Winnie Lim

Writing some of my recent posts made me reflect on how far I’ve come with regards to my chronic migraines so far, so I thought it’ll be fun (to nobody except myself) to document my ongoing journey. Perhaps it will be helpful to someone out there.

timeline

prior to 2007

I remember having some migraines during my teenage years and 20s, but they were quickly resolved by a night’s sleep or aborted by NSAIDs. At some point they stopped working, which only now I am grateful for because I didn’t know there can be serious side effects from the long-term use of NSAIDs.

2007 – 2011: the beginning years of chronic migraines

Sometime in 2007 I went from working as a full-time designer to freelancing. With more freedom in making my own schedule I started to gravitate towards sleeping late hours. At my worst I was sleeping at 8am to late afternoon. I guess on hindsight it wasn’t very surprising that I developed chronic insomnia and migraines at this point. Back then I wasn’t aware of health in general. You could even say I was anti-health – I tend to zone out when I encounter health-conscious people. I also didn’t know the importance of sleep or the circadian rhythm.

My migraines are debilitating: once they occur I would feel like somebody is carving the insides of my head with a knife. They are accompanied with nausea and fatigue. Some people with headaches can get on with life, but migraines are not headaches. I wouldn’t be able to move or get out of bed, and painkillers would not work.

jan 2008

First mention of migraine on twitter. By this time I was probably having migraines for a long while. I would continue to have them regularly until 2011.

dec 2010

First mention of seeing a traditional chinese (TCM) medicine doctor for migraine.

2011-2015: the north america years

I experienced the longest migraine remission over these years. A large part of it was the euphoria of being in a completely different world from the one I was born in. I guess it allowed me to escape a lot of the unpleasant emotions I associate with Singapore and the people here.

jul – dec 2011: first visit to SF/Hawaii fixed my sleep permanently, and experienced my first remission

I had chronic insomnia for years before this trip, but visiting the US did a major reset to my body clock and I started waking up early in the morning from then, and this miraculous effect actually lasted till now. I tasted the sweetness of deep restful sleep, and somehow it had gotten into my head that I needed to have strict sleep hygiene – sleeping at the same time every day – in order to avoid insomnia. This is also the first time since 2007 I stopped having migraines. It was so strange I couldn’t believe it at first.

I unexpectedly found a job in SF, and spent a couple of months building a prototype while in Hawaii.

feb 2012 – july 2012: Vancouver

I was in work visa purgatory so I went to Vancouver for 6 months to be on the same timezone with my team. I remember having one major migraine attack there, out of desperation I went to see a random tcm physician in Chinatown. He gave me a bunch of herbs which I had to boil in a claypot until one bowl of soup remained. Again, tcm saved the day.

dec 2012: officially moved to SF for work

Probably the happiest time of my life, even though on hindsight it was because I had very rose-tinted glasses on. Migraines in remission until…

jan 2015: first signs of trouble again

By this time I have moved to SF for a couple of years. Hardly had migraines until it was mentioned again on this date. On top of migraines I also started having very painful dry eyes, my migraines and dry eyes seem to trigger each other. I remember having flu around this time, and now that we are starting to learn the long-term impact of viruses, I wonder if what I had back then was actually the start of long-flu. I was also undergoing a ton of emotional and mental stress, due to my grandmother passing away late 2014, and work.

sep 2015: moved back to Singapore

Unable to work anymore due to chronic migraines and painful eyes, so I made the decision to move back to Singapore. It wasn’t like I had a real choice. The whole experience triggered a major existential crisis. My plan was to take a sabbatical for a year, before making new plans.

2016 – 2017: initial healing years

I rented a room in an apartment building that had a pool, so I started swimming regularly. This habit lasted a couple of years until I no longer had access to a pool. I also started to visit my family tcm physician for my dry eyes and chronic migraine. The dry eyes did progressively get better over time, and the migraines lessened in frequency, but I would still get them at least 2-3 times a month (versus every day).

I did see an eye specialist upon my return, they found out that the oil glands in my eyes have stopped functioning and I cannot produce much oil or tears. They couldn’t do anything for me except telling me to use eye drops and warm compresses. I am glad I didn’t believe them that it was incurable.

may 2016

Started a relationship with my partner. Being with my partner gave me a sense of psychological safety I had never experienced in my life. This contributed to a ton of inner healing.

late 2016 to early 2017: last design job

I seemed to have gotten a lot better, so I consulted part-time with a government agency. It was then which made me realise I would never go back to design as a career. I could viscerally feel the stress it was causing me. I would attend meetings, then lie flat on the floor for hours because I was so fatigued. Back in the US I was chronically stressed so I didn’t feel the stress, after a period of not working I could acutely feel it.

june 2017: my first apple watch

I got my first apple watch to help me with self-quantification. I am not new to self-quantifying, having started off with a nike fuel band, before trying the fitbit, had the basis watch, then pebble watches. But those were useful for tracking mostly exercise calories burnt. The apple watch started my journey with heart-rate monitoring.

august 2017: started taking coq10

CoQ10 is the first supplement I started to take regularly, and I still take it now. I can’t remember how, but I must have read some research on how coq10 can reduce migraines.

2018-2019: beginning my relationship with exercise

I had issues with exercising my entire life, and my attempts would go in spurts but it would never be regular until my swimming routine. I lost access to a pool in 2018, so I had to find other sources of activity. This is the beginning of my actual health journey, not just in terms of movement, but truly understanding the mechanics behind health.

After giving myself ample of time to heal since leaving SF in 2015, my migraines were still not going away. I realised rest alone is not enough.

jan 2018: started taking magnesium

I probably read this somewhere too. Do you know magnesium is required for 300+ biochemical reactions in our body? It is also impossible to eat enough in our diets these days because of soil depletion. Of all my supplements magnesium is the only non-negotiable one.

jun 2018: started a running streak

After several unsuccessful attempts to run over the years, I finally managed to start running by not breaking a daily streak. I ran daily for almost 3 months before it was interrupted by a trip. I did not know of zone 2 or anything about running so I was basically running haphazardly.

aug 2018: started glucose monitoring

Through some research I found out that migraines can be caused by oxidative stress, and high blood glucose is one of the main culprits, so I started glucose monitoring. However, I had a stop-start relationship with it until sometime in 2022, and since then I have just been monitoring daily.

feb 2019: first record of intermittent fasting

…in my zero app so I guess I started taking fasting seriously around this time to improve my insulin sensitivity. Like most of my other interventions it was on and off for a while. But for the past few years I’ve been fasting 14:10 minimally and 16:8 on average, occasionally making exceptions for travel or special occasions. My heart rate during sleep gets elevated for the whole night if I eat too late, say after 7pm. Most days my last meal occur around 4pm.

april 2019: started wearing the oura ring

After reaching a plateau with my migraine recovery and also realising I am not attuned to my body, I got the oura ring to see if I can detect periods of invisible stress. I probably realised belatedly that exercising every day is not a good idea. It was probably (a lot of probablys because I cannot fully recall) because of the oura ring that I was introduced to the concept of heart rate variability and how it relates to stress.

may 2019: food delivery

I wanted to find something that would keep me active, so I started delivering food. I started as a walker, and then transitioned to a bicycle. I acquired a secondhand tern foldie, my first bicycle after leaving SF (where I had a bike I didn’t ride much).

feb 2020: bought my first road bike

Little did I know bicycles would become expensive and difficult to buy in the next few months, so I was very lucky to get one right before shit happened.

april 2020: started to measure morning hrv

Oura measures continuous overnight hrv during sleep, but I learnt that measuring hrv upon waking up in a sitting position is a better indicator of stress. I use this gauge if I should exercise or go into recovery mode.

2020 – 2022: the cycling years

Singapore had full and semi lockdowns for almost 2 years, so I cycled almost every day to keep myself sane. When omicron appeared on the scene we elected to continue isolating until late 2022.

aug 2020: the stanton protocol

someone on reddit introduced Angela Stanton’s work on migraines, so I bought her ebook and joined her facebook group. This is the first time I came across electrolyte imbalance as a migraine hypothesis. Her protocol required significant changes to diet so I wouldn’t implement her protocol till much later.

2022 – now: finally signs of recovery

After suffering for 7 years non-stop my migraines reduced its frequency dramatically. I guess I was finally desperate enough to try the Stanton protocol. I wasn’t disciplined enough to do it fully, but I think 80% adherence seemed to be good enough to have a significant effect.

2022: home cooking for almost a year

my partner suffered from MCAS symptoms, so I had to cook for her. In turn I started cooking for myself too. Ate a predominantly low carb diet and tried to implement the Stanton migraine protocol during this period. As a result, I experienced significantly less migraines.

feb 2022: menstrual cycle spreadsheet

Created a giant spreadsheet that has the days of my cycle correlated to biometrics from oura etc.

mar 2022: started taking allithiamine regularly

Through Angela Stanton’s work I learnt the importance of vitamin B1 with regards to our metabolism and how that relates to migraines, so I started taking a allithaimine, the more bioavailable form of thaimine (vitamin B1).

may 2022: wore my first continuous glucose monitor

Keen to know how my blood glucose behaves the entire day and how it responds to certain food, I wore my first cgm.

jul 2022: started seeing current tcm physician regularly

The remaining of my migraines seemed to be triggered by my monthly menstrual cycle, so I started seeing a tcm physician specialising in female hormone disorders at my neighbourhood. This further reduced the frequency and intensity of my migraines.

Traditional chinese medicine takes a holistic view of health and attempts to correct the imbalances of the body instead of simply addressing the symptoms. We could see it as someone personalising a set of herbs for me every visit depending on my condition.

I was somewhat getting better and was probably ready to “graduate” from her care early last year (mar 2023) until I got infected with covid, so that set back my overall health and fitness, hence I am still seeing her now. It supports quicker recovery from exercise too, so my plan is to improve my overall fitness while being on a tcm regime until my body gets strong enough. Unless I reinfected again, I guess.

oct 2022: zone 2

Somewhen around this time I connected the dots between oxidative stress, migraines and mitochondrial health, so with the support of tcm I started zone 2 running again in hopes of improving my mitochondrial health.

april 2023: first covid infection

Got infected with covid for the first time. I was very afraid that my migraines would worsen post-covid but they actually lessened. I was on a zero-carb diet during my entire infection till I tested negative, so I wondered if being in deep ketosis – I never had so much ketones in my life prior (3+ mmol) – triggered some neurological healing at some level. Ketones are known to repair myelin and other neurological damage, so who knows?

However in exchange I now have mild dysautonomia. Previously electrolyte imbalances would cause migraines for me, but now they result in elevated heart rate. I seem to be gradually getting better as long as I continue to be vigilant on the level of oxidative stress I am experiencing. I guess I am not truly over it if stress triggers this again.

Migraines are hypothesised to be a protective mechanism – in the face of overwhelming oxidative stress it forces us to rest and recover – so I am not entirely sure if having less migraines now is an entirely good thing. Did covid make me lost my protective mechanism?

oct 2023: started strength training for the first time

I’ve always wanted to strength train but it felt too intimidating. I finally gave it a go and hired a personal trainer just to get me started.

Apart from my desire to get simply stronger, strength training prevents muscle loss from ageing and grows muscles, so it improves metabolism.

now

The last time I had pain in my head as documented was 4th of June this year, which makes it almost 3 months ago. However it did not progress to a full blown migraine and resolved itself overnight. Usually it lasts for more than 3 days.

concluding reflections

the cause and resolution of migraines

After all the research and interventions, I personally conclude that the main cause of migraines is oxidative stress. Since the producers of oxidative stress is mitochondria, mitochondrial health is the key to improving migraines.

This explains why the onset of chronic migraines usually starts when there is a drop-off in our mitochondrial health due to ageing, hormonal changes, stress – or all of the above. Since what we eat directly affects how well our mitochondria processes energy, managing diet will be one of the main factors of improvement. Exercise – both strength and endurance – will increase the capacity of what our mitochondria can tolerate in terms of food and day-to-day stressors. Relaxation techniques would probably help too, because any kind of stress contributes to oxidative stress.

Our body has very complex biochemical reactions according to what we encounter and consume. I am only scratching the surface. This could be an entire essay, if not book.

how and why I care so much about my health now

New readers or people who are new to me may think I am obsessive with self-quantifying and how I manage my health. But looking at the timeline it was actually cumulative over many years. I was pretty abusive to my own body and didn’t care about it until it was too late. The interventions I have now is a result of self-experimenting and self-directed research that occurred only because I had nowhere else to go. If my migraines spontaneously resolved after a period of rest I wouldn’t be micro-managing my health now.

I am actually grateful for it in some ways (and resentful in others), because of it I begrudgingly learnt to take care of my body in my late 30s, which is early enough to prevent a lot of the metabolic dysfunction – high blood pressure, diabetes, pcos etc – I would have now if not for my changed lifestyle.

Many people accept symptoms like high blood pressure as part and parcel of ageing. I don’t think it has to be. There are also people who simply believe that they are not “fitness” people and hence they don’t even bother to try.

I was a literal sloth for at least the first 3 decades of my life. I hardly moved. Yes perhaps if not for my migraines I would probably still be a sloth. But now I cannot unknow what I’ve learnt. People associate activity with managing weight, but it is so much more than that. Movement grows our brains and those little creatures that produce energy in our body. The problem with age is that our health will decline if we do nothing about it, because the body needs the correct signalling and stimuli to maintain its health. Yes, you read that correctly: not even to improve, just merely maintaining.

On hindsight my chronic migraines are an outcome of having terrible health for many years, and if I didn’t take concrete steps to address it, it would probably have profound consequences. Age and biology does not let us get away (perhaps a minority can idk). I couldn’t sleep well, ate like shit, ate at 3am, didn’t move, stared at screens all day, endured a huge ton of psychological stress, etc. Knowing what I know now, it is actually a miracle and shows how much the body can actually tolerate that I didn’t implode sooner.

why I wrote this boring post

I know most people wouldn’t read this post. Why would anyone be interested to know about my migraines in such detail (lol)? I tend to write posts that I wished existed – if I read something like this 10 years ago it would have saved me a lot of grief and time. I probably wouldn’t need to move back, though I am now glad that I did so.

Also based on my personal observation, people don’t usually blog about health experimentation and self-quantifying. If you know any please let me know, I would love to read other people’s journeys!

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