What Your Doctor May Not Tell You About Migraines: The Breakthrough Program that Can Help End Your Pain

I can't stand it anymore! That damned aura, the dizziness, the nausea, the two-by-four slamming inside my head for days at a time!"

"It's the most excruciating pain you can imagine. To say it's like an ice pick jabbing into my brain, or an atom bomb going off in my skull, just doesn't do it justice."

This is how some of my thousands of patients have described their migraine pain to me. Migraineurs suffer from horrible pain that can go on and on. These headaches can become so terrible that some victims actually wish they would die—while others fear they won't.

Over 25 million Americans suffer from migraines. Twenty-five million people crippled by nausea, intolerance of light and sound, sweating, double vision, bright spots before their eyes, numbness and tingling in the face and hands, confused thinking, slurred speech, weakness of the limbs, diarrhea, chills, sometimes auras, and always pain—that horrible pain that never seems to end. Some people consider themselves lucky if the terrible pain vanishes in a mere four hours, for migraines often last ten hours or more. And some throb on for three or four days!

Women are more likely than men to suffer from this terrible type of headache. Indeed, 70 percent of migraine patients are female. Thirty percent of migraineurs suffer their first attack before the age of ten, and the problem is most common among adolescents and young adults. But it can strike at any age, even in infancy. The dollar cost of migraine headaches is tremendous: Over $20 billion a year is spent by sufferers desperate for relief. And the personal cost? It's too high to calculate.

Migraine headaches are an ancient problem, dating back thousands of years. Julius Caesar, England's Queen Mary, Thomas Jefferson, and many others whom we've read about in history books were plagued by this mysterious and diabolic head pain.

Countless writers have been victims of the terrible pain, including Virginia Woolf, Lewis Carroll, and Spain's Miguel de Cervantes. Painters are not immune to migraines: Impressionist Claude Monet and postimpressionist Vincent van Gogh suffered, as did Georges Seurat, whose name doctors appropriated when dubbing visual disturbances of the migraine aura the "Seurat effect."

Keeping your brain active is not a shield against migraines. After all, inventor Alexander Graham Bell, German philosopher and poet Friedrich Nietzsche, musical genius Peter Tchaikovsky, and founder of psychoanalysis Sigmund Freud all suffered. Neither is keeping your body active a guarantee of migraine-free living, for athletes are stricken as frequently and severely as couch potatoes. Basketball great Kareem Abdul-Jabbar developed crippling migraines at the age of fourteen. More recently, Denver Broncos star Terrell Davis had to sit out part of a Super Bowl game because of a migraine headache. Baseball greats Dwight Gooden and Jose Canseco have suffered, as has golfer Fred Couples.

Gold records and Grammy awards cannot ward off migraines, or else Elvis Presley, the King of Rock and Roll, would not have been hit with the horrible pain. Neither would singers Carly Simon and Loretta Lynn.

Fame and fortune have not shielded actors Elizabeth Taylor or Whoopi Goldberg. And beauty has certainly not been a medicine for supermodel Elle Macpherson.

In other words, migraines can happen to anyone.

Does this recitation of migraineurs seem long? It's not; it's just the beginning of a list too lengthy to compile. And it doesn't include the most important migraineur of all: you.

You would think that defining a headache would be simple: If my head hurts, and it's not because I just bumped it against the wall, it's a headache. If it hurts because I had a lousy day at work, it's a tension headache. If I have light sensitivity, it must be a migraine. Unfortunately, it's not that simple, with doctors identifying numerous types of headaches. And head pain might switch from one type of headache to another, or may meet the criteria for two types of headaches at once!

We generally speak about the four most common types of headaches: migraine, tension-type, cluster, and organic. (We used to divide headaches into vascular and muscle-contraction types. Migraines and cluster headaches were all considered to be vascular headaches. The latest scientific evidence suggests, however, that both vascular and muscle-contraction headaches may be triggered by problems with neurotransmitters in the brain.)

• With migraine headaches, problems with neurotransmitters may be the underlying cause.

• With tension-type headaches, the culprit is thought to be muscle tension, although migraine is also accompanied by tension in scalp muscles. That headache you get after a long, difficult day's work or during an argument with your spouse is most likely a muscle-contraction (tension) headache. Most headaches are tension-type.

• With cluster headaches, the problem may lie in a part of the brain called the hypothalamus, which helps regulate hormones and body rhythms. Or the headaches may be triggered by special receptor sites in the neck arteries that determine how much oxygen and carbon dioxide feed the brain via the blood.

• With organic headaches, the head pain is a symptom of another ailment, such as inflammation around the brain, elevated blood pressure, a buildup of fluid in the brain, or even a brain tumor. Less than 1 percent of headaches are organic, but the underlying problems can be life-threatening, so if you have persistent or unusual headaches, see your physician immediately.

How can you tell which type of headache you have? Only a physician can give a definitive diagnosis, but here are some indications of a migraine. You don't have to have all of these features-two or three is enough to make it a migraine.

• The pain grips one side of your head.

• The pain is moderate to severe.

• The pain is "throbbing" or "penetrating."

• The pain lasts anywhere from a couple of hours to days.

• You may see flashing lights or have other visual disturbances before the headache appears.

• Lights and noise make you feel worse.

• You feel nauseated during your headache and may vomit.

• You feel dizzy.

• You sweat, even though it's not hot.

• You feel chilled.

• You have double vision.

• You have difficulty keeping your thoughts straight.

• Your speech is slurred.

• You feel weak in the arms and legs.

• You have diarrhea.

• Part of your face, or perhaps your arm, tingles and/or goes numb.

• The problem often begins during "down" times-such as weekends and vacations-when you're not feeling stressed.

Just as there are signs suggesting migraines, there are indications that tend to rule them out. For example, if your headache usually strikes while you're laughing hard, exercising, or enjoying sex, it's quite likely an exertion headache. If the pain typically zeroes in on the days you skip meals because you're trying to lose weight, the problem may be due to low blood sugar. If the headache produces dull pain, generally strikes during or after a long or difficult work period, and your shoulders and neck muscles are knotted and stiff, it's probably a tension headache. And if the headaches grow steadily worse over time, they may be due to an organic problem.

We haven't yet determined exactly what causes migraines. But we do know that millions of Americans are susceptible to migraines because they have hair-trigger responses to certain stimuli. Their migraines may be brought on by eating common foods like cheese, bacon, nuts, avocados, chocolate, yeast, spices, hot dogs, corn, or anything fermented, or by drinking red wine, beer, or beverages containing caffeine. But that's not all; skipping meals, stress, fatigue, bright lights, strong odors, certain medications, perfumes or other odors, air pollution, hormonal changes, the weather, seasonal changes, and altitude have all been implicated as migraine triggers. But remember, these triggers only affect certain migraine-prone people. The latest research suggests that most people with migraine headaches have minor genetic abnormalities that make them more susceptible to these headaches. This may be true even for those who have no clear family history of migraines.

In later chapters we'll take an in-depth look at migraines and other types of headaches, their causes and treatments. For now, remember that there are many types of headaches and a great many treatments. Some headaches are mere annoyances; others can make your life miserable. Some headaches can be ignored, while others must be attended to immediately. Some can be handled with a few simple changes in lifestyle or diet; others require more serious measures. Some respond quickly to treatment; others are difficult to deal with. That's why it's vital that you see a physician to get a proper diagnosis. You must know what's wrong before you can begin to attack it.

When we think of migraines we typically conjure up pictures of excruciating pain: sledgehammers smashing into the skull or a vise crushing the head. But there's much more to a migraine than simple pain. "If it were only the pain," says forty-two-year-old Nadine, "it would be a blessing. But that's just the beginning of the problem."

Your migraine may begin with the prodrome, a period of sensitivity to light, noise, touch, and smell, with mood changes, memory problems, or other symptoms. Then comes the aura, the flashing lights and other visual disturbances that herald migraines in perhaps 15 percent of sufferers. Next comes the headache itself, with its terrible pain, often accompanied by nausea, weakness, dizziness, and other problems, and lasting for hours or even days. The headache fades away during the resolution period, and you then enter the postdrome, the "after-event" phase, in which you feel tired and miserable for up to a day.

Amy, a thirty-two-year-old publishing executive, suffered from frequent migraines. But it wasn't the pain that stopped her from working; she could tolerate a great deal of pain. It was the nausea that came with it that was completely incapacitating. The slightest head movement or any odor—just a whiff of food cooking or the scent of perfume—would cause a wave of intense nausea and often vomiting.

Terry, a forty-year-old television producer, could also tolerate her migraine pain. But not bright light! She had to wear sunglasses indoors, and even then could not go on the set with its bright camera lights. She was frequently forced to go home to sleep off her headache.

A study published in the journal Neurology in 1999 looked at the increase in migraines throughout the 1980s. The researchers found that while the number of migraines in men had gone up by 34 percent, the increase for women was even greater: 56 percent. And the greatest surge in migraines occurred in women between the ages of twenty and twenty-nine.

Why are women, especially young women, becoming more and more likely to develop migraines? The numbers may be growing simply because women are being diagnosed more often than they were in the past. Or, more likely, women may be hurting more because of increasingly stressful workloads. The 1980s saw more pressure placed on women to work, get ahead, and take care of children, often without the help of a husband. These new stresses may trigger migraines in women who are already susceptible to the disease.

When the healing arts were in their infancy, dealing with migraines and other headaches was simple: Stone Age doctors used flint tools to cut away pieces of their patients' skulls, opening up the head and allowing the evil spirits, the supposed cause of the problem, to leave the head. But medicine became more complex as time passed, and by about A.D. 800 the British had devised an interesting remedy, a drink made from cow's brain and goat dung, among other things.

Today, doctors have numerous sophisticated drugs for migraines: There's Imitrex, Maxalt, Zomig, Inderal, Depakote, Midrin, Botox, aspirin, ibuprofen, and other drugs. Unfortunately, all these medications can have side effects such as stomach upset, weakness, elevated or low blood pressure, rapid heartbeat, and chest pain. Many of these can be quite troublesome.

For example, I have a patient whose frequent migraines were treated with a tricyclic antidepressant, a type of drug shown to be effective in preventing migraine headaches. However, her former physician did not tell her that this class of medications could also cause weight gain and constipation. Her headaches were under control, but she was extremely unhappy to see her weight rising and find her bowels "locking up."

Another woman came to see me for her headaches, which were partially controlled by propranolol, an FDA-approved migraine medication that is also used to treat high blood pressure. Yet despite taking the drug, she still had some headaches. And when I asked about side effects, she realized that this medicine made her feel out of breath and very tired when she tried to exercise. The irony is that regular aerobic exercise might have been more effective than this drug in preventing her migraines, but she could not exercise because of the drug.

Divalproex sodium is an antiepileptic medication that is also effective in preventing migraine headaches-but sometimes it triggers weight gain and hair loss. One of my patients responded very well to a different antiepileptic drug. However, it caused short-term memory problems that made it impossible for her to function at work. She had to stop taking the drug.

There are newer drugs for migraines, such as Imitrex, Maxalt, and Zomig. These medications certainly have their place, but like all drugs they can cause side effects, such as chest pain, dizziness, somnolence (sleepiness), and nausea. Despite the new drugs, we're still in pain. Twenty-five million Americans still dread the onset of the next migraine, lose time from work, must beg off personal and family chores, and must tell their friends that they can't make it today. The sad truth is that we're still tortured by migraine headaches. We just don't have a drug that can reliably and safely prevent them from striking.

While there is no 100 percent effective "prevention" drug, there is a way to stop hurting so much: a new, safe, natural, and tremendously effective way to hold migraines at bay. That something new is the "triple therapy" I pioneered at the New York Headache Center, where I've treated thousands of headache patients over the past fifteen years.

Before discovering this therapy I was like other neurologists, routinely prescribing the latest medicines for my migraine patients. I was doing everything right: I was an associate professor of clinical neurology at State University of New York and an attending neurologist at the prestigious Beth Israel Hospital. I directed symposia, wrote papers, and received grants; I was chairman of this and president of that. I had a busy clinic filled with migraine patients who came to see me over and over again. But the fact that those patients kept coming back meant that I wasn't curing them. I was certainly helping them, but I wasn't eliminating their problems once and for all. Taking medicine was simply not a permanent solution to migraines.

Determined to find the answer, I searched through the medical literature, spoke to my colleagues, and talked to my patients, looking for new ideas. One clue led to another, and by the early 1990s I was immersed in the study of the mineral magnesium. Later, I added riboflavin (vitamin B2) and an herb called feverfew to my migraine therapy.

I didn't originate the idea of using these natural substances. Ancient Greek doctors prescribed feverfew to treat inflammation and other ills, while riboflavin has long been known to support good health in several ways. And the first suggestion that magnesium might be linked to migraines appeared in the medical literature way back in 1931. While the concept of using magnesium, riboflavin, and/or feverfew was not new, no one had yet conducted the scientific research that would prove that these three substances taken individually could prevent migraines. Nor had anyone put these three ingredients together to make an even more powerful triple punch. With the help of my colleagues, I did just that. I was gratified by the results, and my patients, many of whom had suffered from debilitating migraines for five, ten, or twenty years, were ecstatic.

With the triple therapy, we finally have a safe and natural way to solve the migraine problem. It doesn't stop headaches in progress, but it can go a long way toward preventing them from striking in the first place. And if they never arrive, you don't have to worry about getting rid of them.

Thirty-three-year-old Linda had been plagued by headaches for a dozen years. "It's pretty regular," she said. "There's the terrible, throbbing pain, plus nausea. Light and sound drive me crazy. And even small amounts of physical activity instantly make it worse."

Over the past year, Linda's headaches had become more and more severe. By the time she came to see me, they were occurring every single day.

Although I've seen many people in distress, I was struck by this young woman who wanted so much to feel well again. But was it possible to help her? Her disability score on the MIDAS scale was 35, much worse than the score of 21 that puts one in the severely disabled group. (MIDAS, or the Migraine Disability Assessment Scale, is a brief questionnaire that assesses how much your headaches have interfered with your job, housework, school and family responsibilities, social and leisure activities during the previous three months.) Both stress and menstruation made Linda's headaches worse. She was taking two to four tablets of Fiorinal daily, and she was anxious and fatigued.

My diagnosis was chronic migraine headaches aggravated by the rebound phenomenon due to excessive intake of Fiorinal. I had Linda discontinue the drug and start on Migra-Lieve. This is a patented and carefully formulated supplement containing magnesium, feverfew, and riboflavin in the amounts I recommend. Two months later Linda reported success: very few headaches and much less fatigue.

Another patient, thirty-two-year-old Mark, was a salesman for a microbrewery who had suffered through fourteen years of migraine headaches. Striking every two months and lasting twenty-four hours, the headaches were extremely severe. Each was preceded by a visual aura and accompanied by nausea, vomiting, and extreme sensitivity to light and sound. The slightest movement made everything worse, sending shooting pains through his head. After each attack, he felt "washed out" for at least another twenty-four hours.

Mark had used a prescription medication to stop the attacks, with only modest relief. Fortunately, the triple therapy cut in half the number of headaches he suffered—and those he did have were much less severe. A year later, when he stopped taking the magnesium, feverfew, and riboflavin, the number and severity of his headaches increased. But once he restarted the therapy, they eased off markedly.

A third patient, twenty-seven-year-old Dana, had been plagued by frequent migraines since her early teens. They slammed into one side of her head with a throbbing pain that practically immobilized her, and were made worse by light or movement. Sometimes, about thirty minutes before a headache, she would develop a visual aura that obscured her vision. This was a harbinger of disaster to poor Dana, for she knew what would follow.

After a decade and a half of horrendous headaches, and at her wit's end, Dana was convinced that she was condemned to suffer. "Nothing works," she sighed. "I've tried everything, and I still get those damned headaches, sometimes as often as twice a week!"

To Dana's surprise and delight, all but one of her monthly attacks vanished after I started her on the combination of magnesium, feverfew, and riboflavin. And the single headache that did strike responded well to medication. For all practical purposes, her terrible migraines were gone.

And here's what forty-year-old Kurt had to say about his experience with the triple therapy:

I've suffered from migraine headaches since puberty, getting between two and ten a month, each one lasting from a few hours to as long as forty days! I have seen numerous doctors and all kinds of therapists. I've tried biofeedback, meditation and relaxation techniques, eyeglasses, therapeutic massage, physical therapy, chiropractic, acupuncture and acupressure, exercise, dietary changes, orthodontic mouthpieces, herbs and vitamins. I have taken medications including beta-blockers, inhalers, Midrin, Fiorinal, and injections of Demerol and Imitrex, all with varying degrees of success and a lot of different side effects.

When a friend of mine suggested the triple therapy, I was skeptical. I didn't want to get my hopes up just to be disappointed again, so I reserved my judgment for two months. Much to my surprise, the triple therapy made a difference-and a big one! I was migraine-free for those two months! It had been years since I'd enjoyed such freedom from pain. After several months of this therapy, my headaches are rare events. And when I do have them, they are shorter and less intense. It has truly changed my life.

Linda, Mark, Dana, and Kurt are just four of the many people, male and female, young and old, who have been helped by my triple therapy. They're struck by fewer and fewer migraines, and can often use lesser amounts of standard medicine to deal with those that do strike. In most cases, the results are nothing short of amazing. People who have resigned themselves to endless suffering are stunned to find hours, days, weeks, and even months passing without that terrible pain striking! As one patient put it, "I used to have migraines lining up to take a whack at my head. Now they're no-shows, they just don't show up."

So now let's delve into the triple therapy, beginning with a look at what makes our heads hurt in the first place.

Copyright © 2001 by Alexander Mauskop and Barry Fox

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