Dorian Kramer: Migraines
Published Date
Approximately 45 million Americans suffer from Migraines, with women having three times the number as men. Even with these numbers migraine sufferers are very under diagnosed by up to 50 percent. The financial costs to our country from the 113 million lost work days are a staggering 13 billion dollars, with the actual health costs doubling that number.
Migraine is a chronic disorder characterized by moderate to severe headaches. Although some believe it to be a neurological disorder, there is little evidence to confirm this theory.
A typical migraine headache is unilateral (affecting one half of the head) and pulsating in nature, though bilateral (both sides) migraines are experienced as well; the unilateral one can switch sides sometimes within the same event. These attacks typically last anywhere from two to 72 hours. Symptoms include nausea, vomiting, photophobia (increased sensitivity to light) and phonophobia (increased sensitivity to sound). Approximately one-third of people who suffer from migraine headaches perceive an aura, usually characterized as a transient sensory, motor, visual or auditory phenomenon. Migraine attacks are often set off by certain triggers, for some they may occur after or during times of high emotional stress, others may occur during times of exhaustion. For some migraineurs (migraine sufferers) there are food or beverage triggers, alcohol (especially red wine), foods with MSG or tyramine like aged cheeses, preserved meats with nitrates, and caffeine. In certain cases weather patterns and barometer changes act as a trigger, while of course for some a combination of triggers leads to an attack.
Western diagnosis of migraines is based on the symptoms along with family history once any other conditions are ruled out. Treatment of migraines can be broken up into nonspecific treatment and specific treatment.
The non-specific treatment involves the use of analgesics (pain killers), and is broken up into three levels, low range, midrange, and high range analgesics. The first level is the low range ones which consist of over the counter analgesics or prescription NSAIDs (non-steroidal anti-inflammatory drugs) some combined with caffeine. Examples are aspirin, acetaminophen, and ketorolac, though they have been found to diminish the severity of attacks no one seems to work better than the other. Their side effects are usually restricted to gastrointestinal issues and there is no chance of addiction. The mid-range analgesics use sedatives like butalbital combined with aspirin or acetaminophen, here the concern is some dependency combined with a rebound effect along with specific side effects. High range analgesics usually involve the introduction of opioid/narcotics, the use of narcotics is somewhat controversial with questionable results, in addition to rebound responses and other side effects the potential for abuse and addiction with these medications is always present. A relatively new western approach is the use of Botulinum toxin type A or Botox which is injected into the muscles of the head and neck in order to partially paralyses these muscles and reduce spasms.
The potential side effects of this treatment include but are not limited to chest pain; difficult, frequent, or painful urination; difficulty swallowing or breathing; double or blurred vision, or other vision changes; drooping of the upper eyelid; eyelid swelling; fainting; fever, chills, or persistent sore throat; irregular heartbeat; loss of bladder control, loss of strength; paralysis; seizures; severe or persistent muscle weakness, headache, or dizziness; shortness of breath; speech changes or problems; worsening migraine. Here we should also discuss a previous term, rebound headaches. Patients with frequent attacks can often overuse the analgesic treatments in order to avoid the attack, unfortunately this can lead to a dependency and drug induced rebound headaches forcing a vicious cycle of daily usage of analgesics in order to stave off the headache that they are becoming the root of.
Specific therapy involves the use of drugs that act on certain receptor sites, these drugs activate these receptors causing them to block the release of neuropeptides which lead to neurogenic inflammation. The current choice is a drug called Dihydroergotamine (DHE), which is a safer version of the older Ergotamine. The most common side effects of these drugs are abnormal skin sensations, anxiety, diarrhea, dizziness, flushing, headache, increased sweating, nausea, vomiting.
Combined with the previous treatments lifestyle changes may be necessary. For patients with food triggers an elimination diet may be used to find any specific food triggers and then change their diet in order to avoid them. For some with emotional or stress related triggers, a program of exercise and meditation or relaxation techniques can be introduced.
For those who seek an alternative model or wish to combine their current allopathic treatments with alternative medicine, recent studies have shed a very promising light on the use of acupuncture and Chinese medicine. The first Cochrane review by Linde and colleagues focused on acupuncture for tension headaches. The researchers evaluated 11 studies that investigated 2,317 participants. The studies compared participants who had undergone acupuncture therapy with those who had no treatment except painkillers for acute headaches, or had a sham therapy, which mimicked acupuncture. Patients who received acupuncture had fewer headaches. Forty-seven percent of patients who received acupuncture reported a decrease in the number of headache days by at least half, compared with 16 percent of patients in the control groups.
In a study, published in the March 15 2004 issue of the British Medical Journal, researchers randomly divided 401 adults aged 18-65 years old with chronic headache (at least two headaches a month) -- into two treatment groups. Participants had a history of having predominantly migraine headaches. One group received up to 12 acupuncture sessions during a three-month period in addition to standard medical care, and the other group received standard care alone. After 1 year those who received acupuncture, experienced 22 fewer days with headaches, used 15 percent less medication, made 25 percent fewer visits to their doctor, took 15 percent fewer days off sick from work than the control group.
These studies focused primarily on the use of acupuncture alone. According to case studies in China when acupuncture is combined with other traditional eastern techniques including, but not limited to Herbal medicine, cupping, Gua Sha, and Tui Na the efficacy of the treatments greatly improves.
One should always do one's own research as well to learn more about the side effects of any potential treatment and consult with their physician in order to find the best possible route to health.
Dorian G. Kramer is a graduate from The New School for Holistic Medicine and Research in New York with a Master's degree in Oriental Medicine, and a NH State licensed acupuncturist and Chinese herbal diplomate. He is trained in Traditional Chinese medicine, Japanese meridian therapy, Shonishin or Japanese Pediatric Acupuncture, Dr. Manakas style of Acupuncture, the Hari system of Japanese acupuncture, Shakujyu acupuncture, Tui Na, the NADA protocol and Classical Chinese Herbal medicine. Kramer maintains a full-time practice in North Conway at 170 Kearsarge Street in the Youth and Child Center for Wellness. For more information or to schedule an appointment contact him at 603-356-4114 or This email address is being protected from spambots. You need JavaScript enabled to view it. .
