Headache and hypoglycemia
Symptoms of low blood sugar — or hypoglycemia – vary widely among individuals. Although we understand the mechanisms that cause your blood sugar to fall, we do not completely understand how hypoglycemia brings on headache. And the best test for hypoglycemia — a 6-hour glucose tolerance test — is often normal in this condition.
Eating foods high in carbohydrate and processed sugar such as candy, cake, ice cream and other deserts can result in broad swings in blood sugar, as can the use of alcohol, some medications, and a jolt of caffeine. So the best way to control hypoglycemic symptoms is to avoid foods with lots of processed sugar and to eat six small protein- and complex carbohydrate-rich meals per day instead. Include whole-grain products and fresh fruit, and avoid candy and snack foods.
Alcohol often triggers a migraine attack. Although any type of alcohol can do it, red wine more than white, beer, champagne and eggnog are most frequently mentioned. And dark-colored alcohols such as scotch, rye, whiskey, brandy, bourbon, sherry, and cognac seem to trigger headaches more often than light-colored ones such as gin, vodka and white wine.
Beverages such as coffee, tea, colas, and carbonated drinks such as Dr. Pepper and Mountain Dew, all contain caffeine.
If you drink too much caffeine on a daily basis — such as 3 or more cups of coffee or large amounts of soda – your caffeine intake can cause or worsen your headaches. Moreover, suddenly stopping your caffeine will surely bring on a headache.
If you have a significant headache problem, you should very gradually remove all caffeine and alcohol from your diet.
Alcohol and headache
Many people with headaches wonder if it is a coincidence that they develop a headache after drinking alcoholic beverages – particularly red wine, scotch, sherry, and brandy. It isn’t. These beverages are particularly likely to cause headaches in people with migraine and may, in fact, cause headaches in people who are not normally headache prone. Too much alcohol in anyone can cause a hangover headache.
Alcohol causes headache as a result of its effects on blood sugar. If you already have hypoglycemia, an alcohol-related drop in blood sugar may bring on head pain. Some alcoholic beverages contain tyramine, histamines, and impurities introduced during the fermentation process, which can also cause a painful headache. Drinking alcohol also causes you to urinate a lot, which can dehydrate your brain cells and cause headaches.
Pregnancy and migraine
Most women who have migraine headaches report an increase in headache frequency during the first two to three months of pregnancy. The bad news is that most migraine medications should not be taken during pregnancy, and that many women are not even aware that they are pregnant in the first few weeks. But there is good news, too. About 70 percent of women with migraine note that their headaches improve tremendously during the second and third trimesters of pregnancy.
If you get migraines and are pregnant or considering pregnancy, you should discuss drug-free headache management with your doctor. At The New England Center for Headache we put women about to get pregnant on high doses of Vitamin B2 and magnesium and refer them for biofeedback therapy.
When to get help
Are you one of those people who get a couple of headaches each week and think that it’s trivial? Have you wondered at what point you should seek medical advice for your headaches? Here are some guidelines.
Check with your doctor if:
- your headaches are accompanied by nausea, vomiting, or visual symptoms
- your headaches are severe enough to interfere with your work or with carrying out planned activities
- light and / or sound bother you when or before you get a headache
- you find that you need to take increasing amounts of prescription or off-the-shelf medication to control your headaches
- you have confusion, numbness, weakness or high temperature with your headaches
- exertion or straining brings on a headache
Keeping a headache diary
If you get headaches and want to explore factors that may contribute to the problem, a headache calendar may help you and your doctor to identify you’re your headache triggers.
A headache calendar, which is easy to keep, is a daily log of factors that might relate to your headaches. Each day, record time of onset, intensity, and duration of your headaches, along with what you eat, medications you take, and anything that might have set off the headache.
Be sure to record all medications – both prescription and off-the-shelf – including those taken for headache. If you’re a woman, be sure to record when you get your menstrual periods.
Your headache log can reveal a pattern that can help you to avoid at least some of your headaches. You can download our center’s headache calendar at our website which is www.headachenech.com.
Causes of migraine
What causes migraine? By cause, we mean the process in the body that makes the headache occur rather than substances or events that trigger it each time you get a migraine attack.
We know that migraine is inherited. Up to 90% of people with migraine have a close relative who suffers from them, too. Moreover, if one parent has migraine, each child has a 45% chance of developing it. If both parents have migraine, each child has a 75% chance.
A unified theory about the cause of migraine proposes that migraine begins with a set of electrical and biochemical events in the brain. This results in swelling of blood vessels on the surface of the brain, causes an inflammation around blood vessels, and culminates in the release of pain-producing substances
What are triptans?
Until recently, people who sensed a migraine headache coming on had few options for effective treatment. Most relied on various drugs to abort the headache or, once the headache began, potent medications for relief of pain.
The acute treatment of headache was revolutionized in 1993 with the introduction of a new class of drugs – the triptans. The triptans’ headache-specific activity can quickly reduce the severity of headache, relieve nausea, vomiting, and sensitivity to light and sound. In some cases, these drugs can stop the headache entirely. Available by prescription only, there are 7 different triptan tablets – tablet form is the preferred method to take them. The triptans may, however, work more rapidly when taken by injection or via or via nasal spray. For some patients, bypassing the GI tract by using an injection or nasal spray rather than a tablet will lead to better results.
If you get migraine headaches, see your doctor to find out if you can take a triptan, and do it soon.
How does a migraine feel/what it is?
Did you know that migraine headaches can be experienced in a variety of ways?
About 30% of migraineurs experience a visual change or “aura” that warns them a headache is on the way. Others do not experience the aura at all. For many patients, migraine pain is one sided and throbbing and associated with nausea, vomiting, and sensitivity to light and sound. Although most people think of migraine as a severe pain on one side of the head only, migraine headaches can occur on both sides of the head or all over the head. Whether one-sided or all over, however, the pain is typically throbbing or pulsating and usually becomes intense. The pain may worsen in response to physical activity, such as walking up the stairs or bending over.
Whatever your symptoms of migraine, effective treatment with triptans, preventive medication, and behavioral therapy is available. Call your doctor today
Did you know tension-type headaches are the most common type of headache, occurring in more than 90% of our population?
These headaches are usually associated with tension in the muscles in the head, face, jaw, or neck, and are often experienced on both sides of the head.
The pain is usually not severe enough to disrupt people’s daily lives and is typically described as a mild, pressing, aching, squeezing sensation, or as a tight band around the head that does not throb or pound. The pain is often mild to moderate, tends not to interfere with normal function, is not aggravated by physical activity, and can usually be relieved with off-the-shelf pain relievers.
If you experience tension-type headaches more than 8 days each month, alert your doctor, who may want to make sure that your headaches are not caused by an underlying medical condition.
Vitamin B2 and Mg in migraine – Fever few
Patients often ask whether vitamins, minerals, and herbal supplements can help to prevent headache.
It has been reported that 400 mg of vitamin B2 — riboflavin – taken daily for 3 to 4 months does a better job than placebo – dummy pills – in preventing migraine.
Some patients with migraine and menstrually associated migraine have noted favorable results taking 400 to 600 mg of magnesium daily.
Another study shows that 150 mg of coenzyme Q10 daily may help patients with recurrent migraine.
Studies on the use of feverfew, an herb that belongs to the chrysanthemum family, show mixed results in migraine, but some patients do say that it works.
Please be sure to check with your doctor before you take vitamin or mineral supplements for headache. And be cautious about herbal supplements which sometimes have significant side effects
Caffeine rebound Headache
Did you know that one cup of caffeinated coffee can help to treat a migraine attack?
But, caffeine is a double-edged sword.
Caffeine overuse can cause headaches or worsen them. Here’s what happens. Say you usually have many coffees, teas, or cola throughout the day. You do this every day for years. Then, one morning, you don’t get your usual caffeine boost, and you get a headache.
This is known as caffeine rebound headache because the headache is brought on by the sudden lack of caffeine in your body. It can happen to anyone, but migraine patients are even more susceptible.
At our Headache Center, we slowly take people off their caffeine while we are getting them better, and then they can return to a small amount.
Types of Headache
Did you know that there are many types of headache?
Tension-type and migraine are the most common types of headache.
Tension-type headache is a steady, non-throbbing, mild-to-moderate headache on both sides or all over the head; it usually responds to off-the-shelf headache medications such as aspirin, Tylenol, Motrin and Excedrin.
Migraine headache occurs more in women and is more common than most people think Many so-called “sinus” headaches are actually migraines. Migraine is a severe — often throbbing — pain in one temple or eye or on both sides of the head that may be accompanied by nausea, vomiting, sensitivity to light and noise, and increased with movement. Migraine often interferes with your ability to work or care for the kids or enjoy a family outing.
Do you have bad headaches? If you get severe headaches accompanied by nausea and light sensitivity or that make it difficult for you to function, you may be eligible to participate in a clinical trial to be conducted by The New England Center for Headache.
Screening, medication, and follow-up care are free. Eligible headache patients can try new and existing medications to get rid of their headaches. The Center is also conducting a trial of Botox for migraine.
The New England Center for Headache has been in operation since 1979 and is staffed by two well known, board certified neurologists, a board certified internist, and aboard certified psychiatrist who all specialize in headache.
For more information about The New England Center for Headache and our clinical trials.
What to do about caffeine rebound headache
If you get a headache whenever you don’t get your morning coffee, and if the headache gets better after you have your coffee, then you may be experiencing what is called a caffeine rebound headache.
The temporary solution for a headache is to have a caffeine-containing beverage such as coffee right away, but that’s not a long-term answer. People get caffeine-rebound headaches because they are using more caffeine than they should. What is too much caffeine for one person may not be for another. Caffeine is found in coffee, tea, colas and other sodas It is also an ingredient in many other foods and in lots of headache medicines.
The best way to treat caffeine rebound headache is to very slowly reduce and temporarily stop all caffeine intake over several weeks.
Did you ever wonder whether there is a link between your menstrual periods and your migraine headaches? Rest assured, there is, and such headaches are known as menstrual migraine. Many women with migraine are more headache prone during the time that spans a week before their periods start until a few days after they end. Menstrual headaches are often the longest and the worst headaches women experience.
Why do these headaches occur? The falling levels of estrogen a week before each period appears to trigger headaches in about 60% of women with migraine.
Fortunately, menstrual migraine can be effectively treated either with a triptan at the very start of the headache or with a preventive medicine.
All in your head
Have you ever wondered if your migraine headache is “all in your head,” something psychological that you could control if only you had the will?
Migraine is not psychological. Migraine is a real and sometimes disabling disease produced by significant electrical and biochemical changes in the brain. It can cause nausea and light sensitivity, and it responds well to triptans — medications that have been developed specifically for the treatment of migraine — as well as to other medications/
Doctors diagnose migraine headache on the basis of the history you give them.
When migraine is frequent and severe, many doctors refer such patients to neurologists or to headache treatment centers for evaluation and treatment.
I see many patients who think they have sinus headaches. They see sinus medications advertised on TV and think that sinus problems may be responsible for their headaches. They often do not have sinus headaches, even when the pain is in their sinus areas and their noses are stuffed or running.
When a sinus infection does cause a headache, patients usually look and feel sick with fever and drainage from the nose or a bad smelling or tasting post nasal drip that they have to spit out.
Although a true sinus infection must be treated promptly with an antibiotic, a migraine masquerading as a sinus problem should be treated instead with a triptan.
Ask your doctor if your sinus headache may actually be a migraine and get the correct treatment.
Facts and figures: Epidemiology and adequate treatment
Did you know that over 90% of the world’s population has experienced a tension-type headache at one time or another?
When it comes to migraine, about 12 percent of all people over age of 15 experience migraine headache. In the United States alone, this amounts to about 30 million people. Migraine is 3 times more common in women than in men; about 18% of women and 6% of men have migraine.
Migraine can also affect children and has been diagnosed in kids as young as two years of age, but it is very rarely seen in young children.
Boys between 6 and 10 are actually more likely to have migraine than girls – but once girls start to have their periods, they become much more likely to have migraine.
Undiagnosed migraine, self treatment
If you get frequent or severe headaches, you may be interested to learn that only about 50 percent of people who have migraine headaches have received an accurate diagnosis from a doctor.
People with undiagnosed migraine (or self-diagnosed sinus headaches that are really migraines) do not receive proper migraine medication and may suffer unnecessarily from migraine pain, nausea and interference with daily activities, social events or work.
The belief that headaches are due to stress or sinus problems leads cause many people to self medicate, and they may overuse off-the-shelf medications. These medications may actually cause analgesic rebound and make their headaches worse.
If you have frequent or severe headaches and no diagnosis, please discuss this with your doctor now.
Recognizing analgesic rebound HA
It’s easy to overuse headache pain medication, and many headache sufferers do just that. Overuse, unfortunately, can lead to rebound headache, which requires medical attention to reduce or eliminate the medication associated with rebound, before starting appropriate headache treatment.
If you take off-the-shelf or prescription pain medication on 3 or more days per week, then you are at risk of developing analgesic rebound headache.
Rebound headache typically lasts many hours per day and is a steady, pressure type pain all over the head. It may resolve temporarily with another dose of pain killers.
If you think you may have rebound headache, call The New England Center for Headache for free information at 203 968-1799.
Many people with frequent migraine or tension-type headaches are at risk of developing analgesic rebound headache if they take pain relievers on 3 days or more per week.
The stage is set for developing rebound headache when headache sufferers increase the amount and frequency of off-the-shelf or prescription pain medication and take them almost every day. After a while the medication becomes less effective, and the patient may feel worse rather than better.
In addition, overuse of pain relievers can reduce the effectiveness of medications that have been prescribed to prevent headache or to stop them when they begin.
If you think you may have rebound headache from overuse of pain medication, it is important to seek medical attention promptly.
Use of daily preventive medication for migraine
Preventive medications, which must be taken on a daily basis, can help people who get frequent migraines to have fewer attacks or to avoid them completely.
The preventive medications include beta blockers (such as propranolol), calcium blockers (such as verapamil), antidepressants (such as amitriptyline) epilepsy drugs (such as divalproex sodium and topiramate), blood pressure medications (such as candesartan), and even vitamins and minerals (such as Vitamin B2 and magnesium).
Starting these medications at a low dose and increasing slowly may help to avoid possible side effects. Usually some beneficial effect is seen after 3 to 4 weeks.
These medication need to be taken in high enough doses for a long enough time to work well. Sometimes different medications will have to be tried before an effective one is found, but the search usually leads to fewer and milder headaches.
Types of migraine
Every now and then, when we tell a patient that he or she has migraine, they say that it can’t be so because they do not experience one or more of the symptoms many people commonly associate with migraine.
But migraine can be highly variable in its presentation. Classical migraine, which is experienced by only about 30 percent of migraine sufferers, is characterized by an often dramatic visual disturbance called an aura that comes on about 20 minutes before the headache starts. The other 70 percent of migraine sufferers are said to have common migraine, or migraine without aura, and they do not develop dramatic warning signs. They often have nausea, vomiting, sensitivity to light and sound, and have throbbing, severe pain on just one side of the head that can last from 4 to 72 hours if not properly treated
Mixed headache syndromes
Would it surprise you to learn that headaches do not always fall into distinct and separate categories? It’s true. Recently, we have begun to realize that tension-type and migraine headaches may be different presentations of the same problem.
Tension-type headache is a milder headache common among people with migraine, and – rather than having one type of headache or the other – many patients suffer from both and have a mixed headache syndrome.
Similarly, people who experience mostly milder tension-type headache may occasionally experience migraine symptoms such as more intense, one sided head pain, associated with nausea, sensitivity to light and disability.
Both of these types of headache respond best to a triptans taken early, but the mildest headaches without nausea may also respond to over-the-counter simple analgesics.
A migraine self-test (the 3 questions)
As many as 50 percent of people who have migraine have never been diagnosed by a physician. Migraineurs without a diagnosis can’t obtain appropriate prescription medication such as triptans and are likely to inadequately self-treat their migraines with over-the-counter medication and bed rest. Recently it was found that the answers to 3 questions had a high predictive value for migraine.
- Do your headaches sometimes limit your day’s activity, and cause disability?
- Do you experience nausea when you have a headache?
- Does light bother you when you have a headache?
A “yes” answer to two out of three of these questions could mean that you have migraine and should talk with with your physician about it. A YES answer to all 3 questions makes it very likely that you have migraine. But note that you could still have migraine even if you answer “no” to all 3 questions.
Is there a migraine personality type?
Sometimes patients ask us if their headaches are the result of a “personality type,” stating that they consider themselves driven, perfectionistic, Type A personalities and are often under stress. To date, no studies have associated headache with one personality trait or another. In fact, headache, which is experienced by about 90 percent of the adult population, can occur in almost anyone.
The fact that some driven, perfectionistic people are headache prone, has nothing to do with the cause of their headaches. Stress can certainly start a headache or make one worse, but it is not the underlying cause. If you are prone to headaches, rest assured that it is a medical condition that can be treated. Of course certain life style changes can be helpful, such as arranging time for yourself, sleeping enough, not delaying meals, and exercising regularly.
Did you know that kids get a lot of headaches. About 6 % of 8 year olds have migraine while it is 12 % in adults. Migraine in kids is severe but shorter last ing than in older patients. It is associated with sensitivity to light and sound and is often a one sides or two sided throbbing, sever pain that lasts for several hours and is helped by sleep.
If you have a child who gets severe headaches with nausea who has to stop playing, gets pale and then falls asleep, ask your pediatrician if migraine is the diagnosis.
If your child has migraine, call us about a clinical trial we are doing for adolescents, ages 12 – 17. Call Lori or Lisa at 322 2748 to discuss our new trial for children with a specific migraine medication.
Types of acute care headache medication
Effective treatment of headache with medication depends on matching medication to each patient’s headache type and severity. Headache medications fall into two broad groups: those for acute use, to be taken during a headache to stop it quickly; and those taken daily to prevent headaches from occurring.
For milder tension-type headache, any combination of over-the-counter pain relievers such as aspirin and acetaminophen, with or without caffeine, and anti-inflammatory medications such as ibuprofen can be helpful to stop the pain.
For more severe migraine headaches, the best way to stop an attack is to take one of the migraine medications called triptans early in the course of the headache. Triptans come as tablets, nasal sprays and injections.
Diet and Headache
Many people associate foods they eat with headache, and rightly so. Although foods that trigger headache vary from one migraineur to another, some foods are more likely than others to trigger a migraine attack.
The infamous “hot dog headache” can be caused by nitrites, chemicals used in the preparation of not only hot dogs but also bologna, salami, ham, and other foods such as pepperoni, sausage, bacon, and smoked fish. Monosodium glutamate (also known as MSG) is another likely suspect, as are liver pate, chocolate, fermented foods like aged cheese and balsamic vinegar, freshly baked bread products high in yeast, too much caffeine daily or suddenly stopping your caffeine, and most alcoholic beverages – especially red wine and champagne.
Delaying or missing a meal is another common food trigger.
Exercise and Headache
Can exercise really chase a headache away or prevent it? Many doctors think so. An exercise schedule that involves some aerobic activity such as walking, running, biking or swimming five days a week for twenty to thirty minutes, can make a big difference in reducing headaches and in promoting a general sense of improved wellbeing. Moderate aerobic exercise can also be helpful.
Exercise is good to chase away a tension-type headache and daily exercise may decrease your migraine attacks – but don’t exercise during a migraine.
Benign exertional headache is the other side of the coin. Mild exertion such as coughing, sneezing, stooping, bending, or straining can trigger a headache that may last only a few minutes or up to several hours. If you have headaches from exertion, speak to your doctor.
Ice Cream Headache
Do you know about ice cream headache? Some people – including kids – get headaches when they eat ice cream. Strange as it seems, it does happen. The headache occurs in response to eating something extremely cold. Crunching on ice, eating ice cream or an ice pop, or having anything cold in your mouth can also bring it on. Its more formal name is “cold stimulus headache,” and it may occur more frequently in people with migraine.
Ice cream headache is pretty easy to recognize. It lasts for less than 5 minutes and is felt as an intense steady pain deep between the eyes.
If you get it, don’t feel you have to give up eating ice cream. Just take small amounts at a time, eat slowly, and let it melt in your mouth before you swallow. It is rarely anything to be concerned about, but it may indicate that you have migraine.
Did you ever wonder what factors can trigger a migraine headache? The list includes factors within the body – internal factors — such as chronic fatigue or suddenly getting too little sleep, emotional stress and let-down after stress, and monthly hormonal fluctuations in women.
Factors outside the body – external factors – include changing weather patterns and seasonal change; travel through time zones; going to high altitudes; skipping meals; sensory stimuli such as flickering or bright lights and bright sunlight; odors such as strong perfumes, chemicals, and cigarette smoke; extremes of heat or cold; and loud noises. Some medications, foods and beverages may also trigger migraine.
If you think you have migraine, you should study a list of possible triggers in an effort to determine yours, and eliminate them as best you can.