Headache Help (38 page)

The magnets are usually wrapped and placed about the head or neck for minutes to hours. Some people sleep on a magnet pillow or a bed with a mattress pad full of magnets. Several magnet companies make these products in convenient forms. There is no limit as to how long magnets can be left on. Magnets are primarily meant to treat pain that is already in progress (although they may prevent headache in some people).

The question as to why they may work has not yet been answered. One theory holds that they inhibit the firing of pain fibers in the skin, but they may influence neurotransmitters at deeper levels of the nervous system as well. These magnets are simple: north only, not bipolar, and low intensity (they will attract a paper clip somewhat, but do little more than that).

THE HEADACHE FRONTIER

Most medications now used for headaches were developed for other purposes and then accidentally discovered to help headaches too. Chances are, some headache drugs of the future will be medications already on the market for other purposes.

Botulinum toxin (of which there are two types), for example, is a treatment for very severe muscle spasm. Injections may prove useful for chronic daily headaches when the muscles in the back of the head and neck are very tight. Injections in the muscles around the back of the head paralyze the muscles for three months, thereby providing some relief. It’s still unclear if this treatment will hold up as a good therapy. For migraine or cluster headache pre vention, ten to thirteen injections (mostly in the forehead area) have been used. Some people have had relief for up to four months. In the low doses used for headache, Botox is safe. For the acute treatment of migraine, intravenous Depacon (valproate) may assume a major role in the near future. Also, compounds in the brain, such as nitrous oxide, are being discovered to play a role in generating headaches. New therapies, based on these types of discoveries, are emerging. One new therapy, for example, may be as simple as using vitamin B
₁₂
, which decreases nitrous oxide.

In development, however, are new drugs that focus primarily on neurotransmitters in the brain. Serotonin has been widely investigated. Other therapies involving dopamine, vasoactive peptides, and nitrous oxide may prove helpful in the future.

The immune system may also be a fertile ground for new drug strategies. Scientists have uncovered evidence that a significant number of headache patients have lower numbers of immune cells called suppressors, implying an overactive immune system. Unrelated to allergies that are linked to the immune system, these cells counter the actions of helper cells in the immune response. Although certain drugs, such as the corticosteroids prednisone, Decadron, and Depo-Medrol, help migraine and cluster headaches for a brief time via the immune system, they have a wide array of side effects and their benefits tend to wane if used for long periods. The challenge is to develop safe but effective medications that alter the immune system in a way that helps headache patients and are deemed safe for long-term use. Singulair, a mild asthma medication, may be helpful as a migraine preventive.

As researchers get closer to discovering the gene that is responsible for inherited headaches, it may someday even be possible to alter genes to decrease migraine and tension headaches. Of course, scientists and patients must address many ethical and moral questions before undertaking gene therapy.

In the next thirty years, we will probably see more and more studies assessing the benefits of alternative treatments, such as herbs, sorting out which treatments are effective and worthwhile.

PUTTING IT ALL TOGETHER

This book is chock full of advice and information that your doctor may consider for your headaches. We cannot stress strongly enough, however, that your own management techniques can go a very long way toward reducing the frequency and severity of headaches. To recap, we want to leave you with a roundup of suggestions:

• Recognize your headache problem as a legitimate physical illness. View and communicate your headache problem as if it were just like asthma, diabetes, or hypertension: an inherited physical, medical condition. Remember that a primary reason for your headaches is that you have too little serotonin in the brain. Acknowledge that because of a lack of serotonin, you may also have anxiety and depression.
  
• Help your doctor to achieve a balance between medication and headache pain. Your realistic goal is to improve the headaches 50 percent to 90 percent, while minimizing medications.
  
• Keep careful track of what medications (at what doses) did not work, what other conditions you have, and what other medications you take. In choosing preventives, your doctor will need to know if you suffer from any of these: anxiety, depression, insomnia, gastritis, heartburn, irritable bowel syndrome, constipation, hypertension, asthma, and sensitivities or allergies to other drugs. These often determine which way to proceed with medication. Include in this record any sensitivities or allergies to medications that you have ever had.
  
• Keep your own drug-medication chart. After a few years, you may have tried a dozen or two dozen different medications. Showing your doctor the chart at the beginning of treatment is immensely useful.
  
• You might become frustrated by the lack of effectiveness or by the side effects of daily preventives. Remember: 50 percent (at most) of patients achieve long-term relief with preventives. Knowing this should allow you to realize that if they don’t help, it’s not your fault.
  
• You need to stick with preventive medications for at least four weeks (or longer); if you abandon them too soon, you may not see the beneficial effects.
  
• Consider psychotherapy. Although it won’t necessarily improve your headaches, you can learn to cope better with headaches and the stresses that they produce. Unfortunately, because of stigma, time, and money, only a small minority of patients actually go to a therapist.
  
• If you have chronic daily headaches, understand that the “cure” may not be total. You may still have headaches every day, but they may be less severe. Ask yourself if you have gone from severe to moderate (from a “10” down to a “7”) or from a moderate to a mild (from a “7” to a “4”). If you show improvement, all of the medication probably should not be changed.
  
• Be sure to tell your doctor how much OTC pain relief you use, including herbal preparations.
  
• Do not confuse addiction with dependency (see Chapter 5); when treating chronic daily headache, dependency has to be accepted.
  
• When nothing works: Don’t give up! The end-of-the-line strategies include: MAOs, daily long-acting opioids (methadone, Kadian, Oxycontin), stimulants (dextroamphetamine, methylphenidate, phentermine), intravenous DHE, daily triptans in limited amounts, daily DHE (nasal spray), or combinations of approaches.
  
• Remember, good headache therapy, just like other challenges, requires patience, persistence, and perseverence.
  
• Learn how to cope with stress effectively, whether through cognitive strategies that can be learned from self-help books or in using relaxation and breathing techniques, exercise, yoga, massage, footbaths, or whatever works for you. Don’t overload yourself with too many obligations. Learn to say no.
  
• Exercise regularly. Aerobic exercise—as little as twenty minutes of brisk walking three or four times a week—and daily neck and back stretches can help ward off headaches.
  
• Pay attention to your diet. Keep track of and limit foods that trigger your headaches. Eat regularly and healthfully (plenty of whole grains, pasta, fruits and vegetables; limit sugar, salt, and fat), do not skip meals, and drink a lot of water.
  
• Maintain a regular sleeping schedule. Try to wake up at the same time every day; sleeping late may trigger a headache.
  
• Avoid or limit alcohol, especially types that you know can trigger headaches.
  
• Control environmental factors that may trigger your headaches: avoid smoky rooms, fumes, and perfumes, for instance.
  
• See a doctor if you get headaches that interfere with your life.
  

Appendix A: Headache-Related Organizations and Publications

The following associations and foundations offer free or inexpensive materials on headaches.

FOR HEADACHE INFORMATION AND REFERRALS

Visit Dr. Robbins’s Web site at
www.headachedrugs.com.

National Headache Foundation (NHF)
428 W. St. James Pl., 2
^nd
Fl.
Chicago, IL 60614-2710
Tel: (800) 843-2256; Fax: (773) 52-5-7357
Web site:
http://www.headaches.org

For $20 a year, you will receive a quarterly newsletter and access to the headache libraries.

American Council for Headache Education (ACHE)
19 Mantua Rd.
Mt. Royal, NJ 08061
Tel: (800) 255-ACHE
Web site:
http://www.achenet.org

General information, help in starting a local headache support group, or referrals to members of the American Headache Society. For $20 a year, you can subscribe to a quarterly newsletter on the latest developments in the headache field. On-line support: alt.support.headaches.migraine (newsgroup). Cluster headache:
www.clusterheadaches.com.

TO START A HEADACHE SUPPORT GROUP

Sharing experiences and tips with others who face similar challenges can help you cope and feel more in control over your life and confident about your decisions.

ACHE and NHF (above) can both help. So can the following organization, which locates local self-help groups.

National Self-Help Clearinghouse
25 West 43 rd St.
New York, NY 10036

Another organization that can help you find specific medical programs in your area:

American Self-Help Clearinghouse
St. Claire’s Hospital
25 Pocono Rd.
Denville, NJ 07834
Tel: (973) 625-9665; Fax: (973) 625-8848
Web site:
http://www.cmnc.com/selfhelp
E-mail:
[email protected]

HELP BY PHONE

To access medically oriented tape-recorded messages on medical topics, including relaxation and stress management, call: Health Messages, (888) 493-8300.

BIOFEEDBACK, RELAXATION, AND TAPES

Health Journeys, available on Time Warner AudioBooks:
For People with Headaches
(two-tape set).

Tapes by:

Belleruth Naparstek, Image Paths, Inc.
891 Moe Dr., Suite C
Akron, OH 44310
Tel: (800) 800-9661

The Source Cassette Learning System
Emmit Miller, M.D.
945 Evelyn St.
Menlo Park, CA 94025
Tel: (415) 328-7171

Association for Applied Psychophysiology and Biofeedback
10200 W. 44th Ave., Suite 304
Wheat Ridge, CO 80033-2840
Tel: (800) 477-8892; Fax: (303) 422-8894
Web site:
http://aapb.org
E-mail:
[email protected]

Quantum Quests
Box 986
Oakview, CA 93022
Tel: (800) 772-0090

Academy for Guided Imagery
P.O. Box 2070
Mill Valley, CA 94942
(800) 726-2070

International Imagery Association
P.O. Box 1046
Bronx, NY 10471

COUNSELING AND PSYCHOTHERAPY

American Psychiatric Association
1400 K St., NW
Washington, D.C. 20005
Tel: (202) 682-6000; Fax: (202) 682-6850
Web site:
http://www.psych.org
E-mail:
[email protected]

American Psychological Association
750 First St. NE
Washington, D.C. 20002-4242
Tel: (202) 336-5500; TDD (202) 336-6123;
Fax: (202) 336-5708
Web site:
http://www.apa.org
E-mail:
[email protected]

National Association of Social Workers
750 First St. NE, Suite 700
Washington, D.C. 20002
Tel: (202) 408-8600

Association for Advancement of Behavior Therapy (AABT)
305 Seventh Ave., Suite 1601
New York, NY 10001
Tel: (212) 647-1890; Fax: (212) 647-1865
Web site:
http://www.aabt.org/aabt
E-mail:
[email protected]

Anxiety Disorders Association of America
11900 Parklawn Dr., Suite 100
Rockville, MD 20852-2624
Tel: (301) 231-9350; Fax: (301) 231-7392
Web site:
http://www.adaa.org
E-mail:
[email protected]

Anxiety Disorder Education Program/National Institute of Mental Health
5600 Fishers Lane, Rm. 7C-02
Rockville, MD 20857
Tel: (800) 647-2642
Web site:
http://www.nimh.nih.gov/anxiety/index.htm
E-mail:
[email protected]

National Anxiety Foundation
3135 Custer Dr.
Lexington, KY 40517
Web site:
http://www.lexington-on-line.com/naf.html

Depression and Related Affective Disorders Association (DRADA)
Meyer 3-181, 600 N. Wolfe St.
Baltimore, MD 21287-7381
Tel: (410) 955-4647; Fax: (410) 614-3241
Web site:
http://www.med.jhu.edu/drada
E-mail:
[email protected]

National Depressive and Manic-Depressive Association
730 N. Franklin, #501
Chicago, IL 60610
Tel: (800) 826-3632; Fax: (312) 642-7243
Web site:
http://www.ndmda.org
E-mail:
[email protected]

National Foundation for Depressive Illness
P.O. Box 2257
New York, NY 10116
Tel: (800) 239-1298
Web site:
http://www.depression.org