How to Treat and Prevent Headaches

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Liz Garvey, 38, a Manhattan art dealer, knows a migraine is coming by "a slight pain in the neck that radiates up or a pain in one eye that radiates down" before developing into sharp throbbing behind the eye. She's one of 28 million Americans afflicted by this more severe type of headache. An estimated 18 percent of women, most commonly between 35 and 45, get migraines, though many don't realize it or have been misdiagnosed.

What causes them: The biology of a migraine isn't completely clear, but the theory is that chemical imbalances in the brain inflame blood vessels, irritating nearby nerves that carry pain signals. It is known, however, that a susceptibility to migraines is usually genetic. Triggers include hormones (related to birth control pills, perimenopause, and menstruation; see the following "Menstrual Migraines" section), stress, weather changes, lack of sleep, changes in altitude levels, chocolate, food additives such as MSG or nitrates, alcohol (especially red wine), and excess caffeine.

What they feel like: Throbbing pain that frequently begins on one side of the head, is often accompanied by nausea or vomiting and is made worse by bright light, noise, or physical activity. Research reveals that 75 percent of migraine patients experience neck pain, while another study found that almost half complain of eye tearing, runny nose, or nasal congestion. Only about 15 percent of migraine sufferers see flashing lights or other "visual aura" effects before the headache begins. Untreated, pain can last from four hours to three days.

Treatment options: Over-the-counter migraine remedies that include acetaminophen, aspirin, or ibuprofen and sometimes caffeine can relieve mild-to-moderate aches. For more severe migraines, however, doctors prescribe triptans, which constrict blood vessels and moderate chemical reactions in the brain. Best taken at the first twinge of a headache, these triptans include Imitrex, Zomig, Amerge, Frova, Maxalt, Axert, and Relpax. Some of these prescription medicines can be formulated to melt on the tongue, be inhaled as a nasal spray, or be self-injected for times when nausea makes ingesting oral medication impossible. Other remedies include ergotamines such as Wigraine, Cafergot, or DHE (a nasal spray). Narcotic pain relievers like Percocet or Demerol are prescribed as a last resort for severe migraines.

Preventive measures: Lifestyle consistency is key. "Change is what triggers migraines -- hormones, stress levels, what you eat or drink -- even the weather," says Cincinnati headache specialist Lisa K. Mannix, MD. So try to maintain sleep, eating, and exercise routines every day. Several drugs, including some anti-seizure medications, low doses of antidepressants, and beta-blockers and calcium channel blockers (used to treat high blood pressure), are now being used for migraine prevention. After a year on a preventive drug, you may be able to taper off and still retain the improvements, says Mark W. Green, MD, director of the Columbia University Headache Center, in New York City. A recent study also reveals that taking two 75-milligram tablets daily of an extract of the herb butterbur can cut migraine frequency in half. Biofeedback, which teaches you to relax muscles during times of stress, may help some people. The latest weapon against frequent migraines, Botox, best known for its ability to smooth out wrinkles, can keep patients headache-free for a few months. Injected at various points in the head, neck, and face, it can stop the muscle contractions of migraines. But because Botox is considered an experimental migraine treatment, most health insurance plans don't cover the cost, $400 or more for each round of shots. (Always discuss with your doctor any herbal, alternative, or experimental therapy you want to try.)

Continued on page 4:  Menstrual Migraines


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