Migraine and Brain Fog
Guideline: NICE CG150 Headaches; AHS Migraine Treatment Guidelines 2021; Bárány Society vestibular migraine criteria
What Is Migraine-Related Brain Fog?
Migraine is a primary neurological disorder — NOT just a headache. Brain fog during migraine (pre-ictal, ictal, and post-ictal phases) is caused by cortical spreading depression: a wave of neuronal depolarization that temporarily shuts down brain regions. 'Silent' or vestibular migraine can cause profound brain fog, dizziness, and cognitive impairment WITHOUT any headache. If your fog is episodic, lasts hours to days, and comes with light/sound sensitivity or dizziness — this may be migraine, not 'chronic brain fog.'
What to Do This Week
Seven actionable steps you can start today — free, evidence-based, and designed for when you're foggy.
Body
Regularize your routine: same wake time, same meal times, same bedtime. Regularity prevents migraine more than any single intervention.
Food
Eat every 3-4 hours. Never skip meals. Fasting is a potent migraine trigger. Keep trigger diary rather than eliminating everything.
Water
Drink a glass of water now. Keep a bottle visible. Aim for pale yellow urine. Don't overthink it — just drink regularly.
Environment
Open a window for 15 minutes. Fresh air exchange reduces indoor pollutants. If outdoors is bad (pollution, pollen), use a HEPA filter.
Connection
Reach out to one person today. Text, call, walk together. Isolation worsens every cause of brain fog. Connection is a biological need, not a luxury.
Tracking
Rate your brain fog 1-10 each morning for 7 days. Note sleep quality, food, exercise, stress. Patterns emerge within a week.
Avoid
Don't change everything at once. One new habit per week. Don't compare your progress to others. Don't spend money on supplements before nailing sleep, food, and movement.
What to Eat: The Steady Meals — No Fasting Approach
For conditions where blood sugar stability or regular energy intake is critical. Anti-crash eating.
Sample Day
- breakfast: Eggs + avocado + sourdough toast (within 1 hour of waking)
- midMorning: Greek yogurt + handful nuts
- lunch: Chicken + sweet potato + mixed salad + olive oil
- afternoon: Apple + cheese or nut butter
- dinner: Fish + rice + roasted vegetables
- preBed: Small handful almonds + banana (if needed)
For Migraine: NEVER skip meals (fasting is a potent trigger). Regular timing matters as much as content. Known triggers to test: alcohol (especially red wine), aged cheese, processed meats (nitrates), MSG, artificial sweeteners. Keep a food-trigger diary rather than eliminating everything.
This is about STABILITY, not restriction. Eat enough. If you have POTS, ME/CFS, or migraine, fasting is harmful, not healing. Ignore intermittent fasting trends if you crash.
When to Seek Urgent Help
STOP — Seek emergency care if: worst headache of your life (thunderclap), headache with fever and neck stiffness, headache after head injury, new headache in someone over 50, headache with new neurological symptoms (weakness, vision loss, speech difficulty), headache that worsens with coughing/straining. These may indicate subarachnoid hemorrhage, meningitis, or other emergencies.
Tests and Investigations
Headache Diary Analysis
Neurology Referral Criteria
Evidence-Based Lifestyle Changes
Trigger Identification & Avoidance
Use headache diary to identify personal triggers: irregular sleep, skipped meals, dehydration, alcohol (especially red wine), processed meats (nitrates), aged cheese, bright/flickering lights, weather changes, stress let-down (weekend migraine). Address the modifiable ones.
Evidence: Strong — NICE CG150 first-line recommendation.
Regular Sleep Schedule
Fixed wake time every day (including weekends). 7-8 hours. No lie-ins (weekend sleep-in is a classic migraine trigger).
Evidence: Strong — sleep regularity reduces migraine frequency in multiple studies.
Regular Meals & Hydration
Never skip meals. Eat every 3-4 hours. Stay hydrated (2-3L/day). Fasting is a potent migraine trigger.
Evidence: Moderate — well-established trigger avoidance.
Holistic Support
Morning sunlight
Strong — resets circadian clock, improves mood, supports vitamin D.
10-15 min outside within 1 hour of waking. No sunglasses needed.
Cyclic sighing breathwork
Strong — Balban Cell Rep Med 2023.
5 min daily. Double inhale nose, long exhale mouth.
Nature exposure
Moderate — cortisol reduction, attention restoration.
20 min in green space weekly minimum.
Medical Treatment Options
Discuss these options with your prescribing physician. This information is educational, not medical advice.
Acute Treatment: Triptans
Sumatriptan 50-100mg at onset (or nasal spray/injection for fast action). Take EARLY — most effective within first hour. Max 2 days/week to avoid MOH.
Evidence: Strong — gold-standard acute migraine treatment.
Prevention: CGRP Monoclonal Antibodies
Erenumab, fremanezumab, galcanezumab — monthly or quarterly injection. For episodic (4+/month) or chronic migraine after failing 2+ oral preventives.
Evidence: Strong — FDA-approved. 50%+ reduction in migraine days for ~50% of patients.
Prevention: Oral Options
Propranolol 80-160mg/day, topiramate 50-100mg/day, amitriptyline 10-50mg at bedtime, candesartan 16mg/day. Try for 2-3 months before switching.
Evidence: Strong — all NICE-recommended first-line preventives.
Supplements — What the Evidence Says
Supplements are adjuncts, not replacements for lifestyle changes. Discuss with your healthcare provider.
Magnesium
Dose: 400-600mg magnesium glycinate or citrate daily
Triggers, sleep, and meals matter more. Magnesium is a reasonable adjunct, not a replacement for proper acute treatment.
Evidence: Moderate — AHS Grade B recommendation for prevention. Some RCT support.
Riboflavin (B2)
Dose: 400mg/day
Adjunct only. If you're having 4+ migraines/month, you need medical prevention, not just vitamins.
Evidence: Moderate — one well-known RCT showed 50% reduction in migraine frequency. AHS Grade B.
Psychological Support and Therapy
CBT for migraine (specifically adapted — reduces frequency in some studies). Biofeedback training. If medication overuse headache → supported withdrawal with therapist.
What People With Migraine Brain Fog Say
What Helped
- • Headache diary — discovered the 'weekend migraine' pattern. Fixed sleep schedule eliminated 60% of attacks.
- • CGRP inhibitors — failed 4 preventives. Erenumab was life-changing. Monthly injection, 80% reduction.
- • Treating medication overuse headache — was taking painkillers 15+ days/month. Withdrawal was brutal but fog cleared significantly after.
- • Discovering vestibular migraine — years of dizziness + fog diagnosed as 'anxiety.' Neurologist diagnosed VM. Verapamil helped enormously.
What Didn't Help
- • Being told 'it's just headaches, take painkillers' — painkillers 10+ days/month CAUSES more headaches (MOH).
- • Elimination diets removing 20 foods — turned out only alcohol and aged cheese were real triggers. Restrictive diets caused more stress.
- • Expensive 'migraine supplements' — magnesium and riboflavin are the only two with real evidence. Everything else was expensive placebo.
- • Ignoring the cognitive symptoms — told neurologist about headaches but not about the 2-day fog afterward. Post-drome fog is part of the attack.
Common Mistakes
- • Taking painkillers too often (>10 days/month for triptans, >15 for simple analgesics = MOH risk)
- • Not trying preventive medication when having 4+ attacks/month
- • Attributing migraine-fog to a separate cause and investigating everything else
- • Not recognizing vestibular migraine (episodic dizziness + fog = see neurologist)
Surprises
- • That migraine can cause brain fog WITHOUT headache — 'silent migraine' or vestibular migraine presents as pure fog/dizziness.
- • That post-drome (hangover phase) lasts 24-48 hours with severe cognitive impairment — this IS the migraine, not a separate problem.
- • How much hormonal fluctuations drive it — perimenopausal migraines were 10x worse than reproductive-age ones.
- • That medication overuse headache was the cause of 'chronic daily headache' — stopping painkillers was the cure.
"If your brain fog is EPISODIC (comes and goes, lasts hours to days, with a pattern), consider migraine — even without headache. Keep a 4-week diary. Vestibular migraine is the most underdiagnosed cause of episodic cognitive dysfunction."
Quick Reference
Quick Win
Keep a headache/fog diary for 4 weeks: date, duration, severity (1-10), triggers (sleep, food, stress, weather, menstrual cycle), associated symptoms (light/sound sensitivity, nausea, dizziness, visual disturbances). Show this to your GP. Pattern = diagnosis.
NICE CG150 headache diary recommendation