Traveling when you have migraine or chronic migraine can be an overwhelming experience because there are so many variables and routine changes that must be navigated, but, with the right preparation, it is possible to travel when you have migraine.  You deserve a good vacation and the likelihood is that you’ll feel better on your trip than you typically feel at home because there is less stress. 

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I have high frequency chronic migraine and have traveled the globe since diagnosis. In all of my travels, I can think of two attacks that were debilitating enough that I still remember them. Other than that, all of my memories are from my trips and the fun time I had at each location. And even with those two attacks, I was prepared in advance so that I knew how to manage the attacks when they did happen. Ironically, both of those attacks took place in foreign countries and I managed just fine!  

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Being prepared and instinctively knowing what to do made things much easier. So here are my tips on traveling with chronic migraine, I hope that you find them helpful. 

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Start with a familiar location

If this is your first trip since your migraine diagnosis, you may benefit from visiting a place that is familiar. This way, you know what to expect and you already are familiar with areas that may or may not be triggering. Mentally prepare and set up a plan for what you will do when a migraine attack happens. If you’re traveling with others, review this plan with them so that they know what to do and expect. 

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Create your own safe space

If you’re traveling with a group, book your own room and bathroom. This will give you control over an environment and allow you to have a quiet, safe space to retreat to when necessary and you won’t feel like you’re inconveniencing anyone if you have to spend several hours in the bathroom lying on the floor or vomiting. 

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Consider your itinerary

While your nervous system and stress levels likely will relax during your vacation and your probability of attacks will decrease, it’s important to give your body time to rest and recover. So ensure that your itinerary includes down time and opportunities to meditate and rest. 

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Try as much as you can to adhere to your standard sleep and meal schedule as migraine brains thrive on routine. If traveling overseas, sleep as much as you can on the plane, then do gentle activities until bedtime that night so that you can easily adjust to the time change. A low dose of melatonin (.5mg) 4hrs prior to bedtime can help with any jet lag.

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Prepare for flight

Typically the most anxiety is focused on air travel and getting to the location; but, with the right preparation, navigating the airport and managing a flight does not have to be so overwhelming. 

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Here are a few steps to make this facet of your trip not so overwhelming:

• Arrange a travel bridge and rescue plan with your doctor. If you are concerned about barometric pressure changes, there are certain medications that can help with in-flight pressure changes and make flight easier to tolerate. Medications to discuss could include a low-dose steroid the day before and day of travel or a short bridge of acetazolamide to help with barometric pressure sensitivity.
  
  Other items to discuss with your doctor: a stronger rescue medication like an intranasal NSAID (like Sprix) or an injectable triptan or NSAID to have available in the event you do have an attack that requires stronger intervention than your standard acute medication. Note that Sprix needs to be refrigerated so make room for ice packs.

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• Check prescription status and ensure you have enough acute and preventive medications to last your entire trip. This includes your daily preventive meds, as well as your standard acute meds. When traveling, keep all of your medications (with Rx labels) in your carry-on in the event that checked luggage is temporarily lost.
  
  
• Prepare your carry-on travel kit. Helpful items can include soundproof ear buds, your neuromodulation device, topical gels (like a migraine stick), electrolytes, and rescue meds. I typically like to store all of these tools in my neuromodulation device carrier so that everything is in one place. 

If traveling overseas, I will take a Benadryl shortly after takeoff so that I can reduce histamine levels and get good sleep during the flight.

• Call the airline in advance and arrange for an aid.  They will escort you from luggage check-in to the gate. This person may offer you a wheelchair, if that is helpful for you. If being pushed (in a wheelchair) triggers your motion sensitivity, you can simply ask them to walk you through the airport as you hold onto their arm. This will help you bypass long, triggering lines (helpful especially if you have comorbidities like POTS) and navigating busy areas that may trigger vestibular symptoms.
  
  Having an aid also will allow you to board early and get settled on the plane in advance. The airline also will arrange for an aid to meet you upon landing and they will help you navigate the airport upon arrival.
  
  
• Pack light. I know there is an impulse to pack all of the things but packing light will reduce strain on your neck and shoulders. I typically travel with just a carry-on because larger bags are too much for me to navigate. Also, I don’t like to be separated from my meds and other necessities. By being strategic with the shoes and clothes that I pack, I can reduce weight and include any necessary migraine tools. 

• Use the resources available to you. Don’t feel like you need to pack extra ice packs, etc (one slim one is all I typically take with me) as flight attendants know how to make ice packs if you get a migraine attack mid-flight. I traditionally pack this ice pack in my carry-on luggage and use it to keep meds cool. If big bottles of water are too heavy for you to carry through the airport, flight attendants also will provide you with extra cups of water and ice if you need them.
  
  Also remember that hotels have ice machines on each floor, so you can easily make ice packs in your hotel room if you need to. I personally have found that I end up rarely needing most of my migraine tools during my trips, so using available resources can lighten the load.
  
  
• Be COVID ready. Since COVID can complicate your migraine disease or headache disorder, it’s best to take precautionary steps to prevent infection. This includes wearing a KN95 or N95 mask in the airport and on the plane and when indoors/in high-traffic areas, as well as running a personal HEPA filter during your flight and if dining indoors.
  
  

Be strategic with snacks.
This is something you don’t need to overdo unless you’re completely unfamiliar with where you’re visiting. In the past, I’ve gone overboard with snacks, ended up really enjoying the local food, and did not eat any of my packed snacks.

Read up on your destination in advance and understand what their most common meals are. For example, as someone with gastroparesis and POTS as comorbidities, I seek out nearby places that serve smoothies and other gastroparesis-friendly meals in advance. I will pack a few packets of bone broth, as well as my daily electrolyte intake needed for POTS. But, through experience, I’ve learned that I don’t need all of the granola bars and other snacks - they end up taking up a lot of luggage space and rarely are used!

Since I have gastroparesis as a comorbidity, I follow my gastroparesis way of eating (within reason) so that I don’t add unnecessary discomfort. Doing so means that I’ll be able to enjoy my destination even more.

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Have a nimble daytime emergency kit

Once at my destination, I keep an emergency kit with me throughout the day. This includes one acute medication, my migraine stick, and a note written in the local language that explains what help I need in the event I have an attack in a public space. 

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I have migraine with aura, so public attacks may require more help from strangers than migraine without aura because I experience proprioception, motor weakness, vertigo, and dysphasic auras. So I keep a note saved in my phone and will point to what I need to communicate. It’s been incredibly helpful when traveling in foreign countries. 

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Here is an example of what I used when I used to travel to Barcelona for work: 

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What do I do if I have a flare?

There are times when symptoms flare up and I need to take time to myself. This is why I recommend booking your own room and bathroom so you can have control over the entire environment, including lighting, air conditioning, as well as the bathroom. 

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Having my own space also removes any guilt I may have about not being able to participate in group activities because I can quietly disappear while everyone else goes about their day. I typically find that spending an hour or two in the dark, in a fetal position can return me to baseline so that I can enjoy time with others and give them my best self when I am ready. 

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Additionally, I personally travel with a bridge dose of steroids that I can take in the event if I have a flare. This will return me to baseline so I can enjoy the rest of my trip. 

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So that’s it! I hope that this is helpful for you. I personally have found that preparing for the trip and the anxiety about migraine prior to the trip is much more profound than living with migraine disease during the trip. 

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Anxiety is about being unsure about the future, so being prepared, being as knowledgeable about what to expect, and having a sense of control over my environment will help assuage much of my anxiety so that I can be excited for the actual trip and put more attention toward fun things, like mapping out the sites and thinking about what fun clothes I’m going to pack. 

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