Travel Triggers and How to HALT Them
The movie “Sully” opened recently to mixed reviews. My favorite take on the film came from Washington Post writer, Elahe Izadi, who writes: “Tom Hanks is a great actor and seems like a swell guy, but Tom Hanks in movies does not have a safe track record when it comes to travel.”
She has a great point. Think about it. Most of Hanks’ hits have ended in a travel turmoil, and Izadi rifles them off: “Apollo 13;” “Cast Away;” “Road to Perdition;” “Catch Me if You Can;” “The Terminal;” “Cloud Atlas;” and “Captain Phillips.”
Izadi warns: “…never travel with Tom Hanks.” Sadly, I think I should come with a similar Warning Label: Traveling with Bill could lead to shipwreck, crash landing, frustration, isolation, and potential piracy.
Yes, travel, especial across several time zones by airplane, can leave me hungry, angry, lonely, and tired. You’ve probably heard the H.A.L.T. acronym -Hunger, Anger, Loneliness, and Tiredness. That’s far better than the situations Hanks gets himself into, but any one of the four may trigger a migraine for me. A combination of two or more usually spells trouble.
Travel, by it’s very nature, tends to create unnaturally stressful situations around those four simple factors, and not traveling is not an option. Air travel is most challenging for me. There are time stressors, noise stressors, wrong-food/no-food stressors, plain old fatigue, and even barometric-pressure stressors (yes, the cabin of a plane is pressurized to about 23.1 inches of mercury1). A brief article on the World Health Organization website discusses some medical concerns based on lower barometric pressure in planes2. While none are directly tied to migraine, we do know that changes in weather and barometric pressure do affect most migraineurs3.
Here are some things I do to avoid stressors that can plunge me into an attack:
Wear headphones on the plane (or train or automobile). They are not cheap, but a pair of good, noise-cancelling headphones are fatigue fighters, relieving two two triggers for me—noise and fatigue. The noise part is obvious. The noise level on a place ranges from an average of 85 decibels up to 105 decibels on take-off, according to an article by the BBC4. Long exposure to that level of noise can cause temporary hearing problems, the article says, including tinnitus, which, for me, usually signals an attack.
Most migraineurs (83% based on the Migraine in America 2016 poll) say sensitivity to noise is a symptom. As I look down the list of commonly reported symptoms I see several are also triggers for me. Light, noise, and odor are among the top five symptoms, for example. All can be triggers for me.
We usually put the headphones to good use by downloading and watching a good movie during the flight, which is entertaining, relaxing and even revitalizing…certainly as compared to the engines’ drone.
Get rest when- and wherever you can. This brings us to the difference the lower noise level can make to your level of fatigue. While it is the last letter in our H.A.L.T acronym, fatigue, I think, is my number-one trigger. I can eat well, exercise, and keep my stress level down, but one night of bad sleep can trigger a migraine.
I draw a difference between rest and sleep. I can sleep and not feel rested. That is often the case when I travel. Sleeping in hotels or going to bed and arising in a foreign time zone may not be restful. Therefore, I make every effort to stay rested even if I don’t sleep well. Getting off the plane and not feeling tired from the flight is a great first step.
On a recent trip (more details below) I got that one night of bad sleep while traveling home. We drove several hours from our camp in the Adirondack Mountains and spent a night in Burlington…at a bad hotel. Additionally, we had to get up at 4:30AM Eastern, to get a 6:30 AM flight. That’s like getting up at 1:30 AM Pacific. We did not get home unto 10PM Pacific that night…after a restless night of sleep. I had a terrible attack during the trip home.
One last word on sleep: melatonin. A recent study suggested that melatonin was more effective than sedatives in treating migraines. At one point, I was prescribed trazadone to help with my sleep, but I would often awake like a zombie. Melatonin not only helps with sleep, but also reportedly works on the pain receptors in the brain5. We like the melatonin gummies. They seem to take effect more quickly (As always, discuss with your healthcare provider before trying any new supplements).
Be prepared to abandon ship. I think Captain Phillips would appreciate this one. Our trip to the Adirondack Mountains required a planes-trains-and-automobiles-like travel effort from the San Luis Obispo County, CA. It’s never as easy as making one connection to remote places from our small-town airport. Two connections, a rental car, and 14-plus hours of travel can doom a migraineur.
Our recent trip included a cancelled flight between Dulles and Burlington. So, rather than stress out about it, we changed our plans. We detoured to Annapolis, MD and visited my father for two nights. (That was my wife’s idea.) So, we arrived at our destination late but rested and excited for having the unexpected visit with family.
The lesson learned here is to not stress out over altered outcomes. Using our H.A.L.T acronym, this curbs the angries. At one point in our trip we sat and watched the many people getting upset with the customer service agents who were working diligently to re-route travelers. We also saw many travelers who were kind, polite, and cooperative in their approach to travel. We made a choice to sit down and consider our many options, coming up with a great one for us.
Pack your own food. I am following a diet recommended in Dr. Josh Turknett’s book, The Migraine Miracle: A Sugar-Free, Gluten-Free Ancestral Diet to Reduce Inflammation and Relieve your Headaches for Good6.The title alone is a mouthful but the relatively simple recommendations have made a significant impact on my migraines. Unfortunately, the foods he recommends are not always easy to find. So, we stuffed ziplock bags with almonds, protein and snack bars, cheese sticks, and some deli meats in case we could not find (or did not have time for) a proper meal. We were more successful with that strategy on the outbound trip; less so on our return trip, which may also have contributed to my attack.
Phone a friend. This seems silly, but in keeping with our H.A.L.T theme, I often address loneliness with a brief phone call. I stay connected with a group of guys with whom I am both close and accountable. Their friendship and support always averts the sense of loneliness I can sometimes feel, especially when I’m having an attack. The problem is this: when I have already started to feel bad, I am far less likely to make that call. So, I have discovered that staying connected to close friends is a vary valuable preventative medicine. More than any drug, preventive or abortive, feeling connected to others is a huge stress reliever.
Other migraineurs may very well have different needs in this area. I crave connection. Others may crave solitude. Whatever it is that feeds our souls and staves off loneliness, take the time to do it.
Tom Hanks’ characters have landed in some sticky wickets, far worse than anything we are likely to encounter. Can you imagine trying to land a plane on the Hudson River or fight off Somali pirates while having a migraine attack? The stress of travel alone is enough for me to manage.
Can you tell when a migraine attack is coming?