APRIL 10, 2011 MIGRAINES

"TREAT your friends as you do your pictures, and place them in their best light." --Jennie Jerome Churchill

How do you treat your pictures? I had to think about that for a moment. Then I understood what she meant. I display my photographs of family, friends, and my partner, Rick, in beautiful frames in the den. I do have them in the best light. I love sitting on the couch in the den at night when everyone is sleeping. I glance at those photographs, some new, and many old. I reflect-- smile, tear up and even laugh to myself at some fun old times. I put those old photographs delicately in the frames. I treated those old photos with respect, dignity and love.

This is how I treat my friends --with respect, dignity and love. As I glance at those photographs I think of all the acquaintances and closer friends who are more like family.

Photographs are memories to the heart. Never forget that!

One of the most common complaints to an internist office are headaches. There are many possible causes and the internist must find the cause. I start to think of underlying causes as stress, hormones, food or environmental allergies, dysglycemia, exhaustion, medication side effects and even chronic constipation. I always eliminate dairy and gluten from the diet in a patient who suffers from migraines. A thorough history and physical can give some important clues to the individual's headache. The intake can typically diagnose the specific type of headache and target the most appropriate treatment. Migraines are not hard to miss due to the visual disturbance, acute onset, sometimes accompanying nausea and vomiting and location in a specific spot or side of the head. We do know that migraines are neurovascular phenomena that can occur as frequently as several times a week. I have sometimes (although rarely) seen a migraine occur just once or twice a year.

In 1982, my mother was taken to the hospital in the morning of June 5th for a migraine.It was the worst headache of her life. She was sent home with a pain medication, percocet. Hours later she screamed with head pain and passed out. We found out later that she never had a migraine but the leakage of a subarachnoid bleed which eventually ruptured her aneursym that she never knew she had. Aneursyms do run in families as do migraines.

I listen carefully when a patient describes the worst headache of their life. The main difference in a migraine is the visual disturbance. The pathophysiology of a migraine involves the vasoconstriction, vasodilation and vascular inflammation. There is no clear cut etiology for a migraine. I know many patients that have migraines which can be debilitating. There are many up to date hypothesis for migraines including mast cell release of histamine and serotonin. The conventional medications that have been used for migraines include elavil, beta blockers, methyseride, imitrex and ergot.

The one herb commonly utilized for migraine relief is Feverfew (Tanacetum parthenium). It has the ability to prevent migraines in chronic sufferers. The chemical constituent that is most active is parthenolide. It is supposedly inhibiting the release of serotonin. If taken at the onset of the migraine it can be effective. The herb Butterbur (Petasitis hybridus) has been used in Europe to relieve the occurence of migraines but I have never used it. I have used other herbs including Rumex, Mahonia and Leonurus with some good results. I often have my colleagues in Naturopathic Medicine see these patients. Many migraine sufferers use the homeopathic remedies Atropa belladonna, Spigela and Gelsemiums sempervirens.

Until tomorrow...