Biofeedback is an excellent preventive headache treatment with its efficacy proven in many rigorous studies. What prompted me to write this blog post is seeing yet another child (I see kids with headaches aged 10 and older) who had seen his pediatrician and a pediatric neurologist and neither physician mentioned biofeedback. Instead, they just prescribed drugs. Biofeedback is very effective for adults as well, but seeing a 10-year-old child with headaches who is prescribed medications as the only option was somehow more upsetting than when I see and adult under the same circumstances. Children tend to learn biofeedback with greater ease than adults – sometimes they need only 4 – 5 sessions instead of the usual 10 or more. Biofeedback is a way to learn to relax and stay relaxed under pressure, at least relaxed as far as your body goes, if not the mind. The person learning biofeedback is usually connected to a computer by a probe which measures body’s temperature or muscle tension (or brain wave activity in case of neurofeedback). The computer displays this information on the screen, which helps you learn how to relax your body. Biofeedback is taught by a psychologist, a nurse or another trained professional. Some insurers will cover this treatment, but many do not. Fortunately, studies show that self-taught relaxation training can be as effective as biofeedback. There are many free sources and some that you can buy. Many people are skeptical about biofeedback, but there is a simple explanation why it works. You are supposed to stop for a minute or even less to take an inventory of neck, facial, and other muscles, to make sure you are not tensing them up, then take a few deep breath. This will bring your tension down just a little, but if you repeat this one minute exercise every hour, at the end of the day you will avoid having knots in your shoulders and your neck and may avoid a headache. Eventually, this exercise becomes subconscious as you automatically monitor your body and whenever you feel that you are frowning, holding shoulders up, or holding your breath, you stop doing that without having to pause.
In addition to biofeedback and obvious sleep, exercise, and food recommendations, I suggest that all children take a magnesium and CoQ10 supplements. Both have been shown to help children with migraines.

Risks involved in using Chinese herbs are highlighted in the just released AFP report, which you can read on Yahoo News. Here is an edited quote from this story: The samples analyzed for this study included herbal teas, capsules, powders and flakes were tested by scientists at Australia’s Murdoch University. 68 different plant families that were detected in the 15 samples can be toxic if taken in the wrong doses, but the packaging did not list the concentrations of the elements inside.
I am a big proponent of alternative and complementary medicine, recommend herbs, and am a certified acupuncturist. I think acupuncture and many herbal products have a place in the modern medicine because they’ve been shown to be effective. However, many people who go to acupuncturists are often given Chinese herbs along with acupuncture. Unfortunately, there is very little or no quality control in the production of the Chinese herbs. The most dramatic example of this problem was described in the New England Journal of Medicine in 2000 – an herb people were taking for weight loss was contaminated by a toxic plant which caused kidney failure and urinary cancer in 18 of 105 patients. China (just like India, Russia, etc) still has extreme levels of corruption, which means that we cannot rely on their herbal products unless they are first tested in an American laboratory for purity. For now, stick with herbal products made in the US or Western Europe. Feverfew, boswellia, ginger, valerian root, and other are available from major manufacturers, such as Solgar, GNC, Nature Made, and other.

Omega-3 fatty acids, found in fish oil, have been reported to relieve migraine headaches, although the only such study was relatively small. The dose of omega-3 fatty acids was 6 grams taken daily as a preventive treatment for migraines. A recent study published in Neurology shows another reason to take fish oil. Researchers at UCLA measured levels of omega-3 fatty acids, DHA and EPA in red blood cells of 1,575 healthy people with an average age of 67 +/- 9 years. They discovered a strong correlation between low levels of DHA and EPA and shrinking of the brain as well as impaired cognitive function even in people without any signs of dementia. High fish intake has been associated with reduced risk of death from heart disease and strokes and this study shows another highly beneficial effect of omega-3 fatty acids.

Acupuncture has been widely used for the treatment of migraine headaches and it has been subjected to many clinical trials. A new study published in the Canadian Medical Association Journal confirms what previous research has shown – that acupuncture in fact is effective. This study was performed by Chinese researchers and it involved 480 patients. It was a well-designed and rigorously conducted study. The doctors divided patients into 4 groups with 3 groups receiving different types of real acupuncture and the fourth one receiving sham acupuncture. Sham acupuncture group had needles inserted, but they were not manipulated to elicit a specific “qi” sensation, which was done in the real groups. Patients in all three groups receiving real acupuncture did better than those in the sham group. The benefit persisted for at least three months after the treatment. The difference was statistically significant (meaning it did not occur by chance) but not very large, mostly because the sham group also improved. In summary, this study strongly supports the results of previous clinical trials in migraines, which showed positive effects of acupuncture. It also showed that the type of acupuncture is not important, but needles need to be inserted properly and probably need to have electrical stimulation (all groups in this study had electrical stimulation). One difficulty in following the treatment used in this study is the need for doing acupuncture five days a week for 4 weeks. Many people may have difficulty finding the time (and money) for such a regimen. However, many of the previous positive studies were conducted with acupuncture treatment being performed once a week.

Swearing is a common response to pain. A study just published in The Journal of Pain examines whether swearing can actually help pain. Oxford English Dictionary defines swearing as the use of offensive or obscene language. Prior studies by the same researchers at the Keele University in the UK showed that for most people swearing produces a pain lessening effect. In this new study Richard Stephens and Claudia Umland looked at the effect of repeated daily swearing on experimental pain. They took 71 healthy undergraduate students (who else?) and subjected them to pain using a standard research procedure – submerging subjects’ hand into cold water. They again showed that swearing reduces pain and increases heart rate. The latter suggests that swearing reduces pain not only by distraction, but through physiologic effect on the body. They also found that people who tended to swear frequently throughout the day had less of a pain relieving effect from swearing when subjected to pain. So, listen to your mother and don’t swear all the time – save it for when it can do some good for you.

Yet another study finds that exercise is as good for the prevention of migraines as drugs. The research report in journal Cephalalgia by Swedish doctors shows that 40 minutes of exercise three times a week was as effective as taking topiramate (Topamax) or doing relaxation exercises. Topiramate is one of the most popular drugs for the prevention of migraine headaches, but it can have many potential serious side effects, including kidney stones in 20% of patients, glaucoma, memory and other cognitive problems. The same group of researcher published a large study of over 46,648 Swedes which showed a strong inverse correlation between exercise and any type of headaches, including migraines. So, before resorting to drugs or even Botox injections it is worth trying a regimen of avoiding triggers such caffeine, adhering to a regular sleep schedule, taking magnesium and other supplements, and regular exercise.

Migraine prevention is most effective when a preventive medication and behavioral management are combined together. A study by Dr. Holroyd and his colleagues published in the British Medical Journal showed that a beta blocker alone and behavioral management alone did not help patients with migraine headaches. However, combining these two resulted in a significant improvement. This was a very rigorous trial involving 232 patients who were divided into 4 groups: behavioral management alone (with a placebo pill), beta blocker alone, both interventions, and no intervention group (they did receive placebo pills). Patients and doctors did not know which patient received a beta blocker or placebo. Every patients was seen every month for four months and had 3 telephone calls in these four months. During each visit the behavioral management group received one hour of training. All patients were given optimal acute therapy with a triptan and if needed, ibuprofen and a nausea medication.
All patients were evaluated 10 and 16 months later and the combined group was improved compared to the other 3 groups both in the number of attacks, number of migraine days, and in the quality of life.
This confirms the validity of our usual practice of combining several approaches at once rather than trying one at a time. The list of our typical recommendations includes combination of several of these options: avoidance of caffeine, aerobic exercise, behavioral management, magnesium and other supplements, Botox injections, non-prescription medications, such as ibuprofen, naproxen, and Migralex, as well as triptans and prophylactic medications, such as beta blockers, epilepsy drugs, and antidepressants.

Headache coach, Jan Mundo will be conducting classes at the New York Headache Center (this is a second announcement).   The course consists of 6 weekly sessions which will be held on Wednesdays from 6 to 8 PM from September 22 through October 27.  Jan’s course is “for headache or migraine sufferers who want natural solutions! Learn how to use your body and mind to relieve and prevent your cycles of pain. In a supportive environment: Find your best headache diet, use centering practices to de-stress, learn self-massage to ease pain, practice hands-on headache relief, enlist thoughts, moods, and emotions as allies.”  For details and registration go to http://www.mundolifework.com.  Facebook page:  http://www.facebook.com/pages/The-Headache-Coach/72585407316?v=app_2344061033#!/event.php?eid=102475893145453&index=1..

Headache coach, Jan Mundo will be conducting classes at the New York Headache Center.   The course consists of 6 weekly sessions which will be held on Wednesdays from 6 to 8 PM from September 22 through October 27.  Jan’s course is “for headache or migraine sufferers who want natural solutions! Learn how to use your body and mind to relieve and prevent your cycles of pain. In a supportive environment: Find your best headache diet, use centering practices to de-stress, learn self-massage to ease pain, practice hands-on headache relief, enlist thoughts, moods, and emotions as allies.”  For details and registration go to http://www.mundolifework.com.

Many migraine sufferers feel that food allergies cause their headaches.  There is little dispute that certain foods can trigger migraines.  Some of these foods include chocolate, wine, cheese, citrus fruit, onions, smoked, cured, and pickled foods.  However, migraine that results from eating these foods is not due to an allergic reaction, but rather is due to a chemical reaction.  An allergic reaction occurs when the body’s immune defense mechanisms try to isolate and attack an offending substance, called an allergen.  It is possible to evaluate this immune response by measuring blood levels of immune globuline (IgG) which is specific to to a particular food or substance.  Since there are so many different foods that we eat, literally hundreds of tests are required.  Doing such extensive testing has been controversial, in part because of its high cost.  This testing has been advocated for patients with irritable bowel syndrome.  People who are found to have high levels of of IgG to certain foods can improve their condition by eliminating those foods.  Another way to detect food allergies is by scratch test, where an extract of different foods is placed into skin scratches and then the skin reaction is measured.

A sophisticated study recently published in Cephalalgia by Dr. Ertas and his colleagues looked at food allergies in migraine patients.  They tested IgG levels to 266 foods in the blood of 30 migraine sufferers.  The number of foods these 30 patients were allergic to ranged from 13 to 35.  After testing, for six weeks each patient ate a diet which included or excluded foods they were allergic to. After that, they had two weeks of unrestricted diet, followed by another 6 weeks of the opposite diet (if they first had a diet free of allergen, then they were switched to a diet with allergens, and vice versa).  Neither the doctor, nor the patient knew what foods the patient was allergic to or which diet was given in each 6-week period.  The results of the study showed that significantly fewer migraines occurred when the diet excluded foods patients were allergic to.  This is the first rigorous study which suggests that food allergy testing may find a place in the management of patients with migraine headaches.