Headache Expert Question and Answer
Friday, June 12, 2009
Amlodipine, Magnetics and Headaches
Q: Is there evidence that Amlodipine has any effect on migraines? What about strong magnetic bracelets? Those are the only changes I can really say happened and my headaches continued at least a month after beginning to use either of these.
A: There are some studies that have suggested that some with migraine can benefit from Amlodipine even though the data is not complete. There is really no scientific evidence to support the use of magnetic bracelets in migraine.
Mark Green, M.D.
Columbia Univ. College of Physicians
New York, NY
Menstrual Migraines
Q: What actually causes menstrual migraines and is there any pro-active approach to prevent them?
A: The main cause of menstrual migraine is the drop in estrogen that occurs with menses. This drop can be endogenous (from the woman’s own ovaries) or exogenous (e.g. from the drop in estrogen that occurs on the placebo week of the birth control pills). Approximately 60% of women migraine patients experience menstrual migraine. There are pro-active ways to prevent menstrual migraine. For women who need or want oral contraceptives, continuous use (no placebo) can prevent the drop in estrogen that is the main trigger for menstrual migraine. Taking a non-steroidal anti-inflammatory medication like ibuprofen or naproxen around the time of menses can be helpful, e.g. taking naproxen 500 mg twice a day for 5-7 days. Magnesium has been shown to prevent menstrual migraine at a dose of approximately 400 mg a day. Triptans, migraine-specific medications, can be taken on a preventive schedule, e.g. taken 3-5 days around menses. This is “off-label” use but is widely done in practice. Lastly, increasing the dose of a preventive medication that the woman is already on can help prevent menstrual migraine. For many woman migraine patients their menstrual migraines are the most severe and last the longest. Employing short-term preventive strategies can help lessen the impact of menstrual migraine.
Susan Hutchinson, M.D.
Director
Orange County Migraine & Headache Center
Irvine, CA
Food Triggers and Migraine
Q: I've been a member of the National Headache Foundation for many years and your newsletter and reading other research materials has taught me a lot about headaches. My headaches are tension and migraine now called transformed migraine. I spent years going to doctors and nothing helped. None of the preventives helped at all. Nor did the Imitrex and all the newer ones plus the Neurontin, Topamax etc. My sisters, several aunts and two nephews and one niece had/have headache problems too.
I've been doing all the lifestyle changes for so long that it's all I know. I still keep active and know foods are the major cause of my headaches. I've been through food testing, allergy testing etc. but none of the results and their suggestions affected my headaches.
Last winter, I only ate organic foods low in Tyramine and other amines, salicylates & glutamates. I saw a bit of improvement, it wasn't enough to indicate that I was on the right track. Something else, food- related, was causing these headaches.
I'm now trying a hypo-allergic diet and trying Nasalcrom since research in one of your NHF Newsletters mentioned this as a possibility. I've only begun so don't know if it will help me detect what's safe to eat or not.
Are there doctors, or specialists who are real expert in foods and headaches? I'm much disciplined with my eating and have been trying since 1980 to pin down what I can and can't safely eat. Like with my aunt, the list changes much too often to know what's actually going on. I'm tried food diaries in far more detail then you would imagine trying to seek the relationships to my headaches but with no luck. Within two hours of eating a typical meal, I get nauseated and soon after, the pain behind my right eye begins.
A: I know of no one who is trained in headache medicine in this highly refined area. I would consult with a gastroenterologist however to assure that there is no underlying medical disease of the intestines that would alter the digestion of certain foods and thereby cause headache. One example of such a condition would be Celiac Sprue in which the individual cannot metabolize glutens and gets gastrointestinal as well as neurologic symptoms.
Fred Freitag, D.O.
Diamond Headache Clinic
Chicago, IL
Cluster Headache
Q: My daughter has been suffering from cluster headaches for three years. She averages sixty two headaches each year. She has had to leave two different working positions because of this. She is on her third job with only eight weeks left on her FMLA. She had to give up her spot for nursing school (she was accepted last fall 2007 but, had to give up her dream due to her headaches.) My daughter has no insurance and needs help, I have taken her to allergists, dentist, chiropractor, and also had her eyes checked. She’s tried Botox and went through ten different medications. The family nurse practitioner that she sees at a local clinic feels that she needs to be put in the hospital when she is having an attack and have tests run, but without any insurance it's impossible.
A: Cluster headache can be quite debilitating, and the pain is often excruciating. Hospitalization, however, is generally not required for either the treatment or work-up of attacks. The diagnosis is made clinically, on the basis of the symptoms and timing of attacks. Although your daughter has tried ten different medications, it is not clear whether any of these medications were those that have been identified as most successful in prevention of cluster headache. Your daughter might benefit from consultation with a headache specialist or a neurologist who understands headache.
Christina Peterson, M.D.
The Oregon Headache Clinic
Milwaukie, OR