Heading Off the Hurt - taking care of headaches

Try these techniques and supplements to help ease headache pain

Science today can tell us much more about the causes of headaches and how to head them off before they begin. According to Dr. Roger Cady, director of the Headache Care Center in Springfield, Mo., there have been recent changes in the understanding of headaches, especially in regard to migraine, the most debilitating form that can last from hours to days.

For example, tension headaches (the intermittent, somewhat painful but less debilitating variety) and migraine headaches were once considered two very different forms. But that's changing, says Cady.

"We're learning that migraine and tension headaches may have some very common biological mechanisms," he points out. "People who live with migraines can have tension headaches, as well as others that fall in between the two varieties." In other words, these forms may correspond to different points on a continuum.

According to Cady, people who suffer from migraine and tension headaches tend to have nervous systems that are particularly sensitive to the environment. Changes in such a person's internal environment (such as hormone levels) or in the external environment (light, sound or diet) can trigger headaches. Many environmental factors that a person is exposed to may overload different parts of the nervous system, determining whether the resulting pain is muscular (as in tension headaches) or vascular (as in migraines).

When environmental changes occur, levels of neurotransmitters in the brain can also fluctuate. One of these, serotonin, plays a protective role by preventing abnormal blood vessel dilation, and it also blocks inflammatory chemicals and diminishes pain in the brain. When serotonin levels dip, blood vessels dilate more than normal, irritating the surrounding nerves, and pain is exaggerated; in other words, you get a headache.

While Cady concedes that sufferers in the throes of a migraine usually need medication to stop the pain, he emphasizes that it's often possible to avoid a headache before it exacerbates to a severe one that can interfere with a person's ability to work, play and live normally. That's good news, considering that many of the prescription drugs prescribed for headache relief, including non-steroidal anti-inflammatory drugs (NSAIDs), have side effects.

HEED HEADACHE WARNINGS

By the time a migraine gets its hooks into you, the process of this headache has been going on for hours or days, Cady explains. Learning to recognize the early signs and act accordingly just might spare you the pain. There are three stages in this process:

1. Prodrome

A prodrome refers to the early symptoms and signs a patient experiences before the full-blown syndrome occurs. About 70 to 80 percent of sufferers experience this, but not all of them are aware of it. It's marked by subtle changes in nervous system functioning that come out as one or more of the following: fatigue, irritability and mood changes, muscle aches and pains, pain in the temples, changes in sensory perception, cognitive changes, and food cravings (especially for sweets and carbohydrates).

2. Aura

Only about fifteen percent of migraine sufferers experience an aura, which can be flashing lights, silver streaks, or numbness and/or tingling in the fingers. The aura was once thought to be the result of blood vessels tightening, but now Cady and other experts think it's caused by an electrical phenomenon in the brain.

3. Headache

There is often a mild pain phase of the headache (similar to a tension headache in many people) before it grows into severe, throbbing vascular pain, and there is a good chance of aborting the ensuing disability altogether if treatment is initiated during this phase.

Learning to monitor the body carefully and to recognize the prodrome stage can help sufferers attempt to thwart the potential migraine. Going out and exercising, taking a short nap, tensing and relaxing muscles or simply getting up and leaving a stressful environment may help divert it. In fact, all of these actions help the nervous system generate good neurochemicals, including serotonin, endorphins and others, that help bring the nervous system back into balance when it has been thrown out of whack by environmental stimuli. Women on the birth control pill or on hormone replacement therapy may also experience migraines more frequently.

Here's a look at some other effective natural approaches to halting headaches. Because people who suffer occasional tension headaches don't usually end up in the doctor's office, most of the research regarding headache treatments is based on efficacy in migraine. That doesn't mean, however, that the following therapies have no effect on tension headaches, just that there's less clinical proof.

HERBS, AND SUCH

* Feverfew (Tanacetum parthenium)

Feverfew has proven to be effective at reducing frequency and severity of migraine headaches. Keep in mind that it is a preventive measure, not an acute treatment that's going to stop an already throbbing headache. It appears to limit inflammation that leads to head pain.

Some patients find it useful to take two capsules of a standardized feverfew product during the prodrome phase to ward off an ensuing migraine, says Cady. Taken daily, feverfew may take up to six or eight weeks to really become effective in preventing headaches, however. It should not be used by pregnant or nursing women or by those taking blood thinners, including Coumadin.

* Butterbur (Petasites hybridus)

Butterbur is a relatively new star in the headache-fighting lineup. It has been used to prevent migraines for over two decades in Germany, but doctors stateside are now starting to use it as well. The active ingredients, petasin and isopetasin, fend off inflammatory chemicals according to Professor Werner Grossmann, M.D., of the University of Munich, in a recent interview published in the International Journal of Integrative Medicine (May/June 1999).

While butterbur appears to have no side effects, it's best for pregnant and lactating women to avoid it until further studies prove its safety among these groups. It may take a few months of treatment to begin reaping its benefits. It can be found in capsule form and liquid extract. Follow dosages on the bottle and the advice of your doctor.

* Magnesium

Magnesium supplementation may reduce the frequency of migraine headaches. Our levels of this mineral affect serotonin receptors, and the levels of other migraine-related chemicals and pathways, including nitric oxide. Therefore, it's no surprise that magnesium plays a major role in regulating neuronal excitability among migraine patients. Arteries tend to constrict without adequate magnesium, and sufferers tend to have low levels of magnesium during an attack.

Cady recommends up to 500 mg taken daily. Magnesium can cause diarrhea in large doses, so work up to this gradually. Magnesium oxide may cause less diarrhea, but chelated forms (gluconate, for example), may be better absorbed. People with kidney problems should not take magnesium.

* Vitamin B-2 (riboflavin)

Large doses of this vitamin have proven to reduce the frequency of migraine attacks. Riboflavin seems to help nerve cells generate more energy reserves, which are lacking in an attack. Two-hundred milligrams daily is the dosage Cady suggests. Riboflavin is highly effective, well-tolerated and inexpensive.

* Omega-3 fatty acids

Flax seed oil or fish oil taken in 1,000-milligram capsules, once or twice a day, may have protective effects. Omega-3 fatty acids found in these oils also help prevent heart disease.

OTHER HEADACHE HELPERS

* Homeopathic remedies, including nux vomica, iris, belladona and others seem to help some headache sufferers.

* Acupuncture can reduce headache frequency and the need for medication. Acupuncture may even be helpful in treating acute attacks in some, but is more often recommended as a preventive measure.

* Acupressure, or applying pressure to energy-releasing trigger points of the body to improve the flow of Chi, or energy, can help alleviate headache. Applying firm pressure to the space between first finger and thumb with the opposite thumb and forefinger for a few minutes, or applying pressure to the temples with your fingers might decrease pain.

* Aromatherapy sometimes helps alleviate milder headaches, including the usual tension headache. One drop of peppermint, lavender, chamomile or eucalyptus oil can be diluted in a teaspoon of almond oil and then rubbed into the skin at the temples, neck or shoulder muscles and/or inhaled. Four to seven drops of essential oil added to a bath is also therapeutic for some.

* Manipulative procedures including osteopathy, chiropractic, physical therapy and myofascial therapy require the expertise of a skilled practitioner to move joints or muscles. The goal is to relieve muscle tension and to promote normal joint mechanics, mobilize fluids in the soft tissue and to promote normal neural function and movement.

* Biofeedback has a well-documented history of alleviating headaches and the practice is used in many headache and pain centers.

PLAY DETECTIVE

Keeping a headache diary to track diet, activity, mood and headaches can turn up evidence that will help solve the mystery of what factors trigger an individual's pain. For some, it may be the tannins in red wine, hormone changes during your period, sensitivities to chemicals in foods (nitrites in lunch meat, bacon and hot dogs; MSG or amines in aged cheese, bananas, soup and pickled herring) or stressful deadline days. Keep a record of pain-free days, too; after all, that's what you want to duplicate!

Cady emphasizes that the goal of treating headaches, and migraine in particular, is to accept that you have a tendency toward headache that you can learn to manage; it's not something you "cure."

"So often, people are left to blame themselves for headaches, and in reality they do the same things that the rest of us do," says Cady. He even suggests that if migraine is well-managed, it brings with it a number of attributes and assets.

"This isn't necessarily a curse of nature," Cady emphasizes. "People who have this sensitive nervous system often do well in school and artistic endeavors. The number of famous artists and musicians living with migraines is very long. They tend to be conscientious, organized and very aware of others' feelings." Although knowing that information might not take the pain away, knowing that you're in good company could make living with these types of headaches a bit more bearable.

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Mazzotta G, Sarchielli P, et al. "Electromyographic ischemic test and intracellular and extracellular magnesium concentration in migraine and tension-type headache patients," Headache 1996;36(6):357-361.

Peikert A, Wilimzig C, et al. "Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study," Cephalalgia 1996;16(4):257-263.

Robbins Lawrence and Lang Susan S. Headache Help. New York, New York; Houghton Mifflin, 2000.

Vogler BK, Pittler MH, Ernst E. "Feverfew as a preventive treatment for migraine: a systematic review," Cephalalgia 1998; 18(10): 704-708.

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