VoLUME 8, ISSUE 4  
July 2003

July 8th Meeting:  Food for Thought - The Role of Diet in Migraine

Dr. Stephen Peroutka was the guest lecturer for the third meeting of the East Bay Headache Support Group, way back in March 1996.  At that time Dr. Peroutka was involved in research on the genetic factors responsible for headache, and he has done pioneering work on the basic mechanisms of migraine which led to the development of Imitrex.

We are pleased to have him speak again, this time on the role of diet in migraine headaches.

The meeting will be held in the Monterey Room, downstairs at John Muir Medical Center, on Tuesday, July 8, from 7:30 to 9:00 p.m.  Call 925-938-5252 for more information.

A Revolution in Migraine Care

 By Gary Gately, HealthScoutNews Reporter

Thursday, June 5, 2003 (HealthScoutNews) — Not long ago, migraine sufferers had no choice but to head for darkened bedrooms to wait out the pain.  Or they could down powerful painkillers that could lead to ferocious “rebound” headaches and, ultimately, addiction.

Often, doctors couldn’t—or wouldn’t—help much.  As recently as a decade ago, many of them dismissed migraines as psychologically based ailments, essentially telling patients, “It’s all in your head.”

But dramatic breakthroughs in recent years have led to better understanding of migraines, which produce intense, throbbing pain, typically on one side of the head, sometimes accompanied by nausea and sensitivity to light and sound.  And new treatments have vastly improved the prognosis for sufferers.       

That’s a message specialists are hoping to convey during National Headache Awareness Week, June 1-7.  

Dr. Lisa K. Mannix, a neurologist who has been treating headaches exclusively for seven years since completing her residency, says migraine care has been “revolutionized” in the past decade.  “I often joke that I didn’t have to practice in the dark ages, which makes some of my [older] colleagues a little jealous,” says Mannix, who’s in private practice in Cincinnati.  Unlike her predecessors, she says, “I know I have treatments that are very effective for the majority of patients.”  

A huge advance in the treatment of migraines came in 1993 when the first triptan medication hit the market.  Sumitriptan, also known as Imitrex, mimics the neurotransmitter serotonin, whose supply drops off during migraines.  Sumitriptan causes blood vessels to constrict, which soothes the inflammation of nerve endings in the brain and eases pain.

Over the past decade, six other triptans have hit the market.  Like other classes of drugs such as antidepressants and antibiotics, different triptans might work for some people, but not others.  So more choices mean more hope for migraine sufferers.

Other new treatments appear to help prevent migraines or reduce their frequency and severity.  These include Botox, better known for its ability to smooth away facial wrinkles, as well as beta blockers and calcium-channel blockers, both used to treat high blood pressure and coronary artery disease, experts say.  Antidepressants that affect serotonin levels can  help prevent migraines.  And anti-seizure medications, used to treat epilepsy and bipolar disorders, also have shown promise for their ability to prevent migraines.

And more new treatments seem likely.  Dr. Seymour Diamond, executive chairman of the National Headache Foundation, says he knows of 14 studies now under way on migraine treatments.  “There’s a lot of hope,” Diamond says.  “There’s going to be more and more help and better drugs and drugs suitable to more people.”

Still, millions of sufferers aren’t getting the newer, proven medications for their migraines.  One reason:  Experts say about half of the estimated 30 million.

Americans with migraines are never properly diagnosed.  “It’s an awareness issue, and I do think people are suffering needlessly,” says Diamond, founder and director of the Diamond Headache Clinic in Chicago.

On a more positive note, the number of doctor visits for migraines nearly doubled from 9.4 people per 1,000 to 18 per 1,000, from 1990 to 1998, a recent Wake Forest University study says.  This jump in visits may reflect the newer treatment options.

However, the study also found that many migraine sufferers rely on too many addictive painkillers that provide only short-term relief instead of more effective drugs, such as triptans.

What’s more, many migraine sufferers remain unaware of the triptans and other newer treatments, including the preventive drugs, experts say.  This ignorance stems in part from earlier, failed treatment for migraine sufferers, relatives or acquaintances, says Mannix, a member of the headache foundation’s board of directors.

“People may not come back to the medical system because they may not realize we have better drugs,” she says.  “People say, ‘I went 10 or 15 years ago and got side effects and [treatment] didn’t work.’  Or they say, ‘It didn’t work for my mom so why should it work for me?’”

Mannix says that about 25 percent of migraine patients could benefit from preventive medications, such as anti-seizure drugs, but only 5 percent take them.  “So there’s some serious under-treatment going on here,” she says.

Primary care doctors—the front line in treatment of most migraines—typically don’t have the time necessary to assess the headache patient thoroughly and decide the best treatment, Diamond explains.

Besides medication, practical steps such as eating and sleeping well, exercising regularly, and reducing stress can help fight migraines, specialists say.

But for persistent migraines, Mannix says, “The big thing is you don’t have to suffer.  We’ve sort of unraveled some of the mystery, and there’s a lot of good treatment available.”

As part of Headache Awareness Week, the National Headache Foundation has introduced a new tool for sufferers called MAP, or Migraine Attack Profile.

By tracking the duration of individual headache attacks with MAP, doctors can learn which aspects of a migraine affect a patient most, how long each phase of an attack lasts, and what tends to make them get better or worse.  Eventually, a pattern appears and doctors can use this information to help select the most appropriate medication for the patient, as well as identify the best time to start treatment for individual attacks, the foundation says.

For a free copy of the Migraine Attack Profile, contact the headache foundation at 1-888-NHF-5552 or visit www.headaches.org.

Found on the Internet at Yahoo! News

Headache and Diet  

According to some studies, what we eat and when we eat it plays a significant role in headache and migraine.  Over-activity of the arteries in the head has been found to cause pain, and wildly fluctuating blood sugar levels can prompt these vessels to spasm in susceptible people.  Caffeine, a com-pound commonly found in coffee, tea and chocolate, has been linked to headache.  Researchers believe that people who are prone to headache and migraine may be sensitive to the effects of caffeine.  Limiting drinks or foods containing caffeine is generally recommended.  Food additives and naturally occurring food chemicals can also trigger headache in some people.  If you suspect that your headaches may be linked to your diet, it is important to seek medical attention so that your sensitivities can be properly diagnosed.

Arteries are Affected by Insulin

Most cells in the body need to burn glucose with oxygen to produce energy.  The digestive system breaks down the carbohydrates we eat into glucose.  This simple sugar is then transported to each cell via the bloodstream.  A gland of the endocrine system called the pancreas secretes a hormone called insulin, which helps the glucose to migrate from the blood into the cells.  If the food eaten is absorbed quickly into the bloodstream, then the pancreas has to respond with a strong hit of insulin.  The sudden drop in blood sugars seems to encourage the arteries in the head to constrict.  During a migraine, visual disturbances such as the characteristic aura may be due to this arterial constriction.

Hypoglycemia means low blood sugar

If you skip a meal, your blood sugar level may drop too low for your brain to function comfortably.  In order to boost the amount of glucose to the brain, the body releases hormones which may also cause an increase in blood pressure because they narrow the arteries.  This narrowing of the arteries can contribute to headache and migraine.

Caffeine withdrawal

The chemical adenosine helps to regulate the diameter of the arteries inside the head.  Caffeine is structur-ally similar to adenosine and counter-acts it by constricting the arteries.  To compensate, your body produces even more adenosine.  When you stop consuming caffeine, such as during sleep, the high levels of adenosine will make your arteries dilate.  The excessive blood flow then causes a throbbing headache, which only a cup of coffee can ease.

Foods can cause headache

Some people who suffer from frequent headache and migraine may be sensi-tive to certain food chemicals, both naturally occurring and artificial.  Common food chemicals that have been found to affect the arteries of the head include:

Monosodium glutamate (MSG) – a common flavour enhancer, but also found naturally in such foods as tomatoes.

Nitrites – these preservatives are found in processed meats and some cheeses.

Amines – common compounds found in a wide range of foods, including spinach, tomato, potato, small whole fish, tuna, liver, dark chocolate and alcoholic drinks.  

Treatment options

It can be challenging to discover the exact food or foods that may contri-bute to headache and migraine.  It is best to consult health care profession-als to ensure an appropriate diagnosis and course of action.  Generally speaking, treatment options can include:

·   Blood sugar headaches – avoid high glycaemic index foods, or at least combine them with low glycaemic foods to lessen their impact.  Keep your blood sugar levels constant by eating regularly.

·   Caffeine headaches – don’t quit suddenly or else the withdrawal will cause severe headaches.  Your body needs time to adapt.  Gradually reduce the amount of caffeine you consume over a period of days, weeks or even months.

·   Food chemicals – a health professional will devise ways to test your sensitivities to various foods.  It is important not to self-diagnose, because you may restrict your eating unnecessarily, or fail to find all of your dietary triggers.

   
Where to get help

·   Your doctor

·   Dietitian

·   Naturopath

Things to remember

·   Large fluctuations in blood sugar levels can cause the arteries to spasm, leading to headache. 

·   Consuming a lot of caffeine regularly can cause withdrawal headaches in susceptible people.

·   Sensitivities to food chemicals need to be assessed by a qualified health practitioner.  0

This page has been sourced from the Better Health Channel and produced in consultation with, and approved by:

headache.com.au, an Australian headache and migraine information Web site.  

Found on the Internet at http://www.disability.vic.gov.au/dsonline.dsarticles.nsf/pages/Headache_and_diet?OpenD. Dated 9/26/00.