Best treatments for the most common symptom
Headache has been called the most common symptom. A study, which appeared in Lancet Neurology (Vol 7, Issue 4, April 2008), reported that, worldwide, 47% of people have headaches of some type. Around 15% of people suffer from the most common severe type of headache, migraine. About 3-4% of people have headaches on more days than not. More women have migraine than men because of the added neurological stress of the cycling of estrogens. It, therefore affects women during the most productive years of their lives. Headache disorders in general, cause more disability than all other neurological diseases, because they are so common, ranking 7th on the World Health Organization’s list of reasons for disability.
The symptom of headache is a normal and healthy part of our natural defense system. It is often part of the constellation of symptoms that accompany many illnesses. In those cases, headache serves as an alarm system, warning us that something is wrong or to intentionally disable us so that we rest while we recover from that illness. When headaches reoccur, it is usually not warning of something else wrong but because the headache alarm system, itself is broken. We call these primary headaches.
Primary headaches, such as migraine, are the most common disabling headache condition. A genetic mutation within the headache alarm system is usually responsible for most migraine disorders. Five migraine genes have been found so far. Other factors, including head or neck injuries, can start headaches, or make them worse.
Our goal of headache treatment is to reduce the frequency by 80% and to find ways to stop the headaches that do start. There are four paths to getting headaches under control:
- The first step is making sure there is not an underlying cause. A good headache clinician can quickly rule out these other causes. Once an underlying cause has been ruled out, the patient is best served by focusing on getting better rather than to continue the endless pursuit for the “cause.” When a car alarm goes off, the first thing you do is to look for a burglar. But when it continuously goes off, and no burglars are found, then you must focus on fixing the alarm.
- The second approach is trying physical measures. These include everything from massage and acupuncture, to nerve blocks and Botox. Some of the newer physical measures include wearable or implantable electrical nerve stimulators and devices that send a magnetic pulse into the brain to stop a migraine (TMS).
- The third category of treatment is dietary. We wish that a particular diet would mitigate headaches, but the evidence from research is, unfortunately, showing that our foods play less of a role in headache than we thought in the 1980s or 90s. Most modern headache clinics no long use food trigger lists or rigid diets as we did in previous decades. Many food supplements have also been studied and only about five have evidence of being helpful and that help is modest at best. However, we always try dietary supplements first.
- The fourth category of preventative treatment is using medications. However, until this point, there have been no migraine-specific medications on the market to prevent headaches. That will all change this year when several exciting new treatments specifically targeting migraine prevention will be available.
The development of these new migraine-specific medications is unique because, until now, migraines have been treated with drugs that were created for totally different issues such as high blood pressure, depression and aesthetics (smooth wrinkles). Of the more than 6,000 medications on the market, about 25 to 30 have also been helpful in preventing headaches. These medications can be quite effective and have been proven to be safe with long-term use. It is our goal to use medications, precisely, tailoring to each individual’s type of headache and lifestyle to reduce the headaches the most with no side effects. Often, unlike other bad diseases, headache disorders often resolve over time naturally. I will present these new treatments in detail in the next issue of Heartbeats Magazine.