New Ways to Spell Relief for Migraines

Lord, how my head aches! What a head have I! It beats as it would fall in twenty pieces.

--From “Romeo and Juliet”

Aristotle, Thomas Jefferson, Virginia Woolf, Sigmund Freud, Gen. Ulysses S. Grant, Lewis Carroll, Frederic Chopin, Kareem Abdul-Jabbar, Joan Didion--all did or do suffer from them.

For the estimated 20 million Americans who endure migraine headaches--about 70% of them women--there is nothing quite so agonizing as the throbbing pains which usually occur on one side of the head and sometimes are accompanied by nausea, diarrhea, dizziness and blurred vision.

What, then, is relatively new with one of mankind’s oldest afflictions, one that has for the most part defied a cure?

“For one thing there has been the development of a sustained-release Inderal capsule,” said Dr. Seymour Diamond, founder of the Diamond Headache Clinic in Chicago. If taken on a daily basis, Diamond explained in a telephone interview, this time-released and long-acting beta-blocker propranolol (most commonly used to control blood pressure) can be a prophylactic or preventive measure for migraine sufferers.

Non-steroidal anti-inflammatory agents, originally used as painkillers to treat arthritis, have also proved useful in preventing migraine attacks in some patients, Diamond said. But clinical controversy over migraine drug therapy has been around for as long as the torment itself, he added, and arthritis drugs such as Nalfon and Anaprox have not gained unanimous acceptance in the medical community for migraine treatment.

In the last few years, some patients have reported success in preventing migraines by using calcium channel blockers, such as Isoptin and Calan, Diamond said. “These drugs don’t affect the bone calcium, but work at the blood vessel level, preventing expanding and contracting.”

The drug most commonly prescribed for migraine has been around for decades. Formerly a rye-attacking fungus known as ergot, it is now produced synthetically as ergotamine, mixed with caffeine (which shrinks blood vessels) and marketed under names such as Cafergot and Wigraine. Diamond said that it is available in a nasal-spray form in Europe, where it is meeting with a good deal of success.

Fish Oil Found Helpful

Dr. Seymour Solomon, director of the Headache Unit of the Montefiore Medical Center in New York City, said fish oil capsules--generally found in health food stores--have been found by some to prevent migraines. “But this is so new that it hasn’t been confirmed to any significant extent,” he added.

Last year a University of Cincinnati Medical Center study found that nearly 75% of migraine sufferers reported relief after their diet was enriched with fish oil, taken in capsule form equivalent to eating 12 salmon a day.

“In England, migraineurs are reporting relief from an herb called Feverfew,” Solomon said. “It is taken in powder form in capsules or caplets, and is becoming available in health stores in this country.”

Also commercially available and of possible interest to migraine victims, Diamond continued, is the Cold Comfort Gel Pack. It is said to retain cold longer than water, is kept in a freezer, and when needed is pressed against the forehead for 30 to 45 minutes to help relieve pain.

Prevention Is the Goal

But since there is no known cure, the goal is prevention. Those familiar with migraine attacks are usually familiar with the “triggers”--especially foods--that often can bring on the dreaded throbbing.

These triggers, physicians say, include aged cheeses, chocolate, alcoholic beverages--especially red wines--yogurt, excessive amounts of citrus, caffeine-containing drinks such as colas and coffee, the flavor-enhancer monosodium glutamate, anchovies, chicken livers, hot dogs, sausages and bacon (because of the nitrite preservative), nuts, lima beans, guacamole, excessive amounts of bananas or figs and products containing yeast.

Solomon, of the Montefiore Medical Center’s Headache Unit, said the hospital is also studying whether the artificial sweetener aspartame provokes migraines. “Some comments indicate that perhaps migraine sufferers will have to avoid diet drinks,” he said.

In Mount Vernon, N.Y., Dr. Arthur Elkind, head of the Elkind Headache Center, said, “I don’t believe the new sweetener is a cause. Migraines have been around long before that.”

Caffeine-withdrawal sometimes is responsible for migraines, often on weekends when the workplace coffee break isn’t observed. “If you drink three cups of coffee on weekdays, do the same on Saturdays and Sundays, to lessen the chance of headache from that cause,” Diamond advised.

Dr. Donald Dalessio, chairman of the Department of Medicine at the Scripps Clinic and Research Foundation in La Jolla, said that the converging of as many as 10 factors may be responsible for ushering in a killer headache. He likened the situation to a freeway with on ramps, the strategy being to eschew traffic jams of the factors which bring on migraines.

And the affliction is a headache to more than just one person.

The National Headache Foundation in Chicago (until last September the National Migraine Foundation) is a not-for-profit organization established 16 years ago to promote research, answer questions, and educate the public, some of which it accomplishes through a quarterly newsletter.

Each year in the United States, according to foundation director of administration Suzanne E. Simons, migraine sufferers miss more than 64 million workdays.

Migraines, according to the foundation, fall into two categories:

--Common migraines, which don’t have a dramatic period before the onset, although many people report an uneasy or irritable feeling.

--Classic migraines, which are characterized by a 10- to 30-minute warning period. “The victim may see flashing lights, zigzagging lines or areas of total darkness. There may be tingling of the lips, face or hands, weakness of an arm or leg, loss of appetite, slight speech abnormality, confusion, restlessness, watery eyes, nasal stuffiness and sweating. Soon after this aura, the headache begins.”

The typical reaction is to lie down and avoid light. And when the storm has run its course, there often follows exhaustion and depression.

Vascular Event

What had happened, according to the doctors interviewed, was a two-stage vascular event: First the vessels carrying blood to the brain constricted, then the ones near the scalp dilated.

The debilitating headaches, said Simons, can be hereditary: “If both parents have them, there is a 75% chance their children will have them. When only one parent does, the chance is 50%. If even a distant relative has migraines, a 20% chance exists that any offspring will be prone.”

Diamond, who also is executive director of the foundation, said that among female sufferers, migraine is related to the menstrual cycle in 60% to 70% of the cases.

Although certain foods get much of the blame for the attacks of what are known as sick headaches in both sexes, the foundation mentions stress and/or underlying depression as additional triggers, and new ones are being studied.

Dr. Kenneth Peters, medical director of the Northern California Headache Clinic in Mountain View, said the first step in treating a patient is to determine trigger factors.

‘Weekend Headaches’

“Sleeping patterns may be one,” he said in an interview. “This may sometimes account for what are called weekend headaches. If your habit is to get eight hours of sleep on weekdays, that is what you should get, even when your days off arrive.”

Standardizing sleeping habits also was emphasized by Solomon, who said migraines can result from either too much or too little slumber, or missing a usually scheduled meal.

Peters said other triggers can be environmental--such as high altitudes, smog, changes in barometric pressure, glare from excessive sunlight, or the pungent smells of perfumes or solvents.

Even the cessation of stress can play a role in triggering migraines, said psychologist Alfred Scopp, co-founder of the Northern California clinic.

“The most common day of the week for migraines is Saturday,” he noted. “The arteries which go to the brain dilate when a high level of stress drops to a low level.”

As a preventative measure, Scopp said, stress should be decreased during the week, thereby lessening the gap. There also are certain attitudes that can generate excessive stress, he said: Perfectionism, time pressure, trying too hard to please others, having too many goals.

The Northern California Headache Clinic, the Elkind Headache Center and many other professionals use biofeedback to treat migraine sufferers. In simplified terms, with biofeedback a patient is trained to modify involuntary body functions with the help of electronic devices.

Treated With Acupuncture

Among those who have found biofeedback helpful is Los Angeles Lakers center Kareem Abdul-Jabbar, who suffered his first migraine attack at age 14. “You just can’t explain them to someone who doesn’t have them,” he once said.

In the 1984 championship basketball series against the Boston Celtics, he had six attacks in nine days. So far this season, according to Janice Wise, the team’s assistant public relations director, the 39-year-old player apparently hasn’t been troubled with migraines.

Much of the credit, according to Abdul-Jabbar, belongs to David Bresler, a Santa Monica acupuncturist formerly associated with the Pain Control Unit at UCLA.

“Not only was Kareem treated with acupuncture, but he quickly learned self-management skills such as biofeedback and guided imagery, which is positive use of your imagination,” said Bresler.

“If you think of a lemon, you’ll start to salivate. If you are having a headache because your blood vessels are dilating, you can imagine cooling ice helping to constrict them.”

SOME CAUSES OF MIGRAINE HEADACHES Aged cheeses

Chocolate

Alcoholic beverages, especially red wines

Anchovies

Possibly the artificial sweetener aspartame, although this is very new and still being debated

Excessive amounts of bananas

Chicken livers

Excesive amounts of citrus

Excessive amounts of figs

Guacamole

Changes in altitude

(barometric pressure)

Glare from sunlight

Hot dogs and sausages

Hunger

Lima beans

The flavor-enhancer monosodium glutamate, often used in Oriental cooking

Nuts

Menstruation

Perfume odors

Lack of sleep or excessive sleep

Smog

Stress and anxiety

Yogurt

Excessive amounts of yeasty foods

Physicicans interviewed for the accompanying story mentioned one or more of the migraine “triggers” listed above.