Lord, how my head aches! What a head have I! It beats as it would fall in twenty pieces.
--From "Romeo and Juliet"
Aristotle, Thomas Jefferson, Virginia Woolf, Sigmund Freud, Gen. Ulysses S. Grant, Lewis Carroll, Frederic Chopin, Kareem Abdul-Jabbar, Joan Didion--all did or do suffer from them.
For the estimated 20 million Americans who endure migraine headaches--about 70% of them women--there is nothing quite so agonizing as the throbbing pains which usually occur on one side of the head and sometimes are accompanied by nausea, diarrhea, dizziness and blurred vision.
What, then, is relatively new with one of mankind's oldest afflictions, one that has for the most part defied a cure?
"For one thing there has been the development of a sustained-release Inderal capsule," said Dr. Seymour Diamond, founder of the Diamond Headache Clinic in Chicago. If taken on a daily basis, Diamond explained in a telephone interview, this time-released and long-acting beta-blocker propranolol (most commonly used to control blood pressure) can be a prophylactic or preventive measure for migraine sufferers.
Non-steroidal anti-inflammatory agents, originally used as painkillers to treat arthritis, have also proved useful in preventing migraine attacks in some patients, Diamond said. But clinical controversy over migraine drug therapy has been around for as long as the torment itself, he added, and arthritis drugs such as Nalfon and Anaprox have not gained unanimous acceptance in the medical community for migraine treatment.
In the last few years, some patients have reported success in preventing migraines by using calcium channel blockers, such as Isoptin and Calan, Diamond said. "These drugs don't affect the bone calcium, but work at the blood vessel level, preventing expanding and contracting."
The drug most commonly prescribed for migraine has been around for decades. Formerly a rye-attacking fungus known as ergot, it is now produced synthetically as ergotamine, mixed with caffeine (which shrinks blood vessels) and marketed under names such as Cafergot and Wigraine. Diamond said that it is available in a nasal-spray form in Europe, where it is meeting with a good deal of success.
Fish Oil Found Helpful
Dr. Seymour Solomon, director of the Headache Unit of the Montefiore Medical Center in New York City, said fish oil capsules--generally found in health food stores--have been found by some to prevent migraines. "But this is so new that it hasn't been confirmed to any significant extent," he added.
Last year a University of Cincinnati Medical Center study found that nearly 75% of migraine sufferers reported relief after their diet was enriched with fish oil, taken in capsule form equivalent to eating 12 salmon a day.
"In England, migraineurs are reporting relief from an herb called Feverfew," Solomon said. "It is taken in powder form in capsules or caplets, and is becoming available in health stores in this country."
Also commercially available and of possible interest to migraine victims, Diamond continued, is the Cold Comfort Gel Pack. It is said to retain cold longer than water, is kept in a freezer, and when needed is pressed against the forehead for 30 to 45 minutes to help relieve pain.
Prevention Is the Goal
But since there is no known cure, the goal is prevention. Those familiar with migraine attacks are usually familiar with the "triggers"--especially foods--that often can bring on the dreaded throbbing.
These triggers, physicians say, include aged cheeses, chocolate, alcoholic beverages--especially red wines--yogurt, excessive amounts of citrus, caffeine-containing drinks such as colas and coffee, the flavor-enhancer monosodium glutamate, anchovies, chicken livers, hot dogs, sausages and bacon (because of the nitrite preservative), nuts, lima beans, guacamole, excessive amounts of bananas or figs and products containing yeast.
Solomon, of the Montefiore Medical Center's Headache Unit, said the hospital is also studying whether the artificial sweetener aspartame provokes migraines. "Some comments indicate that perhaps migraine sufferers will have to avoid diet drinks," he said.
In Mount Vernon, N.Y., Dr. Arthur Elkind, head of the Elkind Headache Center, said, "I don't believe the new sweetener is a cause. Migraines have been around long before that."
Caffeine-withdrawal sometimes is responsible for migraines, often on weekends when the workplace coffee break isn't observed. "If you drink three cups of coffee on weekdays, do the same on Saturdays and Sundays, to lessen the chance of headache from that cause," Diamond advised.
Dr. Donald Dalessio, chairman of the Department of Medicine at the Scripps Clinic and Research Foundation in La Jolla, said that the converging of as many as 10 factors may be responsible for ushering in a killer headache. He likened the situation to a freeway with on ramps, the strategy being to eschew traffic jams of the factors which bring on migraines.