A Publication of the East Bay Headache Support Group
A Member of the Americal Council for Headache Education (ACHE) Support Group Network  

VoLUME 11, ISSUE 5  
September 2006

September 12th Meeting:  New Approaches in the Management of Migraine 
 

While medical science has made dramatic breakthroughs in the pharmacological management of migraine headaches, there is still a long way to go to solve this problem.  Too many people continue to suffer from disabling pain that comes at a substantial loss of both quality of life and job productivity.  There are also significant risks that can occur as the result of both prophylaxis and treatment. 
 

Healthcare practitioners are in a constant search for new approaches to manage headaches.  At the September 12th meeting of the East Bay Headache Support Group you will learn about a new technology called photonic stimulation that uses infrared light therapy. 
 

Len Saputo, M.D., the founder and director of the Health Medicine Institute (HMI) and Health Medicine Forum (HMF) in Lafayette, will introduce how this therapy works and share his experience using it for the past 6 years.  Photonic stimulation is a safe, effective, and affordable treatment that is available today in our community.  Several free sample treatments will be offered during the presentation. 
 

Presently, Dr. Saputo and HMI are supporting a nearly completed FDA-approved clinical trial, using photonic stimulation in the treatment of painful diabetic neuropathy, in conjunction with UCSF Medical Center and the Martinez VA Hospital. 
 

There is also a wide range of integrative strategies that can be very effective in managing headaches.  Collectively there is a greater chance for success in controlling the pain when there are more options.  Disciplines such as standard medical treatment, physical therapy, chiropractic, acupuncture, nutritional medicine, Reiki, imagery, massage, psychology, hypnotherapy, meditation, yoga, Qigong, etc., etc., can be combined to synergize treatment outcomes.  Some of these approaches will be covered and some integrative strategies will be shared. 
 

Dr. Saputo received his medical degree from Duke University Medical School and has a private practice in internal medicine and health medicine in Lafayette.  He is also a symposium producer, moderator, interviewer, lecturer, author, editor, and has been featured on many TV and radio programs.  
 

Future Meetings:  

November 14, 2006:  Robin Polokoff, Ph.D., Effective Nutrition for Headache Pain Management

January 9, 2007:  To be determined 
 

Women’s Migraines Linked to Heart Risk - Visual problems felt by some increased chance of heart problems, study finds; research being done to assess risk to men.  By Jamie Talan, Newsday 

Migraines accompanied by visual problems called auras double the risk that women will develop cardiovascular disease later, a new study by Harvard doctors suggests. 
 

Dr. Tobias Kurth and colleagues at the Harvard School of Public Health and the Brigham and Women’s Hospital analyzed records from 27,800 women older than 45 who participated in the Women’s Health Study. 
 

All were free of cardiovascular disease when they entered the study from 1992 to 1995.  Ten years into the Women’s Health Study, there were 580 major cardiovascular events among the 5,125 volunteers with a history of migraine.  The scientists discovered that women with migraine aura had more than double the heart risk of those without an aura. 
 

An aura is a visual sensation—like lights flashing or lines zigzagging, with some reports of temporary blindness—that lasts 20 minutes to an hour.  Then, a penetrating headache arrives, which can also trigger nausea and vomiting.  This can continue for hours, and in some cases up to three days. 
 

Kurth said there are no solid clues to explain the link.  One idea is that some people with migraine are born with a heart defect that increases the risk of blood clots that can travel to the brain and cause strokes. 
 

Women with migraine who never experienced an aura had no greater risk for heart disease or stroke than the rest of the population. 
 

Kurth said the migraine risk was small, and there are much more serious threats to heart health—such as high cholesterol, smoking, diabetes and obesity—that can be modified with lifestyle changes and/or treatment.  Having migraine with aura adds about 18 additional cases per 10,000 women a year, Kurth said. 
 

The scientists are now evaluating this association in males. 
 

The Harvard study will appear today in the Journal of the American Medical Association, only two weeks after its editors announced stricter enforcement of a policy requiring study authors to disclose potential conflicts of interest. 
 

According to JAMA editors, all six of the scientists involved in the study have done consulting work or received unrestricted research grants from makers of treatments for migraines or heart-related problems.  Kurth said they had decided not to make note of the affiliations because the present study had nothing to do with any medicines for migraine, and had not been funded by any pharmaceutical company. 
 

Still, Dr. Catherine DeAngelis, JAMA’s editor in chief, said she would have published the authors’ associations with drugmakers had she known about them.  On Tuesday, the Harvard scientists sent the journal an extensive list of all of their collaborations with the industry.  “Authors should always err on the side of full disclosure,” DeAngelis wrote in her response. 
 

Found in the July 19, 2006 edition of the Contra Costa Times 
FDA Warns of Possibly Lethal Drug Combination , by Jennifer Corbett Dooren, The Wall Street Journal  

Washington—The Food and Drug Administration said patients and doctors need to be aware that taking certain migraine drugs and antidepressants at the same time could cause a potentially life-threatening problem known as serotonin syndrome. 
 

The agency, in a public-health advisory posted on its Web site, said triptan migraine drugs and many newer antidepressants taken together could cause serotonin syndrome, because both types of drugs are designed to boost serotonin, a chemical found in the brain.  The FDA is asking triptan and antidepressant makers to update drug labels to warn of the possibility of serotonin syndrome. 
 

The FDA reviewed 27 reports of the syndrome, the symptoms of which can include restlessness, hallucinations, loss of coordination, fast heartbeat, rapid changes in blood pressure, increased body temperature, nausea, vomiting and diarrhea.  Of the 27 reports, 13 patients were hospitalized, and two cases were considered life-threatening.  An FDA representative didn’t immediately know the time period over which cases were reported.  “Serotonin syndrome may be more likely to occur when starting or increasing the dose” of a migraine drug or antidepressant, the FDA said. 
 

The types of antidepressants involved are known as selective serotonin reuptake inhibitors, or SSRIs, and selective serotonin/norepinephrine reuptake inhibitors, or SNRIs, while the migraine drugs fall into a class of drugs known as triptans.  Brand-name triptans include GlaxoSmith-Kline PLC’s Imitrex, Pfizer Inc.’s Relpax and Zomig by AstraZeneca PLC. 
 

Commonly prescribed SSRI and SNRI antidepressants include Glaxo’s Paxil, Pfizer’s Zoloft, Eli Lilly & Co.’s Cymbalta, and Forest Laboratories Inc.’s Lexapro, among others.  The agency said patients who are taking a triptan along with an SSRI or SNRI should talk to their doctor before stopping their medications.  Doctors should closely monitor patients who might be taking both types of medications. 
 

The FDA also said it was asking antidepressant makers to add warnings about the possibility the drugs could increase the risk of having an infant with persistent pulmonary hypertension of the newborn, or PPHN, if the drugs are taken during the second half of pregnancy. 
 

Found in the July 20, 2006 edition of The Wall Street Journal 
Head Case (a book review)

Paula Kamen has had a headache for 14 years.  Her unlikely and often hilarious memoir explores the secret history of women and pain, and introduces us to a new (but very old) social phenomenon:  The Tired Girls.

By Andrew O'Hehir—April 15, 2005 
 

Paula Kamen has a headache.  On the day I call her in Madison, Wisconsin, where she’s made a stop to promote her new book, “All in My Head,” which is a memoir and a cultural history and a comic odyssey through the licensed and unlicensed health professions and a lot of other things besides, she rates the headache a 3 or 4 on a scale of 10.  For most of us, that would be a pretty bad day, possibly requiring three or four ibuprofens, a couple of grande Starbucks concoctions, dark sunglasses and a lot of grumbling. 
 

But Kamen says she’s feeling great.  See, she got this headache when she was putting in her contacts in a Chicago hotel bathroom—in 1991.  Over the last 14 years it’s been her constant companion, waxing and waning like the phases of the moon—sometimes so intense she can’t function at all, sometimes barely noticeable—but never completely going away.  On one level, this is ludicrous:  A woman gets a headache and writes a book about it.  Kamen is able to appreciate the joke, up to a point.  She was already a first-rate reporter on feminist issues as well as an aspiring humorist with a wry, sardonic tone. 
 

“All in My Head” dramatizes Kamen’s suffering without wallowing unduly in self-pity, and her journey along the highways and back roads of both Western and alternative medicine, while often hilariously rendered, will provoke anguished cries of recognition from anyone who’s dealt with chronic pain (and the medical establishment’s general befuddlement by it).  More than that, as a reporter Kamen marshals most of what is now known or suspected about headaches and related disorders, and as a feminist she drags into daylight a half-hidden social phenomenon we all recognize but rarely talk about:  the Tired Girls. 
 

If you’re one of the Tired Girls, you already know what I’m talking about.  If you’re not, then there’s probably one or more T.G.’s somewhere in your life—in your family or your circle of friends.  A Tired Girl is that youngish woman, probably in her 20s or 30s, stuck in a cycle of pain and fatigue she may not talk about openly, even with her closest friends.  She is known to cancel long-planned social engagements at the last minute, to disappear early in the evening, to oversleep, to spend beautiful Saturdays alone in bed.  Like Kamen, she’s constantly trying some new drug, some new massage or chiropractic technique, some new combination of Chinese herbs, some new diet. 
 

A Tired Girl may suffer from migraines or depression or chronic fatigue syndrome (now called CFIDS) or fibromyalgia or bipolar disorder or the persistent, mixed-headache syndrome called chronic daily headache (CDH), which is Kamen’s diagnosis.  It’s quite possible she has more than one of these conditions; scientists are now inclined to believe that these ailments (along with epilepsy and other seizure disorders) are related at the neurological level, and people who suffer from one are exceptionally likely to have the others. 
 

Tired Girls are nothing new, and if you view the phenomenon with some suspicion, that’s understandable.  Victorian women fainted and had the “vapors,” the desperate housewives of the ‘60s self-medicated with Chardonnay and Valium. Medical testing couldn’t “see” any organic source for these diseases, so they were often regarded as psychological in origin—the result of female “hysteria” or sexual repression.  These cut-rate Freudian theories found their way into the postmodern age, too:  Feminists defined these female-coded illnesses as a form of political resistance to patriarchal oppression, while deconstructionists saw a cultural virus bred of millen-nial angst and spread by media overload. 
 

I probably shared that skepticism myself, a dozen or so years ago.  I never get headaches unless I drink too much or have a sinus infection.  But for more than a decade I’ve lived with a woman who has 10 to 20 severe migraines in a typical month. She has CDH, but headaches are sporadic rather than constant.  She has taken many of the same pre-scription medications as Kamen—mostly powerful psychiatric drugs with whopping side effects—and been subjected to a lot of the same goofball psychologizing. 
 

Along the way, I’ve had to question my own preconceptions about these stereotypically female ailments, especially as I’ve learned that new, more sensitive brain scans now seem able to pinpoint their neurological source.  As Kamen explains, it now appears that disorders like migraine and CDH result from a kind of wiring malfunction deep in the brain stem. Migraine, for instance, was recently described by one medical researcher as “a chronic-progressive disorder that may cause permanent changes in the brain.” 
 

Of course men suffer from chronic pain and fatigue as well.  But for reasons that aren’t entirely clear, women are several times more likely to have these diseases, which has clearly contributed to the centuries-old perception that they’re fragile and untrustworthy creatures, both physically and emotionally. 
 

Paula Kamen thinks it’s time for the Tired Girls to come out of the closet (or the darkened bedroom, as the case may be). Individual women can admit to pain and fatigue, she argues, without stigmatizing their entire sex.  Hardly anyone argues that men should be excluded from the work-place as a group, despite their pronounced tendency to schizophrenic breakdown and random shooting sprees. 
 

As I know very well, Tired Girls can be tough—and Kamen has the scars to prove it.  In her medical odyssey she’s endured painful and useless surgery, gained and lost an enormous amount of weight, beaten a dependency on Xanax with large doses of “Antiques Roadshow.”  She’s tried Botox, fig tea, a burlap sack from Peru (purported to retain energy from the baby who was born on it), “healing stones,” a Russian masseuse who “beat the living crap out of me” and a vibrating hat from a TV infomercial. 
 

In the long run, Kamen, 37, actually found the mental and emotional pain associated with her endless headache harder to deal with than the physical discomfort, as bad as that has sometimes been.  She writes about the details of her personal life with considerable restraint, but it’s clear that her ordeal has made her love life very difficult.  She’s had boyfriends over this 15-year stretch, but none stays in the story for long.  It has also strained and fractured friendships, made her financially dependent on her parents for a time, and rendered her unfit for any normal workplace. 
 

Perhaps that last part was a back-handed blessing.  If the headache literally disabled her, it also liberated her to research and write “All in My Head” as well as her previous volume, “Her Way:  Young Women Remake the Sexual Revolution.”   
 

Almost none of the mainstream or alternative therapies Kamen has tried have worked, or at least not much and not for long.  She still has her headache.  “All in My Head” is the story of learning to live now, with limitations and ambiguity and, yes, pain—and not waiting until some future date when those things will be vanquished. 
 

Editor’s Note:  This book review had to be shortened to fit into the newsletter.  For the complete review, go to dir.salon.com