Posted on: Saturday, December 21, 2002
PRESCRIPTIONS
Migraine sufferers can take steps to tame pain
By Dr. Landis Lum
Q. I get bad, throbbing headaches and get so nauseated I can't do a thing for hours! Pain pills just don't help. What can I do?
A. You have migraines, which affect 18 percent of women and 6 percent of men. Migraines often cause headaches on only one side, sensitivity to light or sound, and worsening when you walk stairs. You may even get auras, where you see zigzag lines, flashing lights, or other patterns before the headache.
Migraines often start between ages 10 and 20, peak in middle age, and improve with menopause. Carsickness is common in people with migraines.
See your physician to make sure something serious isn't causing your headaches. The next step is to wake up the same time on weekends that you do on weekdays. Over- or undersleeping can cause migraines. So even if you party till 3 a.m., get up at your usual time.
Similarly, drink the same amount of caffeine on the weekends that you do on workdays. Caffeine withdrawal can cause migraines. And try to see if other things trigger your migraines, like monosodium glutamate, alcohol, chocolate, nitrates, stress, fatigue, exertion, skipped meals, perfumes or exposure to glare or flickering lights.
It sounds like you've already tried drugs like ibuprofen and naproxen (Aleve, etc.) If so, ask your doctor about serotonin-active drugs like naratriptan, rizatriptan, sumatriptan, zolmitriptan or dihydroergotamine. These can be given by mouth, intra-nasally, or by self-injection.
But beware of rebound headaches, where you get frequent headaches from overuse of pain pills like opiates, Midrin (Isocom), serotonin-active drugs, ergotamine, and pills containing butalbital or caffeine. This can even lead to daily headaches. To avoid this, don't use such drugs more than two days a week.
If you're getting two or more headaches a month causing disability lasting three or more days a month, or need to use headache pills more than twice a week, ask your doctor about taking a daily pill to prevent migraines in the first place.
Evidence-based guidelines in the Nov 19, 2002 issue of the journal "Annals of Internal Medicine" show the best are propranolol (80 to 240 milligrams a day), timolol (20 to 30 milligrams a day), amitriptyline (30 to 150 milligrams a day) and valproic acid. Be patient. It may take two to three months before your headaches improve.
Dr. Landis Lum is a family practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine.
