HEADLINES
VOLUME 5, ISSUE 3
MAY 2000
A Publication of the East Bay Headache Support Group:
(A
member of the American Council for
Headache Education (ACHE) support group network)
May 9th Meeting: Take Charge!
Are you one of the more than 23 million Americans
suffering from migraine headaches? Or perhaps you aren’t sure what type of headache you have, you just know it hurts and it is adversely affecting your life. On Tuesday, May 9th, Glaxo Wellcome Inc. is sponsoring a special two-hour meeting in the Ball Auditorium at John Muir Medical Center. This is a patient information program entitled, "Take Charge!"Donna Johnson, a migraine sufferer, will speak about her experiences, and Michael Stein, M.D., will outline specific steps a migraineur can take to defend her/his lifestyle against the often devastating effects of migraine headaches. There will also be a question and answer session, and brochures with helpful information about managing your headaches.
Come to this informational meeting and bring family members and friends, especially other headache sufferers who may not know of the latest treatment options available.
Common Myths About Headache Patients
Headache causes personal suffering, disrupts families and interferes with work and leisure time. Striking unpredictably, an attack shatters a sense of self-control. Medications are often less than effective or produce unwanted side effects.
Present day myths about headache often induce a sense of isolation, shame and helplessness. Before healing can begin, the headache sufferer needs to know that headaches are a treatable and significant disorder. Psychological conflicts are generally the result, not the cause of chronic headache.
Fortunately, recent advances in research are expanding the medical community’s understanding of headache and creating effective treatments. Headache sufferers have more treatment options to help them control their symptoms. Just as important as physician visits and drugs, the management of headache involves understanding the headache problem, identifying factors that precipitate headaches, and working with your physician in a therapeutic partnership.
Myth #1: Recurrent headaches mean I have a psychological problem.
Fact: Headaches are the result of biochemical changes in the brain. Stress, acting on the nervous system, makes headaches more likely to occur. The stress may be chemical, emotional, biological, or psychological. Psychological problems can arise from poorly managed headaches but, for the most part, psychological problems do not cause headaches.
Myth #2: Recurrent headaches are something I have to learn to live with.
Fact: Headaches can be managed, not cured. With proper medical care, education and effort, almost all head-ache sufferers can reduce the pain and disability of headache.
Myth #3: The only way to stop my headache is to stop living a normal life. Headaches have taken over my life.
Fact: Frequent disabling headaches occur in an unpredictable fashion and create fear of the next headache attack. As headache frequency increases, the greater the fear grows. This can lead to a vicious cycle where anticipation of the next headache becomes the stress that generates more headaches. Proper headache management addressing medical care and lifestyle can break this cycle and restore control.
Myth #4: Recurrent headaches are not serious. After all, it’s just a headache.
Fact: Most headaches are not life-threatening, but may seriously influence an individual’s quality of life and coping abilities. They strain family life, disrupt leisure activity, and diminish career opportunities.
Myth #5: My children will suffer headaches because I do.
Fact: Children learn how to deal with stress from the behaviors of their parents. Research suggests that the threshold of handling incoming stimuli to the brain may be inherited. However, by learning how to manage stress effectively, children experience coping alternatives which will boost their resistance to headache.
Myth #6: Medication is the only
relief for my headaches.Fact: Headaches are the result of many interacting factors. There is no simple answer. Medication is often a necessary part of headache treatment, but rarely is it the complete answer. Some medications when used too frequently can actually cause headaches. Optimal headache care almost always involves a partnership between the headache sufferer and the physician.
Myth #7: Recurrent headaches mean that I am more likely to have a stroke or brain tumor.
Fact: The sudden onset of frequent, severe headaches should be investigated by a physician. But research suggests that heavy cigarette smoking combined with using birth control pills by women over the age of 30 is more predictive of the possibility of a stroke than the occurrence of head-ache. Brain tumors are a rare cause of headaches.
Myth #8: My headaches are caused by my neck being out-of-line.
Fact: The status of the neck needs to be medically evaluated because headache pain may originate with neck and back problems. However, pain during headache is often projected or referred to the neck and shoulders. Usually, tension in the neck is the result, not the cause, of headache.
Myth #9: Severe headaches must be migraines.
Fact: There are many different types of headaches. The diagnosis of most headaches rests solely on the medical history because there are no tests that substantiate the diagnosis. Severe headaches should be diagnosed by a physician to begin proper treatment.
Myth #10: Recurrent headaches are a female disorder.
Fact: Migraines are influenced by hormonal factors. This is reflected in the fact that 3 times more women have migraine than do men. However, 6% of adult men suffer migraine, and studies show that the disability is not influenced by gender.
Myth #11: Headaches are an excuse for getting out of doing what I don’t want to do.
Fact: Headaches can be a serious disabling illness. Quality of life studies of those patients with migraine demonstrate greater impairment of lifestyle than with most other chronic illnesses. There are easier ways of avoiding an undesired activity than with headache.
Myth #12: Headaches are not worth the time and expense of seeing a physician.
Fact: Not managing headaches is far more costly than caring for them. Each year the average headache sufferer loses time and income due to headache disability; these losses exceed the cost of quality medical treatment.
Found on the Web site of The Journal of the American Medical Association (JAMA):
www.ama-assn.org
The Health Medicine Forum (HMF) is bringing together the best from
conventional and alternative medicine to provide multidisciplinary approaches to manage your migraine headaches. This event will be held on Monday, July 24, 2000, from 7:30 to 9:30 pm at the "We The People" Auditorium at 200 Harrison Street, Jack London Square, Oakland.
Featured in the presentation are:
For further information, call the HMF office at (925) 934-7311. Cost is $10.
A Communication Headache
By Nick Fox, specialist registrar in neurology, London, England
The argument taking place among the three people waiting to see me next in the headache clinic was not noisy because it was conducted in sign language. My next patient was deaf-mute and had been arguing with her husband, also deaf-mute, and with the hospital interpreter. My patient was refusing to use the interpreter except via her husband. Communication was virtually impossible. Each question took several minutes to go, via interpreter, to husband and to patient, back and forth between husband and wife, and then finally back via interpreter to me. The answers seemed to bear no relation to the questions I thought I had asked. "Her headache has been present for over 40 years, since the age of 10, is getting worse, is present all the time, and the treatments do not work, and no one listens or cares." Wild gesticulating of hands around the head suggested "pain all over."
Only half listening, I leafed through the voluminous hospital notes to try and extract a history. She had been seen by several specialists, and had been investigated extensively as an outpatient and inpatient. The working diagnosis was recorded as "?chronic daily headache; ?migraine." Communication seemed always to have been a major problem. She had been tried on various treatments to little effect and had had side effects with everything. Her compliance had been questioned and she had been referred to a pain clinic and had had various nerve blocks, again with marginal benefit.
Getting ever later for the next patient, I gave up. I knew that I had failed to understand her and her headache. She knew, too. I increased the dose of migraine prophylaxis, emphasized compliance, weakly said that these things took time, and made her another appointment.
When I saw her again she was obviously no better. Her husband was sullen and glowering. She was tearful and handed me a note about how nothing had worked. It dawned on me that I had not thought of conducting the interview with notes and diagrams. Slowly and laboriously she "drew" her headache for me—it was continuous but fluctuated between 9 out of 10 and 10 out of 10, where 10 out of 10 was the worst pain she had ever had; it was always left-sided and never crossed the midline. When the pain was particularly severe her left eye would partially close, go red, and water. She had previously considered suicide because of the pain. None of the migraine treatments had helped—she had even tried a triple dose of sumatriptan to see if that would work. The history now sounded like hemicrania continua*, in which case the headache should respond to indomethacin. She agreed to try it.
Four weeks later she looked transformed. She handed me a note explaining that her pain was better than it had been for 40 years—again she had "drawn the pain." It now scored 1 out of 10. She had missed one dose of indomethacin and her pain had returned with a vengeance.
A year later she remains nearly pain free. There have been no problems with her compliance with her indomethacin and now communication seems much easier with or without notes and diagrams. It made me think of the assumptions that I must have made when I first met her. Had I assumed, given that she could not speak, that she could not write either?
Found on the Web site of the British Medical Journal: www.bmj.com
*Editor’s Note: Hemicrania continua is
a chronic headache characterized by brief sharp pains on one side of the head,
and which is typically relieved by indomethacin, a non-steroidal
anti-inflammatory drug.
Future Meetings:
July 11th: Talk It Over Night
September 12th: To be determinedNotes...
The East Bay Headache Support Group features medical and other professionals as speakers at its meetings. Notes are taken of each presentation and are available for a suggested donation of $2 each. Past topics include: Biofeedback therapy, genetics, caregiving, dietary triggers, chiropractic treatment, pharmaceutical remedies, hormonal triggers, reducing stress in the workplace, dealing with holiday stress, acupuncture and Chinese herbal therapy, children’s head-aches, temporomandibular joint disease (TMJ), somatic headache relief, compounding medications, allergies, experimental drugs, stress relief, non-traditional therapies, tension headaches, menopause, head injury headaches,
environmental medicine, emotional impact of headaches, sleep disorders, pain management, exercise headaches, cluster headaches, and treatment of headaches in the Emergency Room.The East Bay Headache Support Group is a nonprofit organization dedicated to providing a forum for headache sufferers. The support group meets the second Tuesday every other month at John Muir Medical Center from 7:30 to 9:00 pm. It is open to all headache sufferers and their families; the meetings are free (however, donations to cover printing, postage, and Web site expenses are appreciated!). The support group meetings include lectures by guest speakers, question and answer sessions, and informational materials.
Directions to John Muir Medical Center: Take Highway 680 to the Ygnacio Valley Road exit in Walnut Creek; go East approximately 1-1/2 miles, and turn right onto La Casa Via. Turn left into the medical center parking lot, and enter at the Main Lobby. Take stairs or elevator to the lower level and follow signs to the meeting room.
We value your input! Call, fax, write, or e-mail us if you have any comments or suggestions, or would like to help. The planning committee meets the third Tuesday evening every other month and welcomes new members. Michael Stein, M.D., Advisor; Leslie Davis, Editor; Dana Giese, Webmaster; Donna Johnson, Treasurer; Reg Fong, Meg Johnson, Joan Kelley, Richard Tomchalk.
East Bay Headache Support Group
1844 San Miguel Drive, Suite 316
Walnut Creek, CA 94596
Phone: (925) 938-5252
Fax: (925) 938-1343
E-mail: info@headachesupport.org
Do you know others who suffer from headaches? Make copies of this newsletter and pass it on!