The East Bay Headache Support Group is pleased to have Richard I. Gracer, M.D., as guest speaker for its September 12th meeting. Our last newsletter mentioned an herb, 5-HTP, which is gaining popularity in America as an alternative therapy for depression, sleep problems, weight loss and migraine headaches. Dr. Gracer will talk about 5-HTP (5-hydroxytryptophan) and its ability to increase the serotonin levels in the brain, which can bring about a reduction in the severity and frequency of vascular headaches (migraine and daily headache).

Dr. Gracer has been practicing orthopedic medicine since 1979, and is board certified in Family Practice and Chronic Pain Management. He is also an active teacher, and currently an Assistant Clinical Professor of Community and Family Medicine at UC San Francisco School of Medicine. Dr. Gracer has taught orthopedic medical topics at many seminars and courses both in North America and Europe. His current interest is in the nutritional aspects of musculoskeletal disorders.

The support group meeting will be held in the Ball Auditorium at John Muir Medical Center on Tuesday, September 12th, from 7:30 pm to 9:00 pm. For information, call (925) 938-5252.

You are using more medication while having more headaches.

You are missing family or work commitments because of headache.

You exhibit signs of depression: low mood, sense of helplessness.

You experience severe anxiety in response to early signs of headache.

You notice increasing irritability.

You have declining mental sharpness.

Adapted from Paul N. Duckro, PhD’s "Taking Control of Your Headaches: How to Get the Treatment You Need." Excerpted from the May/June 2000 issue of NHF Head Lines, newsletter of the National Headache Foundation.

The patients may feel a disconcerting tingle travel up their arm and settle on their tongue. Or they may smell something that isn’t there, or inexplicably experience the taste of salt or lemon. Sometimes, even the weight of their clothes becomes unbearable.

These are some of the hidden agonies sufferers of migraine headaches usually do not talk about, said Dr. Rami Burstein, associate professor of neurobiology and anesthesiology at Harvard Medical School and Beth Israel Deaconess Medical Center.

But new headache research conducted by Burstein and others has shown an estimated 25 million migraine sufferers that they are not losing their sanity but experiencing a kind [of] neurological uprising.

Research over the past five years strongly suggests that migraines are not primarily caused by changes in blood flow within the brain, as previously suspected, but by a series of misfiring neuron clusters, Burstein and other researchers say.

"Migraines are a neurological disease. That’s pretty much a done deal," said Dr. Stewart Tepper, director of the New England Center for Headache in Stamford.

Migraine headaches are characterized by severe, throbbing pain, often accompanied by nausea, vomiting and sensitivity to light and sound. Three out of four sufferers are women.

Doctors often fail to acknowledge the severity of women’s migraines because of a tendency to downplay women’s complaints.

one of the key lessons of the new research is that people with migraines should not try to bear the pain but should take new-generation pain medicine quickly...0

In research recently published in the Annals of Neurology, Burstein’s lab showed that during a migraine attack, the skin of 79 percent of sufferers became so sensitive that even running a comb through the hair could cause excruciating pain.

Burstein believes that type of pain is the end result of a molecular chain reaction. At some point after the first cluster of neurons in the brain becomes abnormally sensitive to pain, a second set of neurons also becomes sensitized. Most migraine drugs now in use target the first cluster, Burstein said.

Studies on rats suggest that when the second cluster of neurons becomes sensitized, the sufferer gets little or no relief from existing medications.

"Once the pain has migrated to the second location, drugs have no or minimal influence," Burstein said. "The work shows that you have to treat headaches in the first 20 minutes to an hour to be effective."

Tepper said intervention within 90 minutes with the class of headache medicines known as triptans is now the recommended course of treatment for severe migraine pain.

Drugs such as zolmitriptan and rizatriptan block the neurotransmitter serotonin and have proved effective in treating severe pain.

Doctors no longer regularly prescribe daily preventive treatments with antidepressants, which have side effects, Tepper said. "We hit them hard and early. Most cases of episodic pain we can treat today."

There appears to be a clear genetic predisposition to migraines—if you have relatives who get them, you are more likely to get them too.

People who get migraines are urged to avoid alcohol, keep up with their sleep and avoid stressful situations. In the days before their period, women should be particularly careful about avoiding migraine triggers, Tepper said.

Excerpted from the Health & Fitness section of the August 22, 2000 issue of the Contra Costa Times.

It’s 5:30 am—time to get up and face the day. Will it be a good one or one full of decisions not many people I know have to make? Is it severe, moderate or mild? How long will it last? Will it only remain in my neck, between my shoulder blades, jaw and ear, or will it go to my eye and make me a servant to it? What will I take to make the pain go away? Should I ignore it and hope for the best or do I doctor it up, knowing that in the end it, the pain, will win, like it always does.

I’m sorry to tell you, Georgia, you now have chronic daily headache! As the curtain comes crashing down on my life, I muffle a groan and control an anger so deep it could scare the 153 students I teach every day. My so-called life ended that day, not the two different days when I heard first in 1985 that, "You have lobular cancer of your right breast" and then again in 1997, "You’re lucky, Georgia, it’s the same cancer as the first one, lobular, and it is very treatable."

Surprise, welcome to the world of women! Two days later I was minus one important feminine part and 24 purifying lymph nodes. I had my first cancer too many years ago to be prescribed 6 months of chemo to make sure that the cancer would not spread. You see, I had a 90% chance of complete recovery—pretty good odds in my book. Twelve years later, the same scenario, the same prognosis. Lucky again, you pray. No chemo but 5 years of tamoxifen to ward off any wandering cells that escaped the surgical knife. Unfortunately for me, both tamoxifen and raloxifene gave me aching daily headaches and I had to stop them. My oncologist says there are medicines out there for me, but I must control my headaches before we dabble with them. Migraines are once again playing Russian roulette with my life.

Migraine, its pain and intractability, are lurking every waking hour, making me mentally engaged not with the daily lesson plans but with how do I not lose my temper, how do I go on with this booming pain inside of me? You can’t operate to remove it, you can’t ease the pounding, sharp and stomach-sickening pain, and you can’t spend 10 days in a migraine ward and get over it.

It’s a secret I keep deep down inside of me. How are you, Georgia? Fine. What’s new? Nothing. You look pale today, are you tired? No, just off to a slow start today. Do you want to go to dinner on Saturday? Maybe. Lies, all lies. Oh, if I could only be honest and say I don’t feel well, I have a migraine that is killing me. I can’t think straight, I want to vomit, I need to be home in a darkened room and I need to be alone.

Who wants to hear that? They’d prefer to react to the fact you had cancer. How many people called me from here and there? How many cards did I receive, how many flowers did they send and how many prayers were invoked on my behalf for a complete and speedy recovery? Grateful, very grateful I was, but oh so sad that when I went into the hospital for my migraines, not a call, not a visit, not a flower did I receive for the battle, perhaps too weak a word, the war I was waging against the scourge of my life.

My life has been filled with wonderful experiences, memorable moments and many lonely hours spent trying to be normal and to keep up a social life. Marriage, children, commitment are all sad dreams for me, for how could I shop, cook and guide a family lovingly while not addressing my own pain? I would be too soon to argue, too hurried to scold, too pained to listen. I’d require too many hours locked away in a darkened bedroom. Not knowing when I would resurrect and push open the door to begin to live my life again remains a challenge I tell no one.

I could never promise anyone, let alone myself, a normal life.

Although it is a war I wage daily, it is one I have not surrendered to. I have spent 40 years pursuing an end. A doctor in Sedona once said to me that I was to "never give up hope and continue searching for answers." I have followed his advice to the letter. How do I tell you what I’ve done so you don’t think me a cry baby, a weakling, a pill popper or an emotionally crazed woman who can’t cope with life?

I have tried: acupuncture, biofeedback, self-hypnosis, meditation, Reiki, massage therapy, psychotherapy, psychics, hysterectomy/oophorectomy, jogging, chiropractic, naturopathy, colonic cleansing, 7-month elimination diet,

3-week liquid diet, hypoglycemic diet, TMJ adjustment, a 10-day hospitalization—and then there were the offers of sex by men who felt they would end my migraines! Laughable if it were not so pathetic.

As for medicines, I can’t remember them all, listed on a 2-page document in my folder at the migraine headache center: beta blockers, calcium channel blockers, prednisone, triptans (Amerge, Imitrex, Zomig, etc.), Cafergot, Midrin, anti-epileptic drugs (Neurontin), anti-inflammatory drugs, over-the-counter drugs,Toprol-XL, Naprelan, vitamins B, C, E and on and on.

This anonymous personal profile was excerpted from the Spring 2000 issue.