HEADLINES
A Publication of the East Bay Headache Support Group
A member of the American Council for Headache Education (ACHE) support group network
Volume 6, Issue 2
March 2001

March 13th Meeting:  Overload Syndrome and Noxious Stimuli in Migraine

The East Bay Headache Support Group is pleased to welcome Jonathan B. C. Humphrey, M.D., as guest speaker for its March meeting. Dr. Humphrey is a Board Certified Family Practitioner in Danville with special training and interest in migraine headaches, and overload syndrome including fibromyalgia, bipolar and other related mood disorders.

He will talk to the support group about the overload syndrome and noxious, or harmful, stimuli in migraine. This will include an understanding of the common and atypical presentations of migraine, discussion about many of the origins and triggers of headaches, and a conceptual understanding of headaches.

Join us in the Ball Auditorium at John Muir Medical Center from 7:30 to 9:00 p.m. on Tuesday, March 13th. For more information, call (925) 938-5252. 

Whether I am sitting in an airport waiting for my flight (late again!) or having a conversation with a co-worker, I frequently meet people who suffer from headaches, as I do, but who have not heard about the latest advances in headache treatment. The East Bay Headache Support Group was founded five years ago to educate and provide support for headache sufferers. Though our database includes more than 650 names, there are many others out there we would like to reach.

The planning committee has begun an advertising campaign and we need your assistance. We want to place our brochure in doctors offices and pharmacies, and create a bumper sticker, decal, or license plate frame for our vehicles.

Join our contest—create a catchy slogan for a bumper sticker and win a prize!

Maybe something like this adaptation of the Got milk? commercials:

Bumper stickers can have up to four lines and can be ordered very inexpensively. Would you be willing to put one on your car? Or, more expensive but still feasible, perhaps we could purchase a few static cling decals for car windows, or license plate frames, to advertise our Web site address.  To submit your idea(s), call Leslie Davis at 925-228-1084 or e-mail to ladavis98@aol.com, or mail to 1844 San Miguel Drive, Suite 316, Walnut Creek, CA 94596.

Now thought of as a strictly cosmetic procedure, the "forehead lift" may alleviate more than a wrinkled brow. Plastic surgeons say the procedure could provide lasting relief from migraine headaches.

Research has already suggested that migraines can be treated with injections of Botox, a toxin used cosmetically to paralyze muscle and thwart facial lines. Now surgeons have found that the forehead lift, a surgical procedure to remove the muscle between the eyebrows, not only banishes "frown lines," but may also eliminate migraines.

In a review of 314 patients who had undergone a forehead lift, doctors found that among the 39 who had suffered migraines before the surgery, 80% saw their symptoms improve or disappear after the procedure. Lead researcher Dr. Bahman Guyuron told Reuters Health that he decided to look into the connection after two patients told him they liked their new foreheads, but they really enjoyed the migraine relief.

Guyuron and his colleagues at Case Western Reserve University in Cleveland, Ohio, report their findings in the August issue of Plastic and Reconstructive Surgery.

Guyuron's team has started a trial of using the surgery to treat migraines. The first procedure will be performed by the end of the month, he said. According to Guyuron, "there really is no downside" to the surgery. "The muscle has no major role except in expressing anger or disdain," he said. "It has no positive function." And there are no visible scars. Surgeons can remove the muscle by making an incision in the scalp or the upper eyelid’s crease, Guyuron said.

The surgeon believes that the plastic surgery eases migraines by removing one of the components in the "domino effect" that sets off migraines. The trigeminal nerve, which is found in the face, eyes, nose, mouth and jaws, is believed to be involved in migraine.  Stimulation of the nerve triggers the release of chemicals that increase nerve sensitivity. The trigeminal nerve also travels through the muscle that is removed in a forehead lift. Therefore, this muscle may add to the onset of migraines by compressing the trigeminal nerve, and removing the muscle removes a migraine trigger, Guyuron said.

If the cosmetic surgery turns out to be a true migraine treatment, Guyuron said, "we hope that insurers will consider covering it." Plastic and Reconstructive Surgery 2000;106:428-433. Found on the Web site of Mediconsult.com. Reprinted by permission.

Personal Profile - By Reg Fong, May 1998

My early experience with headaches began when I was about eleven years old. My family doctor thought it was a sinus condition attributed to allergy. I treated my occasional headaches with over-the-counter (OTC) pain and sinus medications. But my headaches during the next twenty-five years gradually became more intense, frequent, and lasted much longer. In my mid-thirties, I was again diagnosed as having sinus-related allergy headaches. After the allergy tests, I was put on a food elimination diet and received allergy desensitization shots weekly for almost three years without improvement. I continued taking OTC pills and got an occasional prescription medication of Tylenol with Codeine or Fiorinal.

As my work career progressed, I took on more responsibilities and my headaches got worse. I was now diagnosed as having tension headaches related to stress.

I took up long distance running as recommended by my doctor friend and later running partner. Although my head-aches vastly improved, I continued my regimen of pills only when absolutely needed. After close to twenty years of running, I developed back pains, plantar fascitis, and a sciatica nerve pain down the right leg. Needless to say, I was advised by an orthopedic specialist to stop my running addiction.

Shortly after discontinuing running, my headaches got worse with greater severity and lasted as long as two to four weeks in duration. I continued with OTC medication and was prescribed other stronger pain pills with no lasting improvement. I later developed chronic daily headaches with varying intensities. I would wake up in the morning with pain over the left eye, a stiff and painful neck on the left side, a stuffy left nostril, and later during the day the pain would migrate to my entire forehead. I took only OTC medications and was very careful to limit their use because I was well aware of rebound type headaches.

I went to doctors, one specializing in headaches, and was told that I would probably have to live with my chronic headaches. I read books and surfed the Internet. I researched until I found the East Bay Headache Support Group, and then came to the meeting when Dr. Stein gave a presentation on tension-type headaches. He described in detail the rebound headache phenomenon associated with the continual use of OTC medication. His presentation mirrored what has occurred in my life. I immediately stopped all the Advils and Excedrins. I now take only one Nortriptylene (an anti-depressant used as an abortive medication) in the evening under Dr. Stein’s care. This treatment and a much better understanding of headaches has helped me considerably in relieving my head-aches. I have been almost headache-free for two months.

It has been almost three years since my Personal Profile appeared in Headlines. I want to update you on my progress, and hope it will be an encouragement to others to find help and gain control over their headaches.

Yes, my headaches did return, but much less frequently and lower in intensity. They seem to occur more often in cold damp weather, or when I am stressed or tired. I find that by maintaining physical and emotional fitness, eating right and getting enough sleep, I can go for weeks without a headache.

I continue to take my prescribed medi-cation (Nortriptylene) each evening, and regularly visit my doctor. When a head-ache persists, I now take an occasional Tylenol instead of Advil or Excedrin.

The headache support group is an encouragement to me. Sharing and learning from others and our speakers has been truly helpful in my quest to maintain control and minimize my headache attacks.

How many kinds of pain relievers do you have in your medicine chest? If you’re like many people, you may have over-the-counter medications such as aspirin, acetaminophen (Tylenol) and ibuprofen (Advil, Motrin), plus one or two prescription drugs called non-steroidal anti-inflammatory drugs or NSAIDs. Many people take these medications occasionally for headache, sore muscles or aches and pains. Many more take these drugs daily, often at high doses. And most folks don't worry about them—after all, everybody knows you can’t kill yourself with aspirin, right?  Well, although it may be hard to kill yourself with them, painkillers can hurt you. In particular, aspirin and other NSAIDs can cause serious gastrointestinal problems when used daily over long periods of time. Many people with chronic conditions such as arthritis already know this—they compromise, sometimes daily, between the pain-relieving benefits of daily high doses of NSAIDs and the stomach upset and even ulcers these drugs can cause.

In addition to aspirin and ibuprofen, NSAIDs include other prescription and over-the-counter (OTC) medications such as Naprosyn (naproxen), Orudis (ketoprofen), Indocin (indomethacin), Relafen (nabumetone), Daypro (oxaprozin) and Clinoril (sulindac). All these drugs work by blocking certain chemicals in the body that cause inflammation. They can also relieve pain not caused by inflammation, such as headaches.

Experts have known for many years that NSAIDs often cause stomach upset, and as early as 1995, the Food and Drug Administration demanded stronger warning labels on this type of drug to alert patients to the possibility of developing stomach ulcers or bleeding. But many doctors still prescribe the highest doses of these medications for their patients and may not take the time to find out about other illnesses or medication a patient is taking, or whether that patient is experiencing warning signs of ulcers. It’s important that you know what adverse effects these drugs can have and what warning signs to watch for.

NSAIDs irritate the lining of the stomach, which can cause gastritis, ulcers, bleeding or perforation (holes) in the lining. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), people with a history of ulcers, gastritis or related complications have an increased risk of developing these side effects, as do older folks and those who take NSAIDs every day. Other factors that increase risk of stomach problems include smoking, kidney failure and using cortisone or prednisone at the same time.

Some people reduce their risk by taking special medicines to protect the stomach’s lining while others have to avoid NSAIDs entirely and take other pain medication. A recently released drug called celecoxib (Celebrex) appears to spare the stomach lining, but it may cause other side effects, especially in those with cardiovascular disease. It’s also three times more expensive than NSAIDs and can interfere with the blood pressure drugs called ACE inhibitors.

In addition to stomach ulcers, NSAIDs have recently been found to increase risk for diverticular disease, in which many tiny pouches develop on the wall of the colon. Also, a study reported in May’s Archives of Internal Medicine suggests that regular use of NSAIDs may increase risk of heart failure.

So what does this mean for you and your pain? Well, first of all, taking any drug involves some degree of risk—that’s why it’s important for you and your physician to discuss your medical history and any other drugs you’re taking before starting a new medication. For most people, even those taking NSAIDs daily for chronic conditions, a little stomach upset is worth it, and they learn to take precautions to avoid more serious side effects.

When you do take NSAIDs, start with the lowest dose possible. You can always increase your dose if that’s not working, and the less medication you take, the less trouble it’s likely to cause. If you’re taking over-the-counter pain relievers, don't continue taking them for more than two weeks without talking to your doctor.

The NIDDK recommends using coated versions of your medication when available, which lessens the risk of irritating the stomach lining. Taking your dose with food, milk or a full glass of water can also reduce irritation. And longer-acting formulations that are taken only once or twice a day are more likely to cause problems than those taken three or four times a day.

Finally, be alert for warning signs, and call your doctor immediately if you experience any of the following: severe stomach cramps or burning sensations, black, tar-like stools and/or blood in the stools or vomiting.

© July 2000 Mediconsult.com. Reprinted by permission.  www.mediconsult.com

The East Bay Headache Support Group is one of 50 support groups in the U.S. under the auspices of the American Council for Headache Education. ACHE is a non-profit patient-physician partnership with two primary goals: helping head pain sufferers find effective treatment, and educating non-sufferers about this misunderstood and misdiagnosed illness. We encourage you to join ACHE— membership is $20 per year and includes a newsletter subscription, discounts on  prescription medications and vitamins, etc., and travel. To join, send your check to ACHE, 19 Mantua Rd, Mt. Royal, NJ 08061.  Phone: 1-800-255-ACHE www.achenet.org