The Migraine Brain

by Bernstein, Carolyn; McArdle, Elaine

  If you have a fever accompanying your headache, the doctor may order a lumbar puncture, also called a spinal tap, to ensure that you don’t have meningitis, a potentially fatal illness.

  But not much else will happen to you in the hospital. Besides painkillers and/or a brain scan, there isn’t much else the doctors are likely to do.

  Recovering from the Migraine

  Once under a doctor’s care, you should concentrate on getting better, including staying hydrated. You’re unlikely to want to eat for a while. But once your appetite returns, it’s important to eat so you get your energy back. Your tastes are probably finicky at this point, and you need healthy foods. Be cautious since hospital food is generally lousy and can be trouble for migraineurs. Obviously, avoid any foods that are migraine triggers for you. You may crave foods that tend to help you recover from migraines: a high-protein health bar, for example. Ask your nurse for a consultation with the hospital dietitian so you can order foods that will help you recover. You are not being self-indulgent: A diabetic would automatically get special attention from the dietitian and an appropriate diet. You deserve to be back on the road to health, and an unappetizing meal that’s high-fat or without enough protein won’t help you.

  What foods will help? That’s an individual matter, but in most cases you won’t want anything heavy. Soup, toast, weak tea, perhaps a banana (unless it’s a trigger!)—these are foods many migraineurs can tolerate after a bad attack. In truth, you should eat anything you can hold down. If you have a friend who can bring something healthy that you crave, call in your chits and ask for that favor.

  When your migraine begins to subside, you’ll be entering Stage Four of the migraine, postdrome or the migraine hangover. If you’ve been hospitalized or spent time in the ER, your migraine was particularly severe and your postdrome may last a day or so. When you first get out of bed and try to stand up, you may be shaky. Take it easy. You’ll likely be exhausted, although some migraineurs also feel a sense of excitement or euphoria during postdrome. Some get a strong sense of renewal or a fresh start, which makes sense, since they may have emptied their bodies entirely through vomiting, and then slept a deep sleep during recovery. Or you may experience such mood changes such as depression or despair. Be gentle with yourself and recognize these as part of the migraine. If the depression lasts, however, make an appointment with your doctor.

  “I always love coming out of a migraine. It’s weird, but it’s like a new start. I feel fresh and pure, especially if I’ve vomited a lot and then slept heavily. It’s like my body was cleaned out. I don’t want to dirty my body with unhealthy foods or drinks, even caffeine.”

  —Fiona, 49, writer

  During your hospital or ER stay, if you’re fortunate, a friend has informed your employer that you’ve been ill with a migraine. But, if you need it as validation for a sick day, ask your doctor for a signed note that explains your medical condition.

  When you’re discharged, have a friend drive you home, or take a cab. You need to gain back your strength and not leap right back into your regular regimen. Have realistic expectations for your schedule over the next day or two. You may need another day off before you return to work. You are not being self-indulgent. If you don’t take care of yourself now and recover entirely, your migraine may well return.

  Eat good food, drink a lot of water, and try to walk around a little bit so you don’t get too deconditioned.

  And sleep as much as you need to. Sleep is a terrific migraine recovery treatment, your body’s way of regenerating. Your goal is to recover completely.

  Inpatient Treatment for Migraine

  Ten or fifteen years ago, some hospitals had inpatient units for pain management, to help people get headaches under control and/or help them detox from headache medications. Some excellent clinics helped headache patients learn new migraine control techniques, participate in support groups, try new medications, or be weaned off drugs. Unfortunately, most of these units have been phased out. Insurance companies are not willing to pay for the high cost of inpatient treatment of headache or other pain-related illnesses.

  If you are addicted to a painkiller for treating your migraine, or are taking so many OTC or prescription meds that you are in an unbreakable rebound headache cycle, you’ll probably have to work on it on an outpatient basis. Together, you and your doctor should come up with a written plan on how you will detox from your medication, including under what circumstances you should go to the ER during this period.

  You may in for a rough time during detox. But your doctor should advise you on why it’s so important to do. Your doctor may very well refuse to prescribe any more medication for you until you detox. That’s the stick part of the carrot-and-stick process.

  The carrot is this: Your migraine disability may improve substantially once you aren’t using so much medication.

  CHAPTER 11

  Complementary and Alternative Treatments

  Pick any treatment for migraine—triptans, caffeine, biofeedback, magnesium supplements—and you’ll find some people who swear by it, and others who find it useless. Each migraine patient has a different list of things that help—and don’t. We still don’t fully understand why that is, but we do know that your Migraine Brain is unique, which is why you need to create your own customized treatment plan. You will want to choose the treatments with which you are comfortable—the treatments that work for you.

  Many migraineurs are drawn to preventive treatments from complementary and alternative medicine, or CAM, which includes nonmedical options, from herbal supplements to yoga. Many of these therapies come from Eastern medicine traditions and use a holistic approach that treats the entire patient rather than a single symptom. CAM recognizes that the mind and body are interconnected and work together as a whole. To rout out illness, the best approach is to look at the entire body and mind, and make sure every part is healthy and working in harmony with the other parts. In the past twenty years, CAM has become much more accepted in the West because of strong scientific evidence that many of these treatments are very effective. A number of doctors in the West now include CAM as part of their medical practice, drawing from the best of Eastern and Western traditions in an integrative approach.

  For many patients, the integrative approach works better than a traditional Western medical approach alone. Treating your headache in isolation is not the best way to feel better. There’s no magic pill to cure you. The more you examine your overall health and well-being, and make changes as needed, the less migraine will affect your life.

  Let’s say that you use medication that helps your migraines but you continue to suffer from back pain due to misalignment of your muscles and spine. You’re also in a high-stress job and you don’t take time to eat well, exercise, or relax. Migraine meds treat your head pain and nausea, but if you address the other issues in your life, too—your back pain, lack of relaxation, poor health habits—you will almost certainly have fewer migraines and you may need less migraine medication.

  Certain complementary treatments are very effective for many of my patients, and there is scientifically valid research supporting their safety and usefulness in treating migraine. For example, the data on the effectiveness of biofeedback is strong enough that we have a biofeedback instructor on our staff at the Women’s Headache Center. Here are the CAM treatments I feel comfortable recommending to you as worth trying:

  biofeedback and certain other relaxation techniques

  yoga

  meditation

  acupuncture

  massage and ice massage

  nutritional supplements—magnesium, riboflavin, or coenzyme Q10

  energy healing.

  Yoga, acupuncture, and the other treatment options listed above may not reduce your migraine illness specifically, but they’re very good for your general health and well-being, which can affect your migraines.

  Complementary practices also convey a sense of empowerment: you give yourself the right and
power to become well, to move out of a “sick role,” so you have an expectation that you can be well and feel good. In contrast to seeing yourself as sick, you see yourself as a well person—who occasionally has a migraine.

  In addition to the complementary treatments I have noted above, scores of others claim to help with migraines, including aromatherapy, diets, and natural hormones. I am less confident about many of these; in some cases, I recommend against them. In general, there are no reliable data strongly supporting their usefulness in treating headaches. Some therapies have no scientific support at all. Others are dangerous.

  Still, it is your choice, in consultation with your doctor. I’m interested in hearing from people about what’s worked for them. If aromatherapy makes you feel better during a migraine, don’t hesitate. I’ve heard plenty of bizarre or funny things people do to feel better. One of my patients, when she feels a migraine coming on, can sometimes stave it off by eating a lot of chocolate or a really sweet dessert. This is fine, since she’s not overweight or diabetic. Whatever it takes to feel better and stay healthy is fine—as long as it’s safe.

  I will never recommend a treatment unless I’m certain it isn’t harmful. Many claims for treating migraine are highly questionable. A new patient revealed she was following a special “migraine diet” she found in a book: she ate nothing but yogurt and bananas. This was not only unhealthy—she wasn’t getting the essential nutrition her body needs—but actually dangerous in the long run. And she still had headaches! Another patient proudly told me during her first appointment that she was using a “women’s herbal combination” for her headaches, recommended by an herbalist. When I looked at the ingredients on the bottle, I was shocked to see that it included digitalis, a very potent cardiac drug that not only slows the heart rate but can cause cardiac arrest. The patient trusted the herbalist and so she had not investigated the ingredients of the herbal treatment. She mistakenly believed that herbal treatments, because they are “natural,” are always safer than medication. When I explained to her the potential dangers of the potion, she was horrified. Fortunately, she hadn’t had any problems yet, but the consequences literally could have been fatal. She immediately stopped using the herbal treatment, and we began working together to come up with a natural treatment plan that was safe.

  If you hear of a “cure” or treatment for a migraine that we don’t address in this book, be very cautious. And always talk to your doctor before you try anything. Otherwise, you may harm yourself. At the very least, you will likely waste money and suffer needlessly when you could be using treatment options that can actually work.

  Whenever you see a claim for a sure “cure” for migraine, be very skeptical. There is no such thing as a migraine cure, not at this time.

  Myth: “Natural” is Better

  Some people have strong prejudices against conventional or Western medicine and believe that a “natural” approach is always better. Perhaps you’ve had a bad experience with a medical doctor who minimized your migraine pain. Maybe you’ve been misdiagnosed several times, or prescribed a drug that didn’t work or had bad side effects. I completely understand your frustration. The medical world still has a long way to go in validating the experience of migraineurs and treating us with respect.

  But it’s simply untrue that a natural approach is always better for your body. First of all, just because something claims to be “natural” doesn’t mean it really is, or that it’s safe. There is little quality control or consumer protection in the manufacture of alternative products. Although new rules passed in 2007 by the FDA require manufacturers to guarantee that labels are accurate and ingredients are pure and safe, it is not clear how well these rules are enforced. The FDA may get involved in natural supplements only if there is a problem. Different brands often contain different dosages of the active ingredient. Different bottles from the same manufacturer may not even contain the same dosages. You can be getting too much, too little, or even none at all. And you won’t learn there’s a problem until something goes wrong.

  Many “natural” products are drugs even though they weren’t created in a lab. If something alters your body chemistry, it’s a drug. Don’t make the mistake of thinking you’re drug-free because you’re eating feverfew leaves, instead of taking a prescription medication. Feverfew can be very hard on your stomach, and people with digestive tract problems or ulcers should never use it.

  While there are many valid criticisms of the pharmaceutical industry and the way drugs are approved, the FDA does provide an important function in reviewing the safety of drugs.

  I support the complementary and alternative medical treatments I’ve listed. I also support your right to make decisions about your health, but I want you to be fully informed when you do.

  If you choose to use a complementary or alternative medical treatment, I advise you to remain under the care of a medical doctor who supports your interest in CAM. (There’s little government regulation of complementary and alternative medical practitioners and their licensing. You may end up with a poorly trained quack who gives you a potion that can harm you.) If you don’t want to use prescription drugs, your doctor should respect your choice and help you find a CAM practice that works and is safe. If you want to use one of the CAM treatments outlined in this book but your doctor is adamantly against it, you have every right to consult a different doctor. Check in your area for a medical doctor who practices an integrative approach.

  Why Consider a Complementary or Alternative Medical Treatment?

  You don’t want to use Western medicine or any medications.

  You can’t use certain medicines because of other health issues.

  You want to use less medicine by complementing your medical treatments with nonmedical treatments.

  You like a holistic approach of treating the whole person, mind and body.

  You like having direct control over your migraines with treatments such as biofeedback or yoga that reduce stress.

  If you are considering an unconventional or nonmedical treatment for migraine:

  Tell your medical doctor. Don’t try a complementary or alternative treatment without first telling your headache specialist, to make sure there’s no medical reason for you to avoid it (for example, pregnant women, and ulcer and heart patients must avoid certain herbs; someone with a serious neck injury shouldn’t see a massage therapist without a doctor’s clearance).

  Make sure the CAM provider is certified in the field and is competent. Ask your medical doctor for a recommendation; ask friends, too. Check the provider’s credentials through certifying or licensing organizations that oversee his or her specialty. And ask the provider for his or her credentials.

  Do your homework. Research the treatment option through a valid medical website such as the American Headache Society at www.ahsnet.org, which information about CAM treatments for migraine. There is also a wealth of excellent information on CAM at www.nccam.nih.gov, the website of the National Center for Complementary and Alternative Medicine, which is part of the National Institutes of Health. As the federal government’s agency for researching and evaluating CAM, it provides reliable information on the latest research in this area.

  Let’s look at these options in more depth.

  Biofeedback

  “Why do I use biofeedback? Desperation. Medicines aren’t working for me. Also, I do well with physically oriented things because I think too much. So I can read books about migraine and take pills but that doesn’t necessarily work. And anxiety is a big issue for me. Biofeedback helps calm me down, and I can see the results.”

  —Kathleen, 25, student

  Biofeedback is nothing more than a formal way of learning to relax your body in order to decrease stress, which can cause numerous health problems including triggering migraines. Relaxation balances out your mind and body and restores you to health.

  Biofeedback teaches you to use your mind to control involuntary physical responses such as your heart rate, hand temperatu
re, and even brain waves. Studies show it can help some migraine patients reduce the number, duration, and pain level of migraines. Certified instructors use special equipment that monitor such body functions as muscle tension, skin temperature, how much you are sweating, and/or brain activity. As you learn techniques to relax, you can monitor your temperature rising, your breathing slowing, and your muscles relaxing. For migraineurs, body temperature biofeedback can be especially helpful because many of us have cold hands and/or feet, either chronically or in conjunction with a migraine attack. By learning to raise your body temperature through visualization and deep breathing, you may counter your stress response and ward off a migraine.

  Many of us live in a constant state of overarousal of our sympathetic nervous system, which is designed to prepare us to flee from danger: the so-called “fight-or-flight” response. This response releases certain chemicals, including cortisol, adrenaline, and epinephrine, that increase our heart rate, inhibit digestion, decrease libido, and move the blood from our feet and hands into our main muscles so we can respond quickly if we need to protect ourselves. But a “fight-or-flight” reaction isn’t useful for the ongoing kinds of stresses we face in the modern world—financial, emotional, work-related. In fact, a racing heart, dry mouth, and inability to digest are counterproductive to these daily challenges. Our bodies are in a chronic state of alert. We never get a break or rest, and our health begins to break down. Under these conditions, if you have a chronic illness such as migraine, more flare-ups are inevitable. And the hypersensitivity of the Migraine Brain makes it especially susceptible to overreacting to stress. That’s why learning to control stress reactions—warming your hands through creative visualization and deep breathing, relaxing tense muscles—is beneficial.