Headache Help (36 page)

E
YE
P
ROBLEMS

Although some severe eye problems, such as glaucoma, can cause eye pain or headache, such pain usually does not involve the eyes themselves. Nevertheless, an exam with an ophthalmologist may be very helpful to rule out the eyes as a contributing factor in headache. (Eyestrain was discussed earlier in this chapter.)

E
AR
P
ROBLEMS

Pain in or about the ear may represent ear disease or referred pain from the jaw joint, as in TMJ, which was discussed earlier in this chapter. Migraine sufferers occasionally experience a sharp, stabbing pain in or around the ear. However, migraine pain is rarely limited to the ear. When the pain around an ear is steady and con stant, it is probably caused by an inner ear infection and needs a doctor’s attention.

H
YPOGLYCEMIA

Most physicians do not believe that hypoglycemia is a real factor in headaches. However,
normal
drops in blood sugar (not
true
hypoglycemia) can produce a “hunger” headache (though not necessarily a migraine) in some migraine sufferers, particularly if they haven’t eaten for twelve or more hours. Diabetics who experience low blood sugar or whose diabetes is not well controlled may also get a headache, even a migraine. A glass of orange juice or a sugary food should relieve the low blood sugar and the head pain.

MISCELLANEOUS FACTORS

Some environmental contaminants may also contribute to headaches. These include air pollution, benzene, carbon monoxide, formaldehyde, glutaraldehyde, hydrogen sulfide, methyl alcohol, toluene, trichloroethylene, and xylene. Other activities that may induce headaches include jet lag, an epileptic seizure, and lactation.

14

More Alternatives

T
HE TECHNIQUES
in this chapter, some of them unorthodox, can be very effective. Whether these strategies provide relief directly or offer a placebo is not known. The placebo effect is real and powerful—some 3 5 percent of headache sufferers report short-term relief after taking a pill that they expect to work. However, the placebo effect usually diminishes in the course of one to two months.

Although we do not necessarily prescribe or recommend any of these treatments, we do think it is important to let you know about the many options available. When appropriate, discuss them with your physician. The most prominent alternative treatments are herbs, aromatherapy, physical therapy, trigger-point injections, massage, and vitamins and minerals.

HERBS

You might benefit from one or several herbs. One problem with herbs, however, is that there is little quality control and standardization. Because of differences in species, soil, weather conditions, and additives, different preparations of herbs (with the same milligram strength) may have widely varying strength and purities. One recent study of ten different preparations of St.-John’s-Wort and feverfew, for example, revealed extreme differences among herbs from different farms in the strength of the active ingredient in each capsule.

Despite these drawbacks, herbs have a wide appeal because of their general safety and less severe side effects. But virtually everything has possible side effects, and many of these herbs can interact with other drugs and various medical conditions. Tell your doctor exactly what herbs you are taking, as there can be significant interactions.

Feverfew is the primary herb used to prevent migraine. Ginger can help fight nausea, especially migraine nausea. Valerian is used as a natural tranquilizer and sleep aid, which helps some headaches. Chamomile or kava kava may be useful as a mild sedative. There is now a
Physicians’ Desk Reference
for herbs available in the United States, as well as several excellent books, including
Herbs of Choice
by Varrû² E. Tyler, Ph.D., Sc.D. (Pharmaceutical Products Press).

FEVERFEW
(Tanacetum parthenium)

Feverfew has been used to bring fevers down since at least the first century
A.D.
, and its use in headache dates to the early 1600s. Feverfew is a wildflower in the chrysanthemum family that is very easy to grow in backyards. This herb has been shown to be mildly effective in reducing the frequency and severity of migraine headaches in a number of reasonably controlled studies. The active ingredient appears to be parthenolide—a compound that inhibits or decreases the clumping up of platelets in the bloodstream and may affect prostaglandins. The result of parthenolide activity may be a decreased release of serotonin in the bloodstream. Serotonin is, as we have seen, a key in headaches. While many people chew the leaves of feverfew, it is easier (but possibly not more effective) to obtain the standardized capsules or tablets.

The usual dose is 125 mg of dried feverfew, containing at least 0.2 percent parthenolide, once per day. The standardized extract is also available in 200-mg doses, containing up to 0.7 percent parthenolide. Liquid extract and whole-herb capsules are also available. Doctors usually advise two capsules or tablets per day, because one may not have the potency that is necessary. An adequate daily dose of parthenolide is 250 meg. While this amount should be contained in the 125-mg capsule or tablet, taking two would usually ensure at least the minimum necessary to help headaches.

Unfortunately, feverfew may take as long as six or eight weeks to become effective. Occasionally, capsules of feverfew or feverfew with caffeine or feverfew with guarana (which is essentially caffeine) are used either as a preventive or to treat a headache in progress. These are available from Eclectic Farms, (800) 3324372. The usual dose would be two or three capsules or tablets. Taking caffeine with the feverfew may increase the effectiveness.

Feverfew should not be used during pregnancy or by women who are nursing. Side effects include minor mouth ulcerations in 10 to 12 percent of people, irritation of the tongue or the mouth in 7 to 12 percent, stomach upset, and possibly an increased tendency toward bleeding. Do not take feverfew if you are on a blood thinner, such as Coumadin. If you take aspirin, it is theoretically possible that feverfew could increase your bleeding time. People occasionally demonstrate an allergy to the feverfew. This may be more likely if you are allergic to plants of the ragweed family.

GINGER

Ginger, in capsule form, is used to offset nausea. One or two capsules every four hours, as needed, four per day at most, is the standard dose. The whole herb capsules are usually 500 mg, and the standardized dried extract is often available in 150-mg doses. An increased tendency toward bleeding or prolonging of bleeding is one possible side effect. Ginger can be used to fight motion sickness, too.

V
ALERIAN

Valerian is probably the most effective herbal tranquilizer and sleep aid. It’s relatively safe, with few side effects. The usual dose is one or two capsules every day as needed, or one teaspoon in one cup of water (prepared as tea). At high doses, headache may ensue. It has been recommended that valerian not be used daily for long periods of time, but long-term toxicity is unlikely.

C
HAMOMILE

Chamomile is a mild sedative or relaxant and antinausea herb; it may also be useful for other digestive problems, since it is a mild antispasmodic (it relaxes the smooth muscle of the digestive tract). There are a number of forms of chamomile, primarily the German versus the English (Roman) varieties. In the United States, German chamomile is most commonly available. As with most herbs, there may be differences in effectiveness among the various species. Chamomile is felt to be a very safe herb. Since chamomile is relatively expensive and easy to adulterate, quality control has been a problem. Previous studies on commercial chamomile oil have indicated a high rate of adulteration. The whole-herb capsules are often available in 355-mg doses, and liquid extract or tea bags are also available.

S
T
.-J
OHN’S
-W
ORT
(Hypericum perforatum)

St.-John’s-Wort is a very popular herbal remedy for mild depression and may also be useful for anxiety. It may work by activity on the monoamine oxidase (MAO) system. St.-John’s-Wort may take four to eight weeks to become effective for depression. For more than very mild depression, the antidepressants or psychotherapy have generally been more useful. Side effects have included stomach complaints, and in rare cases, when someone is taking large doses, skin photosensitivity (increased sensitivity to sunlight). St.- John’s-Wort should not be used concurrently with other antidepressants. Most 300-mg capsules contain from 0.15 percent hypericin to 0.3 percent hypericin. You should be under a doctor’s supervision if you are using St.-John’s-Wort for depression. The optimum dose is not known.

K
AVA
K
AVA
(Piper methysticum)

Kava kava is an anti-anxiety herb that may also be useful for mild insomnia. It is not recommended for those with serious depression, as it possibly has the potential to increase suicide risk. Kava should also not be used during pregnancy or if you are nursing. Rarely, allergic reactions or yellowing of the skin have been reported. Stomach upset also may occur. Kava may increase the sedative effect of alcohol or other sedative drugs. The daily dose has been approximately equivalent to 60 mg to 120 mg of kava pyrones. Kava is often available as a whole-herb extract (300 mg) or a standardized extract capsule of 250 mg (which contains 30 percent kava lactones, or about 75 mg kava lactones).

G
LNGKO
B
ILOBA

Gingko has not demonstrated any clear efficacy in headache. It is most likely better utilized for memory disturbances, circulation problems, or possibly to counteract the sexual side effects of antidepressants.

W
ILLOW
B
ARK

Willow bark (white willow bark is commonly used) contains salicin, an aspirinlike compound that inhibits prostaglandins. While safe in recommended doses, this compound is probably not very effective because it is too difficult to achieve the sufficient doses that are necessary.

G
UARANA

Guarana contains caffeine in its seeds. It is usually used in the form of crushed (powdered) seeds. It is effective for headache primarily because of its high caffeine content. There are no major advantages in using guarana over caffeine.

P
EPPERMINT

Peppermint has occasionally been used to help certain digestive problems; it might be helpful for calming an upset stomach associated with migraine. Peppermint is available as leaves, capsules, liquid extract, or oil extracts.

VITAMINS AND MINERALS

Several vitamins and minerals have been found to be useful to prevent headaches. In studies, magnesium is proving to be the most successful one, but vitamin B
₂
(riboflavin), vitamin B
₆
(pyridoxine), vitamin B
₁₂
(cyanocobalamin), calcium, and certain long-chain fatty acids that are contained in compounds such as fish oil or flaxseed oil might also be useful.

M
AGNESIUM

A number of studies have shown that the brains of migraine sufferers have low levels of magnesium, which is important for arteries and serotonin to function. When magnesium levels are too low, arteries tend to constrict or become more narrow. That’s why magnesium infusions help severe migraines. However, taking magnesium daily supplements to prevent or decrease headaches, especially menstrual migraines, is the most popular use. Dark green leafy vegetables, whole-grain breads or cereals, seafood, legumes, and nuts are all high in magnesium. (However, certain legumes, such as lima, navy, fava, garbanzo, pinto, and Italian beans and lentils, trigger migraines in some people, as do nuts.)

If you want to try magnesium as a supplement, 250-mg doses once or twice per day are common and deemed safe. Try to avoid magnesium sulfate; take magnesium oxide instead. Some of the supplements can cause diarrhea, but magnesium oxide usually does not. It is possible that the slow-release or chelated form of magnesium has advantages over the regular magnesium supplements, primarily because of improved absorption. People with kidney problems, however, should avoid magnesium supplements.

After several months, it might be a good idea to stop taking magnesium, as long-term side effects have not been firmly established.

V
ITAMIN
B
₂
(R
IBOFLAVIN)

Several studies have shown that large doses of this B vitamin (400 mg per day) are more effective in preventing migraine headaches than a placebo. In one fairly small study, for example, those who took 400 mg daily for several months experienced almost 40 percent fewer migraines: these results need to be interpreted with some caution. Also, it took at least a month for any clinical effect. Doctors do not usually use this treatment for more than six months, as long-term toxic side effects of large doses of vitamin B
₂
have not been established. However, in general, the B vitamins are safe.