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HOUSE CALL WITH DR. SANJAY GUPTA
A look at Headaches and Migraines
Aired October 16, 2004 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: Good morning, and welcome to HOUSE CALL. Today, we're talking about headaches. For millions of Americans, headaches are more than inconvenient and painful. They can be crippling, from tension to sinus to migraines. What causes them and how can you beat the pain? Let's start with ways to prevent the misery of migraines. Those who suffer migraine headaches pick the words to describe them carefully.
MICHAEL JOHN COLEMAN, NATIONAL MIGRAINE ASSN.: A headache is like accidentally bumping into somebody on a crowded street. A migraine is like having the living hell beat out of you.
GUPTA (voice-over): A migraine is a headache accompanied by nausea, vomiting, sensitivity to noise and light.
BRIAN WAGNER, MIGRAINE SUFFERER: It feels like someone's taking a knife and basically stabbing you behind your eye.
GUPTA: Brian Wagner was sidelined with migraines for days at a time, several times a month.
WAGNER: I've used all my sick time because of it.
GUPTA: Most experts believe that during a migraine, blood vessels on the surface of the brain expand and push against the outer layer of the brain. The most effective treatments shrink those blood vessels, relieving the pressure.
MARC SCHOLOSSBERG, DR., WASHINGTON HOSPITAL CENTER: If people are having, for instance, more than one or more than headache a week or maybe more than five or six headaches a month, or if they still don't respond appropriately to the abortive agent, then it might be worthwhile taking something preventively.
GUPTA: At least 10 drugs have proven useful in preventing migraines. Most are actually designed to treat high blood pressure, depression, or epilepsy. They work in about two-thirds of migraine sufferers who try them.
Brian has been taking one for about two months, but he's not completely migraine free.
WAGNER: I still get them, but they don't get as bad. They don't last as long. GUPTA: Some prevention drugs have side effects like weight gain or sleepiness. The newest one, Topamax, has a side effect some might actually welcome, weight loss.
GUPTA: Of course, experts aren't in complete agreement about taking medicine to prevent headaches, but everyone agrees there are migraine triggers you can try to avoid. Some common migraine causes, certain foods such as those containing MSG or alcohol, also some odors from perfume to paint thinner. Those can also bring on a migraine. Add to that list, stress. Of course, that's never good anyway. And hormone changes, estrogen and progesterone fluctuations seem to trigger some women's migraines. Another possible problem, too much or too little sleep and weather changes, as well from the seasons to a change in barometric pressure.
Here to help us in the fight against headache pain is Dr. Larry Newman. He's director of The Headache Institute at Roosevelt Hospital Center in New York. He specializes in headache and face pain. Welcome, doctor.
LARRY NEWMAN, DR., HEADACHE SPECIALIST: Hi. How are you?
NEWMAN: Thanks for joining us. You heard this little piece about preventive drugs. How important is it to use preventive medications?
NEWMAN: Well, in general, there's two broad categories in which we treat headaches. There's the acute medications, meaning those taken at the onset of the headache to stop the headache cold. And then there are preventative agents, things taken on an ongoing basis to prevent subsequent headaches.
And in general, as you mentioned in the opening piece, we tend to give preventative medications more frequently than we had in the past. So we'll give preventative medications now for patients who have on average one headache a week or more in an attempt to stop the attacks.
NEWMAN: Of course, it's important for patients to actually go see their doctors. Most people wait until the pain starts, but let's get to some more questions on this topic. We certainly got a lot of them. I know you get these all the time.
Michelle in New Hampshire writes, "I've tried many different medications to both stop current attacks and prevent future ones. Yet I still end up taking more Imitrex in a month than is recommended. Is there any treatment out there that has shown success for chronic migraine sufferers?"
And I got to tell you, Dr. Newman, I - I mean I get these chronic migraines, as well. In your opinion for someone like Michelle, what is the best treatment option?
NEWMAN: Well, there's no one best treatment. So unfortunately, and I -- we talk to our patients at the Headache Institute about this all the time. It's really not a cookie cutter approach. You have to take the individual patient, see what their headaches are like, see if they have any other medical conditions and then you try and tailor a preventative plan.
There is a number of medications that are available preventively. And as you mentioned in the opening piece, the newest one that's just been approved by the FDA is Topiramator, Topamax, which has an excellent success rate in treating peoples' headaches.
NEWMAN: Often patients who come to us are on a variety of medications in the past, but when you look at their list of medications, they're either on the wrong medication or they're on the correct medication or at the wrong dose. So we need to adjust the medications, depending on what's right and what's wrong with their medications. And often a combination of medications will help.
GUPTA: And you know, let's say you get that patient out there. And I'm sure you've seen some of these. They've tried everything. Nothing seems to work. They do have migraine headaches. Is there anything that you know of as an expert, anything coming up on the horizon?
NEWMAN: There's a number of agents that are being looked at. They're all really early in development. And while some of them show promise in early studies and animal studies, they're really not close enough to market to make a valid conclusion.
GUPTA: All right, we'll keep ourselves posted on that. Listen, we sent our cameras out to hear what people on the street were asking about headaches. Take a listen to this question.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: What would you recommend besides medications, whether over the counter or prescription, for alleviating the pain of headaches?
(END VIDEO CLIP)
GUPTA: And I'll say, doctor, there are several options out there besides drugs. Everything from relaxation training to oxygen therapy. Acupuncture I've even heard. What would you recommend for someone who doesn't want to take medications?
NEWMAN: Well, lots of our patients don't want to take medication. And that's valid. And you have to take the wishes of the patient into consideration.
Some of the options that are available are stress management, relaxation exercises, biofeedback where the patients learn how to control their blood vessels by warming and cooling their hands or to control the tension in their muscles by doing exercises to relax the muscles. And in fact, it works quite well, especially for children. And it's a technique that we especially like to use either in young people, or in women who are thinking of becoming pregnant, or who are pregnant, where obviously you don't want to use some medications.
There's some recent studies showing that perhaps magnesium and vitamin B-2, which is riboflavin, can potentially work as a preventive in migraine. Unfortunately, these agents take about three months or so before you see that they can work or not. So there's a long lag time before you know if it's going to work or not.
GUPTA: All right. Really good advice. We're talking to Dr. Larry Newman. We'll take more of your questions on headaches when HOUSE CALL returns.
UNIDENTIFIED FEMALE: Why do women suffer more migraines than men? Are hormones to blame? If so, what can be done?
Plus, could those over the counter drugs be doing more harm than good? Safe ways to stop the pain when we come back.
But first, take today's daily dose quiz. What is the most common type of headache? The answer when we come back.
UNIDENTIFIED FEMALE: Checking the daily dose quiz, we asked what is the most common type of headache? The answer, tension headaches. Nearly 90 percent of adults have experienced one.
GUPTA: And the cause of those tension headaches, uncertain. But some experts believe muscle tightening in the back of the neck could be a factor. Unlike migraines, tension or stress headaches don't usually pulse, but instead create a pressing or vice like tightening pain. Nausea and sensitivity to light or noise can be symptoms, but not always. And that's unlike migraines. Physical exertion doesn't seem to be a trigger.
Talking with us about all forms of headaches is neurologist Dr. Larry Newman. He's director of the Headache Institute at Roosevelt Hospital Center in New York.
Doctor, we've have a lot of questions on this particular topic. Let's jump right back in. Laura from New York writes, I am at a computer all day and, even though I stretch periodically throughout the day, I still have neck and shoulder pain with severe headaches. What can I do to alleviate the problem, other than changing professions?"
So doctor, sounds like this might be a classic tension headache. First of all, do you think it is? And what can you do to get some relief from this?
NEWMAN: Well, it's actually a very good question. And as you mentioned, tension headaches or tension-type headaches as they're now called are the most common headache that's out there in the general population.
It's interestingly not the reason that people with headache go to the doctor. And the reason for that is that by definition, a tension- type headache is not disabling. It's mild or moderate.
So the first thing I would think of, if Laura was talking to me, is that if her headaches in fact are disabling, perhaps she doesn't have tension headache, but maybe she actually has a form of migraine.
And in fact, many doctors and many patients mistake the tension in the neck and in the shoulders that can sometimes accompany a migraine for a tension headache. And it's not where the headache is, as you mentioned in the piece. It's what the headache feels like and what accompanies the headache.
GUPTA: Right, would you ever...
NEWMAN: Nonetheless, whether it's -- sorry.
GUPTA: Go ahead. I was going to ask whether it's starting her on a migraine type medication then?
NEWMAN: Well, it would depend what in fact her diagnosis is after a more complete history and examining her. In fact, there's probably a spectrum of headache with migraine on one end and tension headache on the other. And they meet somewhere in the middle.
So in fact for preventative agents, many of the agents that we use to prevent migraine will also prevent chronic tension-type headache.
But for something simple, for someone like Laura, is just get up every once and a while, every half hour, every hour. Just get up and stretch. Change positions. Massage yourself. Move around. And that will decrease the stress and the tension in your muscles and will alleviate some of the pain.
GUPTA: That's probably good advice for a lot of people who work at desks all day long. Listen, we get a lot of questions from women, as well. They seem to get the majority of headaches. My producer Karen tells me that's because of men.
Let's get to an e-mail now from Colleen in Wisconsin, who asks, "Why are migraines found more often in women than in men? Does it have to do with hormones?" What do you think, doctor?
NEWMAN: Well, that's part of the reason. It's interesting. Women get headaches more than men only after puberty. Prior to puberty, little boys and girls get migraine at about an exactly equal rate. So it's after puberty with this onset of estrogen that women seem to take the lead. So there is probably some hormonal implication in causing migraines to occur more often in women, but it's probably not the only reason. And we don't know the other reasons are yet.
GUPTA: Well, let's keep on topic with that. We got a question now coming from our roving camera on this topic. Take a listen. (BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: What causes menstrual headaches? And what medicine would be good to take for it?
(END VIDEO CLIP)
GUPTA: And so, you know, a lot of women, doctor, seem to get these headaches at the end of their cycles. Is that correct? And what options do they have?
NEWMAN: Well, typically, women who have migraines have migraines around their menstrual cycle. Unfortunately, again, many of these women don't get correctly diagnosed. They're told that it's stress or it's part of the menstrual - it's part of the menstrual cycle. And that's not really the case.
Usually what happens in migraine sufferers, as the estrogen levels fall off, and the menses begin, there's a tendency to develop headache. In fact, about 70 or 75 percent of women who have migraine will tell us that their migraines occur with their menstrual cycle. They can occur other times of the month as well, but they will also occur around the menstrual cycle.
GUPTA: They treat them the same way. Is there anything that they can do with taking hormones to try and alleviate those or what do they do?
NEWMAN: Well, again, many of the medications that we use -- that can be used acutely for a migraine any time of the month will also work for a migraine during the menstrual cycle.
GUPTA: OK, all right.
NEWMAN: What we see, though, is many of these women tell us that those drugs work, but then the headache seems to come back later during the cycle.
So a number of strategies have been developed. You can take an anti-inflammatory medication, one of the enseds, around the women's menstrual cycle starting a few days before and through about five days into it and you can actually prevent the headache. There have been studies using over the counter magnesium to prevent this.
GUPTA: So clearly, a lot of different options there even if you are getting these headaches from -- related to your cycle.
Let's keep going here. Heading to the nation's capitol now, Stephanie in Washington wants to know, "What should one do if the headache actually gets worse, rather than better, when taking Advil or similar medication?"
And doctor, I know you know about this, but there are headaches known as rebound headaches that are caused by taking medications too often or by taking too much. Sounds like Stephanie may fall into this category, doctor. What do you think? NEWMAN: It sure does. What a rebound headache is or a medication overuse headache is, is that the frequent use of certain painkillers, whether it's over the counter medications or the prescription medications that are used specifically to treat a headache over time, as a patient takes them frequently and frequently just means a couple of times a week or more, the medications rather than stopping the headache actually rebound. And as the drug wears out of the patient's system, it actually causes a headache fresh. And they just start chasing their tail. So whereas one medication, one pill in the past would have worked, they're now taking three, four, five, six pills a day or more.
GUPTA: So that's not always the answer, taking more and more pills?
NEWMAN: It's not -- right. And again, many patients confuse the fact that if it's an over the counter medication, it's safe and you don't follow the package direction.
NEWMAN: And just because the drug is not available with a need for a prescription, doesn't mean it can't have some serious consequences.
GUPTA: All right, OK. Dr. Larry Newman, giving us some advice. Of course, we're not just talking about migraines. Those daily headaches as well are a pain. Stay tuned for some relief.
UNIDENTIFIED FEMALE: From changing weather to painful sinuses, what's causing your headache? And when should you get help? Plus, latte withdrawal. How to deal with caffeine headaches.
First, this week's top headlines in the pulse.
(BEGIN VIDEO CLIP)
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): Actor Christopher Reeve died this week at age 52 after a massive infection from a pressure sore caused his heart to fail. Reeve, most famous for his role as Superman, had been paralyzed from a horseback riding accident in 1995. He became one of the nation's leading advocates for spinal cord injury research, including the controversial use of embryonic stem cells.
Also, the Centers for Disease Control, along with flu shot manufacturer Adventis Pasteur announced their plans this week to distribute the limited amount of this year's flu vaccine to the public. The first 14 million doses will be shipped to so-called high priority vaccine providers, such as hospitals and nursing homes. And the remaining eight million doses will be sent to other designated high need areas.
Long lines at public health clinics and supermarkets have already been reported across the country, due to a major shortage of this year vaccine. Christy Fife, CNN.
(END VIDEO CLIP)
GUPTA: Just about everybody gets headaches at one time or another. Welcome back to HOUSE CALL. We're talking about the aching, pulsing, throbbing pain of headaches.
Bringing us up-to-date on how to deal with this pain is Dr. Larry Newman. He's a neurologist who specializes in headache and face pain.
Doctor, I want to just take a second and talk about another type of headache, cluster headaches. They're relatively rare, but incredibly painful.
Coming in groups of as many times as eight times per day. And these are characterized by sharp stabbing pain, that often originates around the eye and can last weeks or months.
We got a question on this topic from Colin in Alberta, Canada, who asks, "Are there any new treatments, developments, drugs or research that may lead to relief for those suffering from cluster headaches?"
Doctor, do you know of any?
NEWMAN: Actually, there's a lot of research going on. The newest approach for people who have intractable cluster, meaning all the medications that are available don't work and surgical approaches don't work, there's now some evidence that using a deep brain stimulator, deep into the brain, can actually shut off the attacks in some patients.
GUPTA: So actually doing an operation perhaps.
GUPTA: Let's get to a question now from Heather, who's a nurse in Wisconsin. "How is weather related to headaches? I experience more headaches when the weather changes are more drastic, and I have noted many people coming into the ER with complaints of headaches as well."
So doctor, how big of a role does weather play? And are certain changes worse for headache sufferers than others?
NEWMAN: It affects migraine - weather affects migraine more often than any other type of headache. And in fact, it's not weather changes, per se. It's the change in the barometric pressure. So when it's raining, the people are fine. But as the storm fronts are coming in, and the barometric pressure falls, that will trigger a migraine headache in a number of people.
GUPTA: Does it trigger sinus headaches as well, because that's a pressure on your sinuses, right?
NEWMAN: Well, that's actually a myth. Many of the people who say that their headaches are triggered by weather have been labeled as sinus headache sufferers. And in fact, if you actually take a careful history on most of these people who think they have sinus headache, they're actually migraine sufferers who have been misdiagnosed.
GUPTA: So there's probably a lot more migraine sufferers out there than we know about. Another e-mail now coming from Julie in Virginia. "Kindly explain, doctor, why going one day without the usual 1-2 cups of coffee in the morning can result in a day-long splitting headache."
I hear that a lot, actually, doctor. We're talking about caffeine withdrawal here, right? What's your advice on that?
NEWMAN: Exactly. You'd probably hear that a lot for patients who are being prepped for surgery. Many of the times, they go into the hospital. They're not allowed to eat, obviously. And their withdrawal from the regular caffeine and from their coffee will trigger a headache.
Caffeine withdrawal is similar to the rebound headaches we talked about earlier.
NEWMAN: As the caffeine that the body is so used to, wears out of the system since caffeine is usually a vasal constrictor, it narrows the blood vessels. Without that, the blood vessels dilate and it causes a headache.
GUPTA: And I know my wife, for example, will just drink more and more caffeine to try and keep up with it. But eventually, that could catch up with her, right?
GUPTA: Yes. Much more medical news as well, coming up on HOUSE CALL.
UNIDENTIFIED FEMALE: Grab a pen. When HOUSE CALL returns, we'll tell you how to find a doctor in your area and what you need to bring on your next visit. Plus some helpful Web sites. But first, here's a tip from our health conscious bod squad.
HOLLY FIRFER, CNN CORRESPONDENT (voice-over): Thirty-five pregnant and searching for some comfort, Lafa Ericson is about to have her first prenatal massage.
UNIDENTIFIED MALE: This is actually designed so you can lay on your stomach.
UNIDENTIFIED FEMALE: Massage therapist say massage can do wonders, such as bringing about relaxation and better sleep. Relieving pain in the ankles, lower back, and pelvis, reducing swelling in the hands and feet, alleviating headaches and sinus congestion. Only in a few circumstances are women cautioned against massage.
ALAN RICHMOND, DR., OB-GYN: Women who shouldn't have massage are those women with known hypertension, known pregnancy induced hypertension, diagnosed preeclampsia and a great deal of swelling in the lower extremities. They should consult their physicians first.
FIRFER: It's also wise for pregnant women to seek out a therapist certified in prenatal massage. Those therapists are trained not to apply direct pressure to the area between the ankle and the heel, because of the possibility of promoting early labor.
After an hour-long massage, Lafa Ericson is feeling relaxed.
Holly Firfer, CNN, Atlanta.
GUPTA: For more information on preventing and treating headaches, click on to www.headaches.org. You can research clinical trials there or take their headache screening quiz.
To find a headache specialist in your area, go to www.achenet.org. That's the American Council for Headache Education.
One of the most important things to bring when you go see your doctor for a headache is a diary. Track your attacks, the time and intensity and how you treated them. Also, write down any triggers or symptoms you think are related as well.
We've been talking to Dr. Larry Newman today. Lots of good advice. Any final thought today, sir?
NEWMAN: Well, all I would say is there's really no reason for somebody with headache to suffer anymore. There's a lot that's offered. Go get help.
GUPTA: Well, we're out of time for today. Thank you, Dr. Larry Newman., Some really good advice for folks out there. Thanks for joining us.
And thank you as well at home for all of your great questions. Make sure to tune in every weekend to HOUSE CALL. Remember, this is the place for the answers to all of your medical questions.
Send them to firstname.lastname@example.org. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.
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