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ASK THE DOCTOR: Crippling headaches; Millions suffer from migraine pain
By DR. JIM MITTERANDO

Q I get awful migraine headaches around my period, during which I cannot work and I have to sit in a dark room. Aspirin helps sometimes. Stronger, prescription pain medicines make me tired and do not get rid of the headache. I cannot go on like this. It is effecting my family and job. What can I do?

A Unfortunately, many people share your misery. Migraine headaches effect 18 percent of women and six percent of men.

Migraines are disabling, severe headaches that can last hours or days. Migraines are often accompanied with nausea, vomiting or sensitivity to light and sound. In contrast, tension headaches - the most common type of headaches - generally last no more than a day and do not cause nausea or vomiting. Tension headaches cause a squeezing pain around the head, often aggravated by stress or neck pain.

People who suffer migraines often get tension headaches, too. Sometimes tension headaches trigger migraines.

The exact cause of migraines is not known. Newer migraine medications, called triptans, effect serotonin and cause constriction of blood vessels that help break the attack. Fluctuating levels of estrogen also trigger migraines, which can strike when these levels are highest and lowest.

Migraines usually get better during pregnancy and go away completely after menopause. Birth control pills and hormone replacement can make migraines better - or sometimes worse - depending on the person.

In this case, decreasing estrogen around menstruation seems to trigger the migraine. By taking birth control pills continuously so that you have a period every three or four months, you may at least decrease the frequency of these headaches.

Prevention
 Regular sleep, regular meals, exercise, stress reduction and avoidance of any dietary triggers can be helpful in preventing migraines. Yoga, massage, acupuncture and biofeedback often help, too.

If you get migraine headaches on a regular basis, such as every month, you may want to consider preventative medications that need to be taken every day. Preventative medications reduce migraine episodes but do not eliminate them.

Vitamin B-2 (riboflavin) 400 milligrams daily can prevent migraines, but do not be alarmed when it causes fluorescent yellow urine. Feverfew is a popular herbal medication that possibly prevents migraines. Studies evaluating feverfew have been conflicting. Riboflavin or feverfew may need to be taken for two or three months to see results.

The most common prescription preventative medications include low dose antidepressants (amitrytiline), blood pressure medications such as beta-blockers (propanolol or atenolol) and calcium channel blockers (verapamil) and anti-seizure medications such as depakote. These medications can have side effects including, dizziness, fatigue or dry mouth. Talk to your doctor about which medicine may be best for you.

Treatment of migraine attacks

Fortunately, the over-the-counter treatments - aspirin, caffeine, acetaminophen (Tylenol), ibuprofen and naproxen - often relieve a migraine when taken early in the attack. If these medications do not work, I recommend the new (but expensive) triptan drugs such as imitrex, amerge, zomig, maxalt, axert and frova. Triptans break the headache cycle by constricting blood vessels. These medications are non-sedating and often allow people to continue working. If one brand of triptan does not work, it is worth trying another kind.

Triptans often cause chest tightness and flushing, which can be quite disconcerting, but is not harmful to people with healthy hearts. Because triptans cause constriction of blood vessels, people with heart disease or people at high risk for heart disease should not take this medication since it can rarely cause heart attacks.

Ergtoamines (cafergot) and midrin are other drugs that can help treat migraine attacks if triptans do not work or are not tolerated. Compazine (prochlorperazine) can help with nausea and vomiting during a migraine. Narcotic pain pills such as codeine, vicodin and percocet can help with severe pain that is not relieved with a triptan but cause drowsiness. Narcotic pain medications can be addictive and need to be used sparingly.

Fioricet (butalbital) is a combination of Tylenol and a sedative. I do not recommend this medication because the sedative can be addictive and is no more effective than Tylenol alone.

Final Notes

  • Keep a headache calendar for at least a two-month period may help to diagnose the kind of headache and possible headache triggers.
  • Blood tests, X-rays or brain scans (CT or MRI) usually are not needed for most headaches.
  • If you develop a change in your headache pattern or develop problems with balance or vision, follow up with your doctor.
  • Headaches can be caused by withdrawal symptoms in people who take pain medicines (either over-the-counter or prescription) on a regular basis.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.


Copyright 2002 The Patriot Ledger
Transmitted Tuesday, December 03, 2002