Andrew Weil's Blog: Dr. Weil's Healthy Living Blog, page 9

Reflection:

Struggling with shoulder and arm pain as I await having a shoulder replacement, I had a hard time finding energy and a legacy topic to write about this month. Then I stopped to reflect about when I feel low-energy and when I feel better; I discovered that my reactions relate to when people act kindly toward me, and when I make the effort to do a kindness for others. Maya Angelou perhaps says it best:

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

A friend told me the other day about waiting to take a left turn in morning traffic to get to work on time, and how her spirits were lifted all day after someone motioned for her to take her turn while he waited.

On my way to the doctor last week, I passed a pre-school playground, and a little boy came to the fence to show me his dinosaur – kindness and genuine openness flowed from him to me and I felt my spirits soar. Every time I felt low or sorry for myself that day, I visualized his sweet face, and I felt better.

A friend of mine who’s recovering from cancer surgery and chemotherapy called me to see how I was doing, and sent me three warrior angels to accompany me now and through surgery. They’re with me as I write you.

An excerpt from Naomi Shihab Nye’s poem, “Kindness”

“Before you know kindness as the deepest thing inside, you must know sorrow as the other deepest thing . . . . .

Then it is only kindness that makes sense anymore, only kindness that ties your shoes and sends you out into the day to mail letters and purchase bread, only kindness that raises its head from the crowd of the world to say ‘It is I you have been looking for,’ and then goes with you everywhere like a shadow or a friend.”

As I have been reminded in recent days about the power of receiving and doing kindness, I am eager in these difficult times, individually and in larger communities, to pass on kindness as a legacy – in my actions and in my words.

Taking Action:

Take time to muse and reflect about some of your experiences of receiving or giving kindness in 2019. How does that value permeate your life? What is the earliest experience of kindness received that you can remember? Recall a time when you were transformed by consciously doing an act of kindness for someone in your family, a friend, or a stranger.
How does the value of kindness express itself in your life and legacy?
Choose a legacy letter recipient – someone with whom you want to share your discoveries about kindness.
In your letter share what kindness has meant to you at various times in your life, and at the present. And share how you understand kindness as part of your lived and written legacy.
After you’ve written your letter, reflect again – about how thinking and writing about kindness makes you feel and think about yourself, and how legacy is a natural part of your life.

On his deathbed, Aldous Huxley reflected on his entire life’s learning and then summed it up in seven simple words: “Let us be kinder to one another…”

May you be enriched by giving and receiving kindness every day of your life,

– Rachael Freed

Rachael Freed, LICSW, senior fellow, Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, is the author of Your Legacy Matters and Women’s Lives, Women’s Legacies: [email protected], and www.life-legacies.com

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Almost everyone has a headache now and then, but many people are plagued with chronic headaches that can interfere with everyday life. The good news is that most headaches can be overcome once you know the cause and are able to get proper treatment.

Here’s a preview that can help you identify what kind of headache you have. Click on the title of each type of headache to find more in-depth information on causes, treatment and prevention:

Allergy Headaches: Research has shown that migraine headaches are more common among people with hay fever (allergic rhinitis) than those without this condition, Treatment to prevent allergic reactions can help prevent associated headaches.
Caffeine Withdrawal Headaches: These throbbing headaches come on quickly if you cut back on or eliminate your morning coffee and other sources of caffeine.
Cluster Headaches: Some of the most severe headaches, these are characterized by throbbing pain usually concentrated around an eye and temple. They can last from 15 minutes to three hours, and during a “cluster” of four to six weeks, the headaches tend to occur an average of twice a day. Check out the latest in prevention.
Depression and Headaches: Depression, anxiety and migraine headaches often co-exist, although experts aren’t sure whether the headaches lead to depression and anxiety or vice versa.
Exertional Headaches: These rare headaches usually come on during or right after exercise and are most likely to develop when you’re working out in hot, humid weather or at high altitude. While a personal or family history of migraine increases the risk for these headaches, you can learn to prevent them.
Eyestrain Headache: Eyestrain occurs from improper focusing of the eyes due to nearsightedness, farsightedness or astigmatism, poor eye alignment, or improper eyeglasses. Eyestrain can lead to headaches, but experts view it as overrated as a cause. Eyestrain resulting from computer use may be a more significant factor.
Hangover Headaches: These headaches typically begin five to 12 hours after consuming too much alcohol and can last as long as 72 hours. There’s no scientific proof that any of the many pills and patches marketed as hangover cures actually work, but there are strategies to help prevent these headaches.
Hunger Headaches: Skipping meals, fasting, following a strict diet and even eating too much sugar can lead to hunger headaches or trigger headaches in people who suffer from migraines. There are effective methods to help you avoid them.
Hypertension Headaches: Very high blood pressure can trigger severe headaches as well as blurred vision, chest pain, nausea and vomiting, shortness of breath and seizures. This is a health emergency requiring immediate hospital treatment. Beyond that, a clear link between high blood pressure and headaches hasn’t been established, although medication for high blood pressure can cause headaches.
Medication Overuse Headaches: Also called “rebound headaches” and “drug-induced headaches,” these stem from taking too much medication for migraines or other chronic headaches. Learn how to recognize these headaches and how to avoid them.
Menstrual Migraines: Migraines that occur between two days before and three days after menstruation begins during at least two consecutive menstrual cycles are considered menstrual migraines. They tend to be more severe, longer lasting and harder to treat than migraines that occur at other times of the month. Several strategies can help prevent these headaches.
Migraines Without Aura: These severe, disabling headaches affect some 37 million men, women and children in the United States. Fortunately, treatment has improved dramatically since the introduction of drugs that specifically target migraine
Migraines With Aura: About one quarter of people who have migraine experience aura, a series of visual and other sensory changes that usually precede the headache. These can range from seeing flashes of light, black dots and zig zags to tingling numbness on one side of the body or an inability to speak clearly.
Occipital Neuralgia: These relatively rare headaches stem from injury or inflammation affecting the two occipital nerves, which travel from the top of the spinal cord up through the scalp along opposite sides of the head and transmit most of the feeling in the head to the brain. Affected individuals can learn how to deal with these headaches.
Sinus Headaches: What you might think is a sinus headache is more likely to be a migraine. Headaches caused by a sinus infection are considered Find out why.
Temporomandibular Joint (TMJ) Headache: Dysfunction of the temporomandibular joint (TMJ) that holds the jaw to the skull and enables us to open and close the mouth causes these headaches. It’s estimated that at any one time approximately 35 million people in the U.S. are affected by TMJ disorders. Learn what to do if you’re one of them.
Tension Headaches: The most common type of headache. They often arise from tense or contracted neck, shoulder and scalp muscles stemming from anxiety, stress, depression or a head injury. Good news – they’re preventable.

 

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What Are Tension Headaches?

Tension headaches are the most common type of headaches. It’s estimated that between 30 percent and 78 percent of the general population have them from time to time and in some cases quite often. Most occasional tension headaches are mild, but those that occur more frequently – some occur daily – can be disabling. They typically present in adults and older teenagers but can occur at any age, tend to run in families and are a bit more common in women than in men.

What Are The Symptoms Of Tension Headaches?

Tension-type headaches can last from 30 minutes to seven days. The pain generally is a mild to moderate dull ache that doesn’t worsen with routine activity; even the most affected people are often able to go about their daily routines. These headaches may result in sensitivity to light or sound, but usually not both. The head and neck muscles may feel tender, particularly if these headaches occur frequently.

Unlike migraines, which are one-sided and throbbing, the steady pain of tension headache can be all over the head, tending to be worse in the scalp, temples, the back of the neck and, sometimes, the shoulders.

What Are The Causes Of Tension Headaches?

Tension headaches arise from tense or contracted neck, shoulder and scalp muscles, which can result from anxiety, stress, depression or a head injury. Another cause is holding the head in one position for a long time, such as while working on a computer. Sleeping in a cold room can bring on one of these headaches as can sleeping with your neck in an abnormal position. Other possible causes are too much alcohol or caffeine (or eliminating caffeine), colds, the flu, sinus infections, clenching the jaw or grinding the teeth, eyestrain, and fatigue.

Some people with tension headaches have sensitive areas, known as trigger points, at the back of the neck or in the shoulders. Injecting a local anesthetic into these areas may eliminate the pain and help prevent the headaches from recurring.

Prevention Of Tension Headaches

If you experience frequent tension headaches, you may be able to prevent them with relaxation therapies, which can include efforts to reduce stress in your neck and shoulder muscles. Using wet heat can help with this as can performing exercises that stretch and strengthen the muscles. Biofeedback can also be beneficial.

Beyond that, your best bet is to make an effort to avoid stress and fatigue, and get adequate sleep. If your headaches are associated with cold, try to keep warm. Exercising your neck and shoulders frequently when at the computer or when doing other activities requiring close focus can help ease tension that could lead to a headache.

Certain drugs may be recommended to help prevent frequent tension headaches. These include:

Tricyclic antidepressants, including amitriptyline (Elavil) and protriptyline (Vivactil).
The antidepressants venlafaxine (Effexor XR) and mirtazapine (Remeron)

Conventional Treatment Of Tension Headaches

Infrequent tension headaches can be treated with aspirin or nonsteroidal anti-inflammatory drugs such as ibuprofen. Be aware that taking medications on more than 3 days a week can lead to “rebound” headaches that come back as soon as the drug wears off. And bear in mind that taking too much acetaminophen (Tylenol) can harm the liver and that frequent use of aspirin or ibuprofen can irritate the stomach and kidneys.

If you have frequent or long-lasting tension headaches, prevention strategies (see above) are recommended.

What Does Dr. Weil Recommend For Tension Headaches?

Tension headaches often respond well to massage therapy and stress reduction techniques such as breathing exercises and meditation as well as training to strengthen your neck and shoulder muscles. Biofeedback training aimed at reducing tension in the shoulders, neck and scalp may be helpful as can traditional bodywork. Dr. Weil recommends shiatsu and acupressure especially but says even a garden variety neck and shoulder rub can make a big difference. He also advises eliminating caffeine since it increases muscle tension as well as anxiety. He notes that musculoskeletal problems in the upper back and neck can produce headaches that resemble tension headaches and recommends trying osteopathic manipulation from a doctor trained in cranial therapy.

Source:

Rigmore H. Jensen, “Tension-type headache – the normal and most prevalent headache.” Headache, February 2018 Biofe; ncbi.nlm.nih.gov/pubmed/28295304?_ga=...

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What Are Temporomandibular Joint Headaches?

These headaches stem from dysfunction of the temporomandibular joint (TMJ), the hinge joint that holds the jaw to the skull and enables us to open and close the mouth, chew and swallow. According to the TMJ Association Ltd., at any one time approximately 12 percent of the U.S. population or 35 million people are affected by TMJ disorders. Most of those who seek treatment are women in their childbearing years. It’s estimated that nine affected women for every one man have severe symptoms: major limitations in jaw movement and chronic pain. Fortunately, these problems tend to be self-limiting, although some can take as long as seven to 10 years to resolve.

What Are The Symptoms Of Temporomandibular Joint Headaches?

TMJ disorders can cause a wide range of symptoms. Headaches – including migraines – are among them, but few people affected with TMJ disorder have headache as the primary problem. Other symptoms include pain and tenderness when chewing, limited movement of the jaw, audible clicks or pops on opening the mouth, pain in the neck and shoulders, ear pain and ringing in the ears, dizziness and vision problems. In general, discomfort from TMJ disorder is occasional and temporary and resolves with little or no treatment.

The International Headache Society holds that headaches due to TMJ disorder typically resolve within three months and don’t recur following successful treatment.

What Are The Causes Of Temporomandibular Joint Headaches?

The causes of TMJ disorder may include muscle spasm and inflammation, rheumatoid and osteoarthritis, injury, stress, and teeth grinding, although often the disorder has no obvious cause. Certain habits, such as chewing gum or frequently resting a phone on one shoulder may contribute. And because TMJ disorder occurs more often in women than men, research is focusing on whether or not female hormones play a role.

What Is The Conventional Treatment?

Finding effective treatment for TMJ disorders may not be easy since there is no certified specialty for treating them in either dentistry or medicine. The National Institute of Dental and Craniofacial Research, a branch of the National Institutes of Health (NIH), recommends seeking a health care provider who understands disorders affecting muscle, bone and joints and is trained in treating pain. Hospital or university pain clinics may be able to direct you to a well-regarded provider.

Short-term use of prescription or over-the-counter anti-inflammatory drugs (such as ibuprofen) may be recommended to help ease the pain of headaches and other symptoms. Muscle relaxants as well as antidepressants and antiepileptic agents with analgesic properties may be prescribed. In addition, behavior modification, biofeedback, hypnosis, and physical therapy may be recommended to help reduce pain and restore normal jaw function. Physical therapy relies on heat and stretching to reduce joint inflammation, restore joint mobility, and eliminating muscle pain.

If you have TMJ disorder, you may be able to ease the pain by eating soft foods, using ice packs, and avoiding chewing gum as well as refraining from wide yawning and other actions placing stress on your jaw.

Be aware that surgical treatment for TMJ disorder is not recommended. There have been no long-term studies of its safety and efficacy. Similarly, studies of the effectiveness of appliances such as acrylic bite guards that fit over teeth have been inconclusive. Some can increase pain. (If so, stop using them.) Splints designed to reposition your lower jaw also should be avoided.

What Does Dr. Weil recommend For Temporomandibular Joint Headaches?

In addition to behavior modification, relaxation training, hypnosis and biofeedback mentioned above, Dr. Weil strongly recommends trying cranial osteopathy (also called cranial therapy), one modality of osteopathic manipulative therapies. (You can find a practitioner through the website of The Osteopathic Cranial Academy, http://www.cranialacademy.org.)  He also recommends guided imagery therapy, acupuncture and taking 500 mg each of calcium and magnesium at bedtime and 12 hours later. Continue these supplements as long symptoms persist but decrease magnesium if you experience a laxative effect.

Source:

Steven B. Graff-Radford, “Temporomandibular Disorders and Headache,” American Migraine Foundation, americanmigrainefoundation.org/resour...

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What Are Occipital Neuralgia Headaches?

Occipital neuralgia headaches stem from injury or inflammation affecting the two occipital nerves, which travel from the top of the spinal cord up through the scalp along opposite sides of the head. These nerves transmit most of the feeling in the head to the brain.

What Are The Symptoms Of Occipital Neuralgia?

Occipital neuralgia can cause piercing, throbbing, or electric-shock-like chronic pain in the upper neck and back of the head, usually on one side. The pain typically begins in the neck and spreads upwards. Some people also experience pain in the scalp, forehead, and behind the ears, and the eyes may become especially sensitive to light. In some cases, neck movements trigger pain and the scalp may be tender to the touch.

These headaches are considered relatively rare and difficult to diagnose. Tenderness in response to pressure along the occipital nerves may help lead to a diagnosis. Pain that resolves with administration of an occipital nerve block (see Conventional Treatment below) can confirm a diagnosis.

What Are The Causes Of Occipital Neuralgia?

The irritation or injury that causes the pain of occipital neuralgia can stem from trauma to the back of the head, pinching of the nerves by overly tight neck muscles, or compression of the nerve as it exits the spine due to osteoarthritis, tumors or other types of lesions in the neck. Localized inflammation or infection, gout, diabetes and blood vessel inflammation (vasculitis) are also associated with occipital neuralgia, as is habitually keeping the head in a downward and forward position for extended periods of time. Often, however, no cause can be found.

Prevention Of Occipital Neuralgia

Rest, massage and warm compresses can help relieve the pain of occipital neuralgia and may ease the pressure on the nerve. Physical therapy can teach you exercises that may help prevent the headaches.

Conventional Treatment Of Occipital Neuralgia

Treatment may include heat, rest and physical therapy as well as massage, and anti-inflammatory medications and muscle relaxants. Anticonvulsant drugs may also be prescribed as may antidepressants in severe cases. If these methods fail, surgery may be recommended to relieve pressure on the affected nerves.

A less invasive option is use of a nerve block to prevent pain signals from the nerves from reaching the brain. These blocks involve the injection of a solution usually containing a long-acting local anesthetic and a steroid anti-inflammatory drug. The infusion itself may be somewhat uncomfortable, but pain relief often occurs within 15 minutes and can last for a few days to weeks and even months. Sometimes the pain doesn’t recur at all. Complications of nerve blocks are considered rare when the procedure is performed by an experienced provider. After-effects may include some temporary numbness in the regions of the scalp and head supplied by the nerves and, sometimes, difficulty speaking or swallowing for a few hours.

What Does Dr. Weil Recommend For Occipital Neuralgia?

Dr. Weil recommends cranial osteopathy, an osteopathic manipulative technique that he has found extremely useful for a wide range of problems that may be caused or affected by small changes in the function anatomy of the skull, spine and central nervous system, from headaches to hyperactivity in children, disturbed sleep cycles and asthma. Cranial osteopathy works through very gentle pressure applied with the hands to the head. The aim is to free up restrictions in the movement of the cranial bones and allow the subtle natural rhythms of the central nervous system to express themselves in a balanced fashion. The Cranial Academy maintains a list of physicians trained in this unique and useful therapy.

Source

Carrie O. Dougherty, “Occipital neuralgia”, Current Pain and Headache Report, May, 2014. doi: 10.1007/s11916-014-0411-x.

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What Are Allergy Headaches? 

According to the American Academy of Allergy, Asthma and Immunology, it is “controversial whether constant blockage of the nasal passages caused by allergic inflammation can lead to chronic headaches.”

Research has shown that migraine headaches are more common among people with hay fever (allergic rhinitis) than those without this condition. One study found that 34 percent of people with hay fever had migraines compared to only four percent of those who didn’t. And in people allergic to it, inhaled pollen can trigger the problem. In addition to allergies, changes in the barometric pressure in the spring can affect nerves in the sinuses, nose or ears, which in turn can lead to headaches.

What Are The Symptoms Of Allergy Headaches?

Symptoms of hay fever or other allergies can include frequent sneezing, a runny nose, nasal congestion, itchy eyes and a dull pain in the sinuses in the cheekbones, bridge of the nose and forehead. (Be aware, however, that true sinus headaches are regarded as rare and that patients who appear to have them actually are much more likely to have migraines.)

What Are The Causes Of Allergy Headaches?

Apart from pollen, headaches related to airborne allergies can be triggered by nasal or sinus congestion, stress and certain foods. A report on migraine, hayfever, asthma and allergies by Vincent T. Martin, M.D., co-director of the Headache and Facial Pain Center at the University of Cincinnati, suggests that allergic inflammation might cause migraine and that nasal congestion associated with hay fever could activate the trigeminal nerve in the nose and trigger migraine.

Prevention Of Allergy Headaches

The over-the-counter nasal spray cromolyn sodium may prevent nasal allergy symptoms if you take it before you’re exposed to pollen or other substances that trigger them. For best results, start using it two to four weeks before the start of allergy season. (Note that it doesn’t work for everyone.) Otherwise, take steps to reduce your exposure to pollen and other allergens. Stay indoors as much as possible when pollen counts are high and get HEPA filters for rooms that you spend most time in.

Allergy shots (immunotherapy) – regularly scheduled injections of small amounts of allergens – may be recommended to help prevent reactions. The goal is to desensitize you so that you no longer react to the irritant. Although this treatment is said to work in about two-thirds of cases, the shots can require years of treatment to become effective. They also may elicit reactions such as hives, rash, and sometimes anaphylactic shock.

Conventional Treatment Of Allergy Headaches

A number of over-the-counter and prescription antihistamines can help prevent allergy symptoms. Decongestants can help relieve a stuffy nose that can be one of the causes of a headache. You also can take over-the-counter pain relievers such as Tylenol or Advil to treat headaches. In addition, antihistamines can help treat allergic symptoms, including sneezing and running nose, but also commonly cause drowsiness, grogginess, and dry mouth. Prescription antihistamines are less likely to cause these side effects but still may.

Decongestant pills and nasal sprays can block the effects of histamine on nasal passages and often can help ease nasal congestion, but their effects are only temporary, and overuse can actually worsen congestion over time. These drugs should not be taken by people with high blood pressure. Over-the-counter and prescription eyedrops can help relieve itchy eyes caused by allergens.  Prescription nasal steroid sprays can tone down the immune response and combat swelling in the nose, which helps ease congestion. They often can take about 2 weeks to start working effectively.

What Does Dr. Weil Recommend For Allergy Headaches?

Among conventional treatments for allergies, Dr. Weil prefers the non-prescription drug cromolyn sodium (Nasalcrom Nasal Solution). If that doesn’t help, he says you may have to try a steroid nasal spray such as Vancensae, preferably for a limited time.  He also suggests trying nasal douching with a warm saline solution to rinse pollen grains off nasal tissues and soothe irritated mucus membranes.

The best natural treatment for hay fever that Dr. Weil has found is freeze-dried stinging nettle leaf. Take one to two capsules, every two to four hours as needed to control symptoms. This herbal remedy works quickly and has no side effects.

To prevent pollen allergies he recommends quercetin, a bioflavonoid found in a variety of fruits, vegetables, and grains. Take 400 mg twice a day between meals, starting at least 6 weeks before the expected start of pollen season.

He also recommends butterbur (Petasites hybridus), which has been used for centuries as an herbal treatment for headaches, back pain, asthma, and painful urinary spasms. Recent research suggests that it may be an effective treatment for hay fever and a means of preventing some migraines. Dr. Weil recommends choosing only butterbur products free of pyrrolizidine alkaloids (PAs), compounds that are toxic to the liver. The adult dosage ranges from 50-100 mg twice daily with meals.

Dr. Weil also recommends the following lifestyle modifications:

Follow a low-protein diet and try to eliminate milk and milk products. Excessive protein can irritate the immune system and keep it in a state of over-reactivity. The protein in cow’s milk is a frequent offender.
Try hypnosis, which can lessen or completely prevent allergic reactions and facilitate the immune system’s unlearning of its pointless habits (in this case, an inappropriate response to pollen).
Consider whether stress impacts your allergy and, if so, take steps to reduce it.
Consider buying an air filter. He recommends a HEPA (high-efficiency particulate air) filter, which removes particles in the air by forcing it through screens containing microscopic pores. These devices work well and aren’t too expensive. Get one for the main rooms in your house or move one from room to room regularly. Avoid air-filtering equipment that generates ozone (HEPA filters don’t).

Source:

Anna Gryglas, “Allergic Rhinitis and Chronic Daily Headaches: Is there a Link?” Current Neurology and Neuroscience Reports, February 22, 2016, doi:10.1007/211910-016-0631-z

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What Are Migraine With Aura Headaches?

About one quarter of people who have migraine headaches experience aura, a series of visual and sensory changes that usually precede the headache. Auras can range from seeing flashes of light, black dots and zig zags to tingling numbness on one side of the body, or an inability to speak clearly. According to the American Headache Society, in more than 90 percent of all cases, the aura is visual. It begins shortly before or during a migraine and can last from five minutes to an hour.

Migraines with aura are triggered by many of the same factors that lead to migraines without aura – stress, certain medications, hormonal fluctuations in women and sensitivity to certain foods. Those include aged cheeses and processed meats (particularly pepperoni and hot dogs); peanuts; bread and crackers containing cheese plus any strong-flavored cheeses; broad beans, peas, and lentils; as well as beverages containing caffeine and chocolate. Wine is another culprit (red usually is more problematic than white). Fermented foods including soy sauce and miso have been implicated, as have some fish including sardines, anchovies, and pickled herring. Other foods linked to migraines include avocados, bananas, citrus fruits, figs, raisins, red plums, and raspberries.

Patients who have migraine with aura have twice the normal risk of ischemic stroke, which is caused when a blockage in a blood vessel in the head interrupts blood supply to an area of the brain. While twice the risk may seem high, the normal risk of these strokes in young people is very low (fewer than 20 per 100,000 people per year). The risk of stroke among women who have migraine with aura and take contraceptives containing estrogen rises to six times normal; it increases to nine times normal among women who take these contraceptives and also smoke.

What Are The Causes Migraine With Aura Headaches?

Aura is caused by the electrical impulses of nerve cells in the brain.

Prevention Of Migraine With Aura Headaches

Aura can be treated with 400 to 500 mg of magnesium taken at its onset or used daily in order to prevent it. Vitamin B2 (riboflavin) at a dose of 200-400 mg can be taken daily for prevention as well. Drugs used to prevent migraine can also help prevent aura. (See “Prevention” section of Migraine Headaches Without Aura entry).

Treatment Of Migraine With Aura Headaches

Treatment for migraines with aura is often the same as treatment for migraines without aura. For full information see the “Treatment” section of theMigraine Headaches Without Aura entry on this site.

For more in-depth information on migraine headaches, and Dr. Weil’s recommendations, check out our Migraine Headaches Without Aura article.

Source:

Deborah Tepper, M.D., “Aura with Headache,” American Headache Society, americanheadachesociety.org/wp-conten...

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What Are Menstrual Migraines?

Migraine headaches that occur between two days before and three days after the onset of menstruation during at least two consecutive menstrual cycles are considered menstrual migraines. They affect 60 percent of women who suffer from migraines. A study from the UK, published in 2004, showed that these headaches are 71 percent more likely to occur during the two days before menstruation begins.

What Are The Symptoms Of Menstrual Migraines?

Menstrual migraines tend to be more severe, longer lasting and harder to treat than migraines that occur at other times of the month. Like all migraines, they occur on one side of the head and may be accompanied by nausea, vomiting, and sensitivity to bright light and sounds. Most are not accompanied by aura.

What Are The Causes Of Menstrual Migraines?

Declining levels of the hormones estrogen and progesterone just prior to menstruation are considered responsible for menstrual migraines.

Prevention Of Menstrual Migraines

If your menstrual cycle is regular, you may be able to prevent a headache by taking one of several medications starting a day or two prior to the expected onset of your period and continuing for up to two weeks after. These include nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen (550 mg twice a day) or Frova (frovatriptan). This last finding came from a study with 443 women sponsored by the manufacturer of Frova. Among women who took the drug twice a day, 59 percent no longer experienced menstrual migraines, and taking it once a day reduced occurrence of the headaches by 48 percent.

If these drugs don’t help, estrogen replacement in the form of pills (0.5 mg tablet twice a day) or a skin patch may be recommended. According to the National Headache Foundation, the preferred form of estrogen is Estradiol. If you’re on birth control pills, taking them daily for three to six months, rather than 21 days a month, is a strategy that reportedly has been used successfully in Europe.

Supplemental magnesium and several other drugs may be recommended to help prevent menstrual migraines. These include beta blockers, anticonvulsants, calcium channel blockers, and antidepressants. Monthly injections of a calcitonin gene-related peptide monoclonal antibody may be recommended if other approaches to migraine prevention don’t help.

Conventional Treatment Of Menstrual Migraines

Treatment of menstrual migraines is similar to the treatment of migraines that occur at other times of the month. Of the several triptan drugs used, studies have shown that rizatriptan (Maxalt) is the most effective for menstrual migraines. One study found that two hours after taking this drug, 63 percent of patients were pain free. Sumatriptan (Imitrex) is almost as effective. 

What Does Dr. Weil Recommend For Menstrual Migraines?

Before seeking a prescription for Frova to prevent menstrual migraines, Dr. Weil recommends taking the herb butterbur (Petasites hybridus). In a study published in December 2004 in the journal Neurology, taking two 75mg tablets of butterbur extract resulted in an average of 48 percent fewer headaches compared to 26 percent among women who received a placebo. When buying butterbur, be sure to choose extracts guaranteed to be free of pyrrolizidine alkaloids (PAs), compounds that are toxic to the liver. Take the supplement with meals.

Dr. Weil also suggests trying to identify and eliminate dietary triggers, as well as taking high-dose vitamin B2. A Belgian study published in the February 1998 issue of Neurology found that 400 mg of B2 daily reduces the frequency and duration of migraines. You’ll need a doctor’s prescription to get that dosage. Biofeedback can also help.

Source:

K. Maasumi et al, “Menstrual Migraine and Treatment Options: Review,” Headache, February 2017, doi:10.1111/head.12978

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What Are Hunger Headaches?

Skipping meals, fasting, following a strict diet and even eating too much sugar can lead to hunger headaches or trigger headaches in people who suffer from migraines. Hunger headaches may occur when you’re shunning food for religious reasons (on Yom Kippur, for example, the Jewish day of atonement, or during Ramadan, the month in which Muslims fast from sunrise to sunset).

What Are The Symptoms Of Hunger Headaches?

Hunger headaches can be quite severe and may be accompanied by mild nausea. Other symptoms can include sweating, changes in mood, yawning, pallor and a craving for sweets.

What Are The Causes Hunger Headaches?

One of the causes of hunger headaches is a drop in blood sugar (hypoglycemia), the result of not taking in enough calories to meet the body’s needs. In addition to headache, hypoglycemia also can cause shakiness, irritability and fatigue. Another cause is the release of stress hormones in response to not getting enough to eat. (Stress hormones also rise if you are dehydrated or haven’t had enough sleep.)

Prevention Of Hunger Headaches

You should be able to avoid hunger headaches if you eat on a regular schedule and don’t skip meals. According to the Migraine Trust, small, frequent low-sugar meals are ideal to help avoid triggering migraine. Be sure to eat breakfast and try to have more than just a sandwich for lunch. If you get these headaches when you wake up, you may be able to prevent them by having some high-fiber breakfast cereal before you to go bed. Make sure you eat a high-quality, balanced diet with plenty of fresh vegetables and fruit, and avoid fast foods and immoderate consumption of sweets. Adding more protein to your diet may also help.

Conventional Treatment Of Hunger Headaches

Managing hunger headaches focuses on preventing them by attending to your food choices and eating regularly, reducing stress, and getting adequate rest.

What Does Dr. Weil Recommend For Hunger Headaches?

If you get hunger headaches, the solution is obvious – make sure you consume an adequate amount of food throughout the day. Don’t skip meals and eat wisely, as by following his anti-inflammatory diet.

Sources:

A. Mosek and A.D. Korczyn, “Yom Kippur headache,” Neurology, November 1, 1995, DOI:https://doi.org/10.1212/WNL.45.11.1953

A.Awada and J. Al Jumah, “The First of Ramadan Headache,” June 17, 2002, https://doi.org/10.1046/j.1526-4610.1...

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What Are Headaches Associated With Depression?

Depression, anxiety and migraine headaches often co-exist, although experts aren’t sure whether the headaches contribute to depression and anxiety or vice versa. It is estimated that migraine patients are about five times more likely to develop depression than people who don’t have these headaches. Even more migraine patients – an estimated 50 to 60 percent – are believed to suffer from anxiety, but here, too, it is unclear which is cause and which is effect.

What Are The Symptoms Of Depression Headaches?

Symptoms of depression include a sullen mood, feelings of hopelessness, guilt and anxiety, loss of interest in things that used to be pleasurable, changes in appetite and sleeping patterns, inability to concentrate, and lack of energy. Symptoms of anxiety include excessive worry, fear and irritability. The most common forms of anxiety in migraine patients are panic disorder, generalized anxiety disorder, and phobias. Panic disorder symptoms include unexpected and repeated episodes of intense fear accompanied by such physical symptoms as chest pain, heart palpitations, shortness of breath, dizziness or abdominal distress. Generalized anxiety disorder is characterized by chronic, unrealistic, and exaggerated feelings of worry and tension. Phobias are extreme, irrational fears.

What Are The Causes Of Depression Headaches?

It is possible that depression in migraine patients stems from the chronic pain due to the headaches, but no one knows for sure. Some genetic studies have found that having one of these disorders increases the risk for the other, possibly because they share underlying biologic and neurochemical mechanisms. We also know that reduced levels of the neurotransmitter serotonin, which helps regulate mood, sleep and appetite, are associated with both depression and migraine. In women, both migraines and depression are associated with fluctuations in estrogen levels.

Prevention Of Depression Headaches

Several medications can help reduce the frequency, severity and duration of migraines. These include beta blockers, calcium channel blockers and other anti-hypertensives that can help regulate blood vessel tone and activity.  Certain antidepressants can help prevent migraines as can the anti-seizure drugs Depakote, Neurontin and Topamax.

Treatments Of Depression Headaches

Recent research has shown that combining cognitive behavior therapy (CBT) with drug treatment for migraine with depression can lead to significant improvement in both conditions. CBT assumes that our thoughts cause our feelings and behavior and that changing the way you think can help you feel and act better. In a 2011 publication, the British Royal College of Psychiatrists concluded that CBT is one of the most effective treatments for conditions where anxiety or depression is the main problem. In a study from Griffith University in Australia 66 patients with migraine or tension headaches and depression who were treated with a combination of cognitive behavioral therapy and a routine drug regime experienced significant reductions in the number of headaches and symptoms of depression and anxiety, as well as increased quality of life compared to patients in a control group. The improvements remained at a four month follow up.

A number of drugs may be prescribed for treatment of migraine with depression including fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). These drugs often are recommended for treatment of migraines even among patients who are not depressed. The fact that they work for both migraines and depression adds to the notion that there might be a common cause of both conditions.

Other treatments that can help ease anxiety and depression and combat stress that worsens migraines include deep breathing or guided imagery. Biofeedback and progressive muscle relaxation are the most widely accepted non-drug techniques for headache control and prevention. The American Migraine Foundation notes that their effectiveness has been established in more than 100 investigations over the past 25 years and these mind-body practices have demonstrated a 45 to 60 percent reduction in the frequency and severity of migraines. The downside for biofeedback is the time commitment required – several visits per week over a number of months.

What Does Dr. Weil Recommend For Depression Headaches?

Dr. Weil’s recommends regular aerobic exercise for immediate, symptomatic treatment of depression. He notes that numerous studies validate the efficacy of a daily workout for improving emotional health and boosting self-confidence. He recommends 30 minutes of continuous activity at least five days a week for best results.

He also recommends breath work, meditation and yoga as approaches to easing depression, and biofeedback as a means of dealing with the stress and anxiety that underlie migraines.

Source:

Esme Fuller-Thomson, Meghan Schrumm, Sarah Brennenstuhl. “Migraine and Despair: Factors Associated with Depression and Suicidal Ideation among Canadian Migraineurs in a Population-Based Study”. Depression Research and Treatment, DOI: 10.1155/2013/401487

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