Migraines

Migraines

Avoid Getting a
Trigger-Happy Headache

It's Friday night at last--time to pamper yourself after a stressful week of work. You sit on the balcony and soak up the sunset, sipping red wine and nibbling on some nice French cheese. You order take-out Chinese food, then crawl into bed to watch the late, late movie. And when the hero finally rides off into the sunset, you yawn and decide to sleep until noon.

But the relaxing evening you cooked up turns out to be a recipe for a very painful migraine. As the first light of day creeps across the windowsill, you wake up dizzy, clammy and nauseated, with throbbing pain covering half your head. Your pleasant weekend has come to an abrupt end.

Eighteen million Americans suffer regularly from migraine headaches, and most of them are women between the ages of 30 and 45. Stress, certain foods and beverages and an upset in sleep patterns cause migraines, but 60 percent of all migraines suffered by women are related to the menstrual cycle. These headaches are caused by hormone shifts before and during menstruation, says Seymour Diamond, M.D., director of the Diamond Headache Clinic in Chicago and executive director of the National Headache Foundation. More than half of all female migraine sufferers will stop having the headaches after menopause, he adds.

But no matter what the cause, millions of us are spending the most productive years of our lives living in fear of a migraine onslaught. When the dreaded pain strikes, we find ourselves curled up in a dark room for hours or even days, wishing for a return to those youthful days when we could eat and drink whatever we wanted, stay up to watch the sun rise and never have to pay the piper.

"A migraine is painful, unwelcome and often debilitating," says Dr. Diamond. "People aren't able to do much at all until it goes away."

The Pain: An Open and Shut Case

Migraines start when blood vessels in your head constrict for a period of 15 minutes to an hour, then rapidly expand, Dr. Diamond says. The culprit in this process is believed to be serotonin, a hormonelike substance produced by blood platelets.

When you trigger a release of serotonin--by eating certain foods, drinking certain beverages, stressing out or sometimes just oversleeping--the blood vessels in your head narrow. As your kidneys process the serotonin and the level of this hormonelike substance drops, the vessels dilate rapidly, pressing on surrounding nerves and causing pain and inflammation. Dr. Diamond says the ache can last for hours or days because the swelling lingers after the blood vessels return to normal.

About one in five migraine sufferers will experience an "aura" minutes before the onset of a headache. Women report seeing flashes of light and zigzag patterns and sometimes experiencing speech impairment, confusion and numbness in their faces and limbs, according to Dr. Diamond.

Heading Off the Ache

Migraine treatments have come a long way over the past 8,500 years or so. (Yes, migraines have really been with us forever.) In ancient Egypt, people with migraines used to nibble on parts of trees--wormwood and juniper were the favorites--to try to relieve the pain. As medical science progressed, doctors began to prescribe treatments such as placing hot irons on painful spots, cutting a patient's temple and rubbing garlic on the wound and even wrapping an electric eel around a sufferer's head.

Fortunately, such "solutions" are no longer in vogue. If you're looking for ways to stop migraines before they start, experts offer these tips.

Watch what you eat. Many foods can cause the body to boost serotonin levels. Dr. Diamond says these include red wine, aged cheese, processed meats such as hot dogs and sausages, citrus fruits, lentils, snow peas and foods prepared with the flavor enhancer monosodium glutamate, or MSG. For MSG, watch the labels on the foods you buy. Chinese food often has MSG, so ask the restaurant to leave it out of your order if you're sensitive to it.

Foods affect people in different ways, so it's a good idea to keep a log that lists what you ate in the hours leading up to a migraine. Dr. Diamond says you might be able to see patterns emerge and to identify your own trigger foods.

Take an aspirin. A study of 22,000 American male doctors found that taking one 325-milligram aspirin tablet every other day may help ward off headaches. The doctors in the study who took aspirin reported 20 percent fewer migraines than those who took placebos.

Researchers are trying to find out if women will get the same results. For now, experts say you should see your doctor before taking aspirin regularly because aspirin can cause upset stomach, internal bleeding and other complications that may put you at risk for other health problems.

Reconsider the Pill. Birth control pills may cause migraines in some women, Dr. Diamond says. Check with your physician about whether you should discontinue use of the Pill or switch to a different dosage.

Try some heavy metal. A study from Henry Ford Hospital in Detroit found that magnesium is in short supply in the brains of most migraine sufferers. So eating foods rich in magnesium, including dark green vegetables, fruits and nuts, might bring some relief.

Kenneth Welch, M.D., chairman of the Department of Neurology at Henry Ford Hospital, stresses that the data are very preliminary. More work is needed before researchers make a positive link between migraines and magnesium. Still, eating a few more servings of fruits and vegetables won't hurt.

Sleep on a schedule. Irregular sleep patterns also contribute to migraines, although Dr. Diamond says the exact reason isn't clear. "We see lots of weekend migraines, when people decide to sleep late," he says. "You should try getting the same amount of sleep every night, even on weekends."

Control your caffeine. Too much caffeine--anything more than three cups of coffee within an hour or so--can constrict your blood vessels and trigger a headache, according to Dr. Diamond. But he says drinking a cup of coffee or tea just at the start of a headache might keep your vessels from expanding too much and could ward off a migraine.

Chill out--then see your doctor. Once a headache flares up, Dr. Diamond says, nothing short of prescription drugs can stop it. He suggests riding out the pain by reclining in a quiet, dark room. Never try to exercise during a migraine episode, since an increased pulse only makes the pain worse.

You might also want to put your headache on ice, says Lawrence Robbins, M.D., assistant professor of neurology at the University of Illinois at Chicago and at Rush Medical College of Rush University, also in Chicago. You have at least a 50-50 chance of getting some pain relief within two to three minutes of applying a soft cold pack and moderate pressure to your head. Soft cold packs are sold at pharmacies and medical supply stores.

Sometimes, Dr. Robbins says, a migraine may be so painful that putting something on your head will make it feel even worse. In that case, forget the cold pack.

If you can't control migraines by yourself, see your doctor. A combination of biofeedback, relaxation exercises and medication may solve your problem.

A Drug to Dispel the Agony

A new drug, sumatriptan (Imitrex), shows great promise in fighting migraines. One study showed that 70 percent of patients who took sumatriptan during a migraine episode reported mild or no pain an hour later. The prescription drug is also free of most side effects common to migraine medication, such as sedation, nausea and vomiting.

"It's one of the great discoveries in migraine research," Dr. Diamond says. "It really offers great hope to people who suffer from frequent migraines." Unfortunately, it's not for those who have high blood pressure or heart problems. Ask your doctor if you would make a good candidate.