May 11th Meeting:  Nutrition and Headaches

The East Bay Headache Support Group is pleased to have Dr. Laura Presnick as its guest speaker for the May 2004 meeting.  Her presentation will be on current nutrition and herbal therapies for headaches, including food sensitivities

and testing that is available for discovering them; migraine nutritional and herbal therapies; musculoskeletal factors

that contribute to headache; and other non-drug treatment approaches to consider for headache relief.

Dr. Presnick is a Doctor of Chiropractic, Certified Clinical Nutritionist, and a Diplomate of the American Chiropractic Board of Nutrition.  She graduated in 1978, received her doctorate, and in 2000 also received an academic degree in clinical nutrition.  Since 1981 Dr. Presnick and her husband, Dr. Bruce Presnick, have had a family practice in Pleasant Hill that offers chiropractic, massage, nutritional therapy, acupunc-ture, and personal fitness/exercise programs to help people regain their health.

We are meeting in the Hanson Room, downstairs at John Muir Medical Center, from 7:30 to 9:00 p.m. on Tuesday, May 11.  For more information, call 925-685-8775.

National Headache Awareness Week — June 6-12

As part of its continuing efforts to educate the public about the impact and severity of headache, and support the more than 45 million sufferers of this legitimate biological disease, the National Headache Foundation has declared June 6-12 as National Headache Awareness Week.

Following the theme of  “Migraine.  The pain is real.  So is the Treatment.  Get Diagnosed,” the goals of National Headache Awareness Week are:

· to gain recognition of headache pain as a real and legitimate condition,

· to encourage sufferers to see a physician for proper diagnosis and treatment, and

· to let sufferers know that there are new treatments available.

Editor’s Note:

On the Web site of the National Headache Foundation, I found a list of ten steps beneficial for better communication between headache sufferers and their healthcare professionals.  Only the ten points are listed here—without any detail.  For the full article, visit http://www.headaches.org/consumer/generalinfo/tensteps.html.

1. Seek help.  Be a self-advocate.

2. Educate yourself about migraine so you will know what to communicate to a physician.

3. Visit a doctor specifically about your headaches.

4. Prepare for a dialogue with your physician.  Keep a headache diary.

5. Have reasonable expectations about treatment.

6. Be honest about all current medications and other medical conditions.

7. Focus on solutions.  Be positive.

8. Ask for detailed instructions for taking medication—and follow them.

9. Partner with your physician for treatment success.

10. Follow up regularly with your physician.

Triggers Differ Between Men and Women

Although more women suffer from headaches then men, neither group can escape what can be life-altering discomfort.  In a research survey conducted by Bruskin Research for Percogesic Aspirin-Free Pain Relievers, 50% of women and 31% of men reported experiencing head-aches that require treatment.  Almost 40% of sufferers turn to an over-the-counter (OTC) medication for relief.  The reasons people get headaches—”triggers,” as they are called—vary between the sexes.

The survey found that females who rely upon OTC medications for headaches are significantly more likely than males to indicate they experience headaches as a result of stress (42% of females vs. 33% of males); sinus allergy problems (40% vs. 23%);  strong smells or odors (24% vs. 14%); spouse or children (18% vs. 11%); and certain foods/medications (10% vs. 6%).  The sole trigger that men report more frequently than women results from ice cream or cold beverages—”brain freeze” (12% men vs. 8% women).  Meanwhile, six percent of men report that hormone changes or the monthly menstrual cycle experienced by their significant other causes the women very frequent head-aches.

The American Headache Society reports that headaches are among the most common complaints seen by primary care physicians, with as many as 45,000,000 Americans experiencing them.  Primary headaches, which are an actual clinical condition and not a symptom of or caused by another disorder, include migraines and tension and cluster headaches.  Secondary headaches stem from other medical conditions, including sinus or dental ailments, allergies, head injuries, or brain tumors.

Over 40% of the survey respondents report regularly suffering from general head-aches, chronic headaches, or migraines.  While stress, allergy/sinus problems, and strong odors are significant triggers, other causes include sunlight or bright light, hormonal changes or monthly menstrual cycles, computer eye strain, work-related issues, cigarette smoke, pollution, noise, altitude, and weather conditions.  Dietary triggers—such as alcohol (specifically red wine and champagne), aspartame, nitrates and MSG, caffeine, chocolate, hard cheese, nuts, and even some medications—were also responsible, particularly in the case of women.

Eighty percent of those surveyed who take OTC headache medications report at least one headache in a typical week; 16% get two; and another 16% experience three to four per week.  Those between the ages of 35 and 49 are significantly more likely than the overall sample to indicate they get headaches (49% vs. 41%).  Respondents in this age group make up 35% of all headache sufferers.

The important aspect of headache prevention is to recognize your particular triggers so they can be avoided.  Head-ache sufferers may find patterns if they track their headaches each day and try to relate them to certain situations, foods, or activities.  Individuals who suffer from frequent headaches should maintain a diary to help do so and thus eliminate the triggers.

USA Today (Magazine).  October 2002, v131 i2689 p8 (1).

Sex-Headache— Cause or Headache Reliever?

Press Release—National Headache Foundation, Chicago, IL, February 13, 2004

For some people, sexual activity can cause headaches, while for others, sex can relieve the condition.

Headaches can be associated with sexual activity, especially with orgasm.  There are two types of these headaches.  In the first type, the excitement accompanying intercourse causes muscle contraction in the head and neck, thus leading to head pain.  Relaxation or biofeedback can help reduce or relieve these types of headaches.

The second type is a vascular headache.  It is a very intense, severe headache usually occurring just before orgasm.  It has been called an “orgasmic headache,” or “orgasmic cephalalgia.”  In some instances, the headache is a response to an increase in blood pressure, in which the blood vessels dilate.  The headache is not usually related to the amount of physical exertion involved in intercourse.  The pain may be located around or behind the eyes.  It usually lasts a few minutes, but can last for hours.  The headache is usually made worse by movement.  The headache most often is a “benign” orgasmic headache; however, the possibility of organic disease should be thoroughly investigated.

According to an online survey conducted by the NHF, 41% of respondents indicated that their sexual headaches last for longer than one hour and 40% of respondents have decreased their level of sexual activity because of this.

“Whether or not an individual regularly suffers from headache or migraine, if they experience one of these conditions during or after sexual intercourse, they should consult a healthcare provider,” said Suzanne Simons, executive director of the National Headache Foundation. 0

Found on the Web site of the National Headache Foundation www.headaches.org

Fibromyalgia and Chronic Headache by Dawn A. Marcus, MD

Fibromyalgia is a common chronic pain syndrome, affecting an estimated 3 to 9 million adults in the United States.  Fibromyalgia is not a specific disease. The term fibromyalgia describes a pattern of symptoms that cluster together, including widespread body pain and sensitivity to pressure on specific spots on the body, called tender points.  Curiously, these particular tender points are uniquely sensitive to pressure in people with fibro-myalgia, while similar spots in other parts of their bodies are not.  In addition, people with other types of chronic pain, such as low back pain or arthritis, do not find that pressing these spots is painful for them.

Until 1990, fibromyalgia was used to describe a variety of unrelated chronically painful conditions.  In 1990, the American College of Rheumatology established specific diagnostic criteria, allowing proper identification of those patients with fibromyalgia. Patients with fibro-myalgia must have pain on both sides of the body, as well as areas of the body both above and below the waist.  In addition, fibromyalgia patients perceive firm pressure over the tender points to be painful.  Patients with fibromyalgia experience a variety of other symptoms in addition to body pain (see Table). 

As you can see, the majority of fibro-myalgia patients also report fatigue, morning stiffness, sleep disturbance, and abnormal body sensations or tingling.  Over half report some headache.

Patients with fibromyalgia share many features with chronic headache patients. Similar to migraine, fibromyalgia occurs most commonly in women of childbearing age, with women affected 7 times more often than men.  Fibromyalgia and chronic headache commonly occur to-

gether.  A study of about 100 patients with transformed migraine showed

fibromyalgia in 36% of the migraine sufferers.  Those patients with both fibro-myalgia and headaches experienced

both greater pain severity, and more

depression. 

Another study compared about 70 patients with fibromyalgia to those with chronic headache.  About 35% of the fibromyalgia patients reported migraine or tension-type headache, while 42% of the headache patients had painful fibro-myalgia tender points throughout their bodies.  Similar to the other study, patients with both fibromyalgia and head-ache reported more pain, disability, and depression than patients with headache alone.  This general sensitivity to touch over the tender points, noted in about 40% of chronic headache sufferers, suggested the presence of nervous system activation or sensitization.  In other words, 40% of chronic headache patients report hypersensitivity throughout the body (in addition to the head), similar to fibromyalgia patients.

These studies suggest that fibromyalgia, like some types of chronic headache, may be associated with increased excitation within the nervous system, which means it over-responds to stimulation that is not normally painful.  Similar to migraine, abnormalities in serotonin, a brain chemical involved in fine-tuning painful experiences, may be contributing to the increased excitation in fibromyalgia.  Also, levels of substance P, a brain chemical that is involved in pain sensation, are high in patients with fibromyalgia.  Finally, patients with fibromyalgia and patients with chronic headaches respond in similar ways to stress, and differently from people who do not have fibromyalgia or frequent headaches.

The cause or causes of fibromyalgia are still unknown.  Some patients develop fibromyalgia symptoms after trauma or illness, while others develop the condition without any identified triggering event.  Fortunately, fibromyalgia is not a degenerative or progressive disorder that would develop into paralysis, memory loss, or other losses of functioning.

Interestingly, a number of headache therapies are also effective in reducing symptoms of fibromyalgia:

As with chronic headache, education about fibromyalgia and pain management is helpful in managing symptoms and limiting their impact on daily life.

Patients with both fibromyalgia and chronic headache should initially try those therapies that may effectively treat both conditions.  Standard headache acute care and preventive therapies should be used when headache persists after completing fibromyalgia treatment, or if head-ache becomes the main pain complaint.

If you are experiencing widespread body pain, it is important to discuss this with your doctors.  Fibromyalgia patients are at increased risk for depression and anxiety, and report more interference and disability from their pain than patients with headache without body pain.  Failure to recognize and treat co-existing fibromyalgia may result in increased pain, disability, depression, and anxiety.  In addition, effective therapies are available for fibro-myalgia that can significantly improve headache in addition to treating the generalized body pain. 0

Dawn A. Marcus, MD.  Multidisciplinary Headache Clinic. University of Pittsburgh. Pittsburgh, PA.

Excerpted from Headache, The Newsletter of ACHE, Winter 2002-2003, vol. 13, no. 4.

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The East Bay Headache Support Group is a nonprofit organization dedicated to providing a forum for headache sufferers.  The support group meets the second Tuesday every other month at John Muir Medical Center from 7:30 to 9:00 p.m.  It is open to all headache sufferers and their families, and interested persons.  The meetings are free (however, donations to cover printing, postage, and Web site

expenses are appreciated!).  The support group meetings include lectures by guest speakers, question and answer sessions, and informational materials.

Directions to John Muir Medical Center:  Take Highway 680 to the Ygnacio Valley Road exit in Walnut Creek;  go East (toward Mt. Diablo) approximately 1-1/2 miles, and turn right onto La Casa Via.  Turn left into the medical center parking lot, and enter at the main lobby.  Take stairs or elevator to the lower level and follow signs to the meeting room.

We value your input!  Call, fax, write, or e-mail us if you have any comments or suggestions, or would like to help.  The planning committee meets occasionally in the evening and welcomes new members. Michael Stein, MD, Advisor;  Leslie Davis, Editor; Dana Giese, Webmaster; Donna Johnson, Treasurer; Carol Bartlett, Reg Fong, Joan Kelley, Richard Tomchalk, Janet Young, Jean Tamayo.