the headache post (part two)
Hi there! I'm back to tell you about this book that seems to help me: Heal Your Headache, The 1-2-3 Program for Taking Charge of Your Pain by David Buchholz, M.D.
Please, please don't take any of this as me preaching to you. I am simply sharing this theory because it seems to work... for me. Everyone must make their own decisions and conclusions when dealing with any health issue. Right? Right.
This is a simplified explanation of this particular neurologist's approach to migraine control. It isn't easy, and it involves drastically altering your diet for at least awhile. If your headaches are currently manageable and you are feeling good about how you deal with them, I'm so glad. If not and (like me) you're reaching a point that they are honestly negatively affecting your life, at least give this book a look-through. I checked mine out from the library, but ended up buying a copy.
First, his basic theory of migraines:
He feels that all headaches, with very few rare exceptions, are the same. Headaches occur when the blood vessels in your brain inflame and cause pain and a myriad of other symptoms. Things like tension and sinus irritation can cause the migraine process to begin; they are not a kind of headache on their own. Everyone has certain triggers that may start this process- some of us more triggers than others. Also some of us have a lower tolerance level for the amount of triggers we can handle before something tells our brains to fully activate the migraine process, leading to, as I called it, A Bad One.
Ding, ding, ding! That was it! That was the key for me, why I liked his approach. I have always told doctors that no matter what kind of headache it was- a slight hangover, tension related, allergies- if I let it go on too long, it would become a migraine! Could they all be migraines to start with?! Finally. Someone backed up my theory. And so I read on.
Step #1: Avoid quick fixes.
The reason coffee and Excedrin make headaches go away is that caffeine constricts your blood vessels thus reducing the inflammation and pain. Of course we use caffeine to manage our pain. It works really well. Triptans like Maxalt (my miracle drug) and Imitrex are powerful vasoconstrictors and in a complicated way trick your brain into shrinking the blood vessels quickly. Ahhhh... relief in minutes. There are several other drugs in this section, but these are the ones that I use.
BUT you see, there is a problem with these drugs. They can cause rebound headaches. Your blood vessels overcompensate after the drug wears off and can, over time and use of the drug, make your headaches worse. (Drastically oversimplified- he explains this all very well.) This, I think, is where I'd been trapped for several months. I'd gotten myself into a nasty rebound cycle and couldn't get out.
Coffee is also a double edged sword- not only is caffeine a drug that can cause some dependency, coffee and tea also contain some other substances that can be migraine triggers. I'd drink the coffee because I needed it to stave off a headache, and then it actually caused me more headaches. Oy.
Step #2: Reduce Your Triggers
This is the doozy. So again, simplifying his theory. Everyone has triggers they cannot control like weather changes, hormonal fluctuations, odors, unavoidable stress, etc. But add to those very common medication and dietary triggers and we can quickly find ourselves in that fully activated migraine state. Ouch.
I know, I know. This is the tough one. He gives you a list of the most common trigger foods and recommends removing them all for a few months to see if you really feel a difference. The lists in his book are very detailed and specific. Here's the short version:
Caffeine, caffeine, caffeine (coffee, tea, soda)
MSG (this one is SUPER tricky and what makes this diet most difficult for me)
Processed meats (often full of MSG and nitrates)
Cheese and dairy products (milk, cream, ice cream, ricotta, cream cheese are ok.)
Nuts (seeds are ok.)
Alcohol and vinegar (except white vinegars)
Certain fruits and their juices (citrus, pineapple, raspberries, fruits dried with sulfites)
Certain veggies especially onions (certain beans are out. green onions, shallots, leeks and garlic are ok.)
Fresh yeast risen breads (they need to be a day old. this is a weird one.)
Any others you suspect affect you.
You take these items out of your diet as best you can, trying hard not to drive those around you crazy, for a few months and hopefully see some dramatic improvement. You probably won't have to keep them ALL out for good- he explains how to liberalize the diet later on.
This brings us to where I am in the plan. I've been on the diet for six weeks. At first it was REALLY. HARD. It's easier now. It sounds like a lot, but you get used to it fast. Eating out is still difficult, but I'm navigating that as best I can.
This diet is helping greatly. I am hoping it's not onions that bother me- that one makes it hard to eat out as does MSG. I thought I'd miss chocolate terribly, but I don't. Same with cheese. I do miss coffee and I'm hoping down the line I'll be able to handle a cup of decaf. I'd also like to be able to enjoy a vodka tonic now and then on the patio this summer. Could I live on this diet forever? Absolutely. Do I think I'll be able to reintroduce a few items? Of course.
And that's the thing about this diet. It is a TOOL, not a life sentence. If you start cheating too much, and the headaches start to creep back in, you can pull out the tool and tighten it back up. I'm also thinking at some point I'll be able to judge a few of my uncontrollable triggers better and decide if a little cheat is doable now and then.
Step #3: Raise your tolerance
Certain preventative medications can raise your tolerance for your particular triggers. Dr. Buccholz lists many good and proven options and I've discussed one with my doctor. (It's a tricyclic antidepressant.) He wrote me a prescription and I'm waiting. I was hoping with the diet and a little more exercise, I could avoid that step all together. My headaches are better, but they certainly aren't gone. But I have to say for the first time in a long time, I feel in control. I'm not just waiting for these headaches to happen.
I've been pondering the medication. If I could raise my tolerance just a little, so that a cocktail on the patio or a piece of chocolate cake at a party didn't throw me into a tailspin, wouldn't it be worth a try? If it improved my enjoyment of life? Surely. I'm trying to stay open minded. I'll make a decision in the next couple of weeks.
. . . . . . . . . . .
So there you go. That's it in a (big) nutshell. Like I said before, this is a "last resort" sort of plan. The diet is a pain in the butt. Yes. But it's helping. If you're feeling at your last straw, go to the library and find it. You never know.
And finally I'm done. I'll hush about it now. : )
Wishing for many headache-free days for us all.