the focus to the next lever we could pull, pulling it consistently, and letting physiology do what physiology does when you lower the water and build the bucket. My client’s have taught this back to me in their own words. One client had generally avoided exertion for years because exercise was a trigger. So we didn’t begin with the 5k he had recently been roped into (leading to a huge 3-day migraine attack). We began with five minutes of slow intentional breathing before bed, three neck-strengthening drills every other day, approachable exercise snacks, morning sunlight on his face, and a glass of water before checking emails. When that was sustainable and he was starting to build some resilience, we added a gentle walk/jog sequence and two simple strength days. Six weeks later, his sensitivity was starting to lower. He wasn’t “cured,” but something crucial had changed: his fear receded and his safe movement boundaries widened. His bucket was building and triggers were more manageable. The migraines that did come were sometimes quieter and shorter, less cruel. And he could now see why. I recognize that this could sound foreign if you’ve been through what feels like everything to address this, but this is just an invitation to curiosity. If your life has slowly arranged itself around your migraines, if you’ve stopped planning weekends, if you ration bright rooms and long conversations, ask whether the story you’re using is helping you get out. “I’m broken” rarely leads to action and subsequent change. “I’m sensitive right now, and sensitive systems can be supported and trained” often does. Here’s what I wish someone had told me years earlier: change is possible, but it won’t look like flipping a switch. It looks like deciding which stream you can turn down this week and which inch of the bucket you can build. It looks like boring fidelity to small acts that matter more than they feel like they should (consistent bedtimes, consistently mindful nutrition, consistent breath work, consistent strength done in doses that leave you stimulated, not annihilated). It looks like noticing your patterns with enough self kindness to stay with the experiment long enough for your nervous system to believe you. I can’t promise a cure. Migraines too individual, complex, and really are a genetic predisposition at their core, then colored by personal, situational, environmental, and behavioral factors. But that predisposition doesn’t guarantee that you have to suffer endlessly with high frequency, debilitating migraines and I can promise that when you treat this with the right framework, your system will respond. Mine did. My clients’ have. And what returns isn’t just fewer attacks; it’s a renewed sense of ownership over your days. You stop arranging your life around what you have to avoid and start arranging it around what you want more of. Take Action So if today is one of those days when you’re tempted to give up, take the smallest step that honors this new story. Drink the water before the coffee. Go to bed thirty minutes earlier than you planned. Do the two neck exercises while your computer boots. Step outside and let the morning light tell your brain what time it is. Not because any one of these is magic, but because together they teach your body how to more consistently return to a balanced state of regulation. I’m here for the long version of this work. The careful sequencing, the troubleshooting, the days that don’t go acording to plan. But even if we never speak, I want you to leave with this: you are not a fragmented collection of parts. You’re a person whose system has been sounding an alarm for a long time. These alarms take time to settle down, but they do get quieter when the environment changes. And environments are built one decision at a time. If you want to tell me which stream (trigger) you’re turning down first or which way you’re working to build your bucket, I’ll read it. If all you can manage today is that practiced smile, I get it. I’ve worn it too. But there’s a way to let it be more than camouflage. There’s a way to make it the first sign that you’re coming back to being yourself again. Until next time,Dr. Dylan Wells, PT, DPT, OCS, CSCSFounder of MoveWells LLC | Creator of Migraine Renaissance Weekly and Podcast This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit movewells.substack.com [https://movewells.substack.com?utm_medium=podcast&utm_campaign=CTA_1]