Migraine Headaches
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1. Get a Diagnosis
"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 percent 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.
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 and note any factors that may have
contributed to your headache, including known food triggers, emotional
stress, alcohol, and not getting enough sleep.
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?
Avoid Amines
For some, a hot fudge sundae studded with walnuts is a midsummer night's
dream. For migraine sufferers, however, this mouthwatering treat can be a
nightmare. Chocolate, along with many other common foods, contains an
amine called phenylethylamine, which can cause your blood vessels to
constrict, then dilate, triggering a headache.
Scientists believe that the worst of the amines is tyramine, an amino acid
found predominantly in strong, aged cheeses and foods like pickled herring
and liver. If you get migraines, you'll also have to watch out for
homemade yeast breads and alcoholic beverages like wine and beer, say
headache experts. All of these foods--as well as the pods of lima beans
and snow peas--contain the dreaded amines.
"Alcohol is actually at the very top of the list of food factors that
affect the most people with migraine," says Dr. Rapoport. "It is a
vasodilator, meaning that it expands blood vessels, which can trigger
migraine. Chocolate may be the second biggest offender."
Surprisingly, even citrus fruits and juices can trigger migraines in
people who are particularly sensitive to a food factor in citrus known as
synephrine.
Nix the Nasty
Nitrites
Many cured meats contain nitrites, chemicals that are added to salt when
curing meats. Unfortunately, nitrites also cause your blood vessels to
dilate, setting the stage for a migraine.
Head pounders caused by nitrites are commonly called hot dog headaches,
because the worst offenders are meat and meat products like hot dogs,
bacon, ham and salami. But remember, these head-thumping chemicals are
found in many other preserved meats as well. If you want to lower your
risk of an onslaught of migraine, doctors agree that you should go for
fresh meat instead of preserved products.
Brew Some
Relief
Ah, Saturday! A day to thumb your nose at the alarm clock, curl up, sleep
in and awaken with an eye-popping headache! At least, that seems to be the
story for many of the people who are prone to migraines.
Noticing that a certain segment of such people got most of their attacks
on their days off, researchers investigated their caffeine-drinking
habits. Sure enough, they found that those who had headaches on their days
off consumed more than twice as much caffeine daily and slept in later on
weekends than those who didn't have weekend headaches.
By sleeping in, the migraine group delayed their first caffeine fix of the
day by a couple of hours. But that delay alone was enough to trigger a
withdrawal headache. "If it isn't a migraine, it acts and feels just like
one," says Dr. Freitag.
Actually, caffeine has different effects on migraine, depending upon how
much you're used to: Excessive caffeine--more than one or two cups a day
for those who get migraines--can trigger headaches. But if you're not a
regular caffeine consumer, one cup can go a long way toward providing
migraine relief.
"Caffeine constricts the dilated blood vessels around your temples," says
Dr. Rapoport. "It also increases the efficacy of pain medication. That's
why it's in most headache medications."
Just Say No to MSG
Monosodium glutamate (MSG) may bring out all those wonderful subtle and
spicy flavors in wonton soup, but if you're one of the many people who are
sensitive to this flavor enhancer, it might also bring on a whopping
headache.
Like other headache triggers, MSG launches its attack by dilating blood
vessels and exciting certain nerves in the brain. Often people who get
headaches from MSG have other symptoms as well, such as feelings of
pressure in the neck and face, sweating, tingling in the fingers and
abdominal cramps. These symptoms are so common that they've been dubbed
the "Chinese Restaurant Syndrome." If you get headaches and other symptoms
from this aggravating additive, ask for your food to be prepared without
MSG or seasoning salt (which contains MSG) the next time you're ordering
Chinese.
Although it can cause headache in anyone, MSG also can trigger migraine,
says Dr. Rapoport. "We think MSG is toxic to the brain and actually
triggers the electrical dysfunction in the brain that starts the migraine
process."
Mineralize
Your Migraine
For some people, low-magnesium levels may trigger a head-pounding bomb. In
one study, researchers found low-magnesium levels in a full 42 percent of
60 migraine sufferers. While experts expect that such shortages are just
one component of migraines, they see no harm in upping your intake of
magnesium rich foods, such as whole grains and seafood, as a preventive
measure.
These are
some of the common foods that trigger migraines in some people. Using your
headache diary, you may discover that certain foods from one or more of
the categories below bring on your headaches.
Additives/Spices
Aspartame, meat tenderizer, monosodium glutamate (MSG), seasoned salt, and
soy sauce
Beverages
Any that contain alcohol (especially beer, red wine, and sherry),
chocolate, cocoa, or caffeine (some migraine drugs contain caffeine, which
can also help relieve headaches)
Breads
Any bread or pastry made with yeast; breads or crackers containing cheese,
including pizza; and products containing chocolate or nuts
Dairy
Buttermilk; chocolate milk; sour cream; cheeses such as blue, brick, Brie,
Camembert, Cheddar, Gouda, Gruyère, mozzarella, Parmesan, provolone,
Romano, Roquefort, Stilton, and Swiss; and any dishes made with these
cheeses, such as blintzes, lasagna, macaroni and cheese, and pizza
Desserts
Any that contain chocolate, nuts, yeast, or the cheeses listed above
Fruits
Avocados, figs, overripe bananas, papayas, raisins, and red plums
Meats, Fish, and Poultry
Any aged, canned, cured, or processed product containing nitrates,
nitrites, and/or tyramine; examples include anchovies, bologna, caviar,
chicken livers, game, ham, hot dogs, lunchmeat, pepperoni, pickled
herring, salami, salted dried fish, sardines, and sausage
Veggies
Beans such as cannellini, chickpeas, fava, green, lima, navy, pinto, and
pole; olives; onions; pickles; raw garlic; sauerkraut; and snow peas
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Comments
It is interesting to note that plenty of exercise helps
migraine sufferers.
When it comes to food, it is a mixed bag.
There are some foods that are not good to eat that can cause migraines.
But at the same time there are foods that are normal healthy that you
should stay away from eating. The best way to handle this would be to
avoid the "bad foods" and if this does not help to reduce symptoms, then
slowly remove some of the "good foods".
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