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Migraine is a common and disabling headache disorder. Painful migraine headaches frequently affect people between the ages of 18 and 44. Many common medication treatments for migraine may cause side effects that are difficult to tolerate, and can lead people to not take their medications as recommended, or to stop taking them altogether. A recent study suggests that up to 20% of patients with migraine have used opioids to treat their pain in the past year. Therefore, there is a great need for better and more tolerable treatments for people who have migraines.

Research has shown that combining behavioral treatments with preventive medication treatments works better for preventing headaches than medications alone. Mindfulness practice has also been associated with improvements in individuals with chronic pain, including migraine. Mindfulness is the mind-body treatment that involves purposely focusing one’s attention on the present momentary awareness and accepting it without judgment.

Stress is a well-known trigger for migraine. Moreover, stressful events have been associated with people experiencing more frequent or chronic migraines versus having them occasionally. Mindfulness can result in stress reduction, reduced emotional response to stress, and improved general happiness. In patients with migraine, pain severity and unpleasant symptoms can be reduced with this treatment.

Mindfulness can potentially strengthen emotional and cognitive control of pain by helping to train someone with migraine to reassess their pain in a nonjudgmental way and modify their evaluation of the pain. In addition, mindfulness practices can help to control depression, anxiety, and pain catastrophizing (an exaggerated negative feeling toward pain experiences), which can play a role in chronic migraine.

The study

In a recent study published in JAMA, a group of researchers investigated whether mindfulness-based stress reduction may provide benefit for people experiencing migraine. The study randomly assigned half of participants with migraine to the mindfulness treatment and the other half to only headache education.

The mindfulness-based stress reduction treatment incorporated eight weeks of two-hour, in-person classes, which included sitting and walking meditation, body scanning (sequential attention to parts of the body), and mindful movement (bodily awareness during gentle stretching using hatha yoga), bringing attention back to the natural rhythm of the breath. In addition, the study participants were encouraged to build their capacity to address physical and mental perceptions of their pain, and they were provided audio files for at-home practice.

The headache education treatment included a standardized protocol of eight weeks of two-hour, in-person classes that contained education about the biological, psychological, and environmental processes associated with migraines, headache triggers, and stress. The patients were also given time for questions, answers, and discussion during each class.

The results

The researchers demonstrated that mindfulness-based stress reduction treatment significantly improved people’s disability, quality of life, self-efficacy, pain catastrophizing, and depression compared to patients who only had headache education. Reductions in monthly migraine days were observed in those with mindfulness-based stress reduction treatment, but were not significantly different from those receiving headache education. The authors of the study explain that the reason they could not demonstrate improvement in the headache frequency could be the use of an active control group such as headache education, which itself may result in improvement of headache frequency.

Most importantly, the study demonstrated that mindfulness-based treatments can reduce the burden of migraine. With mindfulness, the participants of the study may have learned a new way of processing pain that may have a significant effect on their long-term health. The results of this study have major implications for both patients and clinicians, and the research can support a holistic, integrative treatment plan for patients with migraine, with less emphasis on nonmedical treatments.

What you can do

Many healthcare providers, including headache specialists, pain specialists, neurologists, and primary care physicians, have started to incorporate mindfulness-based treatment in their practices, or they have sought mindfulness-based programs or specialists for their patients.

There are also many ways for patients with migraine to practice mindfulness at home. Patients with migraine can integrate some of the following mindfulness-based practices in their daily life, including during a migraine headache:

• Accept yourself, your present moment.
• Lie on your back or in a comfortable position with no distractions, and direct your awareness to your body and breathing. Scan your body and observe your feet, legs, hands, arms, and other parts of your body.
• Try to sit down in a comfortable and quiet place, close your eyes, take a deep breath. Try to do breathing exercises, paying attention to the sensations of your breath while inhaling and exhaling.
• Sitting or walking meditation done outside in nature may be very relaxing. Focus on the experience of walking, being aware of the sensations of standing and the subtle movements that keep your balance.

Resources

There many are apps and quality resources for mindfulness and migraine learning and practice. Here are few online resources to explore:

Body scan mindfulness exercise for pain (Harvard Health Publishing)

Mindfulness Meditation for Migraine (American Migraine Foundation)

Mindfulness series for Migraine & Headache Disorders (Miles for Migraine)

Mindfulness and Migraine (National Headache Foundation)

"No!"

It might have been endearing as your child’s first word, but dread often kicks in when that word starts to follow parental requests. Experiencing resistance to small or big asks? Stuck in arguments that seem to go in circles and leave you exasperated with unmet requests? The good news is that this pattern can be disrupted. First, you’ll need to identify reasons behind the opposition. Then you can apply relevant strategies to see more helpful behaviors instead.

Below are some examples of opposition drivers and tips to address them.

Difficulty with transitions

If you find that your child resists a request right after engaging in an activity, it might be that your child first needs time to transition. This can be a common experience when parents make requests while children are playing video games or another stimulating activity. One way to manage this is to give your child a five- or 10-minute heads-up (whichever they might need) that you will be asking for the game to stop. This gives your child time to find a place to pause if playing a video game and to transition.

Some families find it helpful to talk with their children before playtime begins to learn what game or activities will be taking place, and how much advance notice might be helpful before the activity would need to stop. This invites collaboration and shows that you respect that not all moments are ideal for stopping a game.

Independent streak

Children almost never are in control, and resistance can show up when that wears on them. Try to fold in elements of choice and control throughout the day for children (that are within a framework you determine) to create more of a balance with your requests. Perhaps you let a young child know that they will need to wear long sleeves and pants because of the weather, but they can pick which top and pair of pants to wear that day. Another idea is to invite your child to pick a side dish for a future dinner from a premade list of a few options.

It also helps to create opportunities for your child to practice being independent. This fosters mastery and offers experiences of feeling in control. This could look like your child preparing any parts of meals that are age-appropriate (for example, a three-year-old could pour cereal into a bowl; a five-year-old could measure ingredients for baking). The kitchen counter may be extra sticky as your child learns new skills. With time, your child will be more adept, and your counters will be cleaner.

Hunger and tiredness

We need both food and sleep to recharge our batteries. When we run low on either or both, it’s extra difficult to be our best selves. If you find that your child is crankier than usual, reflect on when your child last ate and how your child slept the night before (or napped if your child is of napping age). If it’s been a while since your child has eaten and/or your child did not sleep as much as usual, your child may need to recharge before being more receptive to requests. Have your child grab a healthy snack or meal if needed. If sleep is the issue, validate to yourself that this is frustrating that there is no quick fix. Acknowledge privately they are not their usual self at this moment and may be more receptive tomorrow.

Resistance also may crop up when children are coming down with a viral illness, so keep an eye out for any symptoms that may emerge.

Mental health challenges

Everyone has off days, but a persistent pattern of resistance to requests and distress following them may suggest that a child is experiencing mental health difficulties. For example, if a child appears oppositional every morning before school, it could be that they experience anxiety about going to school and are trying to avoid the distress they experience when there. In this case, it is important to ignore the "no" bait and focus on the emotion behind the refusal. Validate or acknowledge how your child is feeling to open the door to learn more. For example, you could say, "You seem really worried about going to school. What about school has been so tough lately?"

Use a similar approach for symptoms of depression, such as withdrawing from and refusing to engage in activities: validate your child’s feelings and invite your child to share more to help you understand their experiences. Discovering what is driving the resistance can allow you to develop a collaborative plan to support your child’s needs and get extra help if needed. Cognitive behavioral therapy is an evidence-based treatment for children experiencing anxiety and/or depression. Your pediatrician can be a helpful resource for mental health treatment referrals. The Anxiety & Depression Association of America also provides treatment resources.

Sometimes, oppositional behavior is pervasive. It can include a frequent loss of temper, irritability, difficulty following the rules, defiance of authority figures, spitefulness, and more. If these behaviors occur at home and also show up in other settings, such as at school, a child may be experiencing symptoms of oppositional defiant disorder. Parent training programs such as parent management training, along with problem-solving skills training, are evidence-based treatments, and pediatricians also may be able to provide relevant referrals.

Your patience understandably can wear thin if you find yourself facing repeated resistance. That experience, though, does not have to continue. You can help shift these patterns once you discover what is driving the "no."

Last winter, my wife shooed the dog and visiting toddlers away from our poinsettia plants, saying "they’re poisonous, you know."

I did not know. But it turns out that the belief that poinsettias are deadly is widespread. The same could be said for mistletoe and holly. But are their reputations for danger well-deserved? Since these plants are especially popular to brighten up homes or give as gifts during the holidays, I decided to look into it.

The risks of poinsettia

Could a plant so common and so well-liked in the winter holidays also be so dangerous? If it is dangerous, what problems does it cause? Must it be eaten to cause problems, or is it harmful to just be nearby? And if it’s not dangerous, why does the myth live on?

The answers to these questions are not easy to find. In fact, the bad reputation may have started in 1919, when an army officer’s child reportedly died after eating part of a poinsettia plant. It is unclear if the plant was responsible, though: many other reports describe mild symptoms, such as nausea or vomiting, but no deaths.

Decades ago, a study in the American Journal of Emergency Medicine analyzed nearly 23,000 cases of people eating poinsettia and found

• no fatalities
• nearly all cases (96%) required no treatment outside the home
• most cases (92%) developed no symptoms at all.

According to one estimate, a 50-pound child would have to eat more than 500 poinsettia leaves to approach a dose that could cause trouble. Similarly, pets may develop gastrointestinal symptoms after eating poinsettia, but these plants pose no major threat to animals.

The risks of mistletoe

The story is much the same for mistletoe. It’s not particularly dangerous, but may cause an upset stomach if eaten. In fact, mistletoe has been used for centuries as a remedy for arthritis, high blood pressure, infertility, and headache. The evidence isn’t high-quality for any of these uses, though.

Interest also centers on this plant’s potential as an anticancer treatment. Some extracts of mistletoe contain chemicals shown to kill cancer cells in the laboratory and to stimulate human immune cells. For example, a substance called alkaloids has similar properties as certain chemotherapy drugs used in the past to fight leukemia and other forms of cancer. However, a two-part 2019 review found that adding mistletoe extracts to conventional cancer treatments did not improve survival or quality of life.

No one suggests it's a good idea to eat this plant, accidentally or otherwise. But eating one to three berries or one or two leaves is unlikely to cause serious illness, according to the authors of a 1986 review of multiple studies. And no significant symptoms or deaths were described in one report of more than 300 cases of eating mistletoe. However, some sources warn that serious problems or even death may occur if enough is ingested. The specific dose required to cause death is unknown but, fortunately, it appears to be so high that consuming enough to be lethal is extremely rare.

The risks of holly

This plant can be dangerous to people and pets. The berries of holly plants are poisonous. If eaten, they may cause crampy abdominal pain, drowsiness, vomiting, and diarrhea. While no one would recommend eating holly, it is unlikely to cause death. And for at least one type of holly, knowing the Latin name would be enough to discourage ingestion: the yaupon holly is also called Ilex vomitoria.

The bottom line

No one should eat poinsettias, mistletoe, and holly, but if small amounts are consumed, they are unlikely to cause serious illness. It seems to me that the dangers of these plants appear to be vastly overestimated.

Perhaps the most dangerous thing about mistletoe and poinsettias is the choking hazard the berries pose for young kids, although that risk is not unique to plants: any small object poses similar risks. Try to keep holiday plants out of the reach of small children and pets. And keep in mind that berries may fall from these plants and wind up on the floor.

If a child or pet eats leaves or berries from these holiday plants, or any other plants, check in with poison control, your pediatrician, or your veterinarian. But unless a particularly large "dose" is consumed, don’t be surprised if the recommendation is to simply watch and wait.

Still concerned even if you know the risks are low? You can always regift holiday plants you receive to friends with no children or pets, or find other ways to decorate your home for the holidays.

Various versions of low-carbohydrate diets have been popular for many years. The details of what is allowed and what is not vary quite a bit, and the amount of carbohydrates also differs. Too often these diets contain plates piled high with bacon, meat, eggs, and cheese. Due to the high saturated fat content in these diets, doctors and nutritionists worry about their potential adverse effect on cardiovascular disease.

The American Heart Association recommends aiming for about 13 grams of saturated fat, which is about 6% of 2,000 calorie diet. Recently, a new study published in the American Journal of Clinical Nutrition suggests that at least in the short term a low carb diet with a higher amount of saturated fat might still be heart-healthy. But is it that simple? Let’s take a look at what this randomized diet trial did and what the results really mean.

What did the study actually involve?

The 164 participants in this study were all considered overweight or obese, and had just finished a weight loss trial to lose 12% of their body weight. They were randomly assigned to one of three diets containing different proportions of carbohydrates and fat. Protein content was kept the same (at 20% calories) for everyone. They were not planning to lose any more weight.

The three diets were:

• Low carbohydrates (20%), high fat (60%), saturated fat comprising 21% of calories: this resembles a typical low-carbohydrate diet and has much higher saturated fat than recommended.
• Moderate carbohydrate (40%), moderate fat (40%), saturated fat comprising 14% of calories: this is not far from the typical American diet of 50% carbohydrates and 33% fat, and it is quite similar to a typical Mediterranean diet, which is slightly lower in carbohydrates and higher in fat than an American diet.
• High carbohydrate (60%), low fat (20%), saturated fat comprising 7% of calories: this meets the recommendation of the Dietary Guidelines for Americans and is a typical high-carbohydrate diet, including a lot of grains, starchy vegetables, and fruits or juices.

The study participants received food prepared for them for 20 weeks. They had their blood measured for a number of risk factors of cardiovascular disease, and a lipoprotein insulin resistance (LPIR) score was calculated using a number of blood markers to reflect the risk for cardiovascular disease. (LPIR is a score that measures both insulin resistance and abnormal blood cholesterol all in one number, and it is used for research purposes.)

The researchers found that at the end of eating these diets for five months, the participants in each of the three groups had similar values of cardiovascular disease markers, such as the LIPR score an and cholesterol blood levels.

What were the participants actually eating?

Alas, those who were eating the low-carbohydrate diet were not piling up their plate with steak and bacon, and those eating the high-carbohydrate diets were not drinking unlimited soda. All three diets were high in plant foods and low in highly processed foods (it is easier to stick to a diet when all the food is prepared for you). Even the low-carbohydrate group was eating lentils, a good amount of vegetables, and quite a bit of nuts.

Even the two diets with higher than recommended amounts of saturated fats also were high in the healthy poly- and monounsaturated fats as well. For example, the diets contained a combination of higher amounts of healthy (salmon) and a small amount of unhealthy (sausage) choices. In addition, fiber intake (at about 22 grams/day) was slightly higher than the average American intake (18 grams/day). Overall, except for saturated fat being higher than recommended, the diet as a whole was quite healthy.

What is the take-home message?

Striving for a plant-based diet with saturated fat being limited to 7% of total calories remains an ideal goal. But for people who choose a low carb, high fat diet to jump start weight loss, keeping saturated fat this low even for a few months is challenging. This study at least provides some evidence that higher amounts of saturated fat in the context of a healthy diet do not seem to adversely affect certain cardiovascular risk markers in the short term. How it would affect actual disease — such as heart attack, stroke, and diabetes — in the long run is unknown. However, there is ample evidence showing that a diet that consists of healthy foods and has moderate amounts of carbohydrate and fat can lower the risk of these diseases.

Preventing diseases is a long-term process; a healthy diet must not only be effective, but it should also be flexible enough for people to stick to in the long run. Could a diet with lower amounts of healthy carbohydrates and ample healthy fats with a bit more saturated fat be healthy enough? As the researchers state, we need long-term testing to help answer the question.