02 November 2006

How not to treat a migraine

If you're taking over-the-counter medicines for migraines, there's a good chance you're setting yourself up for more headaches down the line.

If you're taking over-the-counter medicines for migraines, there's a good chance you're setting yourself up for more headaches down the line.

New research shows that over-the-counter pain relievers - and even some prescription medications - can cause frequent and chronic "rebound" headaches.

Too much medication

"Some patients who have migraine develop chronic daily headaches, and that's likely due to too much symptomatic medication of any kind," says Dr Steven Graff-Radford, co-director of the Pain Centre at Cedars-Sinai Medical Centre in Los Angeles.

"The symptomatic medication may result in changes in the brain that don't allow the pain-inhibiting centre to switch on, so that patients with migraine go from once every month to every day, and they take more and more medication and the process continues," he says.

Adds Dr Larry Newman, director of the Headache Institute at Roosevelt Hospital in New York City: "As the drug wears out of the system, it causes a vasodilation [dilation of the blood vessels], which sets off a headache cycle and you re-dose and it's a never-ending cycle of chasing your tail."

Wean yourself off slowly

Most migraine sufferers treat themselves with over-the-counter analgesics, Graff-Radford says. About half use these drugs exclusively.

"The concern is, if they are self-treating and are taking the medication on a regular basis more than two to three days a week, then they're going to develop the potential for a rebound headache," he says.

The key to treating rebound headaches - and migraines - is to wean yourself slowly off any drugs you're taking more than three times a week, Graff-Radford says. He reduces patients' dosage by 20 percent every four days until they're at a minimal dose.

Eliminating triggers

At the same time, patients need to start eliminating migraine "triggers."

"The classic triggers are food triggers," Newman says.

Red wine, chocolate, aged cheeses, nuts, pressed meats, citrus fruits, foods containing monosodium glutamate (MSG), caffeine and Nutrasweet all need to go, he says.

Stress, anxiety, too little sleep and lack of exercise can also unleash migraines.

Other triggers aren't easily eliminated, but they can be managed.

For example, 70 percent of women migraine sufferers have headaches associated with their menstrual cycles.

Weather can also be a factor.

"When the barometric pressure dips, it causes a cascade of events in the brain which triggers a headache," Newman says.

Lack of a regular schedule can also be a culprit.

"Migraine sufferers' brains seem to be wired differently. They're sensitive to changes such as missing sleep," Newman says. "We try to get our patients with migraine to routinely engage in an exercise program, and follow strict eating and sleeping programs."

Other treatments

There are also a number of non-pharmacologic treatments to be considered. The Pain Centre at Cedars-Sinai, for instance, uses a "headache-blasting" combination of vitamins, including magnesium, vitamin B2 and feverfew, Graff-Radford says.

Newman uses a similar combination, but cautions the doses are quite high and it can take up to three months for results. Many of his female patients benefit from additional magnesium around their menstrual cycles.

Self-help, cognitive and behavioural interventions are also becoming more popular. Graff-Radford uses posture and stretching exercises to deal with muscle pain in the neck and jaw. Some patients also use biofeedback, hypnosis and even abdominal breathing. Newman has found acupuncture to be effective with chronic headaches.

In a more experimental vein, there's even evidence that Botox and yoghurt can ease migraine pains, Newman says.

At the same time, many patients receive some form of preventative medication. Graff-Radford says it can be anything from a combination of vitamins to one of the classic preventative medications such as beta blockers, calcium-channel blockers, anti-seizure drugs or tricyclic antidepressants.

Increasing the dose of a migraine medication such as one of the triptans during the week leading up to menstruation can also have a preventative effect, Newman says.

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Headache expert

Dr Elliot Shevel is a South African migraine surgery pioneer and the founder and medical director of The Headache Clinic in Johannesburg, Durban and Cape Town, South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. He recently won a high level science debate in which he was able to prove that the current migraine diagnosis and classification is not based on data. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon. Follow the Headache Clinic on Twitter@HeadacheClinic.

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