Patients who experience painful migraines or chronic daily headaches may be “adding insult to injury” by perpetuating the frequency of this painful disorder by depending heavily on over-the-counter migraine pain relievers.
Recent research indicates the use of over-the-counter migraine pain relievers may affect the brain’s ability to naturally switch off the pain thus perpetuating the frequency of migraine in patients who use these medications to alleviate intense headaches on a regular basis.
Migraines are a debilitating form of headache that strikes more than 28 million Americans. The National Institute of Neurological Disorders and Stroke estimates the loss of 157 million work days because of migraine pain. When the pain strikes, typically patients first line of defense is over-the-counter pain medications that temporarily relieve pain. Since recent research indicates a connection between persistent pain, frequent use of symptomatic headache medicines and the development of persistent or daily headache, it has become increasingly clear that eliminating migraine-triggering factors are just as important as treating acute symptoms of migraine.
The Pain Center at Cedars-Sinai Medical Center offers a multidisciplinary approach to treatment that incorporates exercise, diet and pharmacology to help manage and prevent frequent migraines. Dr. Steven Graff-Radford provides four steps to managing and preventing this painful and often debilitating neurobiological disorder.
“As research continues to hone in on the pathology of migraine disorders, more and more research indicates the need for a non-pharmacologic preventive behaviors to decrease the frequency and severity of migraines,” says Dr. Graff-Radford, “While it is important to manage certain migraine disorders with medication, changing migraine-triggering behaviors is a critical focal point in prevention and empowers patients to manage their pain instead of letting their pain manage them.”
Dr. Graff-Radford recommends the following steps to preventing migraines:
1. Withdraw from over-the-counter migraine medication. When migraines strike, patient’s first reaction is to take something for the pain. Long term however, this may perpetuate the frequency of headache pain and “fuel the fire” for more severe migraines down the line. If you are currently taking over the counter migraine medications to relieve chronic headaches on a regular basis (more than three times a week), begin curbing your usage of medication over a period of time. Don’t stop taking medication “cold turkey” – as it may lead to dangerous or uncomfortable withdraw symptoms like increased headache, sweats, diarrhea and irritability. Reduce your dosage by 20% every four days until you are at a minimal dose. This should be done while aggressively addressing factors in your life that “trigger” migraines.
2. Eliminate “triggering” factors. Most of us live very active, busy and often stressful lives. Stress, anxiety, lack of sleep, lack of regular exercise and poor diet all increase your risk for frequent headaches and migraine. Eliminating the following may significantly reduce the frequency and severity of migraine:
* Stress and anxiety – Though some think otherwise, no one thrives on stress. It leads to poor circulation, high blood pressure, muscle tension, hair loss and yes, frequent headaches. Reducing stress can be accomplished in a variety of ways such as meditation, exercise, time with family and friends, setting limits with regard to work – the list goes on. Take a look at the things in your life that cause the most stress and identify ways to reduce or eliminate it.
* Caffeine – eliminating caffeine from your diet may reduce the frequency of headaches because of caffeine rebound. Although caffeine may help relieve a headache initially, too much can result in another headache starting when the affects of caffeine begins to wear off. However, don’t eliminate caffeine all at once. Slowly curb your consumption over a period of weeks to allow your body the time to adjust – quitting cold turkey may lead to withdrawal headaches. For example, if you currently drink four cups of coffee in the morning, limit yourself to three cups a day for the first week and then two cups the following week and so on.
* Foods high in tyramine, sulfites and nitrates like Cheese, wines, nuts, pressed meats. Tyramine, sulfites and nitrates have been known to cause headaches, and avoiding them will reduce your chances of frequent migraines.
3. Begin a “headache blasting” vitamin combo. A combination of the vitamins magnesium, vitamin B2 and feverfew has been known to reduce frequent headache pain. Although the exact mechanism is not known, it is believed this may alter the “triggerability” of migraine by the brain.
4. See your doctor for a referral to see a pain specialist. In many cases, people with frequent migraines may experience frequent migraine pain even after eliminating “triggering” factors. In this instance, it is important to see your physician for a referral to be seen by a pain specialist. These specialists can help identify the possible source of the problem and provide adequate treatment with specific non-pharmacologic and pharmacologic therapies (medication).