Migraines
More Than One Road to Relief
By Brenda M. Melvin / Illustration By Holly Camp
Like clockwork, the warning signs reappeared each spring—the intense pain on the side of her head, the muscle tightness in her neck, the waves of nausea that stopped her cold. Maria Hartnett winces as she thinks back to those dark days that comprised much of her adolescence and young adulthood—years marked by a desperate struggle with a chronic, disabling condition that afflicts millions on a daily basis. The usual symptoms: sharp, incessant throbbing on one or both sides of the head, nausea, vomiting, visual disturbances—called auras—and heightened sensitivity to noise and light. The culprit: migraine.
A 29 year old Crofton, Maryland mother of two, Maria Hartnett had her first encounter at age fourteen. Initially her headaches were limited to the spring. As she entered her twenties, however, both the severity and the frequency increased. For years, she endured multiple, often frightening, treatments and procedures in an effort to control the pain. She tried numerous pills, sprays, intravenous medications, even acupuncture. Nothing seemed to work for long. “I reached a point where the constant pain was so intolerable that I could not take care of my oldest child for several months,” she recalls. “As a mother, that just broke my heart.”
The Drug Debate: Just Say No?
Hartnett’s story is all too familiar to the more than thirty million migraineurs, mostly women, who regularly suffer from these crippling headaches and their debilitating side effects. While there is no universal cure, some find relief in varying degrees from medications, non-traditional or holistic remedies, or some combination of treatment options. After following the advice of four specialists with minimal success, Hartnett’s ultimate salvation was Dr. David Buchholz, Johns Hopkins University neurologist and author of Heal Your Headache: The 1-2-3 Method for Taking Charge of Your Pain. Hartnett recalls her surprise at Buchholz’ theory on migraine treatment: “He helped me understand that many frequently prescribed migraine drugs, all of which I had taken, actually cause headaches. He literally suggested that I flush those medications down the toilet!” The medications in question were triptans, a class of drug that is intended to reduce the swelling of blood vessels surrounding the brain during a migraine attack as well as block the release of substances from nerve endings in the brain that are thought to play a role in pain and other migraine symptoms, such as nausea. While Hartnett had experienced short-term relief with these drugs, as do other sufferers, Buchholz explained that their overuse can lead to “rebound headaches”—hence, a never-ending cycle of pain. Hartnett stopped taking the medications immediately.
Next, Buchholz encouraged Hartnett to modify her diet to avoid foods that can trigger headaches. This step required a radical lifestyle shift, as Hartnett set out to eliminate caffeine, processed deli meats, citrus fruits, nuts, cheeses and any foods containing monosodium glutamate (MSG) and other nitrates. “I had to learn how to read labels and cook from scratch,” she laughs, relying on staples from Whole Foods and Trader Joe’s to come up with safe, enjoyable meals. Buchholz also stressed regular exercise and at least eight hours of sleep every night.
For Hartnett, the prescription worked. With her “headache diet” and sleep and exercise program in place, she began to notice positive results within a few months. Today, her migraines are many fewer and far less severe. In consultation with Buchholz, she will determine whether or when preventive non-triptan medications are appropriate to sustain her progress. In the meantime, she is thrilled with her happy ending: “I was recently able to have a second child—something I previously would not have considered due to massive headaches during my first pregnancy and frequent struggles thereafter. It has finally been brought under control!”
While Hartnett’s success is tied to major lifestyle changes, there is no doubt that many migraine specialists and their patients continue to rely on drug therapy for headache relief. “I find that rescue medications (triptans) work well for about 80 percent of migraine sufferers, particularly if taken at the onset of the headache,” says Dr. Stuart Stark of the Neurology and Headache Treatment Center in Alexandria. He adds that early action generally results in relief within two hours, and medications taken in injectable form tend to work even quicker than pills and nasal sprays.
Alternative Techniques: Is Tapping the Answer?
Emotional Freedom Techniques, or EFT, have been utilized by certified practitioners to help individuals achieve holistic wellness in a number of areas. The techniques help users eliminate undesirable habits like smoking and overeating, reduce fears and manage pain and stress. “The theory behind EFT is that negative emotions are caused by disruptions in the body’s energy system,” explains Mary Bonnet of Bonnet Unlimited Potential in Herndon. The process involves using two fingers to tap fourteen points on the body—usually on the head, the upper torso and the hand. The tapping sequence is based on the issue the individual is trying to resolve and is intended to move energy, or chi, through the body. To help focus, the individual also repeats a set of phrases as they are tapping. For example, a migraine sufferer might say: “Even though I have a sharp pain behind my right eye, I love and accept myself.” If the pain shifts, a different phrase is used. Bonnet is able to teach her clients the process in about three sessions of 60 to 90 minutes each, either in person or by phone. Depending on the severity of the case, clients can experience some relief immediately and see more sustained results in a matter of weeks. As a preventative measure, she encourages them to do at least a couple of rounds of the technique each day to maintain progress. For clients who begin tapping while they are on migraine medication and experience relief, she advises that they consult their doctor before stopping the medication. Sound unbelievable? Bonnet has heard it all, and encourages naysayers to give it a chance. “You don’t have to believe up front that EFT is going to work, but you have to be open to the possibility.”
Jan Williams is a believer. A migraineur for several years, the Vienna resident had tried many of the usual strategies—medications, lying quietly in a dark room, chiropractic treatments—to no avail. Her daughter consulted Bonnet on her behalf. “I really wasn’t aware of EFT before Mary introduced the technique to me, and I was a bit skeptical but willing to try,” Williams recalls. In the midst of a headache one day, Williams was unable to leave her work station but craved relief. Bonnet, who worked nearby, arrived and worked with her at her job site. “I still wasn’t seeing how tapping could relieve my nausea and migraine pain, but I started feeling results within ten minutes. It was amazing!” Today, Williams rarely experiences migraines, but at the slightest hint of a headache she starts tapping the designated points while repeating her statements in her head, and she is usually able to stop the symptoms right away. “I really don’t want to be on any prescriptions for migraines and I am very grateful that such a simple exercise can work for me. More people could really benefit from this technique if they were just willing to try something a little different. Relief is just a tap away!”
What’s New?
Stark is encouraged by studies of the drug Trexima, which proposes to combine sumatriptan succinate (marketed as Imitrex) and naproxen sodium in a single pill with the hope that migraineurs will experience better, quicker results than they would achieve from taking either drug separately. (Note: final FDA approval of Trexima was still pending at publication date.)
There are a number of nerve stimulators, or implants, currently being studied to determine their effectiveness in treating migraines. The website ScienceDaily.com reports that occipital nerve stimulation (ONS) has shown to be a safe and effective treatment for chronic headaches in clinical trials. The treatment involves implanting a neurostimulator under the skin at the base of the head. The device delivers electric impulses near the occipital nerves through insulated lead wires tunneled under the skin.
Stark adds that the Vegas Nerve Stimulator, originally designed to treat epilepsy, is also being studied for potential use among migraineurs.
Surprisingly, there may be a role for Botox in the fight against migraines. The popular cosmetic quick-fix has been tested on sufferers with varying degrees of success, and continues to be the focus of clinical trials related to migraine prevention. Last fall, research funded by the American Society of Plastic Surgeons further advanced the Botox connection and made a case for surgery as a route to migraine relief. Study patients were given Botox injections to pinpoint the muscular source of their migraine triggers. Those who experienced an improvement in their symptoms post-Botox were selected for surgery to remove portions of muscle or minor nerves in the targeted areas in an effort to relieve the nerve compression and inflammation that generally accompanies migraine episodes. One year after surgery, a remarkable ninety percent of the patients reported a significant decrease in frequency and intensity, and in some cases complete elimination, of migraines. Sufferers who experience severe headaches at least three times per month and those who do not respond to or cannot take medication are potentially ideal candidates for surgical intervention.
For adolescents aged 12 to 17 who suffer from migraines, treatment options have been somewhat limited as most triptan medications are FDA-approved only for use by adults over 18. Imitrex nasal spray has been the sole exception. However, the National Migraine Association has reported that clinical trials are underway to test the tolerability and effectiveness of other triptans in this age group. In a recent study of the drug Axert, participants experienced significant pain relief and a reduction in two out of three migraine-associated symptoms two hours after dosing, and the medication was well tolerated. Additional trials aimed at this patient population are planned.
Self-Care: A Refresher
No matter what path a migraineur chooses to follow in search of relief, experts agree that there are a number of “back to basics” self care strategies that can help: Keep a diary of your triggers. Identify and track the conditions (foods, events) that most often precede migraines and what relieves them. “You may encounter a trigger up to 48 hours before a headache begins. Your diary may reveal patterns that hadn’t been spotted before,” explains Teri Robert, Support Advisor for the National Migraine Association. In women, hormonal fluctuations have been shown to trigger migraines. These include changes in estrogen levels that occur around the menstrual cycle and during pregnancy, as well as effects associated with the use of birth control pills or other hormonal therapies. Female “menstrual migraine” sufferers will generally see a progressive improvement, in terms of a decrease in the frequency and severity of migraines, at or near menopause.
Learn stress management and relax to a headache. Consider meditating, light stretching, or sitting quietly to recharge and center yourself. Watch what you eat and drink. Avoid foods that trigger migraines.
Eat small meals more often to moderate blood sugar levels, and stay hydrated. And stick to a regular sleep pattern. “Too much, too little, or disrupted sleep is a very common trigger of headache,” Robert warns.
He recommends limiting stimuli during an attack. Apply cold compresses to painful areas. Lie in a dark, quiet room.
Massage your scalp and temples and try to fall asleep. Staying educated is extremely important.
“We need to understand our condition to be able to care for ourselves. We need to avoid episodes when possible, and to try and lessen their impact when they can’t be avoided.
We live with these bodies 24/7, so it’s very much up to us to make our own treatment decisions.”
Where to Turn for Help
Northern Virginia Treatment Facilities:
The Neurology & Headache Treatment Center
4600 Kenmore Avenue, Suite 900, Alexandria
703-212-0700; www.neurologychannel.com/neuroheadache
Kaplan Clinic
5275 Lee Highway, Suite 200, Arlington
703.532.4892; www.kaplanclinic.com
Neurology Center of Fairfax
3020 Hamaker Court, Suite 400, Fairfax
703-876-0800
Additional Resources:
MAGNUM
The National Migraine Association
113 South Saint Asaph Street, Suite 100, Alexandria
703-349-1929; www.migraines.org
American Council for Headache Education
19 Mantua Road, Mt. Royal, NJ
856-423-0258; www.achenet.org
National Headache Foundation
428 West St. James Place, Chicago, IL
1-888-NHF-5552; www.headaches.org
World Headache Alliance
www.w-h-a.org
(March 2007)
Tags: Health & Beauty