By Alexander Mauskop, MD
As a neurologist specializing in headaches, I see patients with chronic migraines–a serious and debilitating disease which can cause moderate to severe disability. According to the Migraine Research Foundation, approximately 2% of people in the United States suffer with chronic migraines. Chronic migraine is defined as headaches that occur on more than 15 days each month. Some people suffer from migraine headaches continuously all day long, every day of the month.
Migraine is a neurological disease. It is important to understand that chronic migraines are physiological, not psychological. They are related to how your body functions and not caused by problems with your mind. Most importantly, migraine is more than a bad headache. It is a collection of neurological symptoms that can include headache, changes in vision, dizziness, nausea and vomiting, and extreme sensitivity to light, sound, touch and smell.
Chronic migraines are caused by a combination of environmental and hereditary factors. Some people tell me that "my mother has migraines, but she has them once a year." Having a family member who suffers from any type of migraine can indicate a genetic disposition making you more susceptible to getting headaches. One family member could have daily headaches, another only once a year.
While you can't choose your parents, you can address headache triggers. Stress, magnesium deficiency, caffeine consumption, sleep patterns, and nutritional factors may cause headaches. Your first step to learn your headache triggers is to keep a diary. I developed an iPhone app, the Headache Relief Diary, to help patients keep an accurate record of their headaches. Keeping a diary will help you learn what triggers your own headaches and will help your doctor design a treatment plan specifically for your condition.
I often recommend the following treatments to my chronic migraine patients: Avoid caffeine, get regular exercise, try biofeedback/meditation, take a magnesium supplement, and try Botox (Botulinum Toxin Type A). More than 70% of the patients I treat with Botox find relief. Here are some further coping tips I have for people who suffer from chronic migraine.
Get Aerobic Exercise. One of the proven ways to help relieve stress, particularly proven to help people with migraines, is regular aerobic exercise. I usually recommend at least three times a week for at least 30 or 40 minutes. There is a direct correlation between more exercise and fewer headaches. Some patients say they don't have time to exercise; but you also have to consider time lost when you do suffer a migraine. Exercise is essential if you want to get better.
Try Relaxation Exercises. Everyone knows that stress is a major cause of headaches, and relaxation therapy helps. Biofeedback is a type of computerized relaxation training, and it works for many of my patients. Progressive relaxation also works, as does yoga and meditation. All relaxation therapies are equally effective.
Stick to a Regular Sleep Schedule. Go to sleep at the same time each night; wake up at the same time each morning, even on the weekends. Both lack of sleep and too much sleep can cause headaches.
Take Magnesium Supplements. Magnesium deficiency can cause migraine headaches for some people. Symptoms of magnesium deficiency include migraine headaches, cold hands and feet, premenstrual syndrome, and muscle cramps in your legs. To supplement with magnesium, start with 400 mg daily.
Avoid Food Triggers. Which foods trigger headaches varies from patient to patient. Some food triggers are quickly obvious. If you have a glass of wine and you get a headache, then wine is one of your food triggers. Other common food triggers are chocolate, MSG (monosodium glutamate), preservative-laden food, and sugar substitutes. Many headache suffers may also have a gluten sensitivity and should try a gluten-free diet. Finally, sugar sensitivity is a common problem with headache sufferers.
Avoid Caffeine. Patients often do not realize caffeine is the culprit because caffeine often helps them feel better. The reality is that caffeine withdrawal is what is giving them their headaches. They have caffeine and they feel better, but two hours later they need more caffeine.
Consider Supplements. There are some supplements that can help people with chronic migraines, including CoQ10 (300 mg), butterbur (150 mg), feverfew, riboflavin (vitamin B2), vitamin B12, and fish oil. Keep in mind that butterbur is a toxic plant so never use it in anything except its pure form. Speak to your doctor first before adding supplements to your diet.
Consider Preventive Treatments. You may benefit from taking a medication that decreases the frequency and severity of migraines. Ask your doctor about the best preventive option for you, which may include beta-blockers, antihypertensives, anti-epileptics, or new CGRP blocker medications.
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