The Migraine Brain
Page 15
My male patients include factory workers, lawyers, doctors, and students. They endure the same pain and disability as women, the same devastating effects on their work and personal lives. Yet migraine is often perceived as a women’s disease, since women migraineurs outnumber men by a 3-to-1 ratio. Most TV and magazine advertisements for migraine drugs depict women, and many of the highest-profile migraineurs today are women.
Fortunately, that perception is beginning to change. In recent years, more men have stepped forward to reveal not only that they get migraines but just how devastating the disease can be. NFL Hall of Famer Troy Aikman, former quarterback for the Dallas Cowboys and a lifelong migraineur, recently became a spokesman for the National Headache Foundation to raise public awareness of migraines among men and to encourage them to get treatment. Like many men, Aikman spent years mistakenly believing that there was no help for his headaches, and he simply suffered the pain. Nearly 25 percent of men with chronic headaches have not sought help from their doctor because they choose to “tough it out,” while another 25 percent believe headaches aren’t worthy of a visit to a physician, according to a survey by the National Headache Foundation. Numerous studies have shown that men are less likely than women to seek medical attention for headaches.
For a variety of reasons, men may feel very uncomfortable talking about migraine with anyone, including a physician. Some may feel it’s not “manly” to confide that they have headaches. They may steel themselves to endure the pain rather than seek help. Some of my male patients have been reluctant to be honest with me about how bad the pain is, until they realize I’m a migraineur myself and understand what they’re going through. (I don’t see male patients at the Women’s Headache Center, but through my other practice at the Cambridge Health Alliance, I treat men and women.)
One of the watershed moments in migraine awareness—for both men and women—took place in 1998, during the Super Bowl championship between the Denver Broncos and the defending champions, the Green Bay Packers. During the first quarter, Terrell Davis, a third-year running back from the University of Georgia, was kicked in the head during a tackle.
“I got dazed and blacked out for a minute,” Davis said later. “I couldn’t see.”
Davis, a longtime migraineur, realized that a migraine attack was imminent. Although he made another play, he had trouble walking and was led off the field. He sat out the rest of the half, a towel over his head to block out light. But Davis was determined to return to the game.
“It’s happened before,” he said in an interview. “I knew I would get back in the game.”
Doctors gave Davis oxygen and an injection of a then relatively new drug, sumatriptan (Imitrex). When the second half began, Davis trotted back onto the field—and dominated the game. He went on to lead the Broncos to a cliffhanger Super Bowl championship and scored the winning touchdown with less than two minutes left in the game. He’d also scored two other touchdowns earlier in the second half. In addition to three touchdowns, Davis left the game with a career high rushing 157 yards, breaking the Super Bowl record for rushing touchdowns. And he was awarded the 1998 Super Bowl Most Valuable Player award.
To migraineurs watching that day, Davis’s recovery was nothing short of miraculous. That he could function at all shortly after enduring a crippling migraine—let alone lead the field in athletic achievement during the most high-pressure football event of the year—was unimaginable. The incident made headlines and was the first time many migraineurs learned of sumatriptan.
In the decade since that Super Bowl, other celebrities have come forward to talk about the devastating effects of migraine. In the 2002 music documentary I Am Trying to Break Your Heart, about alt-rock super-band Wilco, lead singer Jeff Tweedy is seen vomiting violently backstage due to a migraine, and Tweedy has written about his migrainess on the New York Times migraine blog. But athletes are the ones at the forefront of raising public awareness about migraine in men. Hoops megastars Kareem Abdul-Jabbar, Scottie Pippen, Andrew Bogut, and Jason Williams get migraines. Miami Dolphin star linebacker Zach Thomas has had to sit out games from migraines. Dolphins teammates Rohan Davey and Sammy Morris also get them, as does Tampa Bay Buccaneers running back Earnest Graham. Pro baseball players with migraines include Johnny Damon, Jose Canseco, David Bell, and Dwight Gooden. Golfer Fred Couples is a migraineur. Their willingness to discuss the disease has had a huge effect on public awareness, helping nonsufferers recognize that migraine is a serious, debilitating illness. Athletes are not only in peak physical condition but trained to fight through pain, so the fact that a migraine can lay them low speaks volumes about the reality of this disease.
* * *
Megastars with Migraines
A number of superstar athletes suffer from migraines, including:
*Jon Papelbon
“When they get really bad, even the slightest amount of noise or light is just brutal. You just want to curl up in a ball and die,” Red Sox superstar relief pitcher Jon Papelbon, who suffers four to five migraines a season, told the Boston Globe. During a migraine attack in September 2007, Papelbon—who’d spent the day in an emergency room—gave up four runs against the Yankees, leading to an 8-7 loss in a rare blown save for the young pitcher.
*Kareem Abdul-Jabbar
Former Los Angeles Lakers superstar center Abdul-Jabbar, who with 38,387 career points holds the NBA’s career point record as well as a record six Most Valuable Player awards, is a longtime migraine sufferer. In the fifth game of the 1982 NBA championship series against the Philadelphia 76ers, he was struck with a migraine, and he later noted, “Nine points, two rebounds. Not much of a game.”
*Scottie Pippen
In the 1990 NBA Eastern Conference finals against the Detroit Pistons, a migraine forced Scottie Pippen, star forward of the Chicago Bulls, to sit out part of the deciding seventh game, which the Bulls lost. Pippen later told ESPN.com that the migraine and its effect on his playing was a “learning situation” that led him to “be better about taking care of my body.”
*Andrew Bogut
Bogut, the NBA’s number one draft pick in 2005, who plays center for the Milwaukee Bucks, comes from a family of migraineurs and has shared his migraine story to raise public awareness. Bogut, 2004–05 Associated Press Player of the Year, knows when a migraine is on its way: his left side goes numb, starting with his fingers and then up through his arm. Then he loses feeling in his lips and nose. He takes Imitrex to treat his migraines, and often takes anti-nausea drugs and a prescription sleeping pill.
* * *
One of my goals in The Migraine Brain is to encourage every migraineur, men and women, to feel supported in accepting their disease and getting treatment in order to lead a healthier life. There is simply no reason to suffer in silence.
“I always envision a little person inside my head. Like some little construction worker with a big sledgehammer is in my head, bashing the back of my eyeball trying to knock it out of my head. The nausea sticks with me, too. I’m incredibly sick, vomiting, and so on: sweats, sensitive to light and sound.”
—Hank, 37, photographer
Important News for Men with Migraine
For years, we doctors believed that there was no real difference in the migraine physiology of men and women, except, of course, that men don’t menstruate. A woman’s menstrual cycle and the fluctuations in her hormones are primary reasons that women are so much more susceptible to migraines than men. But research suggests there may be other reasons for these sex differences as well. A recent study by researchers at UCLA found that female mice are much more susceptible to cortical spreading depression, the hyperexcitability of the Migraine Brain. It took a much higher strength of stimulus—two to three times more—to invoke CSD in the brains of male mice. More research is under way, but researchers believe it’s likely that in humans, too, females are more prone than men to CSD.
Other recent research is important for you to know if you are a man with migraine.
Men with migraines are at a significantly higher risk for heart attacks and heart disease, according to a new study. They also have higher blood pressure and higher cholesterol than men who don’t get migraines. Other recent data supports this. See Ch. 2.
Follow-up research is needed to understand this connection better. But since you cannot change the fact you have migraines, this study tells us that you must be even more careful than other men about caring for your heart and your health. You must reduce other risk factors for heart disease—lower your cholesterol, don’t smoke, keep your weight at a healthy level, and keep your blood pressure under control through exercise and medication, if necessary. You should eat right and get enough sleep. Controlling these risk factors will reduce your risk of heart disease more than controlling your migraine will, experts emphasize.
A 2006 study also found that people with migraines are at an increased risk of high blood pressure, diabetes, and hyperlipidemia, which includes such problems as high blood cholesterol. It could be that migraineurs are more likely to develop blood clots, or because certain migraine triggers—such as sleep apnea—are associated with heart disease. These problems also may be related to the fact that people with migraines have blood vessels that are highly reactive, which could lead to heart disease.
I don’t want you to worry about this connection—but I do want you to use it as one more reason to take good care of your health.
Note: If you have heart disease, you may not be eligible to take triptans.
Painkillers and High Blood Pressure
“I’ve taken so many Advil I’ve probably rotted out my stomach. At one point, I was taking ten a day. They did nothing for my migraine, and I got a rebound headache on top of it.”
—Tom, 44, lawyer
Attention, middle-aged men: Regularly using over-the-counter painkillers such as aspirin, ibuprofen, and acetaminophen may elevate your risk of high blood pressure, which in turn can lead to heart disease.
You probably already know that taking too many over-the-counter painkillers is bad for your stomach and kidneys, regardless of your age or sex. But now there’s evidence of more serious health concerns. Taking more than fifteen pills a week of these medicines—which are the most commonly used drugs in the United States—can have a negative effect on your blood pressure, according to a study published in February 2007 in the Archives of Internal Medicine.
This study highlights why you, as a migraineur, need to be in the care of a physician. If you’ve been self-medicating your migraine with these medicines, you may be putting yourself at further risk for heart disease. These meds aren’t even really helping your pain, if you’re forced to take so many. Other medicines including triptans are proven to be far more effective, eliminating or significantly reducing migraine symptoms in the majority of people who take them.
Middle-aged men who used acetaminophen six to seven days a week had a 34 percent greater risk of high blood pressure than other men, and those who took aspirin often had a 26 percent greater risk. Those who took NSAIDs like ibuprofen had a 38 percent greater risk.
Like so much with migraine, more study is needed—but for now, please be aware of this connection. There are better options for relieving migraine pain than over-the-counter meds, which may danger your health. Please talk to your doctor about your choices.
Orgasm Headaches
“I get migraines and have for years. But I suddenly got an excruciating headache when I never had before—when I was having sex with my wife. It felt like a migraine and was a 10 on the pain scale. I was terrified since it had never happened before. But I was too embarrassed to call my doctor or go to the emergency room. What happened?”
* * *
Nobody Likes Loud Music during a Migraine
Joe Girardi is a former major league catcher appointed manager for the New York Yankees in 2007, who played for the 1996, 1998, and 1999 World Series Champion Yankees teams. He’s also a long-time migraine sufferer—and in September 2002, while playing for the Chicago Cubs, Girardi’s aversion to loud noises got him into a minor disagreement with superstar slugger Sammy Sosa.
Girardi and Sosa were co-captains of the Cubs and generally got along well. But Sosa liked to play loud music to pump himself up before games. One day, Sosa was blaring his stereo in the locker room. Girardi, in the midst of a migraine, walked over and turned the music down, and the two exchanged words.
“What happened was I turned Sammy’s radio down because he wasn’t in here. Sammy thought someone was messing with him,” Girardi later explained. The two said the incident was minor and that they remain friends.
* * *
This man had an orgasm migraine.
Men get orgasm migraines at a much higher rate than women, by a 4-to-1 ratio. These headaches can be really frightening, especially the first time you get one. The symptoms of these sudden, severe headaches can mimic more serious problems. You may have worried that you were having a stroke or aneurysm. Fortunately, those conditions are rare, but they are potentially fatal, so the first time you experience these symptoms, call 911 or immediately go to the emergency room. Remember, anytime your headache symptoms or type of pain change, call your doctor. Your doctor may order a brain test such as an MRI or CT scan to confirm that your symptoms are from orgasm headache and not something worse.
Once other conditions have been ruled out, there are excellent treatment options for preventing or treating orgasm headache. See Ch. 13.
Cluster Headaches
Cluster headaches are one of the most painful medical conditions possible—even more painful than migraines, according to people who suffer from both.
Many researchers believe cluster headaches to be a subtype of migraine, although there are clear differences. For one thing, cluster headaches are primarily a men’s disease, by a ratio of as much as 10 to 1 over women. But cluster headaches are much rarer: only about one in every 1,000 people—or one-tenth of 1 percent—gets them, whereas 7 percent of men and 18 percent of women get migraine. Cluster headaches are far more common among people who smoke, and drinking alcohol can trigger them in some people. So can the use of nitroglycerin.
Cluster headaches come in a cyclical pattern: a person will get a series or “cluster” of attacks for a period of days or weeks, and then the headaches will disappear for weeks, months, even years before suddenly appearing again. The attacks typically come at the same time each day during the attack period. For example, a sufferer may get a headache each day at noon and, say, 6 p.m., for several weeks, and then the headaches will go away for a period of time before coming back. This is the typical pattern, although some unfortunate people get chronic cluster headaches every day.
Beginning when he was nineteen years old, Thomas Jefferson suffered from terrible headaches that seemed to be triggered by stressful events. His headaches would disappear for seven or eight years, then return for two or three weeks at a time, a pattern that supports the theory that they were cluster headaches.
The pain of a cluster headache is usually on one side of the head only, although sometimes the side may shift during an attack. The pain is often centered behind one eye or temple, and is extremely sharp and stabbing, like a knife being driven into your eyeball, or burning, like a hot poker. Unlike migraines, where you feel better when you stay motionless, cluster headaches make the sufferer very restless or agitated, and you may feel the need to pace around. The pain of a single attack may last as little as a few minutes to as long as a few hours.
During an attack, there may be other symptoms on the side of the head that is experiencing the pain, such as a drooping or swollen eyelid, a bloodshot eyeball, tearing up of the eye, a runny nose, and/or sweating on that side of the face. Some people with chronic cluster headaches have a permanently drooping eyelid.
We have a long way to go in understanding the cause of cluster headaches. Current research is focusing on the hypothalamus—the part of the brain that regulates your biolog
ical clock—and its link to cluster attacks. This would help explain why attacks often come at the same time each day, and at the same time of the year.
Cluster headaches, like migraines, have also been the subject of lots of misinformation. In medical school, a professor told my class that cluster headaches are most common in “tall, silent men married to small, overbearing women.” It’s this kind of uninformed comment that perpetuates the preposterous idea that you somehow are to blame for a neurological disease.
Cluster headaches are so painful that over-the-counter medicines like aspirin or ibuprofen typically offer little help. Unlike migraines, biofeedback doesn’t seem to be helpful, either. One of the most effective treatments—if started within five minutes of an attack—is breathing pure oxygen, which can abort a cluster attack. Vigorous exercise also may help since it increases oxygen levels in your body (in this way, cluster headaches are very different from migraines, during which most people find it excruciatingly painful to move, let alone exercise).
Triptans can be very effective for some cluster headache sufferers, especially when delivered by a nasal spray. And there are other possible treatments: patients have responded to preventive drugs such as calcium channel blockers or steroids. Explore these options with your doctor. According to recent research, the use of psilocybin mushrooms and other psychedelics may help abort clusters or relieve the pain, but these studies aren’t conclusive yet, and, of course, as these drugs are dangerous and illegal, I recommend against using them. Other studies have found that stimulating the occipital nerve with a mild electrical current can be very effective in easing cluster headaches, another angle that researchers are continuing to examine.