a publication OF THE east bay headache support group

a member of the American Council for Headache Education (ACHE) support group network

volume 9, ISSUE 2

MARCH 2004

March 9th Meeting:  Is Your Posture Causing Your Headaches? — A Talk and Demonstration About the Alexander Technique

For its 74th meeting, the East Bay Headache Support Group has invited Annette Schmidt, Alexander Technique Teacher, to give a lecture and demonstration showing how students of the Alexander Technique learn to take control of their lives and their pain.  Annette says, “Headaches are caused by a wide variety of factors.  One of these factors is the misuse of the body’s structure.  In fact, experience with headache sufferers shows that the body’s misuse can be directly linked to the onset of headache and other migraine symptoms.  Habitual interference with the proper functioning of the head, neck, and back relationship can bring additional pain and stress which triggers the headaches.  Conscientious study of the Alexander Technique can be a way to become aware of headache triggering factors and to change the habits that cause them.”

Annette is certified by the American Society for the Alexander Technique and has had success teaching people with chronic pain how to relieve and prevent headaches.  Learn how a study of the Alexander Technique can help you to identify and change habits that cause your headaches.  For additional information, visit Annette’s Web site at www.silverfoxstudio.net.

We are meeting in the Hanson Room, downstairs at John Muir Medical Center, from 7:30 to 9:00 p.m. on Tuesday, March 9.  For more information, call 925-685-8775.

Stopping Migraine Pain

By Carey Goldberg, Globe Staff, January 6, 2004

Clamp your head in a vise and ask a friend to stab your face with a gimlet in rat-a-tat rhythm, and you will get an inkling of what migraine means for Nancy Drour.  But there is a subtler aspect to the head agony that has tortured her off and on for 35 years, one she learned about just recently.  When her migraine is underway, her face and head become super-sensitive to heat and cold.  Such skin hyper-sensitivity to touch and temperature appears in about three-quarters of migraine sufferers, and is called allodynia.

New research by Dr. Rami Burstein of Beth Israel Deaconess Medical Center shows that allodynia is a critical signal:  Patients who get it should turn promptly to prescription drugs called triptans, he said.  Otherwise, the headache is likely to progress beyond help, and if that happens too many times, their migraines could generally become harder to treat.

Drour fits right in to the research.  An administrator at the Brimmer and May School in Chestnut Hill (Massachusetts), she has learned that if she doesn’t dose herself quickly with Imitrex, her migraine medication, then she’s in for it, doomed to such pain that childbirth pales in comparison.

But many of the country’s 25 million migraine sufferers and their doctors tend to hold back on using triptans—marketed under names like Imitrex, Zomig or Maxalt—hoping that the migraine will go away by itself and the expensive, powerful drugs will not be needed.  And many insurance companies limit the number of triptans they let patients have each month.

Burstein has argued that for patients who get allodynia, waiting is the worst policy, and offers a physiological model to explain why.

“Defeating migraine pain with triptans is a race against developing allodynia,” he said.  “If we win the race, we can render the patient pain-free within two hours of triptan treatment, rather than have the patient sustain terrible pain for many hours or several days to come.”

Lose the race, he said, and pain neurons in the patient’s spinal cord will reach such a state of hyper-excitation that they will prolong the agony, even if they stop receiving signals from peripheral pain neurons in the head.

“It’s like you kick-started it and it’s going on its own,” said Dr. K. M. A. Welch, a top migraine researcher and president of Finch University of Health Sciences in Chicago.

Migraine tends to be surprisingly under-treated.  One survey published last year in the journal Neurology found that, although the triptans became available a decade ago and work well for many patients, fewer than half of patients even seek medical treatment for migraine.  Some take over-the-counter medications; others just suffer.

But public awareness seems to be growing, said Dr. Seymour Diamond, executive chairman of the nonprofit National Head-ache Foundation, and new drugs are in the offing.  New understanding of the nerve cells’ role in migraine, he said, “opens up a new field:  You’re going to see approval and research into a lot of the drugs that were used for neurological diseases.”  Among them, he expects an epilepsy drug, Topiramate, to be officially approved for migraine within weeks.

Burstein, whose latest findings appear in this month’s Annals of Neurology, has helped lead a sweeping shift over the last few years in the treatment and theory of migraines.

On the treatment side, triptan drugs now offer relief for many migraine patients—but not all, and not always.

On the theory side, many researchers are now convinced that all migraines, whether allodynic or not, begin not because blood vessels inside the head

dilate—the old wisdom—but because nearby peripheral nerves get irritated and hyper-excited.

In Burstein’s work, the two sides collide:  He offers a nerve-cell explanation for why triptan drugs must be taken quickly in the three-quarters of patients who get allodynia.  (For the one-quarter of migraine sufferers who do not get allodynia, the drugs will work at any point in the migraine.)

Triptans can disrupt communication between peripheral and central neurons, but cannot shut off the central neurons themselves.  Once allodynia hits, it means the central neurons are hyper-sensitized, so the triptans are powerless, he said.

“This knowledge is so important because it has such an immediate impact on patients’ lives,” he said.  “Unless we find a way to deliver it both to patients, who are their best self-advocates, and to primary-care physicians and pediatricians, our work will not make a difference in the world.”
 

He and others also believe that untreated migraine may inflict cumulative damage over time that can convert the lucky 25 percent of migraine patients with easy-to-treat headaches over to the harder-to-treat allodynic migraines.  But that remains purely a hypothesis with no direct proof at this point, he said.

For Burstein, the next obvious target is to develop a drug that would act on the  central neurons so as to allow patients to abort migraines later in the attack.

The other big question for him, he said, is whether it is possible to prevent patients from developing allodynic headaches later in life by treating their migraines more vigilantly while they are still young.

Burstein receives some of his research funding from GlaxoSmithKline—which makes Imitrex and also recently began recommending early rather than delayed dosing—but noted that they imposed no conditions on his work and that his results aim at more effective triptan use, not higher sales.

Allodynic patients who wait to take triptans tend to end up taking more of them because the pain lingers, he said.  Also, he has shown in other work that there is no difference among the triptans; they all target the same group of receptors.

Burstein’s track record indicates a rare ability to inspire devotion in subjects:  His clinical studies have required patients—all volunteers—to rush to his office when headaches hit and hold off taking any medications so that they could be studied—often condemning them to a full-blown attack that could have been headed off.

Nancy Drour, who participated in one of Burstein’s studies, so dreaded that possibility that she kept putting off her visit and taking Imitrex instead; finally, she came in—and allowed Burstein to study her during several full-blown migraines.

And not that Burstein gets off pain-free.  He sees so much suffering among his migraine patients, he said, and is so driven to help them, “that it is difficult to stop what I’m doing and go home.”  But it has also been hard on him and his pain clinic team to be on call 24 hours a day all year long, ready to spend hours with each patient who comes in with a developing migraine.  “I love my wife and kids like crazy,” he said, “and it’s hard to leave home at the prompt of a pager, any hour of the day, any day of the year.” 0

Found on the Internet at www.boston.com/news/globe/health_science/articles/2004/01/06

Evaluating Internet Resources:  A Checklist

Unlike most print resources such as magazines, journals, and books that go through a filtering process (e.g. editing, peer review, library selection), information on the Internet is mostly unfiltered.  So using and citing information found over the Internet is a little like swimming without a lifeguard.  The following guide provides a starting point for evaluating the World Wide Web sites and other Internet information.

Authority

· Who is the author of the piece?

· Is the author the original creator of the information?

· Does the author list his or her occupation, years of experience, position, education, or other credentials?

Affiliation

· What institution (company, organization, government, university, etc.) or Internet provider supports this information?

· If it is a commercial Internet provider, does the author appear to have any connection with a larger institution?

· Does the institution appear to exercise quality control over the information appearing under its name?

· Does the author’s affiliation with this particular institution appear to bias the information?

Currency

· When was the information created or last updated?

Purpose

· What appears to be the purpose for this information?

· Inform

· Explain

· Persuade

Audience

· Who is the intended audience?

Compared to what?

· What does this work/site offer compared to other works, including non-Internet works?

Conclusion

· Given all the information you determined from above, is this Internet site appropriate to add to your bookmark?

Adapted from Consolidated Listing of Evaluation Criteria and Quality Indicators.

1999 InFoPeople Project, http://www.infopeople.org/howto/bkmk/select.html, last updated January 18, 1999.

Emergency Room Tips

Dr. Stuart B. Shikora, an Emergency Room physician, spoke to the East Bay Headache Support Group in 2000 and again in January 2004.  Following are some highlights from his presentations:

Probably the most aggravating part of going to the Emergency Room for treatment for your headache is that you have to give your medical history, sometimes more than once.  A nurse will first ask about your condition as she tries to perform triage on the patients waiting to be seen by Emergency Room doctors.  She/he must ask questions to try to determine which patients are in need of the most urgent care and which patients can wait without further compromising their life or health.

Following are things you can do to ease the process of being treated in the Emergency Room: