Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

Headaches are certainly the most frequent and perplexing of all problems seen by physicians. Headache is the ninth most common cause of physician visits.(1) The symptoms of migraine include headaches that last from 3 hours to 3 days, with an average of about 12-18 hours. They usually occur no more often than 1 per week and one or two per month is about average. The onset of pain is usually gradual and on one side, but may switch sides or involve the entire head. The pain is throbbing and moderate to severe. There are often symptoms which precede the attack by several hours or days manifested generally by emotional or mental disturbances, digestive upsets and fluid imbalances. Neurologic manifestations may occur of a visual nature such as rainbows around lights, streaks or pings of light, but may also include loss of appetite, nausea and vomiting, and other neurologic features.

Migraine can be most easily explained as a result of the release of chemical substances in the brain and other tissues following antigen: antibody reactions. The eating of foods responsible for the antigen: antibody reactions account for the presence in the tissues of chemicals that cause the headache, noradrenaline, histamine, and other biochemical substances capable of causing the symptoms of migraine.(2)

Migraine affects about 20% of the adult population, with more women affected than men.(3) One hundred and twenty children with migraine showed an average onset of 5 to 15 years with about equal sex ratio under the age of 9. Family history was positive for 79%. Eye symptoms occurred in 42%.(4) People with migraines often have a family history of "sick headaches," or a history of digestive upsets, travel sickness, asthma, eczema, or hay fever.(5)

The cause of the headaches is different from the triggering agent. As an example: the cause of a migraine may be a food sensitivity, whereas the trigger may be an emotional upset. Attacks may be triggered by numerous factors such as eating certain foods, a low blood sugar (hypoglycemia), tension, depression, alcohol, vasodilator drugs, water retention, and menstruation. Chocolate, alcoholic beverages or tyramine containing foods such as cheese and wines are triggers for recurrent headache. There may also be multiple aggravating factors which may neither cause nor trigger an attack but make it worse once it occurs.(6) The aggravating factors include poor air, constipation, chilling, noise, etc.

There is a genetic predisposition to migraines, just as to asthma and allergies. The autonomic nervous system malfunctions and fails to keep all things orderly in the blood vessels and in the chemistry.

There is a relationship between exposure to the sun and the development of migraines. Of 263 patients, 30% of the patients with migraines reported an exposure to the sun as a precipitating factor, whereas only 17% of patients with non-migraine headaches and 7% of patients with muscle contractions headaches observed this relationship. Probably these persons dilate their blood vessels too much in response to the sunshine. Sun exposure is a more frequent triggering factor in migraine than diet.

Pain-sensitive structures outside the heat that may be involved with migraines include the skin, scalp, fascia, muscles and arteries. The lining of the sinuses, mouth, pharynx, and nose are all pain sensitive. The functioning tissues of the brain (white and gray matter are not, nor are the covering membrane of the brain), the dura and meninges or the ependyma, the structure that forms the spinal fluid. Pain in the head from any cause is derived from one or more stretched blood vessels. In migraines an artery, most commonly the superficial temporal artery becomes constricted at first, then the same segment of the artery becomes widely dilated, and overstretched. The pressure of the blood carried in the artery increases the pain, whereas compression of the artery with the hands on the side of the head over the dilated segment will cause relief of pain. The control of blood vessel tone is through the autonomic nervous system.

The objectives of treatment are twofold: to reduce the number of headaches or to stop them entirely, and to treat the acute attack without the injurious medications usually used. The medications that migraine patients sometimes take often become as troublesome as the symptoms themselves.(7)

To take advantage of the blood vessel mechanism to break the constriction-dilation cycle by changes in temperature of the body, it is suggested that a hot bath followed by a cold shower at the onset of pain can bring relief. The patient can know that he can exert some control over the pain by things done himself, and can therefore gradually reduce or omit medications. The exposure to the hot water needs to be long enough to cause reddening of the skin, and the cold should be long enough to bring a bit of a shivering. Cracked ice in the mouth or throat can sometimes bring tightening up of blood vessels and relief of the headache. Exercise has also been found to reduce the frequency of migraine headaches.(8)

Foods implicated as causes of migraines in one survey were dairy products (especially cheese), citrus fruits, alcoholic drinks, fatty or fried foods, onions, tea and coffee, meat (especially pork), and sea food.In another survey the commonest foods causing migraines were wheat (78%), orange (65%), eggs (45%), tea and coffee (40% each), chocolate and milk (37% each), beef (35%), and corn, cane sugar and yeast (33% each). When an average of 10 common foods were avoided there was a dramatic fall in the number of headaches per month, 85% of patients becoming headache free. The 25% of patients with high blood pressure also became normal in blood pressure.(9)

Journal of Chronic Diseases 34(4):147-158, 1981

Postgraduate Medical Journal 56(659):617-621, September 1980

The Lancet 2(1884):1-2, July 5, 1980

Journal of the Royal College of General Practitioners 29(652-665) November 1979

Biochemical Society Transactions 9(4):351-357, August 1981

Postgraduate Medical Journal 56(659):617-621, September 1980

Headache, January 1980, page 42

Physician and Sportsmedicine 9(8):24, August 1981

The Lancet 1(8123):966-969, May 5, 1979

Family Practice News, May 1, 1980, page 40