Dr. Carolyn Bernstein is a neurologist with a special interest in migraine headaches. She is on the teaching staff of Harvard Medical School and runs a busy headache clinic through the Cambridge Health Alliance, where she works with patients to manage their migraines. She’s currently working on a book on migraines, The Hip Harvard Handbook for Healing Your Headache, and is launching a Web site to find out what migraine sufferers want to know about managing this condition. On the site, http://www.harvardheadachebook.com, you can share your stories about migraine for possible publication in her book. Dr. Bernstein recently talked to HEALTHbeat about her book and what migraine sufferers can do to help themselves.

Q. What exactly is a migraine headache?

A. A migraine headache is a very severe headache that occurs due to changes in nerve cell activity in the brain. These changes result from a cascade of neurochemical events, and eventually trigger the throbbing pain and accompanying symptoms such as nausea, sensitivity to light and sound, and for some the visual changes (or aura) that can precede a migraine. (It is important to note that not everyone who suffers from migraines experiences an aura.)

Q. Tell us about your upcoming book.

A. I am very excited about this book because I am soliciting information directly from patients. I want their thoughts on what should be included and what they really need to know. Plus, the book is being written in a totally readable and interactive style. There will be activities and questionnaires to help readers really understand their migraines. I have an integrative and patient-centered practice, and the book will reflect this approach to migraine care. There will be lots of true patient stories. I'll be including an entire chapter devoted to hormonal headaches, the types of exercise that can really help with migraines, migraines and relationships, and lots more.

Q. Can you tell us more about the Web site you've developed to collect this information from migraine sufferers? What do you want them to share with you as you work on the book, and how can they do that?

A. I'm very excited about the Web site! We'll be providing some important information about migraines as well as a resources list and links to other useful sites. There will be weekly questions, surveys, and quizzes — and a place where you can submit your own story — I’ll try to publish as many as possible in the book. Just go to www.harvardheadachebook.com to tell me what you'd like to see in a migraine book. I've made an effort with my own patients to learn what they would find most helpful in their headache care, and I'd like to learn the same thing from a wider audience for this book.

Q. Chronic headaches severely affect many people’s lives. Can you describe the typical patient who comes to see you?

A. My typical patient is a young woman in her 20s who has had probably at least 10 years of headaches characterized by throbbing pain on one side of the head and accompanied by nausea. Her headaches cause her to want to avoid light and loud noises — and she's probably missed at least two days of work per month because of them.

Q. How can a person tell what kind of headache they have?

A. The best way is to see a headache specialist who can make the right diagnosis and a treatment plan. You can read about the common symptoms and characteristics associated with each type of headache, and that may help you understand what you suffer from, but to really pin down the problem and determine the treatment that's best for you, visit a physician trained in headache care.

Q. Why are women nearly three times more likely than men to suffer from migraines? Are there treatments that are particularly effective for women?

A. A number of women suffer from hormonally related migraines —“menstrual migraines.” A careful history will help with this diagnosis. Hormonal treatments can be very effective. Interestingly, by the second trimester of pregnancy, women who suffered from migraines often feel a lot better. The headaches may not return until the baby is born.

Q. What medications and lifestyle changes are most effective against migraines?

A. Your doctor can work with you to determine whether you need preventive treatment in addition to treatment for the headache once it occurs. Frequent or disabling headaches may require a daily preventive drug. Some people do well by using medication (in the form of a pill, nasal spray, or injection) only when they get the migraine. These drugs are very specific and stop the migraine from spreading. Lifestyle modifications and changes can definitely have a positive impact on migraine reduction as well. Regular nutritious meals and exercise can decrease migraine frequency. Stress is clearly a migraine trigger for many people, and finding ways to reduce stress can help a lot. I often recommend yoga to my patients, for example.

Carolyn Bernstein, M.D.
Instructor at Harvard Medical School

Q: Is exercise a good treatment for depression?

A: Studies consistently demonstrate that apart from its general health benefits, exercise can enhance emotional well-being. People who exercise regularly report a more cheerful mood, higher self-esteem, and less stress. Their sleep and appetite also tend to improve. So it’s no surprise that exercise can be useful in the treatment of clinical depression. It appears to influence mild more than moderate or severe forms of depression, and like all depression treatments, it doesn’t work for everyone.

We don’t know enough to say how much exercise is the right “dose.” There is no single type or amount of exercise that is ideal for treating depressive symptoms. A good start is 30 minutes of aerobic activity (producing some heavy breathing and a light sweat) three or four times a week. Then the intensity and duration of workouts can be gradually increased. Daily exercise is reasonable with the right combination of activities. What’s most important is to choose a program that you can keep up over the long run.

That may be particularly difficult for depressed people. If their mood does not improve soon after starting regular exercise — or if they find it difficult to sustain the will to work out — people with mild depression should consider standard treatments such as medication and psychotherapy.

Michael Craig Miller, M.D.
Editor in Chief, Harvard Mental Health Letter
www.health.harvard.edu/mental