We hear discussion regarding migraine triggers all the time. Why do they start and why do they stop?  Hormonal fluctuations, stress, and barometric changes are just a few triggers of migraine onset. Recently however the question “how does migraine stop?” was posed to several leading headache specialists. While understanding that drugs can bring about the end of a migraine attack, the investigators wanted to know if there is a “natural” conclusion to a headache.  Are there triggers of termination?  Robert E. Shapiro, MD, PhD at the University of Vermont believes the end of a migraine attack is the final round in a sequence of events rather than the subsiding of the initialed triggered circumstance. Sleep is the most common terminator of headache.  Reports dating to Hippocrates suggest that taking a nap can resolve a headache.  Vomiting is also a termination trigger.  Dr. Shapiro points out that sleeping and vomiting can particularly help children with headache.

It seems likely that migraine termination is an active process, and is not related to the events that triggered the attack…. Headache  The Journal of Head and Face Pain January, 2012  Andrew H. Ahn, MD, PhD; K.C. Brennan, MD

Preventing a headache is definitely better than trying to cure one. There are many preventatives available but it’s important to know that these may take about 3 months at a high enough dose before you might get full relief. Additionally, headache prevention medication is much more effective when following a headache friendly lifestyle as well. These include:

-Improving sleep patterns. Try for 8 hours each night, going to bed at a regular time. Avoiding caffeine past morning can help.

-Hydrating. We’ve all heard the benefits of drinking 8 glasses of water daily. Another plus is hydration can help keep headaches at bay.

-Exercise. Even one hour twice a week can reduce headaches by one third.

Weight Management- People who are overweight are at a risk of increased frequent headache, with obesity multiplying the chances to six times greater than an average weight person.

Stress Avoidance- Everyone has stress of some form in their life. Good stress can motivate us to perform our best when it motivates us. Bad stresses are those where you feel out of control and you aren’t able to get a handle on the stress. It’s imperative to resolve or retrain your reaction to the stress.

There are many options in the treatment of headaches. As difficult as it may be, try not to get discouraged. There are constantly updates and developments, and we can be certain there are always more developments to come.

For many migraineurs, the headaches they experience do not always feel the same. At times one may feel a dull, generalized headache that occurs with aura. At other times, the migraine may be felt on one side of the head, but it throbs, and nausea and vomiting are also present. John Rothrock, MD at the University of Alabama explains that the symptoms of migraine can vary for each person, and that there may be a progression of symptoms with each attack.  Consequently, if migraine is allowed to advance unchecked it can become tougher to treat.

Stopping the headache in the early stages or “right away” can be most effective.  However, for many people, headaches may escalate even with early intervention, and additional therapy may be needed.  For others a “full-blown” headache may appear after waking up… consequently the therapy used may be again different.

As Dr. Rothrock suggests, the concept of “stratified” care acknowledges there is a dynamic nature to migraine… that each attack can evolve and build into a more severe attack.  By selecting a therapy based upon the intensity and symptoms, you will hopefully be able to better control your migraine attacks…. Headache  The Journal of Head and Face Pain   January, 2012

People with headache have anxiety and/or depression at higher rates than those without headaches; we look at these conditions as “shared comorbidities” that people inherit. When people are born, they are more prone, genetically, to these conditions.  I believe they are “side by side” conditions that we inherit, not that depression causes headaches or vice versa.  Certainly, severe headaches may fuel and increase anxiety and depression, and depression may worsen headaches, but these medical comorbidities do not actually CAUSE each other.

Headaches are a physical, not psychological, illness, and the same for anxiety/depression; there are many differences in the brain for all of these situations, and viewing them as “all in your head, or psychological” is unfair and misleading.   

These comorbidities do drive where we go with medications, so if someone has headaches and depression, we would usually try and find an antidepressant that treats both. Just like if a person has headaches and high blood pressure, we would go with high blood pressure meds.  The idea, of course, is to minimize meds, and attempt to treat 2(or 3) conditions with one medication.  Exercise,yoga/pilates,psychotherapy, etc. are also crucial for those with anxiety/depression.

The degree of pain a person feels is partially regulated by the firing rate of nerve cells in the affected area. It may be possible to reduce pain by blocking a gene that regulates the electrical signaling in the body. Scientists at the University of Cambridge tested two groups of mice.  Half were genetically engineered so that their pain responsive neurons lacked the HCM2 gene.  Those mice appeared to endure discomfort much longer than the normal mice.  Does this mean humans can also become less sensitive to chronic pain if a gene is silenced?  According to the study author Peter McNaughton its possible… in the future.  ”The next challenge is to develop HCN2 blockers that could target pain-sensitive neurons in humans.”  Those drugs may become available in the next eight to ten years…. Psychology Today  February, 2012  Katherine Schreiber

These eight foods are so good for you that it’s important to try to incorporate them into your diet daily.

Spinach- a rich source of plant-based omega-3′s and folate helps reduce risk of heart disease, stroke and osteoporosis.

Yogurt-contains probiotic organisms that help boost the immune system and provide protection against cancer. However, not all have probiotics; make sure the label says “live and active cultures”.

Red tomatoes- packed with the antioxidant lycopene. Studies show a diet rich in lycopene can decrease risks of certain cancers, as well as reduce risk of coronary disease. Canned tomatoes are an equally good source.

Carrots- like most red and orange vegetables, carrots are loaded with carotenoids which are fat-soluble compounds that are associated with a reduction in a wide range of cancers.

Blueberries-also known as “brainberry”, blueberries have more antioxidants than any other fruit. They can help prevent cancer, diabetes and age-related memory changes.

Blackbeans- good for your heart, they also boost brain power because they are full of anthocyanins, antioxidant compounds that improve brain function.

Walnuts-richer in heart-healthy omega-3′s than salmon, more anti-inflammatory polyphenols than red wine.

Oats-packed with soluble fiber which lowers the risk of heart disease. Even though they are high in carbohydrates, the sugars are slowed because the fiber and protein help deliver steady, muscle friendly energy.

There seems to be a new trend in consumer shopping. The public appears to be seeking out food products more for what they contain, and less for what they don’t have. According to Tom Vierhile of Datamonitor, the term “diet” has plunged over the last five years. Likewise, the terms “low-fat” and “low-calorie” have declined in usage.  Words such as “zero” which carry a more positive vibe appear to be catching on.  It seems that consumers are tired of “avoidance” products, and are attempting to be more pro-active in terms of their overall health and lifestyle….  Tufts University Health and Nutrition Letter   February, 2012

Americans are spending more time in their cars commuting to work these days. One likely reason… less job opportunities are compelling people to search for work farther from home.  That additional time behind the wheel can cause real pain in the back and neck for a lot of drivers.  Dr. Carrie Diulus, M.D., an orthopedic spine surgeon at the Cleveland Clinic has a few tips to help the trip be ache-free…..

Cushion your neck. “The headrest is there for a reason,” says Diulus.  It can help with neck soreness, and it’s the safest place for your head in a crash.  Slumping can increase pressure on your spinal disks.  However, you don’t want to sit perfectly straight either.  The best position is upright and leaning back slightly.  Taking pressure off your lower back can also help.  Try rolling up a towel to the thickness of your forearm and tuck it into the space where the small of your back meets the seat.

Of course, spending time in traffic congestion can trigger a headache for many people.  While listening to music or an audio book may not keep the headache away, listening to something enjoyable while you are in a traffic jam may help ease the tension…..  Women’s Health  March 2012

For many women with migraine, menopause can actually signal a time of headache relief. However, the years leading up to menopause when hormone levels fluctuate and ovaries produce less estrogen, headaches can actually become worse. According to Susan Broner, MD, of The Headache Institute of New York, perimenopausal
women may experience insomnia, irregular periods, and hot flashes… changes that may lead to more frequent migraines. “Some women who haven’t experienced migraines since their 20s find they return with a vengeance during perimenopause.” While this can be a troublesome time, Dr. Broner suggests there is room for optimism. “Once the hormone fluctuation stops and menopause begins, most women tend to see improvements.”    HeadWise  Vol 1, Issue 3  Sarah Fister Gale

Walking may be the purest and most uncomplicated exercise we can do for our bodies. Health experts tell us consistent walking not only is great at burning calories, it can also tune up our cardiovascular system, and strengthen our bones.
Its easy to get started. Make sure you wear athletic shoes that are properly fitted… you don’t want to get blisters. Begin slowly-maybe ten minutes the first few days, and increase your time as you feel stronger. Walking at a brisk pace, as opposed to a slow walk will also maximize health benefits.  Walking is also a perk for our checkbooks… no fancy machines, health clubs or trainers needed!  You can find many people heading to their local indoor mall to walk when the weather is snowy, rainy, or too cold!
Tennis champion Martina Navratilova, an advocate for walking also sees the intangible benefits.  Enjoying the surroundings, catching a glimpse of nature, and just having fun can make the journey more meaningful…..   AARP 9/10