During the Stone Age, pieces of a headache sufferer's skull
were cut away with flint instruments to relieve pain. Another
unpleasant remedy used in the British Isles around the ninth
Century involved drinking "the juice of elderseed, cow's brain, and
goat's dung dissolved in vinegar." Fortunately, today's headache
patients are spared such drastic measures.
Drug therapy, biofeedback training, stress reduction, and
elimination of certain foods from the diet are the most common
methods of preventing and controlling migraine and other vascular
headaches. Joan, the migraine sufferer, was helped by treatment
with a combination of an antimigraine drug and diet control.
Regular exercise, such as swimming or vigorous walking, can also
reduce the frequency and severity of migraine headaches. Joan found
that yoga and whirlpool baths helped her relax.
During a migraine headache, temporary relief can sometimes be
obtained by using cold packs or by pressing on the bulging artery
found in front of the ear on the painful side of the head.
.There are two ways to approach the
treatment of migraine headache with drugs: prevent the attacks, or
relieve symptoms after the headache occurs.
For infrequent migraine, drugs can be taken at the first sign of
a headache in order to stop it or to at least ease the pain. People
who get occasional mild migraine may benefit by taking aspirin or
acetaminophen at the start of an attack. Aspirin raises a person's
tolerance to pain and also discourages clumping of blood platelets.
Small amounts of caffeine may be useful if taken in the early
stages of migraine. But for most migraine sufferers who get
moderate to severe headaches, and for all cluster patients,
stronger drugs may be necessary to control the pain.
One of the most commonly used drugs for the relief of classic
and common migraine symptoms is ergotamine tartrate, a
vasoconstrictor which helps counteract the painful dilation stage
of the headache. For optimal benefit, the drug is taken during the
early stages of an attack. If a migraine has been in progress for
about an hour and has passed into the final throbbing stage,
ergotamine tartrate will probably not help.
Because ergotamine tartrate can cause nausea and vomiting, it
may be combined with antinausea drugs. Research scientists caution
that ergotamine tartrate should not be taken in excess or by people
who have angina pectoris, severe hypertension, or vascular, liver,
or kidney disease.
Patients who are unable to take ergotamine tartrate may benefit
from other drugs that constrict dilated blood vessels or help
reduce blood vessel inflammation.
For headaches that occur three or more times a month, preventive
treatment is usually recommended. Drugs used to prevent classic and
common migraine include methysergide maleate, which counteracts
blood vessel constriction; propranolol hydrochloride, which stops
blood vessel dilation; and amitriptyline, an antidepressant.
Antidepressants called MAO inhibitors also prevent migraine.
These drugs block an enzyme called monoamine oxidase which normally
helps nerve cells absorb the artery-constricting brain chemical,
MAO inhibitors can have potentially serious side
effects--particularly if taken while ingesting foods or beverages
that contain tyramine, a substance that constricts arteries.
Several drugs for the prevention of migraine have been developed
in recent years, including drugs which mimic the action of
serotonin, including serotonin agonists which mimic the action of
this key brain chemical. Prompt administration of these drugs is
Many antimigraine drugs can have adverse side effects. But like
most medicines they are relatively safe when used carefully and
under a physician's supervision. To avoid long-term side effects of
preventive medications, headache specialists advise patients to
reduce the dosage of these drugs and then to stop taking them as
soon as possible.
Biofeedback and relaxation training
for migraine is often combined with biofeedback and relaxation
training. Biofeedback refers to a technique that can give people
better control over such body function indicators as blood
pressure, heart rate, temperature, muscle tension, and brain waves.
allows a patient to consciously raise
hand temperature. Some patients who are able to increase hand
temperature can reduce the number and intensity of migraines. The
mechanisms underlying these self-regulation treatments are being
studied by research scientists.
"To succeed in biofeedback," says a headache specialist, "you
must be able to concentrate and you must be motivated to get
A patient learning thermal biofeedback wears a device which
transmits the temperature of an index finger or hand to a monitor.
While the patient tries to warm his hands, the monitor provides
feedback either on a gauge that shows the temperature reading or by
emitting a sound or beep that increases in intensity as the
temperature increases. The patient is not told how to raise hand
temperature, but is given suggestions such as "Imagine that your
hands feel very warm and heavy."
"I have a good imagination," says one headache sufferer who
traded in her medication for thermal biofeedback. The technique
decreased the number and severity of headaches she experienced.
In another type of biofeedback called
, the patient learns to control muscle
tension in the face, neck, and shoulders.
Either kind of biofeedback may be combined with relaxation
training, during which patients learn to relax the mind and
Biofeedback can be practiced at home with a portable monitor.
But the ultimate goal of treatment is to wean the patient from the
machine. The patient can then use biofeedback anywhere at the first
sign of a headache.
The antimigraine diet
.Scientists estimate that a
small percentage of migraine sufferers will benefit from a
treatment program focused solely on eliminating headache-provoking
foods and beverages.
Other migraine patients may be helped by a diet to prevent low
blood sugar. Low blood sugar, or hypoglycemia, can cause dilation
of the blood vessels in the head. This condition can occur after a
period without food: overnight, for example, or when a meal is
skipped. People who wake up in the morning with a headache may be
reacting to the low blood sugar caused by the lack of food
Treatment for headaches caused by low blood sugar consists of
scheduling smaller, more frequent meals for the patient. A special
diet designed to stabilize the body's sugar-regulating system is
For the same reason, many specialists also recommend that
migraine patients avoid oversleeping on weekends. Sleeping late can
change the body's normal blood sugar level and lead to a