JANUARY 1998 MEETING

TOPIC: "TALK IT OVER NIGHT"

The twenty-fifth consecutive meeting of the East Bay Headache Support Group (EBHSG) was held on January 13th in the Ball Auditorium at John Muir Medical Center. Seventeen people attended our twice-yearly Talk It Over Night, where we sat in a circle and talked about our experiences with headaches and attempts to relieve them. Dr. Michael Stein, our advisor, facilitated the discussion and answered questions.

The group is sponsoring a Vendor Night the second Tuesday in May. Anyone who has a product or service that offers relief to headache sufferers is welcome to set up a booth at this special meeting. To reserve a space, call (510) 938-5252 and leave your name, phone number, and description of your product or service.

New drugs for the relief of migraine headaches are being introduced this year. Dr. Stein said that Zomig just came out on January 9th. Zomig is the brand name for zolmitriptan, and is considered a "sister" of Imitrex. It was developed by Glaxo, but now is being marketed by a British company, Zeneca. Zomig is available in 2.5 mg and 5 mg tablets, and, according to Zeneca, works faster and lasts longer than Imitrex, and doesn’t have as many side effects.

In April 1998 look for Amerge (naritriptan), and in July, Maxalt (risotriptan). These new 5HT 1D agonists were all mentioned by Dr. Jerome Goldstein of the San Francisco Headache Clinic when he talked to our group last October.

Glaxo has also just recently come out with Imitrex in a new dosage form--it is packaged in a single dose nasal spray. Dr. Stein said the nasal spray seems to work about the same as the Imitrex tablets, but it may work a little faster. The best news is that it doesn’t have the extreme side effects of the injection, for which several of the group’s members expressed relief.

The group started talking about migraine headaches, and Dr. Stein gave us some information about migraines: 1) Only about one in four migraineurs experience an aura before the pain. 2) There are different phases of a migraine: a) During the prodrome phase one may experience difficulty in thinking or focusing, and may have food cravings. The prodrome is frequently the day before the actual head pain starts. b) The postdrome phase is after the pain goes away, where some people say they feel lethargic, while others feel hyper.

We took an informal poll of the migraine sufferers in the group and asked them how long their headaches tended to last. Three days seemed to be the average, and Dr. Stein agreed. He said there may be a biological phenomenon occurring that takes three days to run its course in the body. When you intervene with Imitrex, the pain may go away for a while, but the next day it’s back, and Imitrex is needed again.

Dr. Stein also mentioned the term status migrainosus. For that you need to get an injection of Demerol or some other medication that will allow you get a good long sleep, say eight to twelve hours.

One member of the group asked about Depakote, and those with experience with the drug gave their comments. Donna Johnson said that you have to get the dose just right, which takes some experimenting. Physicians have two approaches to treating headaches:

1) Abortive therapy--relieving the pain after the headache starts (preferably soon after).

2) Preventive therapy--taking medication on a daily basis to prevent headaches.

If a patient goes to his doctor complaining of two headaches a month, and Imitrex seems to help those headaches, then probably preventive therapy is not needed. If, however, a patient has four or more headaches a month, or a headache that lasts many days, preventive therapy is warranted.

Let-down headaches were also discussed. Dr. Stein said these headaches can be brought on by changing sleep schedules, like sleeping late on the weekend. They can also be caused by caffeine withdrawal. For example, if a person drinks coffee early every weekday morning, and then sleeps late on the weekend (thus missing his coffee), he may wake up with a headache.

Participants in the group discussion were then asked about other triggers that they were able to identify, such as stress, and altitude. Dehydration was also discussed as a possible headache trigger. Dr. Stein said there have been studies of migraine and dehydration. Jan Mundo said that it was important to drink at least a liter to a gallon of water every day. She said one should drink "one-half ounce of water per pound of body weight." One person asked if others had experienced diuresis (larger urine output) after a migraine had subsided.

We also talked about the the flicker in fluorescent lights and on computer screens, and strobe lights, which can trigger migraines. Dr. Stein said that people who have migraines tend to be very sensitive to strong patterns. In fact, he has noticed that migraineurs usually do not wear clothing with busy patterns, such as zigzags or stripes, or bright paisley patterns, and this sensitivity shows up in their home decorations also.

Dr. Stein mentioned light therapy for "seasonal affective disorder" and asked if anyone in the group had tried it, but no one responded. He has wondered if light therapy might be beneficial to a headache sufferer.

Leslie Davis said that some headache sufferers have found that nonsteroidal anti-inflammatory drugs, such as Naproxen Sodium, can help sometimes in aborting migraine headaches.

Toradol is another headache abortive medicine that some people find effective. It is available in both injection and tablet form.

One woman in the group mentioned she knew someone taking Imitrex daily, and asked if that would cause a rebound headache. Dr. Stein said he thought that Imitrex taken that frequently would more than likely cause rebound headaches. He then asked the group if anybody took a combination of drugs for their headaches and several responded.

Dr. Stein was asked how much Imitrex can be safely taken, and he answered, "100 mg is the most you can take at one time for a migraine, and 300 milligrams is the maximum in a twenty-four hour period."

Dick Tomchalk asked about other types of headaches, besides migraines. He said that his wife bought him some Breathe Easy nasal strips to try to reduce his snoring at night, and he’s discovered that they keep him from waking up with a headachy feeling in the morning.

Dr. Stein asked if members of the group had tried any herbs to prevent their headaches. Feverfew, Ginkgo, and St. John’s Wort were some that were discussed. A problem with using herbs is that there are no strict guidelines like the FDA has for drugs marketed in the U.S. It is hard to know how much is a safe amount, or if there are long-term side effects caused by herbs. Echinacea was another herb that was mentioned. One man in the group said that he takes Echinacea cyclically, i.e., every day for five days, then off for two days, then back on for five days. Homeopathic remedies can be purchased at a health food store, and several stores in the area were mentioned by name.

Marijuana was another possible headache remedy that was mentioned. Dr. Stein said he doesn’t know of any good research on it, only anecdotal reports (some say it works, some say it doesn’t). It is hard to do a controlled study with herbs because the participants know when they are getting a placebo. Also, there is always a placebo response which needs to be subtracted out; that is, 20% of participants get headache relief even with just a placebo.

Jan Mundo said there was something about a body/mind connection. Dr. Stein also said that volunteers in a controlled study are either risk takers or people who have very refractory headaches (nothing seems to work for them).

Nortriptyline and other blood pressure medications are used as preventive therapy for headache patients. Some other drugs named were Inderal, Elavil, Prozac, and Tenormin.

One side effect from these drugs is vivid dreams, or even nightmares. Dr. Stein cautioned us that one should never mix St. John’s Wort and Prozac.

Dr. Stein said that patients usually will give traditional medical therapy two tries. He stressed that everybody is an individual, however, and that there is no one set way of treating everyone’s headaches. It is a trial and error process to find the medication that works for each headache sufferer. He was asked by one participant, "What constitutes a fair trial for a preventive medicine?" Dr. Stein answered, "One to two months."

It was noted by more than one participant that whatever may have worked at one point in time to relieve their headaches did not last, i.e., your experience with the same drug or herb may change over time.

Dr. Stein mentioned a new drug like Prozac, called Serzone. Also Zanaflex is an anti-spasmodic drug, for spasticity.

Headache affects sixteen million women and nine million men in the United States.

One person asked Dr. Stein about Bellergal. He replied that is is a mixture of belladonna and other ergotamine-like medicines. It is mainly used to treat menopausal symptoms.

Jan Mundo, a massage therapist who participated in this discussion, and was also our speaker for the April 1997 meeting about somatic headache relief, asked the group if anyone would be interested in doing research therapy with natural stuff only, no drugs. She didn’t say she was actually doing this research, only thinking about it.

The intention of the East Bay Headache Support Group is to provide information and resources. It does not provide medical advice, which should be obtained directly from a physician.