Beating Migraines

Migraine isn't just any headache. It's a severe, throbbing pain that can keep you home from work, disrupt your family life.. and leave you with significant disability.

Migraines are very common. In fact, they affect 18 per cent of women and 6 per cent of men in the US. Without treatment, they can recur year after year.

A Typical Migraine...

Most migraine sufferers (migraineurs) can recognize what's called a prodrome in the 24 hours leading up to a migraine-sudden depression or exhilaration, increased or decreased appetite, disruptions in sleep, etc.

About 15 per cent of migraine sufferers "see" flashing lights or strange shapes just before the headache hits. Such hallucinations are known collectively as an aura.

There's no easy way to tame migraines. But when migraineurs get good medical care and take an active role in their treatment, nine out of 10 can reduce a once debilitating problem to a minor inconvenience.

What Triggers Migraines

A migraine starts with abnormal electrical activity in the cerebral cortex, the thinking part of the brain. It spreads quickly to the hypothalamus and the midbrain.

Levels of the brain chemical serotonin rise and then drop sharply, making blood vessels swollen and inflamed.

Though the migraine predisposition is inherited, most individual attacks are triggered by either dietary or environmental factors...

How to Prevent Attacks

The first step in controlling migraines is to keep a "headache diary,"

Record due frequency and severity of your attacks... as well as the foods you consumed during the 24 hours prior to each attack. Other key strategies...

Deep breathing: Loosen your clothing and sit in a quiet place. Breathe in as you count to five, then out to the count of five. Silently repeat to yourself, "Breath in relaxation, breath out tension."

Biofeedback:

With this high-tech relaxation aid, you're hooked up to a unit that measures skin temperature or muscular tension.

With practice, you learn to raise the temperature or loosen the muscle. Either way, your body relaxes.

When Traveling:

Give yourself plenty of time to pack. Don't carry heavy bags using a neck or shoulder strap. Avoid alcohol during air-plane flights.

Exercise regularly. Physical activity relieves stress and boosts levels of endorphins, the body's pain-relieving chemicals. At least three times a week, have a moderate, noncompetitive workout. Competitive exercise boosts your stress level.

Most Effective Medication

If migraines persist despite these lifestyle changes, daily medication may prove helpful.

Over-the-counter (OTC) painkillers like acetaminophen, aspirin, ibuprofen and naproxen are often effective in treating an attack. If you do not respond to one of these, "combination" analgesics like Excedrin or Anacin may help. These products combine aspirin or acetaminophen with caffeine, which constricts swollen blood vessels and enhances pain relief.

If OTC remedies don't work, ask your doctor about Tyienol with codeine... Fiorinal (aspirin plus a mild sedative)... and Midrin (acetamin-ophen plus a muscle relaxant and a drug to shrink swollen blood vessels).

For preventing attacks, daily use of the beta-blockers propranolol (Inderal) and nadolol (Corgard) is often effective. The calcium channel blocker verapamil (Calan, Verelan) and antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor) and fluoxetine (Prozac) are also effective.

Although methysengide (Sansert) is often effective, it can scar the lungs, kidneys and heart. If it must be used for more than five months, periodic chest X-rays, MRI scans of the kidneys and other tests should be performed to make sure no harm is taking place.

What about alternative remedies? Some migraineurs get relief from a daily dose of the anti-inflammatory herb feverfew, which is available at health-food stores. Others get relief from fish oil supplements.

Cautions :

Fish oil can increase cholesterol to dangerous levels. It should be taken only with a doctor's supervision.

To the Rescure

Acupressure may offer relief to some migraineurs. At the first sign of a headache, press the web between your thumb and index finger, on the same side as your headache, for five minutes.

Sumatriptan (Imitrex) is the biggest advance in migraine care in more than a century. One self-injection relieves most migraines within 60 minutes. The pill form is also effective, but it takes longer.

Beware : Don't use sumatriptan if you have heart disease - it narrows blood vessels. If you're at risk for heart disease (men over 40, family history of heart attack, smoking, blood pressure over 140/90, cholesterol over 220), the doctor may want to administer the first dose in the office, and check your electrocardiogram.

A sensation of pressure in the chest after a dose of sumatriptan is common. But if the drug cause chest pain, discontinue it.

Dihydroergotamine (Migranal) is as effective as sumatriptan but takes longer to work. Inhaled and injectable versions of dihydroergotamine (DHE) and sumatriptan are very helpful when vomiting makes it impossible to keep pills down.

Submitted By
Fred Sheftell, Md. The author is the president of the American Council for Headache Education, and director of the New England Headache Center, Stamford, CT. He is author of Headache Relief for Women. Little Brown.

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