The Migraine Brain

by Bernstein, Carolyn; McArdle, Elaine

  For most of us living at the frenetic pace of Western life, the idea of sitting still and being calm, watching our thoughts as they arise in our minds and drift away, seems strange or difficult. But there are very few serious critics of meditation. It is not a religion; it’s a relaxation technique and a way of approaching life. And, since stress is such an important trigger for many migraineurs, it can be very helpful as a means of calming yourself down.

  Meditation is worthwhile but it is something you have to learn and practice. It won’t simply come to you. Like anything else, the more you do it, the better you get. Twenty minutes a day is all you need to start off and to see some benefit in a few weeks.

  To find a meditation center in your area, Google “meditation” and your city or town. Meditation today is so widespread a practice—taught at churches, hospitals, and other sites—that you should be able to find someplace convenient.

  Massage

  Tight muscles or muscles in spasm can be a migraine trigger for many people. You may have a tight neck, back, or shoulders, especially if you sit in front of a computer or drive for hours each day. You may have tight facial or scalp muscles. You may clench your teeth, especially at night, so that you wake up with a migraine. If you are upset or under stress, you may tense up muscles.

  Massage can help if your migraines are accompanied by components of muscle spasms and tightness because it will loosen them and relax you. While the data isn’t overwhelming, a study at a major university found that twice-weekly massage for five weeks cut back on migraines by 50 percent. There are many different kinds of massage: Shiatsu, Swedish, neuromuscular, deep-tissue. Reflexology is a type of massage that focuses on parts of your feet that are believed to correspond to other parts of your body. Which style you try depends on your personal preference. All help to relax you, which in itself helps with migraine.

  As to whether massage can help a migraine that’s already under way, the data is unclear. Since scalp muscles often become inflamed during an attack, you may find that a gentle scalp massage feels good. But many of us can’t stand our heads or scalps to be touched during a migraine. And some massage therapists avoid the head area if you’re having a migraine because it’s believed to make the pain worse.

  Massage can be expensive. Insurance typically doesn’t cover it. And don’t forget to talk to your doctor first. If you have severe arthritis in your neck or serious back problems, for example, massage may not be appropriate for you.

  If you find that massage is helpful, by all means, go ahead. But if you are going to a massage therapist, make sure she or he is licensed. You don’t have to go to a massage therapist, of course, if you’re just looking for a little relaxation in your shoulders or neck. Your spouse or children may be happy to give you a gentle massage. You can also try this easy method: put a tennis ball on the floor, lie down, position the tennis ball under your sore shoulder or lower back, and roll around on it. It can help unkink the tightness. Just don’t let anybody see you because it looks pretty weird!

  Ice Massage

  Ice is great for migraines. It may not work for everyone, but it’s one of the cheapest, easiest, and best treatments we know for an acute migraine attack. And there are no side effects except your hair getting messed up. Even if you use medicine for migraines, I recommend trying ice massage to help you feel better.

  It’s simple: grab a bag of ice, a bag of frozen peas, or a gel-pack you buy in a pharmacy, the kind that turns cold when you break the inner bag. Place it on your head or scalp, or wrap it around the back of your neck. If the side of your face is throbbing, place the ice there.

  Ice is one of the best anti-inflammatory treatments we know. It helps shrink tissues that are inflamed, soothes the soreness, and the extreme cold distracts from the pain of the headache. (Some of my patients get the same effect by standing in an ice-cold shower and letting the water roll over their heads during a migraine attack.) It’s so effective that when a patient comes into the Women’s Headache Center with a bad headache, we immediately hand her a gel-pack to crack open and place on her face or head. Our patients almost always feel better, even if they have a severe migraine, and at the very least it gives them a bit of comfort while they’re waiting for more treatment.

  Ice should be your first line of defense. If you find it works to help you feel better, be prepared: keep a bag of ice in your freezer at home and at work. There are also products made especially for icing your migraine, including a head wrap you can wear like a headband. If you’re out and about, carry a gel-pack in your purse. If you forget your gel-pack and start to feel a migraine coming, duck into a fast-food restaurant, ask for a cup of ice, and place this on your head. For many people, it’s a tremendous help.

  Magnesium

  Magnesium may be the miracle mineral for migraine. Although it doesn’t help everyone, adding a daily magnesium supplement to your diet may help you prevent migraines. Numerous studies have shown that a magnesium supplement can help with migraines, including reducing menstrual migraines. It may even help abort migraines if taken intravenously, although the research is less solid, and I don’t prescribe this.

  Taking a magnesium supplement in order to prevent migraines is an option I recommend to some patients, especially those who don’t want to or can’t take medication. Magnesium supplements are cheap, easy to take, and there are few downsides.

  How does magnesium help migraine? It’s a mineral critical to a number of your body’s functions including your heart, bones, and muscles. It regulates how your blood vessels operate, reduces pain, and calms your nervous system, which is probably why it helps with migraines (it can help cluster headaches, too). It also helps decrease stress by acting on your sympathetic nervous system, and it helps regulate blood-sugar levels, two common migraine triggers. And, perhaps most important, it affects the production and regulation of serotonin.

  Many people are deficient in magnesium, in part because the high fat and high sugar in the Western diet block its absorption into the body. Studies show that people with migraines have lower magnesium levels than normal. The U.S. recommended daily allowance is 320 mg per day for women, 420 mg for men, where most people get only about 200 mg a day. If you take calcium supplements—to fight osteoporosis, for example—you may want to consider adding a magnesium supplement because calcium blocks your body’s ability to absorb magnesium.

  Even if you aren’t magnesium deficient, adding more to your diet may help your migraine, and you shouldn’t have any side effects as long as you don’t take high doses. The most common are diarrhea and stomach upset, which can be minimized by taking the supplement with a meal.

  I recommend taking 400 mg of magnesium a day. You can purchase a magnesium supplement in any drugstore. As with any treatment, you have to give it a decent trial period before giving up. I recommend trying this approach for at least two months. Mark in your headache diary when you began so you can measure any improvement.

  Talk to your doctor first to make sure you don’t have any health conditions that would prevent you from safely taking a magnesium supplement, such as kidney problems. Don’t increase your dosage without telling your doctor. At very high dosages, you can experience nausea, low blood pressure, and other problems.

  Riboflavin, Coenzyme Q10

  Many migraineurs may be deficient in two other important substances, riboflavin and coenzyme Q10. Studies have shown that patients who added supplemental riboflavin and/or coenzyme Q10 had significantly fewer migraines. If you are interested in a migraine prophylactic—a preventive—and can’t tolerate or don’t want to take a drug, this is an option to consider.

  Riboflavin, or vitamin B2, is essential to energy production in the cells, including those in the brain. Patients who added riboflavin to their diets each day decreased their headaches by 50 percent or more, according to several studies. While more research is needed, there are few downsides to taking riboflavin in a reasonable amount. I recommend a supplement of 400 mg daily.

&n
bsp; Coenzyme Q10 has a similar function in the body as riboflavin and apparently works the same way in preventing migraines. Patients who took 100 mg of coenzyme Q10 three times a day had a 50-percent reduction in the number of migraines. Talk to your doctor about this option. If there are no problems, consider adding 100 mg three times a day.

  Herbs and Herbal Supplements

  A lot of patients ask me about using herbs for treatment of migraine; in particular, feverfew and butterbur, both of which are long-time folk remedies for headache. (Patients have also asked about using kava kava as a mood stabilizer and ginkgo biloba as a treatment for depression, for which I have the same concerns.)

  There is quite a bit of information on the web about these herbs as migraine treatments. Many migraineurs claim that they’ve gotten significant relief from feverfew or butterbur, and studies seem to support this. However, as a medical doctor and headache specialist, I don’t recommend using herbal treatments. There are potential dangers. Never use them without telling your doctor. There are other options that we know work and that don’t have the potential to harm you.

  Those are the general concerns I have with herbal supplements. Now let’s look specifically at the two most popular herbal treatments for migraine, feverfew and butterbur.

  * * *

  Warning—If you are pregnant or nursing, do not take any herbal supplements unless you get clearance from you obstetrician or pediatrician. Do not use feverfew if you are pregnant or nursing.

  * * *

  Feverfew, a bitter green herb with a little white flower, has been used for centuries to help with migraine and is especially popular in Great Britain. You can chew fresh or dried leaves or take a prepared herbal supplement. Some supplements are sold under the names of Migrelief and MygrAid.

  Feverfew contains a compound called parthenolide, believed to help with several aspects of migraine including acting as an anti-inflammatory, preventing muscle spasms, and stopping blood vessels from constricting. A number of studies strongly suggest that use of feverfew—by itself or in conjunction with other ingredients—can be very helpful in preventing or treating migraine. Other studies are less optimistic.

  Like any drug, feverfew has potential side effects including mouth ulcers, swelling of the lips and tongue, diarrhea, and vomiting. It can also result in rebound headaches. One of my patients broke out in a rash on her arms after trying feverfew.

  * * *

  GelStat Migraine

  GelStat Migraine is an over-the-counter medication sold as a migraine abortive. Composed of feverfew and ginger, it’s different from other herbal remedies because it has been approved by the FDA as safe and effective in treating migraine. GelStat Migraine is helpful for some people and may be worth trying as long as you have no health reasons to avoid it (e.g., you are pregnant). Be sure to tell your doctor if you are using it so your treatment can be monitored.

  * * *

  Feverfew absolutely should not be used by children under two, pregnant ore nursing women, or anyone with a bleeding disorder or who is taking a blood-thinning medication, including aspirin—since feverfew may promote a tendency to bleed.

  Butterbur (also known as purple butterbur and sweet coltsfoot) is a plant that grows in Europe and parts of Asia and Africa. Migraine treatment products with butterbur include Petadolex Butterbur Gelcaps, which claims to prevent migraines.

  While some studies claim success in treating migraines, there is a particular safety issue because butterbur contains high levels of chemicals that are carcinogenic. Petadolex Butterbur Gelcaps use a manufacturing process that removes these chemicals.

  Since the data on the usefulness of feverfew and butterbur in treating migraine is inconclusive and there are risks associated with each of them, I recommend against taking them. Until we know more, I would much rather see you try a different treatment option.

  But if you decide to go ahead with an herbal supplement, tell your doctor! He or she will know whether you have health conditions that make it particularly dangerous for you to use particular herbal supplements, or whether those you want to try will interact badly with other medications you use.

  Relying on herbal supplements as migraine treatment is different from including nutritional planning as part of your plan. For more on nutrition and migraine (including the migraine-magnesium connection), see Ch. 12.

  Energy Healing

  Energy healing is based on the theory that the human body has seven energy fields or chakras that run through it. If one or more of these chakras is out of alignment or blocked, illness will result. By rechanneling or unblocking the energy flow, practitioners believe, you return to a point of wellness. Energy healing wasn’t addressed when I was in medical school, and it’s unlikely that many schools have it on the curriculum today. But the concept of energy healing is ancient, and it is worth considering if it appeals to you.

  There are many forms of energy healing. Perhaps the best known is Reiki, a Japanese form. Other types include aura healing and chakra healing. An energy healer does not touch you. Instead, she speaks with you, learns what is ailing you (or, if you don’t know, asks questions to help figure this out), then runs her hands above and around your body without touching in order to realign your energy fields. Many patients report they can actually feel their energy begin to move during a treatment session.

  People who aren’t interested in traditional Western medicine or who have long-term chronic conditions for which other treatments haven’t worked may want to explore this option. It’s noninvasive and has no side effects. If it doesn’t work, the only downside is that you’ll be out the cost of the treatment. I have patients who tried other treatments that didn’t work, then turned to energy healing and found it very helpful.

  Reiki is particularly popular, and you can find a practitioner in your area through searching “Reiki” on Google. Another way to find an energy healer in your area is to contact the Barbara Brennan School of Healing at www.barbarabrennan.com. A former NASA physicist, Dr. Brennan has studied human energy fields for three decades, and her school has graduated hundreds of energy healers.

  Part Three:

  Your Personal Wellness Plan

  “It was a long time before I began thinking mechanistically enough to accept migraine for what it was: something with which I would be living, the way some people live with diabetes.”

  —Joan Didion, “In Bed,” from her collection of essays, The White Album

  INTRODUCTION

  If you have a chronic illness such as migraine, you must take good care of your health. Otherwise, you’ll get more migraines and they may be worse. It’s that simple.

  This doesn’t mean that migraines are your fault. Nor will you cure them by living healthfully. But if you take care of yourself, you can reduce the number you get and how bad they feel, and you’ll recover faster from migraine attacks. These are proven medical facts.

  If you’re working all the time to the exclusion of other vital parts of life—including health, family, friends, and personal happiness—you’re out of balance, and it will catch up to you. It’s the same if you are always caring for others at the expense of yourself. A pill can’t cure you—you need a revolution in your lifestyle.

  Put your Migraine Brain first, and everything else will follow.

  Every human being must follow certain rules to stay healthy. If you follow the Eight Steps to Wellness described here, physical and emotional well-being almost certainly will follow. If you ignore them, illness and unhappiness will result.

  You deserve to be healthy. You deserve to live a life that’s as migraine-free as possible. One of my goals in this book is to give you the support you need to put your health first and take care of your whole self. I’m not suggesting that you become self-absorbed or selfish. But when you have fewer migraines, you can do a better job at work, and become a better partner, friend, and parent. Self-care is better for you and those around you.

  As a mother and a doctor, I know exactly how har
d it is to fit self-care into your busy life. We all feel overwhelmed caring for our children and families, keeping up our homes, and earning a living. In the daunting list of tasks you face each day, the things that seem easiest to ditch are those you do for yourself: exercise, getting enough sleep, taking time to relax. When you have to wake up early and rush to drop the kids at school, race to the office, work hard for eight hours, rush back to pick up the kids, get dinner on the table, supervise homework, clean your house, and spend some time with your partner—well, squeezing in half an hour of walking or meditation seems laughably out of reach.

  But you have to. It’s essential to your Migraine Brain’s health. And, in taking care of yourself, you will help everyone around you. You want as few migraines as possible. Whenever you get a migraine and end up immobile on the bed in a dark room, unable to talk to your kids let alone interact with them, you and your family suffers. Your quality of life plummets as does that of your loved ones.