Oh My Aching Head
By Alice R. Laule, M.D.
As someone who has
suffered from migraines for years, I’ve spent a lot of time researching ways to
reduce them, prevent them, and cure them. Along the way, I’ve discovered quite a
few useful tricks. I suspect my age has something to do with it, but also
believe that it is some of these tricks that account for the fact that I
personally am about 95% migraine free at this point in my life, and have been
nearly free of them since 1996.
There are
many forms of headache, none of them pleasant. Sinus infections or merely
pressure from blocked sinuses causes pain in the face above and below and
behind the eyes. These headaches typically are worse with certain positions,
such as leaning over with the head down. Getting a pan out of a lower kitchen
cabinet can leave you feeling like your face is going to fall off.
Tension
headaches creep up the back of the neck or start in the temples (from jaw
clenching) or the brow (from furrowing). The neck and facial muscles that
attach to the skull, if they are tense long enough, will begin to cause aching
at their insertions. Relaxation techniques, adequate sleep, and muscle
relaxants can help relieve these. Sometimes just a conscious effort to determine
where the tension is and allow those muscles to relax, or a shift in focus from
a stressful problem to a more positive thought will help prevent and relieve
these headaches.
Migraine, on the other hand, is a
whole different animal. A migraine is far more than just a headache. Many
migraineurs have other symptoms full time, such as a tendency toward getting
car-sick. Most of us do not like roller coasters, or other vertiginous carnival
rides because we actually feel bad all over afterwards. My oldest stepson
had migraine, and I had to explain to his two siblings that he wasn’t a
“chicken” when he opted out of the rides at an amusement park. He and I would
give the rest of them our blessing, and go find a bench to sit on until they
returned from the wild rides.
It is
possible to have a migraine without a headache. One form of so-called
“acephalgic migraine” is the type that has a visual aura but no headache. The
aura consists of zig-zag shimmering lights that the migraineur cannot see through.
It can seriously disrupt the vision. This aura may last from 5 to 50 minutes,
then go away leaving no headache behind. Sometimes the person afflicted with
this will feel badly for a few hours afterward, sometimes will have no other
symptoms. Since the same symptoms can come from an impending stroke, it is a
good idea to contact a knowledgeable doctor the first time this type of aura
occurs, to be sure it’s just migraine.
The other
form of migraine without headache comes on just like the headache would,
perhaps with an aura, then progresses to discomfort in the body, enough to send
the person to bed. I used to think I was a real whimp for having to go to bed
with my migraines. I have a high pain tolerance, and a high stubbornness titer.
I would try to keep working with them, but sometimes couldn’t. Usually by the
time I would stop working, I was too sick with a headache even to drive myself
home. At times, though I felt unable to even drive, the headache itself would
not seem that severe. Then in the early ‘90’s I began to have migraines in
which the headache was almost non-existent, but I would have the same taste in
my mouth, the same whole body feeling that I have with migraine, and
those would send me to bed just feeling awful all over. Once I realized that a
migraine is a whole body phenomenon, I didn’t feel like such a whimp any more.
The
biology behind this is a chemical called Substance P that is released into the
circulation during migraine — the P stands for pain. There are also a slew of pro-inflammatory
biochemicals released that can wind up circulating throughout the entire body
during a migraine. Thus the entire body is involved in the “feel-bad” part of
the headache. Children below the age of 10 sometimes have their predominant
migraine symptoms in the abdomen, and there are cases reported where children
have had their bellies cut open surgically to explore the cause of their pain,
only to have it turn out to be childhood migraine. Migraine is inherited, and
actually starts quite young. The headaches can manifest by age 10. If you have
a pulsating headache accompanied by nausea and/or vomiting, severe light
sensitivity, sound sensitivity, or preceded by some type of “aura” like the
visual one I described earlier, and if your MRI or CAT scan is normal, then you
have a migraine. A doctor experienced in headache evaluation won’t always have
to order a CAT or MRI to make the diagnosis.
Oddly, the exact mechanism of migraine
is still unknown. The neurotransmitter serotonin is involved, and the drugs
called triptans (and thank heavens for those in my life, at one time!) work by
stimulating serotonin receptors. Vascular changes also seem to play a role,
although that aspect is currently being played down. First blood vessels
constrict, causing ischemia to part of the brain (the aura), then they over
expand causing vascular congestion (the pulsating headache). There is a
spreading, slow depolarization wave that begins hours before the symptoms do,
and involves the hypothalamus, as it spreads across the cortex of the brain.
Then somewhere along the line, the brain becomes irritated and releases a flood
of inflammatory compounds, including Substance . It is complex, and the
more one reads the more clear it becomes that the entire mechanism is still poorly
understood.
The first
step in prevention of migraine is to understand the triggers so those can be
avoided. The triggers are many, and often involve something akin to allergy.
(See January 2008 newsletter for more information on types of food allergies.)
Bright lights, strong smells, loud noises, changes in sleep pattern, tobacco
smoke exposure, skipping meals, dehydration, weather fronts, menstrual cycles
and birth control pills, any irritant that starts a tension headache, and
certain foods all serve as triggers. I can personally claim every single one of
those things as a trigger for my headaches.
The
classic foods are red wine and beer, aged cheeses, smoked fish, chicken liver
and figs. These are the foods that contain tyramine, which initiates blood
vessel changes in the brain in sensitive people.
Other
foods seem to cause migraines through an immune system pathway. This list
includes chocolate, citrus, grains, nuts, avocado, cow dairy, sulfites,
aspartame and MSG. I personally would have to add bananas and eggs to this
list, as either eaten in excess will start headaches for me.
Clearly, avoiding all triggers is
impossible. Weather fronts, hormones,
and the occasional exposure to certain smells, lights and noises are not
entirely avoidable. However, a lady with severe migraine should not take birth
control pills in my opinion. I’ve seen young women migraineurs with permanent
vision loss from strokes suffered while on birth control pills. Other exposures
can be minimized, hydration can be maintained, regular meals eaten, sleep
cycles protected. Food antibody testing or elimination diets and food diaries
explored to find specific food triggers.
Nonetheless,
for a lot of us, it ultimately comes
down to finding some form of treatment.
The –triptans
are now rather standard treatment, and there are a number of them. Just because
one of them does not work, does not mean another one won’t be successful. It’s
a matter of trial and error. Another trick I occasionally recommend is the use
of an indomethacin suppository at the time of the aura. The anti-inflammatory
effect will ward off the severity of a migraine for some people. I use this in
suppository form (made up by a compounding pharmacy to my prescription) because
during migraine, by the time the aura
has occurred, the stomach is not emptying or absorbing well. That may be one of
the reasons for the vomiting. Nothing goes anywhere
by the oral route, for some people. The oral -triptans always worked very
poorly for me, due to this fact.
Transcranial
magnetic stimulation is being tried with some success, and instruments to do
this for ourselves may eventually be available. This helps the depolarization
wave phase of migraine. Biofeedback, and hyperbaric oxygen are successful.
Various forms of body work, including myofascial release and acupuncture, have
good reports of success. I personally am convinced that my migraines stopped
because of two treatments of Enertropic Therapy, the hands-on, pressure point
treatment we do at our office. (More information about Enertropic Therapy is
available at www.futurevisionsfoundation.org.) I had been having headaches
weekly or more. After the first treatment they lessened significantly. After
the second session, they went away, and have stayed away.
Other treatments
include feverfew,
a classic herbal remedy for migraine. An old study showed 70% reduction in
frequency and severity of migraine. On numerous occasions, I have been able to
abort a migraine attack by eating the
leaves of a feverfew plant. The encapsulated feverfew, on the other hand, has
not worked as well for me. I suspect a European standardized version, not
available when I had migraines, would work better.
Butterbur
is
also successful at a dose of 50-75 mg. daily. Depending on the study, 49% to
68% of people got significant migraine relief with butterbur. Regular, native
butterbur has some toxicity, but a purified form, Petadolex, does not have the
toxins.
CoEnzyme
Q10
has some good data, with 60% of people getting reduction of headache after
taking this daily at a dose of 100 mg.
Kudzu
has been shown to be effective, probably due to its effects on serotonin.
Magnesium
is vital to relaxation of blood vessels and muscles. I have both given and
received magnesium intravenously to break a migraine attack with good success.
The only time I get headachy now is when I let my magnesium levels get low. I’m
personally convinced that daily oral supplementation helps prevent migraine in
some people.
Riboflavin
may be effective only in a subgroup of people, but a trial of 400 mg. daily for
3 months helped 67% of migraine patients reduce their headaches.
I would
wish for all of you a headache free existence, but for those of you who have
migraine, I hope this is helpful information. 18% of women and 6% of men have
migraine, so you may know someone to whom to pass on this newsletter, so more
of us can….
Stay healthy.
Alice R. Laule, M.D.