Headache Help (15 page)

HEADACHE HELP TIP: WHAT TO DRINK IF YOU MUST DRINK

If you really want to drink, your best bet is to have no more than two normal-size drinks and choose one of the following, which are less likely to trigger a migraine: a Sauternes or Riesling wine; Seagram’s VO whiskey or Cutty Sark scotch. Of all alcohol, vodka is the least likely to set off a headache.

LESS COMMON MIGRAINE FOOD TRIGGERS

• Onions
  
• Beans, such as lima, navy, fava, lentil, garbanzo, pinto, and Italian
  
• Snow peas
  
• Sauerkraut
  
• Pickles and pickled food
  
• Marinades
  
• Chili peppers
  
• Licorice or carob candy
  
• Figs, raisins, avocados, bananas, passion fruit, papayas
  
• Fried food
  
• Peanut, peanut butter
  
• Popcorn
  
• Nuts or seeds, all types
  
• Soy sauce
  
• Sugar in excess
  
• Salt in excess
  
• Seafood
  
• Sour cream or yogurt
  
• Pork and chicken liver
  

W
EATHER AND
S
EASONAL
C
HANGES

Spring tends to be the worst season for migraine sufferers, then fall. The hot humid days of summer may also be bad. You may be sensitive to weather changes, regardless of the season, because such changes can alter the body’s chemical balance. Weather tends to affect the severity, not the frequency, of migraines. Although research on weather and headache produces conflicting results, more often than not weather emerges as a major trigger. However, most weather triggers for migraines can’t be pinpointed to any single identifiable cause.

S
MOKE
, P
ERFUME
, G
ASOLINE
, P
AINT
, O
RGANIC
S
OLVENTS

Certain people are particularly sensitive to these substances. Sensitivity to cigarette smoke may develop anytime, even in people who used to be smokers. Many people cannot stand to be exposed to even small amounts of perfumes or gasoline. Magazines that contain perfume are often a hazard for the migraine-prone (subscription magazines may be ordered without them); paint smells are also common triggers for migraines.

H
UNGER

Most people who get migraines recognize that if they miss meals they are more likely to get a headache. If this is true for you, be sure to eat regularly, at least three times a day. Anticipate periods when there may not be food available (when traveling, for example) and be sure to bring a snack.

F
ATIGUE OR
L
ACK OF
S
LEEP

Children who get migraines are especially sensitive to lack of sleep. Other migraine sufferers who are awakened early in the morning, particularly by a bright light (sun shining through an uncovered window), often experience a migraine. People who must change time shifts for their jobs often experience migraines during the adjustment period. Whenever possible, be consistent with your sleep habits.

H
ORMONAL
F
ACTORS

Menstruation, especially, but also birth control pills, pregnancy, menopause, and estrogen supplements often play a crucial role in triggering migraines in women. Menstrual migraines often are the most severe and tend to be the most difficult to treat. Headaches are sometimes better during pregnancy, at least in the last two trimesters. (See Chapter 7 for detailed information on the relationship between hormones and migraines in women.)

O
VERSLEEPING AND
E
XCESSIVE
S
LEEP

Although most children and adolescents are unaffected by oversleeping, too much sleep in adults can lead to a migraine attack. Be careful about regulating your sleep, especially on weekends. Naps can also be a problem. Even just a half hour of extra sleep on a Sunday morning, after a stressful week, may be enough to trigger a migraine.

E
XERTION
, E
XERCISE, OR
S
EX

For some people, certain types of exertion, including sex, consistently trigger a migraine. Anti-inflammatories taken before exercising or having sex often prevent the headache. (See Chapter 13 for more on exertion and sex headaches.)

B
RIGHT
L
IGHTS

If you get migraines, chances are you are sensitive to bright fluorescent light and sunlight, even when you don’t have a headache. Wearing sunglasses can help; be sure to keep a spare pair in the car because windshield glare is a common trigger. Many migraine sufferers are also bothered by oncoming headlights at night. Camera flashes, fluorescent lights in grocery stores, and too much time in front of a computer screen are also triggers. Anti-glare screens (and taking frequent breaks) may ease computer-related headaches.

H
EAD
T
RAUMA

A blow to the head can cause migraines whether or not you have a history of migraine headaches. Rear-end whiplash accidents are common triggers, and the related migraines may persist for months or years. (See Chapter 13 for more on post-traumatic headaches.)

A
LTITUDE

Some people get migraines at high altitudes. One reason may be that there is less oxygen high up, and the blood vessels in the body try to compensate by dilating, a cause of headache in some people. Exercise may help by getting more oxygen into the blood. Vitamin C might also help ward off the effects of high altitudes. Sometimes special medications, such as a water pill called Diamox or steroids, can help too.

M
OTION

Sometimes travel by car, plane, train, or boat can trigger a migraine for reasons that researchers can’t explain. Some children who get motion sickness develop migraines several years later. Preventing motion sickness by riding in the front seat and making frequent road stops may help ward off a potential migraine.

PREVENTING MIGRAINES WITH MEDICATIONS

If you suffer from frequent headaches and the strategies discussed so far are not adequate to relieve them, your doctor may recommend preventive medications, though the ultimate decision to try them will be yours. Think about the fact, however, that you will probably end up taking less medication for migraine prevention than if you simply chase after frequent headaches with pain relievers.

Consider preventive medication if:

1. You get moderate to severe migraines more than three times a month.
   
2. The medications to relieve the migraines fail to provide adequate relief.
   
3. Your quality of life is sufficiently compromised by migraine severity or frequency.
   
4. You are willing to take medication daily, accept that possible side effects may occur, and change medications if necessary.
   
5. You have daily, or near-daily, headaches in addition to migraines.
   
6. You have other conditions that could be helped with a daily preventive medication. For instance, if you are anxious or depressed, antidepressants could help prevent headaches and the anxiety and depression; high blood pressure could be lowered by beta- or calcium blockers and help prevent headaches. If you have arthritis, anti-inflammatories could help ease it and your headaches.
   

Although these medications won’t usually completely eliminate migraines, they usually significantly reduce the overall impact that migraines have on your life. A trial course of about four weeks is necessary before you can assess a medication’s usefulness.

Choosing a preventive medication will depend on factors such as whether you also get chronic tension headaches, your age, sensitivity to side effects, sleeping patterns, stomach sensitivity, blood pressure, pulse, and other medical concerns.

Starting on preventive medication will take some patience and perseverance. Here are some general guidelines:

U
NDERSTAND THE
G
OAL

Although it would be great if you could eliminate 90 to 100 percent of your migraines, that would probably require too much medication with too many side effects. Your goal for reducing migraine frequency, therefore, must be modified to a realistic 50 to 90 percent improvement; your goal for reducing the intensity or severity of your migraines should be a realistic 70 percent improvement.

B
E
W
ILLING TO
C
HANGE

Be open to changing medications if one doesn’t work or causes too many side effects. And remember that what worked for someone else won’t necessarily work for you.

B
E
T
OLERANT

Try to be willing to endure mildly annoying side effects in order to achieve positive results with the headaches.

B
E
P
ATIENT

Many of the medications need several weeks to become fully effective, and doses may need to be adjusted. Call your doctor if you have problems or concerns, but try to stick with each medication for the desired length of time.

B
E
W
ELL
I
NFORMED

Most of these medications are used for other health conditions besides headache. Learn what they are and why you are using the drug for headache. Be aware of possible side effects so you are not frightened or confused if they occur. Consult the
Physicians’ Desk Reference
to learn about risks associated with any medication.

FIRST-LINE MEDICATIONS FOR PREVENTING MIGRAINES

QUICK REFERENCE GUIDE: FIRST-LINE MEDICATIONS FOR PREVENTING MIGRAINES

1. D
   EPAKOTE
       Very effective and safe, but fatigue and weight gain may occur.
   
2. A
   NTIDEPRESSANTS
   (E
   LAVIL
   , Z
   OLOFT
   , P
   AXIL
   , S
   INEQUAN
   , V
   IVACTIL
   , N
   ORPRAMIN, AND
   S
   O ON
   )
       Effective, inexpensive, and also useful for daily headaches and insomnia. Some of these drugs cause sedation, weight gain, dry mouth, and constipation. (See Table, page 111.)
   
3. B
   ETA
   -B
   LOCKERS
   (I
   NDERAL
   , L
   OPRESSOR
   , C
   ORGARD
   , T
   ENORMIN
   )
       Effective, though sedation, diarrhea, lower gastrointestinal (GI) upset, and weight gain are common. Very useful in combination with amitriptyline.
   
4. NSAIDs (N
   APROSYN
   , N
   APRELAN
   , A
   LEVE
   , A
   NAPROX
   , A
   NSAID
   , O
   RUDIS
   KT, O
   RUVAIL
   , V
   OLTAREN
   , C
   ATAFLAM
   , C
   ELEBREX
   , V
   IOXX
   )
       Particularly useful for menstrual migraine. Nonsedating, but frequent GI upset (except for Celebrex and Vioxx).
   
5. C
   ALCIUM
   B
   LOCKERS
   (I
   SOPTIN
   , C
   ALAN
   , V
   ERELAN
   )
       Less effective, but fewer side effects, except for constipation; usually nonsedating and don’t cause weight gain.
   

1.
DEPAKOTE

Depakote is now one of the primary headache preventive medications because it’s very effective for migraine and daily headaches. Depakote is also prescribed for certain types of seizures, and as a “mood stabilizer” for anxiety and depression in people with bipolar illness (manic-depression). Antidepressants, calcium blockers, or beta-blockers may be taken in conjunction with Depakote. As with most medications, smaller doses of Depakote are prescribed for headaches than for other conditions, such as seizures.

TYPICAL DOSE
: 250 mg a day to start, with food, increased over days to an average dose of 500 mg once or twice a day (sometimes up to 1,500 or 2,000 mg a day). It takes at least four or five weeks to know if Depakote will work. Blood tests (to check your liver) will occasionally be necessary. However, Depakote has generally been a very safe medication, particularly in low doses.