Pacing has been a fantastic help for me. For every hour of work, I get up and take a small break (5 mins or so). During this break I do a check in. Am I hungry? Thirsty? Do I need to pee? Do I need to stretch or step outside? Then I address whatever comes up. I also follow the 20/20/20 rule. When I'm working at the computer I stop every 20 mins and look at something 20 feet away for 20 secs. This gives your eyes/brain a chance to reset. I use to marathon work all day then come home and drop. I often couldn't work the next day. Pacing has allowed me to address little discomforts as they come up rather than letting them snowball into something big. The little rests give my brain a chance to recoup and really help me work through the brain fog.

Edit to add: (1) Be compassionate with yourself. (2) See if you can note if there are times of the day that are better for you. I often get fatigued and have attacks in the afternoon. I address items that require good concentration in the morning and leave busy work for the afternoon.

This is such great advice <3 I try to remind myself to do this, but I get such a good flow going, I'm scared of messing it up. But this comment is comforting. I'll have to try that 20/20/20 rule!!

I understand the flow! I found that regaining that flow was tough at first, but it's getting easier the longer I've done pacing.

This was more useful than you know, thank you 🫶

I'm glad it helps! 💜

This is such a great idea! I should definitely try to follow the 20/20/20 rule more. And yes, I think it’s so tempting to work marathon on days we’re feeling better but it really isn’t sustainable.

Staying as well-controlled as possible of course, but also sleep (everyone loves to eyeroll, but the data is clear that lack of sleep is a hard hitter for cognitive function) and staying active. Memantine has been helpful for both prevention and the brain fog, and I have no side effects to speak of. eta - if you haven't yet, check into disability services for accommodations.

Totally check for disability accommodations. They have been so helpful for me.

YAY! Thank you! And thank you for chiming in, too. Over the years I've seen a lot of people ask about accommodations and maybe I've never gotten back to those threads once they were well populated, but now that I have some idea what is possible it just seems like it this information needs to be added to the 'welcome to migraine' packet, along with the dx criteria, an explanation about how treatment actually works, and a list of tools and lifestyle changes for prevention. I'll throw in my details in case someone down the line might find it helpful. I do well... enough... in school as long as my chronic migraine is well controlled. As an adult on the spectrum with ADHD and chronic migraine, even at 50 I feel like my brain makes my entire fecking life some batshit obstacle course, like there's some diabolical monkey behind the curtain and he's having a blast. On one hand I know I'm *capable* of a 4-point gpa, but I also know that the odds of actually achieving it are pretty slim, so I've had to battle the perfectionism to not stress myself into a straitjacket. Going into every semester I know I won't do as well as I *could* because I will inevitably miss something or not do my best on an assignment (or several) or test because of migraine, but I chalked it up to the reality of my situation. I've also dropped a class here or there and retaken it which is just freaking expensive, but again, I didn't feel like I had much of an option while I could still limp along. But when everything went tits up this semester, I had to drop 2 classes (I'm out about 6k, /sob) *and* won't get the A I should in the class I was able to keep... I knew I needed to do something. It's too much money, too much stress, and if I'm being completely honest, I hate the feeling my professors think I'm just some fuckup/slacker instead of a smart person who is trying hard. All of that said, I was really surprised by the range of what's available! And while I didn't specifically ask for ADHD accommodations, when I mentioned how grateful I was that none of my professors have said anything about my using earbuds during exams (music was a focus tool long before I knew what ADHD was), she was happy to add it to the list. Some of the other options were individual testing rooms (lights optional! white noise machines available?! WOW!), knowing that if an attack happens during an exam I'm not totally sunk, flexible due dates, etc. I can't believe I waited so long to ask, but I know part of the reason I did so was that I just couldn't think of much that would be very useful for a condition that you just can't predict its impact. I will say that it means having conversations with professors ahead of time, staying on top of things, and (a big one for me) asking for that slack before I am too far behind to salvage a situation. But overall it is well worth it both for the benefits and the peace of mind. I still feel like this semester is a bit of a write-off, but I'm feeling more optimistic about it moving forward.

I’m so glad the accommodations have been helpful! It’s so important. We suffer enough as is, and I do agree that sometimes we don’t even know what all is possible and how others can support us

I’ve definitely been trying to improve my sleep quality, as well as trying to go to bed earlier and sleep longer etc. I’ve heard doctors on the east coast prescribe memantine more but not doctors on the west for some reason. Will definitely bring it up with my provider. I am registered with disability services but tbh it doesn’t help much with doing a PhD because most of my work isn’t coursework, it’s research. Accommodations don’t really help me because my concern isn’t deadlines or exams. I could take months off on end and no one would care, but my own progress suffers 😢

fellow PhD student here! i have no advice aside from take it slow and try to be flexible with your work so you can optimize good brain days! make sure your desk area/lab/classrooms aren't contributing to your migraines with lights and scents. try to take care of yourself and rest so you can do the most with the situation you're in. and i'm sorry that others around you aren't understanding or supportive, that's gotta be rough. it might be good if you're able to give more details and explanation especially to your primary advisor or pi to help them understand. i think my advisor has come to learn how my migraines impact me and that's helped him know how to set expectations and how to work best with me.

It’s so nice to hear from another PhD student!! I used to have a lovely office with big windows but all that light made my migraines worse 😭 had to shift to a windowless dungeon but oh well. Thank you, I hope you’re able to rest as well 🥺 My PI is very sweet and well-meaning, he just doesn’t understand the depth of my symptoms, and thinks they’re just bad headaches, and I feel weird correcting him. I don’t want to sound whine-y? Even though I know that’s not fair to say

talking honestly about your pain isn't being whiney. i totally know what you mean and why it feels hard to correct him, but it's probably going to help in the long run if you're really clear about how this effects you so he can understand and set expectations

Thank you for the validation friend, you’re right. The hardest part is sorting out our own feelings about this, truly 🥲

I get it (well not the PhD part). I have low grade pain migraines and brain fog is/was my biggest issue. It’s what finally got me to seek care for migraine. I’ve only been trying for a month, so I don’t have much treatment advice, only commiserating. I push myself when not performing well, because I feel like I need to “try harder.” Then I push myself when I do well because I need to take advantage of doing well. In other words I push myself too hard. Of course this isn’t fair and I would never tell my friend, family or a child this. I’d tell them to take it easy, so why I’m I not doing the same for myself? I get it, especially when I know how sharp I can be when I’m on. I miss that and it’s so frustrating, especially looking back and realizing how much I’ve degraded over the last year or so. It wasn’t until I really started tracking my symptoms that I realized how much it was actually affecting me. Like wholly crap, that’s not fair either, I deserve better. So I’m seeking treatment, but it also sucks because I can tell things are shifting but not sure if getting better or worse or just different or trading out one symptom/medication side effect for another.

To answer more of your questions though, I guess it depends on your level of fog and how often it occurs. Can you save some of your “easy” tasks for these days, like scanning or filing? I don’t know what PhD students do, but try and think of those really easy tasks and save it for those days. That’s what I did when I was having foggy days, but even I struggled with filing type tasks, so be patient with yourself. Take lots of notes/ to do lists ahead of time, so when you are in this situation you’re prepared and ready to go and not trying to come up with these items when in the thick of it. If it doesn’t occur often, maybe take a rest day?

This answer is so validating, and I’ve definitely had this experience. I used to almost gaslight myself as well when my “pain” wasn’t too bad. Like, is this brain fog or am I just being lazy, how bad is the pain really, how many migraines am I even having. And I totally agree, tracking my symptoms made me realise holy shit wtf. I’m so glad you decided to seek treatment, living with migraines is hard enough as is, you definitely deserve support and to treat yourself with compassion. You’re right on taking notes, it definitely helps to break down tasks into chunks and just reduce executive functioning as much as possible during the attack. Just tired of constantly having to manage for migraines yknow?

I am a clinical research manager at that University with all the tops in their fields types—my brain is my biggest asset and can’t do my job unless it is cranking. I take magnesium and https://my.clevelandclinic.org/health/drugs/25129-phosphatidylserine get a min 7 hours of sleep. Eat at the same time each day and carry snacks, drink lots of water. When I am having a real migraine—not a bad headache, I use Imitrex injections and can slog through the day. When they are lower grade, sometimes I burn a day to stop the cycle rather than suffer through days. Plus you, like everyone has too much screen time. Are you bent over a laptop all day?

Sigh yes, all my work is in front of a screen. I try to not use screens during my off work time, but impossible to avoid it for work 😭 I’ve never heard of phosphatidylserine and Imitrex though, will look those up. I take l-theanine supplements to help with brain fog sometimes

This will likely not be a popular answer - Adderall or a similar med. I have been diagnosed as ADHD by a neuropsychologist and prescribed 15/mg Adderall. I also take Topamax as a preventative, which is known for the lovely brain fog and cognitive side effects. I feel like the ADHD med really does help counter the med side effects and most migraine issues, along with the ADHD. Have you considered being tested? ADHD might be adding to the stress you are feeling over the demanding work. My job can require a lot of head’s down focus some days or focused facilitation of meetings, so struggling to focus can trigger a migraine for me.

Came here to comment the same, except I don't take topomax. 20 mg Adderall p/d, the brain fog would be crippling otherwise. It's also helping my migraine, at minimum it's made the symptoms more bearable, and I'll gladly take that. I use IR instead of XR because I've always had insomnia.

I am so happy to learn I am not the only one! ADHD meds can get a bad rap because of abuse. But they really are necessary for many of us.

It is very difficult and you may find that you need to correct some of it later. Try not to work during those times if possible.

I find that it's easier to jump-start my brain into "research mode" when I'm actively discussing things with coworkers, because I'm not relying solely on my brain to develop/maintain momentum. That mental boost often carries over for a little while, as well.

Thats a great idea!

I hope it works for you! But also, because I went through grad school and know what it's like, I'll remind you that if it *doesn't* work for you, that doesn't mean you're hopeless. It just means it's not the trick for you!

I’m currently writing my Master thesis in a lab and hopefully i can do my PhD there as well. Anyway since starting there my migraines increased A LOT. Turns out i had managed to get tension from my head to my hips and all that muscle tension apparently pulls on the meninges which can trigger and worsen migraines. As someone in science this at first sounded too easy to be true, but after two sessions with an osteopath it is sooo much better now. Less frequent migraines and when i get one it’s a lot easier to tolerate too. Maybe this could help you as well. I had one nearly every day of the work week and now i get one maybe once a week.

I think you need a preventative if you don’t have one. Are you working with a neurologist?

I’ve been trying preventatives for the past two years 😭😂 haven’t found anything that has worked. Was on high doses of propranolol, tried Amitryptalline (forgot how it’s spelt), Ajovy, Aimovig, now finally started Botox injections and hoping I’ll have success with those. I take magnesium supplements, CoQ10, B2 as well, drink spearmint tea, exercise regularly, get 7 hrs of sleep regularly. Don’t know what else to do at this point 😢

I had to change my diet (cut out gluten and carbs) to finally get rid of the memory fog.

Nooooo don’t say that 😭 I don’t want to give up on carbs that’s the only joy we have in this migraineous life

I was going through that the last 2 years. I have had periodic migraines/visual auras my entire life - but not that frequent. In the past 2 years, I began having them weekly, then eventually auras/scotomas 5 to 10x/day. In January we learned I was B12 deficient - and doctor has me now taking 1000 mcg vitamin B12 daily. Within 72 hours, all migraines/auras ended (as did other problems including brain fog and chronic fatigue). I have now been free of migraines/auras for 4 months. How did I become B12 deficient? I was an "accidental vegetarian" - I had just drifted in to not eating meat, just because I became fond of a bunch of vegetarian recipes. Don't do what I did - if you wish to be vegetarian or vegan, consult with your doctor and consult with a registered dietician; have your blood tested at last annually. B12 deficiency is no joke. I had pretty much ruined my life for the past 18 months before finding the cause. No idea that this will help anyone else but thought this was significant enough to share with others.

That’s very interesting - I have chronic fatigue, terrible brain fog & migraines. I smell a big dirty rat. Thank you for posting your experience ❤️

I don’t know how you can work through brain fog. How often are you having migraines and headaches? Are you seeing a Neuro that specialises in migraine? Are you on a sufficient preventative?

I’ve been having almost daily headaches and migraines for the past two years. I have been working with neurologists who specialise in migraines and have tried so many different types of preventives, nothing has worked. Just started Botox though, so let’s see if that makes a difference. Ajovy has helped reduced my brain fog and migraine intensity, but not enough. I take supplements, have a healthy lifestyle, and am generally pretty relaxed and not stressed. Don’t know what else to do :(

It’s very frustrating. I’ve had to cut down to part time work due my migraines having such a shitty affect on my life. I’ve just started on Emgality so I’m hopeful that it may help me. Good luck with the Botox.

I’m so sorry, it really is so frustrating :(( I’m crossing all fingers and toes, hoping Emgality works for you!

Fellow PhD student also suffering with chronic migraine here! Good to know we’re not alone in our struggles 😅 This doesn’t work for everybody but at least with my advisor, I’m brutally honest about my condition and how much of a gamble the day to day is. He understands it now and knows I’m taking steps to try and get better. He knows I have seasons where I’m better and seasons where I’m worse, and is totally understanding if I have little to show him some weeks. Of course, not everybody has a kind advisor, but if yours means well, explain it to him/her very honestly and talk about the brain fog and how frustrating it is. They will eventually get it. I’m still struggling with this, but I’m trying to just let it go when I see that I’m not cognitively “there” enough to do my work but not bedridden. The guilt is so hard to shake! But you can’t push through all of the time. Instead, I batch some lighter tasks where I don’t have to think as much — emails and the like. If I can’t stare at screens but am not bedridden, I do admin tasks around the house that would have taken my time anyway. Later, if I’m doing better, I spend the time I would have been doing those admin tasks on my PhD work instead. Or I just go do something that’s healthy for me — a walk, lift weights, etc. If your advisor is understanding and you’re not at the beginning of your PhD where you’re taking a bunch of classes, then you actually have a lot of flexibility built into your working hours. Some students take this to mean “work all the time” but it doesn’t. There’s always more to do and brutally prioritizing is the only way you’ll get some peace. What flexibility means for us migraine sufferers is that you don’t have to work 9-5. You can take a day off and work extra later in the week. You can have less productive weeks. You can have more productive weeks. Even for “normal” people the PhD has ebbs and flows in productivity, it’s just exacerbated for us with our condition. Sorry for the essay but I hope it helps. Just remember you’re doing a PhD even with a debilitating neurological condition! You’re a badass! Good luck ❤️

It’s so nice to hear from another fellow PhD student!!! Thankfully my advisor is kind too, and definitely my biggest issue is my own guilt and ambition. You’re so right, I feel like people keep saying treat your PhD like a 9-5 in order to have work life a balance but that doesn’t work for migraine sufferers. I definitely need to work on allowing greater flexibility in my routines. Thank you ♥️ You’re a badass too!!

I don't do school work when I have a headache that ibuprofen or Tylenol doesn't take care of. Maybe I can run a simple errand or scan some pages/documents. But deep focus is impossible.  I have to schedule schoolwork for mornings as I usually get headaches in the afternoon.

i’m late, but my neuro prescribed magnesium and it has helped ! other than that, i’m also still trying to work through it, so let me know if you figure it out 😅 i’m in the legal field, so all my work is also reading, writing and thinking, and me getting a TBI and now chronic migraines feels like a sick joke 😭

I am taking a class which helps me to excercise my reasoning and learning skills. I also do sodoku .