Staying Ahead of the Ache : Special Treatment, Lifestyle Changes Can Help Those Who Suffer Migraine, Other Kinds of Head Pain

Sharlynn’s migraines over a 21-year period left a trail of marital misery, deep depression and bitterness toward the medical community.

But now, the 41-year-old Dana Point woman says her quest for understanding and proper treatment has borne results, that the vise is starting to loosen from around her head. She says she has finally found relief at the Headache Treatment Center of Orange County.

Sharlynn, a psychiatric nursing instructor who asked that her last name not be used, had been frequently taking Excedrin every three hours to relieve the pain. “It was affecting my blood coagulation, and I was covered with bruises,” she said.

She went from doctor to doctor searching for relief, only to be met with patronizing comments. “The first doctor told me to stop focusing on myself,” Sharlynn recalled. “He said if I did, I would be just fine.”

The other physicians she visited were even less comforting, offering treatment suggestions ranging from having sexual intercourse to having babies.

As have others, she looked into alternative treatments such as acupuncture and herbal therapy when she found that traditional medicine was not helping her. All were equally unsatisfactory.

Then she turned to a clinic that specializes in treating chronic headaches.

“If there’s one thing we do,” said David E. Sosin, M.D., director of the Headache Treatment Center of Orange County, where Sharlynn goes, “we believe the patient.” Sosin, who sees 15 to 20 patients a day in his Tustin clinic, says his philosophy gives him a different bedside manner.

He requires that a 15-page medical history questionnaire be completed by each new patient before he conducts a first examination. The medical background, he says, is an integral part of the headache treatment process. “What we do is individualize the treatment and make sure what we’re doing is good for the patient,” he said.

In general, a person vulnerable to headaches needs to be watchful of “triggers,” which include changing estrogen levels, powerful odors such as perfume, irregular sleep, skipped meals, excessive exercise, bright sunlight, heat, stress, high altitudes, motion sickness and alcohol. He also said certain foods can be troublemakers--such as those that contain the amino acid tyramine, found in aged cheese, chocolate and chicken livers; nitrates, found in smoked and cured meats, and monosodium glutamate (MSG), often found in restaurant or packaged foods.

Although research continues in this area, headache specialists now suspect that several components of the brain are involved in the syndrome.

A neurotransmitter in the brain called serotonin is suspected as a primary factor. Research shows that blood levels of serotonin drop significantly before a severe headache, and this may be what causes the mood changes and depression that takes place before and during an attack.

There are also hormonal factors involved in the trigger mechanism of a headache.

Dr. Joel Saper, director of the Michigan Head Pain and Neurological Institute in Ann Arbor, said that by adulthood, 75% of the patients seeking treatment for troublesome headaches are women, whereas the malady is shared equally with males during childhood.

“This directly reflects the fact that the headache trait is aggravated with shifts in estrogen,” Saper said.

Many physicians specializing in headache treatment have found that their female patients who get migraines typically experience them during ovulation and menstruation.

“Studies show that at these times a women’s estrogen level drops, which seems to trigger the headache,” Sosin said.

Because menstrual migraine is predictable, it can be treated with specific medication and hormonal therapy, Sosin said.

For other headache sufferers, the first task is to determine what sets off a headache. Next, the patient should keep a record of when the headaches occur, how long they last and, most important, what happens shortly before an attack--such as sleep loss, eating a certain food or looking into bright sunlight.

After a pattern is established, the headache patient can try food substitutions or alter his or her life in other ways so as to avoid some of those triggers, Sosin said.