ASK DR. BAUGHAN                                     March 1, 1996

MIGRAINE REVIEW

A patient writes, “I wondered how many migraines are too many?  I was getting migraines on a schedule, but lately they have been every other day.”

The ideal answer to this question, of course, is – any migraines are too many.  Unfortunately, though, we still do not know why some people get migraine headaches and others do not.  There is a genetic pattern, but that does not explain why one person may have mild infrequent headaches and someone else has frequent disabling migraines.  The pessimist’s answer to the question would be, “You have to just live with however many you have.”  Many people seem to share that perspective since 60% of people with migraines never seek medical help for them.  A realistic answer lies somewhere in between.

The goal of treating migraines is two-fold: to relieve suffering and to maintain function.  If there has been a change in the person’s degree of suffering to the worse, and a decline in functional abilities at home, work or play, then it is time to review the behavioral and medical strategies for managing migraines.  Being your own detective can often pinpoint environmental or behavioral factors that trigger migraines.  Keeping a diary of when and where headaches occur can be invaluable.  Anything the person thinks may be of value would be worth reviewing.  Particular issues include sleep patterns (too much, too little, changing sleep schedules, jet lag, etc.), changes in physical activity, changes in work situation, personal activities, emotional stress.  Diet can be an important factor; there are many substances that can bring on migraines – too many to eliminate for everyone.  I encourage patients to notice patterns in their diet.  Common foods include chocolate, caffeine, age or processed cheeses, nuts, processed meats, breads made  with yeast, and certain food preservatives.  Alcohol is a common trigger, sometimes in very small amounts.  Smoking or even exposure to smoke can set off  headaches; so can sunlight.

A change in headache pattern is a signal to review if other health problems may have arisen.  Are there problems local to the head, such as dental problems or allergies that are setting off migraines?  Sometimes systemic illnesses can be the cause, and a general review may be helpful.

If no such conditions are found, a change in medical treatment may be timely.  There are two basic strategies - abortive or prophylactic.  Abortive treatments attempt to stop a migraine in process.  Sumatriptan (Imitrex), ergotamines, anti-inflammatory medications among others may be useful.  They may lose their effectiveness after a while, though, and a new treatment needed.  Prophylactic treatments may be indicated if headaches are becoming more frequent.  These treatments are taken before the headaches begin, sometimes on a daily basis, to decrease the frequency and severity of the migraines.  There are various types of medicines that have been found to be effective - beta-blockers, anti-depressants, calcium-channel blockers, anti-inflammatory pain medicines.  These categories are identified by the conditions for which these medicines were originally used before they were found to be helpful for migraines even if someone did not have the original problem (high blood pressure, depression, etc.).  Oxygen treatment works  well for some patients.

Some people find relaxation techniques, meditation or yoga exercises to be valuable in preventing or even aborting migraines.  If we all included quiet relaxation in our lives more there may be many fewer headaches.  Unfortunately, it often takes a health problem for people to accept that a lifestyle change may be in order.  Then they may pursue meditation as a treatment, they may get out of an abusive relationship, or they may realize they feel stuck in a rut at work and pursue a cherished dream.  With the many ways to treat migraines, I would encourage anyone with a change in headache pattern, or an existing pattern that interferes with functioning, to be persistent in pursuing the options with their physician until all avenues are explored.  There may not be a cure, but there is a lot of help available.