17 Feb 2016

How to manage and prevent migraines and chronic headaches

From Nine To Noon, 10:10 am on 17 February 2016

A world expert on migraines says lifestyle changes combined with medication can greatly improve the condition.

Stanford University migraine expert Robert Cowan told Nine to Noon he is just one of the millions of people worldwide who suffer from migraines or chronic headaches. 

Migraines cause a throbbing headache that lasts between four and 72 hours, and is located in one hemisphere of the brain. Other symptoms include nausea and vomiting, and light and sound sensitivity.  

But, Dr Cowan said, lifestyle changes and medication can vastly reduce suffering.

The founding director of the Headache and Facial Pain Clinic at Stanford Health Care said he has had migraines since childhood, finding them particularly bad as he studied at medical school. But since implementing lifestyle changes and taking medication, he has reduced the number of migraines he gets to about six a year.

He said doctors were starting to get a better understanding of migraines, which are three times more likely to affect women than men.

"We know that migraine in particular is a genetic disease, so one might say the cause is not selecting your parents carefully. But, the underlying path of physiology - what actually happens in the brain - we are starting to get a better understanding of that.

"It appears there is a genetic defect with patients that get migraines," he said.

People who got migraines were also more sensitive to changes in their environment, such as bright lights or loud sounds, fluctuations in hormone levels, and changes in sleep patterns and meal schedules.

"The best way to look at this is to think of there being a continuum from people who simply don't perceive pain - of course they don't do well, they die young -  and at the other end are people who are overly sensitive to these environmental stimuli. In other words the brain does not process sensory input properly in either extreme ."

Non-threatening stimuli such as flickering lights or a skipped meal could trigger a migraine for sufferers, he said, as the brain sent inappropriate pain messages that the the body was "heading into a volcano", Dr Cowan said.

Normally it took a combination of triggers to cause a migraine. Red wine with dinner and a broken sleep, or a storm front coming in and dehydration, could be enough to do it. The important thing was to get a sense of how best to manage exposure to these triggers to make more informed decisions, Dr Cowan said.

Dr Cowan, who has been involved in the Headache Cooperative of the Pacific, recommends keeping a headache diary and having a treatment plan, which might include medication.

Medication is effective in reducing the frequency, severity and duration of attacks, he said.

But an injectable medication to treat cluster headaches, which are particularly painful, is currently unavailable in New Zealand.

Pharmac director of operations Sarah Fitt told Nine to Noon there were global supply issues with sumatriptan injections and New Zealand's supply ran out in December last year.

The tablet form of sumatriptan was still available, but the injectable form of the drug was particularly effective because it worked quickly.  

However, Dr Cowan said the patients who see the most improvement were those that looked beyond treating the condition with medication alone.

"The patients who do the best are the ones who seriously accept the importance of lifestyle management... In the long run, to keep your migraines from getting worse, your best bet is to take care (to have) regular sleep schedule, regular exercise, regular eating, and stress management."

If you get a migraine when you drink red wine, you can choose not to do it, he said, but things got more difficult when triggers were out of a patient's control, such as changes in barometric pressure. 

There was some anecdotal evidence that radical changes in diet such as eliminating carbohydrates or wheat and gluten could lead to fewer, less severe migraines. However, there were no large studies with solid data, Dr Cowan said. 

Websites recommended by Dr Robert Cowan:

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