July 13th Meeting:
Hormonal HeadachesHave you noticed a correlation between your menstrual cycle and your headaches?
Do you frequently have a headache at ovulation, pre-menstrually, or post-menstrually?
Has the "Pill" made your headaches better or worse?
Are you approaching menopause and experiencing an increase or decrease in headaches?
Has hormone replacement therapy helped or worsened your headaches?
If you answered "yes" to any of these questions and would like to learn more about hormones and how they trigger headaches, and especially what can be done to lessen or alleviate your headaches, come to the July 13th meeting of the East Bay Headache Support Group. Sondra Altman, M.D., will be speaking on the effects of PMS, birth control pills, and menopause.
Dr. Altman, a Walnut Creek gynecologist, frequently lectures to the lay community and physicians and nurses groups throughout California, especially on the topics of menopause, perimenopause, and hormone replacement therapy.
Though she will be talking about female hormones and the role they play in triggering headaches in women, we encourage men to attend also to learn along with their partner about the major role hormones play in a woman’s life.
Dr. Altman is an entertaining speaker, and shares her medical knowledge with a sense of humor. At our September 1996 meeting she told us there are two types of PMS sufferers:
u
Chocolate-craving, weepy, clumsy, tired, suicidal women.u
Salt-craving, irritable, bloated, homicidal women.And then she proceeded to explain how to eliminate these symptoms.
The meeting is Tuesday, July 13th, from 7:30 to 9:00 pm, in the Ball Auditorium at John Muir Medical Center, and is funded in part by a grant from Glaxo Wellcome. For more information, call (925) 938-5252.
MIGRAINE: What If My Headache Doesn’t Respond to Therapy? Several drugs are effective when administered in the physician’s office or hospital setting in relieving an acute headache attack that does not respond to other medications. Generally, these drugs are not intended for ongoing treatment or prevention of migraine headaches.Dihydroergotamine
Dihydroergotamine, sold under the brand name DHE-45, is given by injection. It may be administered for up to a week if you are hospitalized for headache pain. Possible side effects include diarrhea, leg muscle pain, and abdominal cramps.
Opioids (narcotics)
Meperidine, sold under the brand name Demerol, can be injected or taken in tablet form or as a syrup mixed with water. This narcotic pain reliever can become habit-forming if used regularly for a long time. Possible side effects include dizziness, lightheadedness, drowsiness, nausea, and vomiting.
Butorphanol, sold under the brand name Stadol, is injected or given as a nasal spray. Both injection and nasal spray provide rapid pain relief. Its pain-relief effect is highest about 30 minutes after administration; its effect lasts 3 to 4 hours. Possible side effects include drowsiness, nausea, and sweating. Both meperidine and butorphanol have some addictive potential.
Neuroleptics
Two neuroleptics, or phenothiazines, are most effective against headaches, especially when injected. Prochlorperazine is sold under the brand names Compa-Z, Compazine, and Ultrazine-10. Chlorpromazine is sold as Thorazine and Ormazine. Possible side effects include constipation, dizziness, drowsiness, dry mouth, and nasal congestion.
Corticosteroids
Corticosteroids are effective against headaches, especially when injected. Hydrocortisone is sold under the brand names A-hydroCort, Cortef, Cortenema, Cortifoam, Hydrocortone, and Solu-Cortef. Among the brand names for dexamethasone are Decadrol, Decadron, Decaject, Dexasone, Hexadrol, and Mymethasone. Possible side effects include hunger or loss of appetite, indigestion, restlessness, and trouble sleeping.
Found on the Web site of the American Medical Association: www.ama-assn.org
Ask the Doctor by Michael Stein, M.D.Dr. Michael Stein, a Walnut Creek neurologist who specializes in treating headache patients, is a co-founder of the East Bay Headache Support Group and serves as the group’s medical advisor.
Q.
Why is caffeine in most over-the-counter medicines?A.
By itself, caffeine is a weak analgesic and a mild constrictor of blood vessels, meaning it can reduce pain to a slight degree. Many patients have found that a strong cup of coffee can lessen the pain of an impending migraine. When caffeine is combined with other analgesics, such as aspirin or Tylenol, it acts to increase their effect, which is why many medicines contain caffeine. Examples are Anacin (aspirin and caffeine) and Excedrin (aspirin, Tylenol and caffeine).Q. Why do I get migraines at ovulation and menstruation?
A.
Come to the July 13th meeting to hear Dr. Sondra Altman explain what medical science has learned about hormones. She will tell us specific things we can do to reduce the incidence and severity of headaches triggered by hormonal fluctuations.Q. When is it appropriate for a head-ache patient to have a CT scan or an MRI (magnetic resonance imaging)?
A. Following are symptoms that should make your physician suspicious enough to do screening tests. If you experience any of these, tell your physician. If he/she doesn’t suggest a screening test, be an advocate for yourself and ask to be tested.
• Your headaches are new and they don’t follow a pattern.
• Your headaches are getting progressively worse, and/or last longer.
• You have other symptoms along with the head pain, such as blurred vision, weakness, dizziness, loss of consciousness.
• Your headaches began after the age of 50.
Q.
Can I get rebound headaches from triptans?A.
When triptans (sumatriptan, naratriptan, zolmitriptan, rizatriptan), are used more than two to three times per week, it is certainly possible to get rebound headaches. Overuse of the medication causes the headache to relapse or "rebound" as the last dose of the medication wears off. It is, however, less likely to occur with triptans than with many of the over-the-counter medicines, such as Excedrin. If you find yourself taking a triptan (brand names are Imitrex, Amerge, Zomig, or Maxalt) almost every day, you may have developed rebound headaches and need to see your physician about a preventative medicine. Rest—At Last Following is a case study excerpted from Physician’s Update: Headache—A Practitioner’s Guide to the Care and Counseling of Patients. This is a special supplement to Hippocrates, Fall 1998, produced in association with the National Headache Foundation.When Sarah Perillo was 12 years old, migraine headaches began leaving her bedridden several times a month. She was 17 when near-daily tension-type headaches joined her migraines. By 1995 the 25-year-old Perillo had spent almost a decade in pain. That’s when she went to see Carmen Montoya, co-director of the South Texas Headache Institute in San Antonio.
Perillo wanted relief from her severe migraines. Montoya had a different priority. "Intractable tension headaches signal a chemical imbalance in the brain," says Montoya, a physician who is board-certified in family practice and pain management. "My first goal was controlling Sarah’s less severe, daily pain."
Perillo told Montoya she woke up several times a night and rarely felt rested. Montoya wasn’t surprised. "Sarah’s nervous system never fully relaxed and recharged, and that produced a serotonin deficit," she says. Serotonin helps control the body’s perception of pain; insufficient stores of the chemical left Perillo vulnerable to tension-type headache.
Montoya learned that her patient, a single mother who managed a large apartment complex, was highly anxious. Perillo exercised at least 4 times a week—and left each workout with a splitting headache. "Sarah depended on an adrenaline rush to relieve pain," Montoya says. When that rush subsided, pain kicked in and left Perillo with a "letdown" headache. All things considered, Montoya decided to prescribe both drug and nondrug therapies.
She targeted the serotonin deficiency with a tricyclic to help Perillo sleep. Montoya also diagnosed anxiety, for which she eventually prescribed paroxetine.
Montoya initiated the nondrug part of the strategy by having Perillo stop exercising for 2 weeks to break the letdown headache cycle. During those 2 weeks, a psychologist at the institute taught Perillo to relax by using bio-feedback. She learned how to slow her pulse rate and lower her blood pressure in response to signals from a machine, and then to produce those effects without the machine. Audiotapes helped Perillo practice guided imagery and mentally escape to a quiet, restful place.
Perillo also began using "stress dots." She placed small red stickers around her home as a reminder to breathe deeply and relax. She wore a blue, heat-sensitive dot on the back of her hand; when increasing stress made her body temperature drop, the dot turned black. "The relaxation techniques helped me take time for myself," Perillo says.
Two months after her initial meeting with Montoya, Perillo had her first headache-free week in nearly 10 years. The frequency and severity of her migraines were reduced. She began sleeping better, and within 3 months no longer needed the tricyclic. After a year under Montoya’s care, Perillo stopped taking medication altogether—and soon became pregnant. Weekly tension-type headaches returned during her second trimester, but Perillo refrained from medications during her pregnancy and while she was nursing.
Today Perillo is raising her two kids and finishing an accounting degree. She eases anxiety with regular physical therapy and relaxation, and she just started taking 20 milligrams of paroxetine daily. Montoya isn’t surprised that Perillo is back on medication. "Headaches often return when stress builds," Montoya says. "But now Sarah understands where her headaches come from. That’s crucial for controlling them."