A Migraine Cure

Robert Cowan • November 11, 2011

We would love to have titled this article The Migraine Cure, without the question mark. But the reality is we’re not there yet. We tend to look for and latch on to the notion of a cure, that one thing that will make it all go away forever. That is why there is such a proliferation of websites, books, articles and blogs claiming to offer “the cure”:

  • “Heal your Headaches with Magnesium!”
  • “Magnets Cure Migraines!”
  • “Eat Away your Headaches!”
  • “Pilates for Headache Health!”

The list is endless. Any one of these approaches may be helpful for a given patient, but in 40 years of caring for headache patients we have studied—and tried—dozens upon dozens of miracle cures. But the headaches continue. The reality is, there is still no cure. A “cure” would not stay a secret for long. If we had a one-size-fits-all solution to headaches, it wouldn’t be buried in a back-page ad in the National Enquirer, you would not need to search the internet for it, and you wouldn’t hear it from your aunt in Omaha. Sixty million of us suffer from migraine and other bad headaches, so a cure would be on the front page of The New York Times, Matt Lauer would be talking about it on The Today Show, and the Internet would be lit up with references to major medical journals.

Your brain is complex, and so are the conditions that affect it. If every headache sufferer had the same triggers, responded the same way to every medication, and had readily predictable headaches, migraine management would be easy. But we don’t and it isn’t. Still, I have yet to meet the headache sufferer who, with the help of a headache specialist, does not experience a significant improvement in their quality of life, usually through a reduction in the quantity, severity, and duration of their headaches. Every headache patient is unique, and so are their headaches. Migraines are not just about pain because of the complexity of the brain. They are about nausea, vomiting and sensitivity to light and sound. They are about missed work and family events. They are about a whole collection of problems that can dramatically affect your life. Improving your headache burden begins with identifying your unique migraine or other headache characteristics and learning how to use this information to better manage your headaches.

The son of Poseidon, Procrustus invited weary travelers to rest at his inn and then he broke their bones so that they would fit into a bed that was too small for them. Many doctors have a very “Procrustean” approach to headache treatment. They generate lists of foods that give some people headaches, asserting that avoiding those foods will prevent every patient’s headaches. Or they simply prescribe one drug after another, oping one will work, and they try the same therapies in the same order, on patient after patient. Sometimes these measures work, but often not. Your pain and headache characteristics are probably not exactly like your friend’s. What works for you might not work for your friend, and vice versa.

Until very recently (about 20 years ago), headache was the “poor relation” in neurology. Most doctors felt there was little good science explaining where in the brain migraine lived or what the basic cause was. We had no fellowship programs (special post-residency training) in headache and no board certification for doctors in Headache Medicine. Even today, there are only a handful of programs that train headache specialists. Indeed, through seven years of training in medical school and residency, headache was covered in just a few hours, with the emphasis on secondary headaches (those headaches that are a symptom of something else, like brain tumors, infections or ruptured blood vessels). Today, federal funding for headache research is less than 15 million dollars per year. Headache sufferers and their treating physicians know the frustration in treating a condition about which they know little and for which there is minimal support, either from the medical community or from the society at large. And sadly many doctors do not know enough about headache treatment and consequently do not like taking care of a headache sufferer.

If migraine were like an infection, we could draw some blood, put it in a petri dish, see which infectious agent caused the problem, and pick the right drug to knock it out. But migraine is not an infection. Migraine is a disorder of sensory processing and overload of the brain. It is a genetic disease that inherit from your parents most of the time. It affects the whole body. People with migraine are so sensitive often feel discomfort after a stimulus that typically does not bother a non-migraineur. Migraine sufferers have symptoms in common, starting with the pain (although some forms of migraine do not have pain as a component). But migraine can affect everything from the stomach, to balance, to vertigo, to energy levels. What triggers the migraine attack, however, varies from person to person. This is the focus of much clinical research. We endeavor to identify the unique features in migraineurs that will lend insight to the common underlying causes of head pain. For example, recent research suggests that people who experience their headaches as exploding from the inside may have a different response to certain treatments than those whose headaches are described as imploding from the outside. While this has yet to be verified, it is an interesting and maybe important clinical observation that can teach us a great deal about the nature of head pain and its treatment.

Since every headache sufferer has their own unique triggers, symptoms and clinical presentation, they each need their own, unique management plan to address the pain and other symptoms that result. This means that one of the biggest problems for migraine sufferers today is problems with our health care system. While the medical community is becoming extraordinarily good at dealing with acute and life-threatening conditions (like major trauma, heart attack, stroke, cancer and pneumonia), it is not set up to treat chronic, episodic and sometimes progressive diseases—like asthma, depression, diabetes, obesity, heart disease and migraine.

When a physician’s schedule only allots seven minutes to take a headache sufferer’s history, examine the patient, and design a treatment plan, it is impossible to provide ample time to customize and treat the patient’s migraines. But, without that level of individual care, the plan is doomed from the outset. Instead, patients and their doctors arrange many tests and perform endless experiments with drug after drug, or get referrals to psychiatrists, neurologists, ophthalmologists or pain specialists. They try herbs and spices and alternative therapies in a desperate search for relief. The fortunate ones may find their way to headache specialists but, because there are very few headache specialists in the US, these superspecialists are overworked and overwhelmed. In the end, patients often feel they have not been listened to, their questions have not been answered, and their treatment plan not well thought out. But they usually have a new prescription and a follow-up visit in three months when, hopefully, they will get some relief.

We shouldn’t blame the doctors, the emergency room staff, or anyone else who is honestly trying to help. Most of them weren’t trained for this and are doing the best they can. Still, the greatest challenge in implementing your treatment plan can often be enlisting effective support from your doctor, your insurance company, your benefits counselor, and everyone else involved in your health care.

And that journey begins with telling your story. Setting down your headache story in a clear, concise and thorough way that your doctor can process and use to develop a diagnosis and treatment plan.

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