When it comes to pain management, focusing only on reducing the intensity of pain may lead to treatments that do as much harm as good. Ideally, pain-management plans should be tailored to each patient and include a range of therapies that not only reduce pain but also help improve pain-related quality-of-life problems.
Severe headaches are a misery, whether they cause a dull ache or a steady, stabbing, or blinding pain. Such pain rarely comes from something catastrophic, like a tumor or a bleeding in the brain. Yet an estimated 12% of people with headaches get brain scans. A new study shows that these unnecessary scans add several billion dollars a year to health care costs for very little benefit. Excessive brain scanning costs more than just dollars. Repeated CT scans deliver enough radiation to increase the odds of developing cancer. Scans also tend to lead to more scanning if the test turns up something strange. Many people who see a doctor because of severe and recurrent migraine headaches don’t need brain scans. They need the right therapy to stop their pain.
At least once a week throughout my childhood, a migraine would force my mother to retreat into her bedroom. She’d shut the blinds and burrow under the covers, overwhelmed by a pain so severe it turned the faintest sound into an agonizing roar and launched waves of nausea with the slightest movement. Though my family and I tried to be sympathetic, it was hard for us to fully comprehend my mother’s migraines or understand why she had to miss so many events because of them. When you’re on the outside looking in, you can’t begin to appreciate how severely disabling—and life disrupting—chronic migraine can be. A study from Thomas Jefferson University in Philadelphia, released last week in PLoS One, found that chronic migraine sufferers experience as much social stigma as people with epilepsy—a disease that produces far more obvious and dramatic symptoms. Some of that stigma is external—for example, getting treated differently by friends or colleagues, and some is internal.
When migraine or another type of headache strikes, some people turn to … Twitter and Google. And their Tweets and searches are providing a glimpse into how—and when—migraine and headache affect lives. In a letter to the editor published in the January 2013 issue of Cephalalgia (the journal of the International Headache Society), researchers from Harvard-affiliated Boston Children’s Hospital analyzed Google searches conducted between January 2007 and July 2012. There were more searches for “migraine” on weekdays than on weekends or holidays. A similar pattern was seen in Twitter feeds. In the Google searches, the work week peak came on Tuesday and the low on Friday; on Twitter it was Monday and Friday. The most common time for migraine Tweets was between 6:00 am and 8:00 am, which the researchers say is a peak time for migraine attacks. Tweets could help researchers learn more about migraine triggers.
Migraines can be debilitating events. As Harvard Health editor Christine Junge wrote in this space last year about her battle with migraine, “On the days when I couldn’t get out of bed, it felt like someone was tightening screws into the sides of my head and pounding a hammer above my left eye.” Most migraine sufferers long to prevent these painful episodes. About one-third of migraineurs could benefit from taking a preventive pill. But only a minority of them actually take advantage of this option. New treatment guidelines from the American Academy of Neurology and the American Headache Society profile the best preventive medications, and an herbal preparation, for migraine. Preventive medications include antiseizure drugs, beta blockers, antidepressants, and triptans. The guidelines also indicate that an herbal remedy made from butterbur, a plant in the daisy family, can help prevent migraine. The downside of these preventive pills is that they must be taken every day, and may cause unwanted side effects.
Migraine was once a largely unpreventable and untreatable condition. Today there are dozens of prescription and over-the-counter medications, and even a few herbal preparations, proven to prevent migraine. Unfortunately, only about one-third of people who could benefit from a preventive therapy take one. New guidelines from the American Academy of Neurology and the American Headache Society highlight effective treatments, which should make choosing a preventive agent simpler and safer for migraine sufferers. The guidelines were published in the April 24, 2012 issue of the journal Neurology. The guidelines endorse the use of butterbur extract, an herbal preparation, for preventing migraine, along with several over-the-counter medications, such as ibuprofen and naproxen, and a bevy of prescription medications, including divalproex sodium (Depakote), sodium valproate, topiramate (Topamax), and beta blockers such as propranolol (Inderal, generic versions), metoprolol (Lopressor, generic versions), and timolol.
If exercise is good medicine, then yoga is, too. Research published recently suggests that yoga can be a useful therapy for lower back pain. An article in the November 2011 Harvard Health Letter indicates that yoga may also be a good way to keep feet strong and flexible, and so prevent falls. It can also help people who suffer from migraines. In The Migraine Solution, which will be published in January by Harvard Health Publishing and St. Martin’s Press, coauthor Paul B. Rizzoli, M.D., says that yoga can be a useful treatment for migraine because it is widely available, affordable, and very likely has benefits beyond migraine.
If you suffer from migraines, does what you eat affect your headaches? It depends on you, and what you eat. There are no magical foods that cause or prevent migraine. Instead, it differs from person to person, says Harvard Health editor Christine Junge, who attended a talk given by Sandra Allonen, a nutritionist at Harvard-affiliated Beth Israel Deaconess Medical Center, as part of Harvard Medical School’s monthly nutrition seminars.
Headaches that appear every day can take over your life. An editor at Harvard Health Publishing, who prefers to go by the name CJ for this post, tells what it’s like to live with migraine every day and offers tips for coping with the worst.