The East Bay Headache Support Group is pleased to have Dr. Tara Levy, a naturopathic physician, as our speaker for the first meeting of the new year 2003.

Naturopathic medicine offers a unique approach to healthcare. The principles of naturopathic medicine — the healing power of nature, find the cause, do no harm, treat the whole person, doctor as teacher, and prevention — guide the naturopathic doctor and provide a framework from which to work. Dr. Levy will discuss how these principles and the natural therapies used by naturopathic doctors can be applied to people who suffer from chronic headaches.

Dr. Levy’s presentation will be in the Ball Auditorium, downstairs at John Muir Medical Center, from 7:30 to 9:00 p.m. on Tuesday, January 14. For more information, call 925-685-8775.

Headache is three times more common in women than in men during the middle age, adult years. The highest prevalence for headache in women is during the middle years (30-50 years of age) —a period of their lives when they are trying to build a career and raise a family. This differs from other chronic diseases that are equally common in men and women and that present later in life (such as diabetes or high blood pressure). Goals of treatment among these disorders differ. For example, for diseases that present later in life (when many are retired), goals of treatment may not focus so heavily on the impact medications have on work, family, and social life. For headache, given the prevalence, severity of illness, associated disability, and time when it presents during a female patient's lifetime, it is clear that advocating for the best available treatment for headache is a political issue that should be of concern to all women.

Treating diseases like high blood pressure and diabetes is done early because it makes clinical sense and saves “dollars and cents.” Lowering blood pressure and keeping blood sugar under control costs money but prevents development of more expensive problems like heart attack, stroke, and blindness. For diabetes and high blood pressure, insurance companies, health maintenance organizations (HMOs), and employers agree that these disorders need to be treated early and aggressively because of the cost benefits and improved quality of care. However, similar treatment strategies (early, aggressive therapy) for other conditions not usually considered life-threatening, such as headache, are not clearly supported by health care organizations.

One reason that health care organizations do not support the concept of “early and aggressive treatment” for headache is that the “financial benefits” (cost benefits) are less obvious. Newer medications like the triptans work better, are faster, and cause less fatigue than older medications (such as barbiturate-caffeine-aspirin combinations, opiates, and ergotamine combinations). One problem is that new medications are more expensive.

Nonpharmacological techniques for treating headache, such as biofeedback or relaxation training, also appear to be expensive in the short term, and insurance companies or HMOs are often reluctant to pay for these options. For women who may wish to become pregnant, and who need or want to avoid using medication, however, such economizing may not make personal sense. Some patients do not receive adequate therapeutic benefit from traditional headache medications, while others need to use nonpharmacological techniques to help the medicine work. Unfortunately, nonpharmacological techniques are often not broadly available. In other cases, payers are not motivated to pay for nonpharmacological techniques because the “cost benefit” for these procedures has not been established; some health care organizations are not convinced that nonpharmacological technique will save them money.

Health care organizations need to maintain at least a financial balance and hopefully earn a profit; therefore, “cost management” is built into their restrictions for care that are placed on the patients and physicians. The business concept may resemble: “If there are several different medications that work (eventually), then prescribe the least expensive one.” For these large health care businesses, the loss of function, time from work, and lost time from family is not factored into defining “successful migraine management.” In this light, “patient priorities” and “health care company priorities” are at odds.

In an effort to address the cost benefits of more expensive therapies (i.e., triptans) for migraine, outcome studies are underway. One recent study involved patients enrolled in an HMO who were allowed to use sumatriptan for treatment of migraine. During the course of the study, patients reported fewer migraine-related disabilities. Patients taking sumatriptan also had lower migraine severity scores, and they used fewer healthcare resources. Specifically, the total migraine healthcare costs were 41% lower after starting treatment with sumatriptan. This study also shows that patient satisfaction is an important factor defining treatment success. Patient satisfaction is directly related to the level of disability in addition to pain relief. Successful migraine treatment parameters are evident when considering:

Leaving work to go home to lie down versus staying at work and finishing a project.

Calling the neighbor, friend or family member to care for children versus providing care for the children.

Relying on multiple medications and other less clearly established effective nonpharmacological techniques (vitamins, herbs, hypnosis, massage therapy, acu-puncture) instead of using more specific and effective treatments.

Some of these differences may seem minor when considered as a single event. However, when considered over a lifetime of headaches, these differences have a significant impact on one’s well-being. Some insurance companies, HMOs, and other healthcare providers may be slow to recognize the value of “first-class” care for headaches, but patients should insist on it. Specifically, first-class treatment may include:

Specialty care for patients with hard-to-treat headaches or other health concerns lending headache care challenging,

Access to newer and more specific headache drugs (even if they are more expensive),

Availability of medications to allow for early treatment, and

Choice of pharmacological and/or nonpharmacological technique (such as relaxation therapy or biofeedback).

As patients learn more about their own medical conditions and assume more responsibility for care, health care businesses may modify medication restrictions in order to keep and attract customers. Patients also may ask physicians to play an active role in addressing such health care concerns with management organizations. For example, physicians may write individualized letters requesting that specific, expensive, treatments need to be prescribed for individual patients.

Customer service, quality guarantee or product satisfaction are all concepts people expect when shopping for cars, houses, and even daycare centers for their children. However, people are not used to “shopping for healthcare.” Perhaps during the new millennium, health care organizations will become more competitive and support treatment strategies to help patients and health care providers effectively manage headache. In turn, the headache sufferer certainly can be more demanding about getting their health care needs met, and they also can be more selective about health care choices.

Found on the Web site of the American Council for Headache Education (ACHE). http://www.achenet.org

Have a suggestion for a future meeting topic
or speaker, or want to submit an article or
personal profile for the next newsletter?
Contact Leslie Davis at 925-685-8775 or
davis0774@sbcglobal.net.

Keep a diary of your headaches to try to determine triggers and to better explain your distress level when seeing your doctor.

Get adequate and restful sleep. Maintain a regular schedule for sleep. Do you have sleep apnea?

Take good care of yourself, both physically and emotionally.

Drink lots of water.

Exercise!

Practice good posture.

Limit your intake of alcohol, caffeine and nicotine.

Limit over-the-counter pain medications. And don’t use any medication (OTC or prescribed) more often than recommended—be alert for rebound headaches.

If you have frequent headaches, ask your doctor about taking a preventive medication.

See a compounding pharmacist to have medications put into a more easily tolerated dosage form.

If your migraines could be triggered by cyclical dips in estrogen level, talk to your doctor about the pros and cons of taking supplemental estrogen.

If a sensitivity to foods is suspected as a trigger, try an elimination diet.

Practice ergonomics in the workplace and at home.

Give your eyes frequent breaks when working on a computer.

In the event you need to go to an Emergency Room, carry a letter from your doctor listing your migraine diagnosis, medications you’re taking, and any known allergies.

Consider alternative therapies: biofeedback, chiropractic or massage therapy, acupuncture or herbal therapy.

Pfizer Inc. said it received approval from the Food and Drug Administration to market its Relpax migraine drug. Pfizer said Relpax is the newest product in a class of antimigraine medicines known as triptans. Discovered and developed by Pfizer, Relpax acts on blood vessels and sensory nerve endings to relieve symptoms of migraine attack. Relpax has been approved for migraine treatment in 51 counties and has been introduced in

17 countries. The FDA’s review of Relpax had been stalled for more than a year while Pfizer conducted additional tests to assure agency concerns about coronary safety. Pfizer of New