And God Created Headache

Splitting apart the mysteries of the migraine

By Dr. Jim Shafer
Published: Feb 14, 2008

Nearly 30 million people suffer from migraine headache in the United States. A full 2/3 of those affected are women. Though the cause of migraine is not clearly understood, it’s agreed upon that hormonal influences are responsible for the increased prevalence in women. The physiologic mechanisms responsible for the pain and suffering due to migraine have been extensively studied and are quite well understood. Migraine-specific medications are now available and are highly effective in aborting the symptoms of migraine. This class of medications are known as triptans, of which many products are available.

Most recurrent stereotyped headache syndromes are some form of migraine. Classic symptoms include one-sided throbbing pain, nausea, light and sound sensitivity. Many headaches are preceded by “aura” symptoms such as a feeling of confusion or difficulty concentrating, bright flashing white or colored lights in vision, numbness on one side of the body or the face. Headaches may last hours to days and are precipitated by factors unique to every person. Over 50 percent of people may experience nagging shoulder or neck pain prior to their headache. Certain foods and not just MSG, caffeine, chocolate, aged-cheeses or processed meats may be triggers. Drops in barometric pressure, i.e., when storms enter your area, are a common trigger. The greatest cause of recurrent daily headache is the over-use of over-the-counter medications (BC powder, ibuprofen, and Excedrin). The over-use of caffeine is a major trigger, as is the lack of regular small frequent meals and restless sleep. Recurrent stereotyped disabling headaches, while usually benign, should be evaluated by a specialist. Most often this is a neurologist. Warning signs for headache which may be due to other more serious causes include new-onset headaches and headaches that are changing in character.

A very common trigger for women is their menstrual cycle. Many women suffer from these headaches days before, during or after menstruation. Effective preventative and abortive therapies are available to reduce the frequency and intensity of these headaches.

migraine causes In people who suffer from more than 3-4 headaches per week, consideration of a daily preventative medication is suggested. Several medications are available; the best depends upon the patient’s history. For example, if poor sleep is a factor, then a nighttime medication may be used that provides a sedative affect as well as a preventative one for headache.

If caffeine consumption is high, it may be suggested that the dose of caffeine be reduced slowly over time with complete omission for at least 30 days to determine if caffeine is the primary trigger for the headaches.

Upon initial evaluation it is important to keep a headache diary for at least one month, each day documenting headache character and frequency, the circumstances surrounding the headache such as food and environment, and finally noting how the headache responded to whatever treatment may have been given. In keeping a diary, patterns for triggers that could proceed to treatment and headache characteristics can be evaluated.

The human brain can only utilize glucose as a substrate for energy. Missing meals, especially breakfast, strains the brain of needed fuel to properly function. Frequent small meals, low in simple sugar, are the best way to keep the brain fueled for a rigorous day.

For those who think they suffer from “sinus headaches,” think again. Over 70% of sinus headache patients evaluated actually suffered from migraines. Actual headaches from sinus disease, especially sinusitis, are quite uncommon and a major cause for under-diagnosis of migraine. Currently, with the knowledge that we have in migraine and effective therapies, only 50% of migraine sufferers are treated appropriately due to misdiagnoses.

Stress is another common factor in patients who suffer from migraine. While dealing with and eliminating stress is the best medicine, this is not always a possibilty. Thus, exercise is a wonderful stress-reducer and should be a regular part of your week. As little as 20-30 minutes three times weekly of aerobic exercise can dramatically reduce stress levels while enhancing cardiovascular fitness and ultimately reducing headache frequency.

Migraine headaches can be socially, physically and professionally disabling. Seeking out a healthcare professional knowledgeable in treating headaches affords you the best opportunity for treatment and proper education. Effective and safe therapeutic choices are available enabling most migraine sufferers to lead a normal, productive and healthy lifestyle.

S. James Shafer, MD, received his undergraduate degree from University of Florida, his med degree from University of Miami and completed his Neurology residency at University of Florida. He has been in private practice for 11 years at Vero Neurology, is the Department Chairman of Neurology and Psychiatry at Indian River Medical Center, and is Medical Director of the Indian River Medical Center Stroke Team, and the Multiple Sclerosis Center of Vero Beach...where does he find time to be a marathoner and avid triathlete? Who knows? But he has the tan to prove it.

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