8 WAYS TO CLOBBER THE BIG HEADACHE

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Living with migraine pain? You don't have to. New scientific breakthroughs can stop the Godzilla of headaches in its tracks

Teacher Mary Riley awoke one morning with searing pain on one side of her head. It started on top, then worked its way down and around the back of her neck.

She thought it would go away with time and a little help from an over-the-counter (OTC) pain reliever. It didn't. It was the first of many headaches she would endure that day and every day that followed. At age 48, Riley had become a migraineur, a term used to describe migraine sufferers.

She's in good company. An estimated 28 million Americans-13% of the population, and most of them women-suffer from migraines. Not "just a headache," migraine is a complex disease that causes severe and often disabling head pain, usually located on one side of the head, often accompanied by nausea, light and noise sensitivity, dizziness, and other symptoms. Ten to twenty percent of migraineurs have a visual phenomenon called an aura, during which they may see flashing lights, blind spots, and zigzag lines, and experience vision loss, dizziness, and numbness.

Migraine symptoms can be so debilitating, and the pain so explosive, that a recent survey found that one-quarter of those who experience it go to the emergency room for help. Yet more than half of migraineurs never see a doctor for a diagnosis, depriving themselves of new and effective treatments that can stop the symptoms dead and may actually short-circuit the entire headache process.

There may not be a cure for migraine, but you certainly don't have to live with the pain. Here are eight medically proven ways to clobber the BIG headache.

1. Get a Diagnosis
Why don't more migraine sufferers see a doctor? Because some get adequate-if not entirely reliable-relief from OTC pain relievers, says Richard B. Lipton, MD, professor of neurology, epidemiology, and social medicine at Albert Einstein College of Medicine in New York City.

But many others "don't know that headache is a treatable medical disorder," says Dr. Lipton, who was the lead author on the study that found so many migraineurs keeping mum around their doctors. Since migraine runs in families, it may seem normal to get these headaches-as if the pain is something they just have to live with, he says. And, "just as migraine runs in families, so too does not seeking care for migraine."

But it's only in a doctor's office that you'll find the latest treatments that could help you to control your migraines-or even prevent them-reliably and for good.

"Our goals in therapy today aren't just to stop the pain," says Merle Diamond, MD, associate director of the Diamond Headache Clinic in Chicago. "With some of the newer medications, such as the triptans, we can actually turn off the headache process. That means we can stop the pain and get rid of the nausea and other symptoms without causing drowsiness. That's something we didn't have 10 years ago."

The triptans-available as tablets, dissolvable wafers, an injectable, and a nasal spray-may work in part by correcting a "glitch" in brain chemistry that causes a drop in the neurotransmitter serotonin. The triptans mimic serotonin, attaching to specific serotonin receptor sites in the brain, which not only relieves pain but also other migraine symptoms. They also stop the release of certain neuropeptides, the vasoactive and inflammatory chemicals that cause blood vessels to dilate and activate pain-sensitive nerve endings.

2. See a Specialist
Still in pain after consulting your doctor? It may be time to call in the big guns.

Most family doctors can treat headaches quite well, says David M. Biondi, DO, headache division director at the Michigan Head-Pain & Neurological Institute in Ann Arbor. But a recent survey found that 48% of people who do see a doctor report that they're still often in severe pain.

If your headaches aren't being controlled after several months, or your doctor is unsure about your diagnosis, ask for a referral to a neurologist or headache specialist.

Neurologists have a special interest in headaches, says Dr. Lipton. And headache specialists are usually neurologists who spend even more time on headaches, offering greater expertise in diagnosis and treatment, he says.

Most important for you, a headache specialist will also be up to date on the latest migraine medications, such as the triptans and preventives that are taken daily to reduce the frequency, intensity, and duration of migraine attacks.

Some specialists are also using Botox, a natural substance that can be injected into the forehead, temples, or back of the head, temporarily paralyzing the muscles and causing them to relax. Some patients have reported complete or nearly complete relief from their headaches for up to 4 months, says Alexander Mauskop, MD, director of the New York Headache Center in New York City, who uses Botox in his practice. However, Botox, like other migraine treatments, doesn't work for everyone.

A specialist can also help you manage your medications and help avoid what's known as the rebound headache, which occurs when the medications you're taking on a regular basis (more than two or three times a week) to alleviate pain actually cause a headache.

3. Catch It Early
Never ignore the early signs that a migraine is coming on. Most pain relievers become less effective as the headache progresses, says Dr. Biondi.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium may bring pain under control when used at the first glimmer of a headache. "But once the migraine headache reaches a more intense phase, where there's more pain, nausea, light and sound sensitivity, and other associated symptoms, the nonsteroidals and other simple pain relievers are usually less effective," he says.

"Simple pain relievers" include aspirin, acetaminophen, or aspirin/acetaminophen/caffeine combinations.

4. Hop On the Treadmill
Walking, jogging, swimming, or any form of aerobic exercise may help prevent migraine headaches. Exercise stimulates the body to release endorphins, which are brain chemicals that improve mood, explains Dr. Mauskop. Exercise also helps relieve stress, one of the known headache triggers.

Any form of aerobic exercise will do, but find something you like so that you're more likely to stick with it. Aim for 40 minutes a day, 5 days a week.

One thing exercise will not do is stop a migraine in progress. In fact, exercise makes a migraine feel worse.

5. Get in a Groove, and Stay There
Boring though it may sound, sticking to a routine helps prevent a migraine. That's because changes in your daily schedule-sleeping in late on the weekends, blowing off breakfast, or skipping your daily bike ride-can trigger a migraine, says Dr. Biondi.

"The brain of a person with a migraine likes to have consistency. When you get off schedule, the brain may respond by triggering a headache. So a person with a migraine should stay on as regimented a program as possible," advises Dr. Biondi.

Keep to a regular bedtime schedule, don't skip meals, and try to eat at the same time of day every day. If your blood sugar falls too quickly, it can trigger a migraine.

6. Learn to Take It Easy
Stress is one of the most common migraine triggers, so learning to cope with stress may help reduce the severity and frequency of attacks, says Dr. Mauskop.

What seems to work best for migraine sufferers is biofeedback. Using special equipment that measures muscle tension or body temperature, biofeedback teaches you how to control both muscle contraction and the swelling of blood vessels, two physical reactions that seem to play a major role in headaches of all kinds. Once you've become adept at biofeedback, you can use what you've learned to alleviate or even stop a mild attack.

You can go low-tech too. Progressive muscle relaxation can reduce or even stop migraine pain. It's easy to learn and requires practice but no training. Find a quiet room where you can lie down on a flat, comfortable surface. Take a few deep breaths. Now, slowly tighten, then relax, the different muscle groups of the body in succession from head to toe. As you tighten each muscle, inhale deeply, and hold the tension for several seconds. Relax, and exhale slowly.

Other stress relievers include yoga, meditation, and guided imagery. Basically, "anything you can do daily that takes your mind off your worries will go a long way in helping to prevent migraines," says Dr. Mauskop.

7. Know Your Food Triggers
The old expression "you are what you eat" can mean something very painful to a migraineur: It's long been thought that certain foods and food additives may trigger a headache. (Though recently it's been theorized that cravings for these foods may actually signal the onset of a migraine.) Chocolate, for example, contains vasoactive amines, which can provoke a headache by dilating blood vessels. You may also have a headache associated with foods such as processed meats that contain additives called nitrites. Like amines, they cause blood vessels to swell, provoking headaches in migraine-susceptible people.

Other common food triggers include aged cheese; alcohol; pickled and marinated foods; citrus fruits; bananas; onions; monosodium glutamate (MSG), a food preservative; and aspartame/ phenylalanine-containing foods and beverages.

Uncovering your food triggers may take time, says Dr. Biondi. "One of the most difficult things about food triggers is that a food may only be a trigger once or twice out of 10 times you eat it." You may be more susceptible to food triggers when other triggers are present, such as stress, bright lights, or loud noises. And foods that trigger migraines in one person may have little effect on someone else.

8. Keep Track of Your Headaches
Keeping a headache diary is one of the best ways to identify your triggers and prevent future attacks. It also helps your doctor to find a prevention and treatment plan that works for you.

Write in your diary every day, even if you don't have a headache, and include the following information:

• Did you have a headache?

• What time did it start?

• Were there any warning signs?

• How did it feel (mild, moderate, severe, etc.)?

• What medications did you use, including dosage?

• How long did the headache last?

Then note any factors that may have contributed to your headache, including known food triggers, emotional stress, alcohol, and not getting enough sleep.

PHOTO (COLOR)

PHOTO (COLOR): FYI: You can avoid a migraine if you keep to a routine.

PHOTO (COLOR): FYI: Ease migraine symptoms by taking a hot bath with an ice pack on your head.

PHOTO (COLOR): FYI: See your doctor if your headache is sudden and the worst you've ever had. It could be a stroke. Source: National Headache Foundation

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By Julie A. Evans

with Pam Boyer

Contributing Editor Julie A. Evans lives and works in Cleveland Heights, OH. Pam Boyer is the Prevention staff specialist on headache.

NATURAL PAIN KILLERS
Two supplements, riboflavin and magnesium, are under study as potential migraine relievers.

Stewart Tepper, MD, director of the New England Center for Headache in Stamford, CT, says that his patients who take 400 mg of the B vitamin riboflavin daily (the amount used in studies) have a 50% decrease in the frequency, duration, and severity of their migraines. The only side effect: bright yellow urine. "But it does take 4 months to work," he advises.

The studies on magnesium are more equivocal. "The study that showed the best evidence for magnesium supplementation was in patients with menstrually associated migraines, especially premenstrual migraine," says Dr. Tepper. "I've spoken to a number of migraine specialists across the US, and they've recommended 400 to 600 mg of chelated magnesium on a daily basis."

Equally equivocal are the studies on the herb feverfew. "I've been very underwhelmed with feverfew," says Dr. Tepper. "I've never really found it to be enormously helpful." But some studies show that a capsule a day can be helpful to prevent migraines. According to herbal expert Douglas Schar, DipPhyt, MCPP, MNIMH, a standardized tableted extract providing the equivalent of 0.25 to 0.50 mg pathenolide-feverfew's active ingredient-may begin to help within about 2 months.

ANATOMY OF A HEADACHE
The causes of migraine headaches remain as elusive as a cure. In all likelihood, says David M. Biondi, DO, headache division director at the Michigan Head-Pain & Neurological Institute in Ann Arbor, "there's a whole series of events that take place" to cause this monster headache.

We do know that, during a migraine, a signal from the brain activates the trigeminal nerve, the main sensory nerve of the head and face and a major conduit for pain. Trigeminal nerve endings respond to the signal by releasing neuropeptides, inflammatory chemicals that dilate blood vessels and irritate nerves, starting a pain cycle that can last from several hours to several days, explains Dr. Biondi.

"There are changes in the electrical activity of the brain that might contribute to some of the associated effects that some people have, such as dizziness, inability to concentrate, and fatigue so severe that they can feel as wiped out as if they have the flu," he says. "That's because their whole brain is in turmoil during a migraine."

Studies have shown that there are changes in bloodflow to the brain's cortex and brain stem when a migraine occurs, and the activity remains high in the brain stem even after the migraine is relieved by drugs. One area of the brain stem in particular contains large amounts of the neurotransmitter serotonin, which is widely thought to play a role in migraine.

There's also decreased bloodflow in the occipital part of the brain-where visual symptoms of migraine originate-that coincides with the beginning of the headache and the aura that some migraineurs experience. The reduced bloodflow lasts for a few hours-along with changes in the electrical activity in that part of the brain-then gradually increases.

This complex process is one reason that it may take some time for you to find the right medication or treatment to ease your symptoms, and why you may need to take more than one drug combined with various lifestyle changes.

As scientists learn even more about migraines, more treatments are likely to be identified. And there is the very real possibility that migraines may become a thing of the past. FYI: Ease migraine symptoms by taking a hot bath with an ice pack on your head.

DIAGRAM: A migraine is like an electrical storm in your brain.

IT'S A GIRL THING
Blame it on hormones: Approximately 70% of all women who get migraines can predict the onset of a headache around their menstrual cycle, says Merle Diamond, MD, associate director of the Diamond Headache Clinic in Chicago. For some, it's the hardest headache to treat because it's longer and more severe than the headaches they get at other times of the month.

Menstrual migraines are brought on by changing levels of estrogen-usually falling-that happens twice a month: with ovulation and with the menstrual cycle. While estrogen doesn't cause a migraine, it's one of the most powerful triggers for women, says Dr. Diamond. That may help explain why women are three times more likely to get migraine headaches than men.

As women reach their 30s and 40s, their headaches tend to get more frequent and more severe, in part because of stress, says Dr. Diamond (a migraineur herself). Another reason: Hormonal fluctuations increase as women approach menopause. Keeping a diary of your menstrual cycle helps because you can predict when you're most at risk-typically the days immediately before and after the menstrual cycle-and use medications before the headache hits.

There is some good news. With the end of menopause, migraines stop or become significantly less frequent for 65 to 70% of women. FYI: See your doctor if your headache is sudden and the worst you've ever had. It could be a stroke.

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