NWHSU expert featured in Martha Stewart Living
How to Handle Any Headache
By Laura Beil at Martha Stewart Living
The list of headache triggers reads like a long, bewildering journal entry. You can get one from drinking too much coffee (or skipping your usual cup), having a glass of wine, eating the wrong meat (with nitrates) or an aged cheese, feeling stressed, sleeping too little—or too much. Regular exercise can help prevent them, except when strenuous exertion brings one on. They may come when your period starts, or stops; they can be a side effect of an unrelated medical condition, or the drugs you take for it. And some aches just appear out of nowhere.
Thankfully, there are almost as many simple and effective remedies. Dehydration is often at the root, so drinking water is a great idea, as is lying down for a little while, or (a biggie these days) peeling your gaze away from the eye-drying, tension-drumming phone or computer screen. Other natural soothers include dabbing peppermint oil on your temples or lavender oil above your upper lip, says Angela Patterson, chief nurse-practitioner officer for CVS MinuteClinic. DIY acupressure works, too: Squeeze the webbing between your thumb and index finger and hold it for 10 seconds, or massage that spot for 20 to 30 seconds, suggests Michele Renee, director of integrative care at Northwestern Health Sciences University, in Bloominton, Minnesota.
If you need something stronger, drink caffeine, which “narrows blood vessels in the brain and slows the rush and pressure of blood flow to the area,” suggests Los Angeles physician Bita Nasseri, MD, who prefers coffee to tea because it has fewer by-products that can sometimes worsen headaches. And if none of the aforementioned tactics bring relief, try taking an over-the-counter pain reliever like ibuprofen or acetaminophen, with food (to avoid stomach upset) and wash it down with a caffeinated drink to make it more effective, Patterson says.
Of course, all these ideas sound like child’s play when it comes to the mother of all headaches: the migraine. Its excruciating symptoms—bouts of nausea, visual disturbances, throbbing pain—are far more complicated, and can last a few hours or even days. (Chronic sufferers experience them at least 15 days a month.) “Migraine is the number-one most disabling disease in the U.S.,” says Amaal Starling, MD, a neurologist and headache specialist at the Mayo Clinic in Scottsdale, Arizona. And until the past few years, “we had nothing—zero—available designed to treat it, which is crazy given that in the U.S. alone, it affects nearly 50 million people.”
But today, thanks to a revolution in migraine research, help is truly here. For generations, preventive measures consisted of taking B vitamins or medications originally developed for seizures or depression, or more recently, getting cranial Botox shots. You could also try drugs called triptans to quiet overactive nerves at the onset of an attack. But as scientists better understand the causes, including the role of certain molecules in the body, more powerful treatments are being created. Here, a run-through of the latest and greatest.
Meet a new protein: calcitonin gene-related peptide, or CGRP, which is present throughout the body but especially prevalent in the sensory nerves of the brain and spinal cord. Discovered almost 30 years ago, it has long been thought to play a role in migraine disease. But the first medicine aimed at CGRP, an antibody that latches onto it and reduces its activity, wasn’t approved until 2018. Now several different antibodies are on the market. They’re delivered monthly or quarterly by injection or IV, says Teshamae Monteith, MD, chief of the headache division at the University of Miami Miller School of Medicine. Since they are designed specifically for migraine prevention, she adds, they may have fewer side effects than antiseizure or antidepressant drugs, too. Best of all—hallelujah!—they work for many people: One of the latest studies, published in May in the International Headache Society journal Cephalalgia, found that among 609 chronic migraine patients receiving monthly shots of CGRP antibodies, most who completed the study reported that the frequency of their attacks dropped by at least half. A lucky 8.9 percent had none at all.
Gepants are another new type of CGRP antibody. They’re for in-the-moment migraine relief, not prevention, and come in pill form; the first, Ubrelvy, was approved by the U.S. Food & Drug Administration (FDA) in 2019. Unlike triptans, they don’t restrict blood vessels, so they’re safer for patients with a history of heart disease or stroke. Clinical trials showed that compared with those on a placebo, study participants who took them were significantly more likely to be totally pain-free two hours later. About 20 percent had their migraine go away completely, versus between 12 to 14 percent of participants taking the placebo.
A migraine is thought to involve stimulation of the trigeminal nerve, which runs from the base of the brain upward, behind your eyes—so scientists are developing novel ways to calm that nerve. In 2014, the FDA cleared a first-of-its-kind device called Cefaly ($399, cefaly.com). It’s a diamond-shaped pod that sticks to your forehead and generates a soft current; you can wear it for 20 minutes a day as a preventive measure, or for up to an hour to help relieve an attack. In a recent study of 100 patients in Japan, the average number of attacks reported fell from 5.33 to 3.94 after 12 weeks; participants also took fewer acute antimigraine medications.
Other new options include the GammaCore, a smartphone-size tool you hold to the pulse point on your neck to target the vagus nerve (also a major connection to the brain) and remote electrical neuromodulation (REN) device, called Nerivio, which fits on your arm like a blood-pressure cuff and comes with a smartphone app so you can adjust the current as needed. In a study published last year in the journal Headache, REN relieved pain for two-thirds of patients, compared with 39 percent using a placebo device.
These techy options are appealing if you’re looking for relief that doesn’t involve a drug, Dr. Starling says: “They kind of press the reset button in your brain and recalibrate everything.” Since the last three are prescription-only, and can be pricey, ask your physician about them; she can help you determine which one to try.
Small lifestyle changes can have a huge preventive effect. Dr. Starling teaches her patients the acronym SEEDS, which stands for “sleep, exercise, eating, dehydration, and stress management.” Different strategies work best for different people. For you, it could mean setting a 10:30 p.m. bedtime, avoiding tomatoes or red wine, or doing yoga twice a week. Once you figure out your formula (through trial and error and journaling), stick to it. “It’s all about consistency,” says Dr. Starling. Slowly but surely, you should start to feel better.