Tuesday, August 21, 2007

I have cramps, therefore I have headache

In honor of my current headache which is more than likely related to my awful menstrual cramps, here is an article I stumbled upon from the National Pain Foundation. If you have had headaches for a while, it's nothing new, but if you're just now starting to get them, the article may help you. It's a good idea to try different things to see if you can get rid of your headaches, but just FYI - the chocolate thing is silly. Who can go without chocolate?

Just kidding - if it meant not having headaches, I'd drop it like it's hot.

Quick updates before I post the article: I'm now taking Desipramine, recommended by my neuro for headache prevention. It's for depression, and similar meds I've tried did not work, but he said I need to try it for a while and said it's the "most tolerable" one as far as side effects go. I'm also still seeing a chiropractor, but they were charging me toward my deductible even though I was only supposed to be paying copay, so I worked that out after several phone calls.

LESSON: Never trust anything related to insurance. Pay attention and make sure you are not being overcharged.

Now for the article. Here is the link: http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZW5W10AFE&sub_cat=0

And here are the highlights:

Non-medicinal Treatments for Menstrual Migraine
Women with migraine are generally more susceptible to dietary, physical, environmental and other triggers for migraine attacks during the week before and the first few days of their period. Following are some guidelines that can decrease the likelihood of having a migraine from these triggers.
1. Eat regularly scheduled, well-balanced meals. Avoid missing meals because low blood sugar and hunger are frequent triggers for migraine attacks. On the other hand, avoid eating sweets or meals the contain a lot of carbohydrates because doing so might lead to a rapid drop in blood sugar levels two to three hours after you have these foods (this is sometimes called a "sugar or carbohydrate crash").
2. Drink plenty of fluid. Avoid dehydration because this too is a frequent migraine trigger.
3. Get a good night's sleep. Follow a regular and consistent schedule of waking and sleeping. Avoid going to bed late, "sleeping in," becoming sleep deprived, or a haphazard sleep schedule.
4. Stay away from well-known migraine triggers such as wine, beer or other alcohol containing drinks; chocolate and other sweets; aged cheeses such as cheddar or Brie; and salty foods, especially during the week before your period.
5. Participate in a regular aerobic exercise program. If you have not been exercising regularly, discuss exercise plans with your doctor or a personal trainer and set up a physical conditioning plan that matches your needs. Start your exercise program slowly and gradually build up your level of activity as your physical condition improves. This type of treatment works best if you continue the exercise program on a regular basis, not just on weekends or only once in a while.
6. Learn and regularly practice biofeedback and other relaxation techniques. These types of treatment have demonstrated excellent benefit in clinical studies; and best of all, there are no potential side effects.

Short-term Prevention of Menstrual Migraine
Short-term migraine prevention, often called "mini-prophylaxis," can be used to preemptively manage predictable migraine attacks such as those related with menstruation or ovulation. Your physician may prescribe a medication that you begin taking a day or two before the expected onset of headache and continue taking on a regular daily schedule for five to seven days. There are several medications that have been used for mini-prophylaxis of migraine.
1. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, in "prescription strength" dosages have been used successfully for the prevention of menstrual migraine. Women with stomach ulcers or certain kidney problems usually cannot use these medications. Consult with your physician before taking any over-the-counter medication.
2. Migraine-specific drugs such as triptans or ergot derivatives also have been successful for short-term prevention of menstrual migraine. Women with certain heart or circulation problems might not be able to use these medications.
a. Ergot derivatives, such as ergotamine tartrate, dihydroergotamine or methylergonovine, have all been used for mini-prophylaxis. Nausea and muscle cramps might occur in some women. Dihydroergotamine is available as a nasal spray while the other two are tablets.
b. A few triptans have been found effective for mini-prophylaxis of menstrual migraine in clinical drug studies. The medications that have been studied specifically for this purpose are frovatriptan, naratriptan and sumatriptan. These medications generally are better tolerated than the ergot derivatives.
3. NSAIDs can be used together triptans or ergot derivatives in cases of menstrual headaches that do not respond to any of these medications alone. Triptans and ergot derivatives should not be used together or within 24 hours of one another. Non-medicinal treatments can certainly be added to any of these medications, and this often is a way to get the best results.

Long-term Prevention of Menstrual Migraine
Long-term prevention, which means taking preventive medication(s) every day of the month, might be required if migraine attacks occur too frequently (ie, averaging more than four headache days in a month), migraine attacks cause too much disability, or medications used for mini-prophylaxis are not effective, too expensive, or unsafe to use because of other medical conditions. There are many different kinds of medications prescribed for long-term migraine prevention. The medications most often used for migraine prevention are blood pressure lowering drugs such as beta-blockers or calcium channel blockers, antidepressants and antiepileptic drugs. Each medication in these classes of medication has its own benefits and side effects. Your physician will determine which medication is best for you. Sometimes you may need more than one medication to control particularly resistant headaches. It is not unusual to try several medications or combinations of medications before the best treatment is found. It might take several weeks for a medication to demonstrate its benefit.

This article is written by David M. Biondi, DO.