Letter to Editor: Aspartame and Headaches

[Guest guest]

Dear Editor: Cameroon Radio TV:

 

Quite an indepth article on migraines. I was

glad to see that aspartame is mentioned as it is

#1 on the FDA list of 92 symptoms.

 

Aspartame Disease is a global plague that has

completely been ignored although the FDA In the

US knows. Read how it was

approved:

http://www.mpwhi.com/australia_nasty_aspartame.htm

It has its own 1000 page medical text: Aspartame

Disease: An Ignored Epidemic by H. J. Roberts, M.D., www.sunsentpress.com

 

Headache is discussed and Dr. Roberts says,

" There are multiple possible mechanisms for

aspartame headache. They include altered

concentration of brain amino acids,

neurotransmitter dysfunction, reactions to the

diketopiperazine metabolism, aggravated

hypoglycemia, the ingestion of large amounts of

fluid in response to increased thirst and

allergy. Methanol-induced cerebral edema,

alterations in brain water, sodium and potassium,

vascular stasis and the neurotoxic effects of

formaldehyde and formate also may be

operative. " Dr. Roberts in discussing

neurotransmitters says they have considerable

relevance to the headaches and atypical

facial/neck pain experienced by aspartame reactors.

 

He also states that the aggravation of severe

hypoglycemia - or decreased glucose availability

to the brain (cerebral glucopenia) - was

mentioned as a mechanism whereby aspartame can

trigger migraine and related headaches. This is

likely in the case of women having " functional "

hyperinsulinism who attempt to lose weight by

decreasing food intake drastically and

concomitantly engage in strenuous exercise.

 

He says further: " I have reviewed the

interrelationships between migraine and

hypoglycemia. Only a few of the evidences are cited here.

 

* Attacks of vascular headache are predictably

precipitated by prolonged delay in eating,

increased activity, ingesting sugar or alcohol

and increased insulin release from oral contraceptive use.

 

* The patient's exact headache often can be

reproduced by fasting or triggered when reactive

hypoglycemia develops during a glucose tolerance. "

 

H. J. Roberts, M.D., is a diabetic specialist and

says that aspartame can precipitate diabetes,

aggravates and simulates diabetic retinopathy and

neuropathy, destroys the optic nerve, causes

diabetics to go into convulsions and interacts

with insulin. It's the free methyl alcohol in

aspartame that causes so many to lose limbs.

http://www.wnho.net/letter_to_senator_goyp_concerning_aspartame.htm

It can also trigger hypoglycemia. There is a

safe sweetener, " Just Like Sugar " ,

www.justlikesugarinc.com which is made from

chicory used for 70 years to improve the diabetic

condition, and orange peel. It also has Vitamin

C from organic oranges and calcium.

 

Dr. Roberts also says that nocturnal aspartame

induced headache could reflect delayed

IgE-mediated hypersensitivity. This may be

comparable to aspartame induced delayed urticaria (hives) or angioedema.

 

Further: " Physicians who are not aware of the

relationship between severe headache and

aspartame use are likely to order

electroencephalograms (EEGs) and CT scans or MRI

imaging studies. Concomitant complaints by

aspartame reactors - confusion; memory loss;

visual disturbances; personality changes - also

reflexively generate these studies and neurologic

consultation. The high medical costs so incurred

may surpass the limits set by insurance carriers. "

 

The author is correct that MSG also can trigger

headaches, and MSG has an additive and

synergistic effect with aspartame.

www.truthinlabeling.org Remember that the

aspartate in aspartame like glutamate is an

excitotoxin. Dr. Roberts wrote that " Entry of

excitotoxic breakdown products of aspartame into

the brain are probably greater than heretofore

realized. Studies on the neurotoxicity of

aspartate and glutamate demonstrate that several

small regions of the brain lack a blood brain

barrier, thereby enabling these blood borne

substances to penetrate freely. Dr. John W.

Olney (Professor of Neuropathology at Washington

University School of Medicine) wrote the

following explanation to Senator Howard Metzenbaum on December 8, l987;

 

" If glutamate and aspartate are released from

cells and not rapidly taken back up, they flood

the excitatory receptors on the external surface

of nerve cells and excite nerve cells to death.

 

" It has recently been shown that certain drugs

which block the action of Glu and Asp at these

excitatory receptors can protect the animal brain

against damage associated with stroke, cardiac

arrest or perinatal asphyxia. This, it is an

ironic fact that today knowledgeable

neuroscientists in many parts of the world are

working fervently to develop methods for

preventing endogenous excitotoxins from damaging

the human brain, while other elements of society,

including the FDA, are promoting and sanctioning

the adulteration of foods with unlimited amounts

of exogenous excitotoxins which are known to

destroy nerve cells in the mammalian rain following oral intake. "

 

Be sure to read: Excitotoxins: The Taste That

Kills by neurosurgeon Russell Blaylock, M.D.,

www.russellblaylockmd.com His detox

program (What To Do If You Have Used Aspartame)

is www.wnho.net/wtdaspartame.htm

 

If someone is not on aspartame and has continued

headaches, if not from some source that needs to

be diagnosed like brain tumors, they are usually

cured by prolotherapy. Dr. Hemwall who was

taught by the inventor of prolotherapy told me he

had cured every case of migraine. He died in his

90's, and his practice was taken over by Dr. Ross

Hauser. You can check out his web site,

www.caringmedical.com for further information and

prolotherapists throughout the US and other

countries. Prolotherapy is the cure for chronic

pain. Indeed, every headache case I ever sent to

Dr. Hemwall was cured. Dr. Hauser is one of the

top prolotherapists, trained by Dr. Hemwall.

 

I highly recommend the aspartame documentary,

Sweet Misery: A Poisoned World, www.soundandfury.tv

 

Also remember that aspartame damages the

mitochondria so it interacts with virtually all

drugs and vaccines. Merck in the US makes Maxalt

to treat headaches and even has aspartame in

it. They care not what misery and

disability they inflict on aspartame victims as

they have been written repeatedly and you'll find

lots of information in google. They also in

their home edition of the Merck Manual say

aspartame is okay for pregnant women, when in

fact, aspartame is a teratogen and triggers birth

defects and mental retardation. It is also an abortifacient.

 

Dr. Betty Martini, D.Hum, Founder

Mission Possible International

9270 River Club Parkway

Duluth, Georgia 30097

770 242-2599

www.mpwhi.com, www.dorway.com, www.wnho.net

Aspartame Toxicity Center, www.holisticmed.com/aspartame

Aspartame information List, www.mpwhi.com scroll down to banners

 

 

 

Migraine headache often under-diagnosed and under-treated?

20/06/2008: Many people turn to get confused

between regular head arch and migraine. This is

because the symptoms of both illnesses are

basically the same. In the following discussion

with our medical consultant, Serge Emaleu focus shall on migraine headache.

Elvis Teke: What is a migraine headache?

 

Serge Emaleu: A migraine headache is a form of

vascular headache. Migraine headache is caused by

a combination of vasodilatation (enlargement of

blood vessels) and the release of chemicals from

nerve fibers that coil around the blood vessels.

During a migraine attack, the temporal artery enlarges.

 

(The temporal artery is an artery that lies on

the outside of the skull just under the skin of

the temple.) Enlargement of the temporal artery

stretches the nerves that coil around the artery

and causes the nerves to release chemicals. The

chemicals cause inflammation, pain, and further

enlargement of the artery. The increasing

enlargement of the artery magnifies the pain.

 

Migraine attacks commonly activate the

sympathetic nervous system in the body. The

sympathetic nervous system is often thought of as

the part of the nervous system that controls

primitive responses to stress and pain, the

so-called " fight or flight " response. The

increased sympathetic nervous activity in the

intestine causes nausea, vomiting, and diarrhea.

 

Sympathetic activity also delays emptying of the

stomach into the small intestine and thereby

prevents oral medications from entering the

intestine and being absorbed. The impaired

absorption of oral medications is a common reason

for the ineffectiveness of medications taken to

treat migraine headaches. The increased

sympathetic activity also decreases the

circulation of blood, and this leads to pallor of

the skin as well as cold hands and feet. The

increased sympathetic activity also contributes

to the sensitivity to light and sound sensitivity as well as blurred vision.

 

Migraine afflicts millions of Cameroonians, with

females suffering more frequently (17%) than

males (6%). Missed work and lost productivity

from migraine create a significant public burden.

Nevertheless, migraine still remains largely

undertreated and under diagnosed. Less than half

the sufferers are diagnosed by their doctors.

 

E.T:What are the symptoms of migraine headaches?

 

S.E: Migraine is a chronic condition of recurrent

attacks. Most (but not all) migraine attacks are

associated with headaches. Migraine headaches

usually are described as an intense, throbbing or

pounding pain that involves one temple.

(Sometimes the pain can be located in the

forehead, around the eye, or the back of the head).

 

The pain usually is unilateral (on one side of

the head), although about a third of the time the

pain is bilateral. The unilateral headaches

typically change sides from one attack to the

next. (In fact, unilateral headaches that always

occur on the same side should alert the doctor to

consider a secondary headache, for example, one

caused by a brain tumor). A migraine headache

usually is aggravated by daily activities like

walking upstairs. Nausea, vomiting, diarrhea,

facial pallor, cold hands, cold feet, and

sensitivity to light and sound commonly accompany

migraine headaches. As a result of this

sensitivity to light and sound, migraine

sufferers usually prefer to lie in a quiet, dark

room during an attack. A typical attack lasts between 4 and 72 hours.

 

An estimated 40%-60% of migraine attacks are

preceded by premonitory (warning) symptoms

lasting hours to days. The symptoms may include

sleepiness, irritability, fatigue, depression or

euphoria, yawning, and cravings for sweet or

salty foods. Patients and their family members

usually know that when they observe these warning

symptoms that a migraine attack is beginning.

 

An estimated 20% of migraine headaches are

associated with an aura. Usually, the aura

precedes the headache, although occasionally it

may occur simultaneously with the headache. The

most common auras are 1) flashing, brightly

colored lights in a zigzag pattern (fortification

spectra), usually starting in the middle of the

visual field and progressing outward and 2) a

hole (scotoma) in the visual field, also known as

a blind spot. Some elderly migraine sufferers may

experience only the visual aura without the

headache. A less common aura consists of

pins-and-needles sensations in the hand and the

arm on one side or pins-and-needles sensations

around the mouth and the nose on the same side.

 

Other auras include auditory (hearing)

hallucinations and abnormal tastes and smells.

Complicated migraines are migraines that are

accompanied by neurological dysfunction. The part

of the body that is affected by the dysfunction

is determined by the part of the brain that is

responsible for the headache. Vertebrobasilar

migraines are characterized by dysfunction of the

brainstem (the lower part of the brain that is

responsible for automatic activities like

consciousness and balance). The symptoms of

vertebrobasilar migraines include fainting as an

aura, vertigo (dizziness in which the environment

seems to be spinning) and double vision.

Hemiplegic migraines are characterized by

paralysis or weakness of one side of the body,

mimicking a stroke. The paralysis or weakness is

usually temporary, but sometimes it can last for day.

 

For approximately 24 hours after a migraine

attack, the migraine sufferer may feel drained of

energy and may experience a low-grade headache

along with sensitivity to light and sound.

Unfortunately, some sufferers may have

recurrences of the headache during this period.

 

E.T: How is a migraine headache diagnosed?

 

S.E: Migraine headaches are usually diagnosed

when the symptoms described above are present.

Migraine generally begins in childhood to early

adulthood. While migraines can first occur in an

individual beyond the age of fifty, advancing age

makes other types of headaches more likely. A

family history is usually present, suggesting a

genetic predisposition in migraine sufferers. In

addition to diagnosing migraine from the clinical

presentation there is usually an accompanying normal examination.

 

Patients with the first headache ever, worst

headache ever, or where there is a significant

change in headache or the presence of nervous

system symptoms, like visual or hearing or

sensory loss, may require additional tests. The

tests may include blood testing, brain scanning

(either CT or MRI), and a spinal tap.

 

E.T: How are migraine headaches treated?

 

S.E: Treatment is can include non-medication and medication approaches.

 

Non-medication therapies for migraine

 

Therapy that does not involve medications can

provide symptomatic and preventative therapy.

Using ice, biofeedback, and relaxation techniques

may be helpful at stopping an attack once it has

started. If possible, sleep is the best medicine.

Preventing migraine takes motivation for the

patient to make some life changes. Patients are

educated as to triggering factors that can be avoided.

 

These include smoking cessation, avoiding certain

foods especially those high in tyramine (sharp

cheeses) or those containing sulphites (wines) or

nitrates (nuts, pressed meats). Generally,

leading a healthy life style with good nutrition,

adequate water intake, sufficient sleep and exercise may be useful.

 

Medication therapies for migraine

 

Individuals with occasional mild migraine

headaches that do not interfere with daily

activities usually medicate themselves with

over-the-counter (OTC, non-prescription) pain

relievers OTC analgesics have been shown to be

safe and effective for short-term relief of

headache (as well as muscle aches, pains,

menstrual cramps , and fever) when used according

to the instructions on their labels.

 

There are two major classes of TC analgesics:

acetaminophen (Tylenol) and non-steroidal

anti-inflammatory drugs (NSAIDs). The two types

of NSAIDs are aspirin and non-aspirin.

 

The difference between OTC and prescription

NSAIDs may only be the amount of the active ingredient contained in each pill.

 

E.T: What are precautions that should be observed with OTC analgesics?

 

S.E: Children and teenagers should not use

aspirin for the treatment of headaches, other

pain, or fever, because of the risk of developing

Reye's Syndrome, a life-threatening neurological

disease that can lead to coma and even death.

 

• Patients with balance disorders or hearing

difficulties should avoid using aspirin because

aspirin may aggravate these conditions.

• Patients taking blood thinners such as

warfarin (Coumadin) should not take aspirin and

non-aspirin NSAIDs without a doctor's supervision

because they add further to the risk of bleeding

that is caused by the blood thinner.

• Patients with active ulcers of the stomach

and duodenum should not take aspirin and

non-aspirin NSAIDs because they can increase the

risk of bleeding from the ulcer and impair healing of the ulcer.

• Patients with advanced liver disease should

not take aspirin and non-aspirin NSAIDs because

they may impair kidney function. Deterioration of

kidney function in these patients can lead to

rapid and life-threatening deterioration of their liver disease.

• Patients should not overuse OTC or

prescription analgesics. Overuse of analgesics

can lead to the development of tolerance

(increasing ineffectiveness of the analgesic) and

rebound headaches (return of the headache as soon

as the effect of the analgesic wears off, usually

in the early morning hours). Thus, overuse of

analgesics can lead to a vicious cycle of more

and more analgesics for headaches that respond

less and less to treatment and occur more frequently.

 

E.T: What is the treatment for severe migraine headaches?

 

S.E: Migraine-specific abortive medications

usually are necessary for moderate to severe

migraine headaches. The abortive medications for

moderate or severe migraine headaches are

different than OTC analgesics. Instead of

relieving pain, they abort headaches by

counteracting the cause of the headache, dilation

of the temporal arteries. In fact, they cause

narrowing of the arteries. Examples of

migraine-specific abortive medications are the triptans and ergot preparations.

 

The triptans attach to serotonin receptors on the

blood vessels and nerves and thereby reduce

inflammation and constrict the blood vessels. This stops the headache.

 

Traditionally, triptans were prescribed for

moderate or severe migraines after OTC analgesics

and other simple measures failed. Newer studies

suggest that triptans can be used as the first

treatment for patients with migraines that are

causing disability. (Significant disability is

defined as more than 10 days of at least 50%

disability during a three-month period.).

 

Triptans should be used early after the migraine

begins, before the onset of pain or when the pain

is mild. Using a triptan early in an attack

increases its effectiveness, reduces side

effects, and decreases the chance of recurrence

of another headache during the following 24

hours. Used early, triptans can be expected to

abort more than 80% of migraine headaches within 2 hours.

 

E.T: What are the Side effects of triptans

 

S.E: The most common side effects of triptans are

facial flushing, tingling of the skin, and a

sense of tightness around the chest and throat.

Other less common side effects include

drowsiness, fatigue, and dizziness. These side

effects are short-lived and are not considered serious.

 

The most serious side effects of triptans are

heart attacks and strokes. Triptans are effective

in migraine headaches because they narrow

arteries in the head; however, they also can

narrow arteries in the heart. In individuals

without existing carotid or coronary artery

disease, the narrowing caused by triptans usually does not cause problems.

 

However, in patients whose carotid and coronary

arteries are narrowed by atherosclerosis or who

suffer from intermittent spasm of the coronary

arteries (a condition called Prinzmetal's or

variant angina), the narrowing caused by triptans

can further reduce the flow of blood through the

arteries and have been reported to cause heart attacks and strokes.

 

Therefore, triptans should not be given to

patients who have had heart attacks and strokes,

or to patients who have symptoms of

atherosclerosis such as angina, transient

ischemic attack (TIAs), and intermittent claudication.

 

Healthy adults may have atherosclerosis and

narrowing of the coronary arteries that are

" silent " , that is, without past strokes,

transient ischemic attacks, heart attacks, or

angina. Therefore, before prescribing a triptan,

a doctor should evaluate patients for possible

atherosclerosis if they have one or more risk

factors for developing atherosclerosis.

 

These risk factors include cigarette smoking,

diabetes mellitus, high blood pressure, high

levels of LDL ( " bad " ) cholesterol in the blood,

obesity, male and over 40 years of age, female

and postmenopausal, or a family member(s) who

have had heart attacks at an early age. Some

patients who are at risk should receive their

first dose of a triptan in the doctor's office

while being monitored with an electrocardiogram (EKG).

 

Triptans can interact with other drugs. For

example, there have been rare reports of triptans

causing a " serotonin syndrome " when given

together with a selective serotonin reuptake

inhibitor. Selective serotonin reuptake

inhibitors (SSRIs) are a class of medications

widely used to treat depression. The symptoms of

serotonin syndrome include confusion, fever,

tremor, high blood pressure, diarrhea, and

sweating. Triptans should not be used in pregnant

women and are not generally used in young children.

 

E.T: How are migraine headaches prevented?

 

S.E: There are two ways to prevent migraine headaches:

 

1) By avoiding factors ( " triggers " ) that cause the headaches, and

2) By preventing headaches with medications (prophylactic medications).

Neither of these preventive strategies is 100%

effective. The best one can hope for is to reduce the frequency of headaches.

 

E.T: What triggers migraine?

 

S.E: A migraine trigger is any factor that causes

a headache in individuals who are prone to

develop headaches. Only a small proportion of

migraine sufferers, however, clearly can identify

triggers. Examples of triggers include stress,

sleep disturbances, fasting, hormones, bright or

flickering lights, odors, cigarette smoke,

alcohol, aged cheeses, chocolate, monosodium

glutamate, nitrites, aspartame, and caffeine.

 

For some women, the decline in the blood level of

estrogen during the onset of menstruation is a

trigger for migraine headaches. The interval

between exposure to a trigger and the onset of

headache varies from hours to two days. Exposure

to a trigger does not always lead to a headache.

Conversely, avoidance of triggers cannot

completely prevent headaches. Different migraine

sufferers respond to different triggers, and any

one trigger will not induce a headache in every

person who has migraine headaches.

 

Sleep and migraine

 

Disturbances such as sleep deprivation, too much

sleep, poor quality of sleep, and frequent

awakening at night are associated with both

migraine and tension headaches, whereas improved

sleep habits have been shown to reduce the

frequency of migraine headaches. Sleep also has

been reported to shorten the duration of migraine headaches.

Fasting and migraine

 

Fasting possibly may precipitate migraine

headaches by causing the release of

stress-related hormones and lowering blood sugar.

Therefore, migraine sufferers should avoid prolonged fasting.

Bright lights and migraine

 

Bright lights and other high intensity visual

stimuli can cause headaches in healthy subjects

as well as patients with migraine headaches, but

migraine patients seem to have a lower than

normal threshold for light-induced pain.

Sunlight, television, and flashing lights all

have been reported to precipitate migraine headaches.

Caffeine and migraine

 

Caffeine is contained in many food products

(cola, tea, chocolates, coffee) and OTC

analgesics. Caffeine in low doses can increase

alertness and energy, but caffeine in high doses

can cause insomnia, irritability, anxiety, and

headaches. The over-use of caffeine-containing

analgesics causes rebound headaches. Furthermore,

individuals who consume high levels of caffeine

regularly are more prone to develop withdrawal

headaches when caffeine is stopped abruptly.

Chocolate, wine, tyramine, MSG, nitrites, aspartame and migraine

 

Chocolate has been reported to cause migraine

headaches, but scientific studies have not

consistently demonstrated an association between

chocolate consumption and headaches. Red wine has

been shown to cause migraine headaches in some

migraine sufferers, but it is not clear whether

white wine also will cause migraine headaches.

 

Tyramine (a chemical found in cheese, wine, beer,

dry sausage, and sauerkraut) can precipitate

migraine headaches, but there is no evidence that

consuming a low-tyramine diet can reduce migraine

frequency. Monosodium glutamate (MSG) has been

reported to cause headaches, facial flushing,

sweating, and palpitations when consumed in high doses on an empty stomach.

 

This phenomenon has been called Chinese

restaurant syndrome. Nitrates and nitrites

(chemicals found in hotdogs, ham, frankfurters,

bacon and sausages) have been reported to cause

migraine headaches. Aspartame, a sugar-substitute

sweetener found in diet drinks and snacks, has

been reported to trigger headaches when used in

high doses for prolonged periods.

 

E.T: Female hormones and migraine

 

S.E: Some women who suffer from migraine

headaches experience more headaches around the

time of their menstrual periods. Other women

experience migraine headaches only during the

menstrual period. The term " menstrual migraine "

is used mainly to describe migraines that occur

in women who have almost all of their headaches

from two days before to one day after their menstrual periods.

 

Declining levels of estrogen at the onset of

menses is likely to be the cause of menstrual

migraines. Decreasing levels of estrogen also may

be the cause of migraine headaches that develop

among users of birth control pills during the

week that estrogens are not taken.

 

E.T: What should migraine sufferers do?

 

S.E: Individuals with mild and infrequent

migraine headaches that do not cause disability

may require only OTC analgesics. Individuals who

experience several moderate or severe migraine

headaches per month or whose headaches do not

respond readily to medications should avoid

triggers and consider modifications of their

life-style. Life-style modifications for migraine sufferers include:

 

• Go to sleep and waking up at the same time each day.

• Exercise regularly (daily if possible). Make

a commitment to exercise even when traveling or

during busy periods at work. Exercise can improve

the quality of sleep and reduce the frequency and

severity of migraine headaches. Build up your

exercise level gradually. Over-exertion,

especially for someone who is out of shape, can lead to migraine headaches.

• Do not skip meals, and avoiding prolonged fasting.

• Limit stress through regular exercise and relaxation techniques.

• Limit caffeine consumption to less than two

caffeine-containing beverages a day.

• Avoid bright or flashing lights and wearing

sunglasses if sunlight is a trigger.

• Identify and avoid foods that trigger

headaches by keeping a headache and food diary.

Review the diary with your doctor. It is

impractical to adopt a diet that avoids all known

migraine triggers, however, it is reasonable to

avoid foods that consistently trigger migraine headaches.

 

E.T: What are prophylactic medications for migraine headaches?

 

S.E: Prophylactic medications are medications

taken daily to reduce the frequency and duration

of migraine headaches. They are not taken once a

headache has begun. There are several classes of

prophylactic medications: beta blockers,

calcium-channel blockers, tricyclic

antidepressants, antiserotonin agents and anticonvulsants.

 

Medications with the longest history of use are

propranolol (Inderal), a beta blocker, and

amitriptyline (Elavil), an antidepressant. When

choosing a prophylactic medication for a patient

the doctor must take into account the drug side

effects, drug-drug interactions, and co-existing

conditions such as diabetes, heart disease, and high blood pressure.

 

E.T: Who should consider prophylactic medications

to prevent migraine headaches?

 

S.E: Not all migraine sufferers need prophylactic

medications; individuals with mild or infrequent

headaches that respond readily to abortive

medications do not need prophylactic medications.

Individuals who should consider prophylactic medications are those who:

 

1. Require abortive medications for migraine

headaches more frequently than twice weekly.

2. Have two or more migraine headaches a month

that do not respond readily to abortive medications.

3. Have migraine headaches that are

interfering substantially with their quality of life and work.

4. Cannot take abortive medications because of

heart disease, stroke, or pregnancy, or cannot

tolerate abortive medications because of side effects.

 

E.T: How effective are prophylactic medications?

 

S.E: Prophylactic medications can reduce the

frequency and duration of migraine headaches but

cannot be expected to eliminate migraine

headaches completely. The success rate of most

prophylactic medications is approximately 50%.

Success in preventing migraine headaches is

defined as more than a 50% reduction in the

frequency of headaches. Prophylactic medications

usually are begun at a low dose that is increased

slowly in order to minimize side effects.

 

Individuals may not notice a reduction in the

frequency, severity, or duration of their

headaches for 2-3 months after starting treatment.

 

E.T: What is the proper way to use preventive medications?

 

S.E: Doctors familiar with the treatment of

migraine headaches should prescribe preventive medications.

 

• Decisions about which preventive medication

to use are based on the side effects of the

medication and the medical conditions that the patient may have.

• Propranolol (Inderal) often is used first,

provided that the patient does not have asthma, COPD or heart disease.

• Preventive medications are begun at low

doses and gradually increased to higher doses if

needed. This minimizes side effects from the

medications. Preventive medications are to be

taken daily for months to years. When they are

stopped, the dose needs to be gradually reduced

rather than abruptly stopped. Abruptly stopping

preventive medications can lead to headaches.

• In some instances, more than one drug may be

needed. Non-medication and behavioral therapies also may be needed.

 

E.T: What is the treatment for menstrual migraine?

 

S.E: There are several aspects to treating menstrual migraines:

 

1. To abort menstrual migraine, take

medications after the onset of menstrual

migraine. Generally, medications that are

effective in aborting non-menstrual migraines are

effective at aborting menstrual migraines.

 

2. To prevent menstrual migraine, take

medications just before the onset of menstruation

and continue for the duration of the expected

headache. Taking hormones such as estrogens or

estrogen related medications also help to prevent migraine.

 

3. To reduce the frequency and duration of

menstrual migraine, take prophylactic medications

(such as beta blockers, calcium channel blockers,

anticonvulsants, tricyclic antidepressants) that

are normally used on a continuous basis to prevent non-menstrual migraines.

 

If these medications are ineffective, doctors may

try daily preventive medications such as

beta-blockers, anticonvulsants, calcium channel

blockers, and tricyclic antidepressants to reduce

the frequency and the severity of menstrual

migraines. The choice of the preventive

medications is based on the experiences and

preferences of the doctor, the medication side

effects, and the woman's other associated medical conditions.

 

For women already taking preventive medications

and yet still experience headaches, the doses of

preventive medications can be increased around

the time of the menstruation (some doctors use

preventive medications only around the time of

the menstruation). Alternatively doctors may try hormone treatment.

 

Since a drop in estrogen level just prior to

menstruation is the trigger for menstrual

migraines, estrogen replacement before

menstruation has been used in preventing

menstrual migraines. For some women with

menstrual migraine, Estradiol skin patches (such

as TTS 50, TTS 100) applied 2 days before

menstrual migraine and continued for 7 days

during the expected headache period is effective.

However, the dose of estrogen must be closely

monitored, as too high of a dose can actually

trigger migraine in susceptible individuals.

 

Some women with difficult to treat menstrual

migraines may be helped by using low dose oral

contraceptives to reduce the estrogen fluctuations.

 

Generally, Migraine is often under-diagnosed and

under-treated. There is no cure for migraine.

Nevertheless, there are numerous interventions

that may help restore an improved life for

migraine sufferers. These measures should

consider the various aspects of the particular

patient's condition. Triggering factors, nerve

inflammation, blood vessel changes and pain are

each addressed aggressively. Individualizing

treatment is essential for optimal outcome.

 

<tekeeElvis Teke

Dr Serge Blaise EMALEU

Department of Genetics/Immunology

Stanford University, School of Medicine

Palo-Alto, CA 94305-5318

California- USA

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